Weight management for improved pregnancy outcomes

摘要：从历史上看，营养不良一直是一个主要的健康问题。然而最近， 在美国和其他国家，营养过剩也已成为一个严重的公共健康问题。 工业化国家。随着新的肥胖流行病，我们看到发病率，死亡率， 和公共卫生负担，特别是育龄妇女。虽然病态 肥胖曾经在孕妇中很少见，但在产科中的比例迅速增加。 病人现在的肥胖程度大大增加了他们严重怀孕的风险 并发症这些并发症包括流产、死胎、 胎儿太大，导致剖宫产或分娩伤害的母亲和婴儿， 阴道分娩和新生儿死亡。超过三分之一的女性在 美国现在开始怀孕时的体重指数为30或更高，这种情况 在50年前是罕见的考虑到体重增加的严重后果 肥胖妇女妊娠期间，如妊娠糖尿病、先兆子痫或剖宫产 分娩时，怀孕期间的最佳策略可能是保持稳定的体重， 体重增加15磅或更多不幸的是，很少有关于疗效的研究， 减少怀孕期间体重增加的可行性。本研究旨在解决 问题. 200名在怀孕开始时BMI为30或更高的妇女将被 被招募来进行可行性测试所有参与者都将是非营利性管理式护理的成员 提供高质量产科护理的组织。自愿参加的患者将 随机分配到体重维持干预或常规护理。参与者 分配到干预将参加体重维持计划，旨在帮助 他们吃营养均衡的饮食，并控制能量摄入，以尽量减少体重增加 在怀孕期间。两组的参与者（和他们的婴儿）将参加以下活动- 在产后2周、产后6个月和产后1年进行评估。的 主要的结果测量将是母亲在怀孕期间的体重增加， 产后滞留，且胎龄儿比例大。二次 结果将包括母亲及其婴儿的多种安全措施。除了 安全措施，我们的二次分析将解决的可行性和可接受性， 肥胖孕妇的体重管理干预。

ABSTRACT: Historically, under nutrition has been a major health concern. Recently however, over nutrition has also become a serious public health problem in the United States and other industrialized countries. With the new obesity epidemic we see increasing morbidity, mortality, and public health burden, particularly among reproductive-aged women. Whereas morbid obesity was once rare among pregnant women, a rapidly increasing proportion of obstetrics patients now have levels of obesity which dramatically increase their risk of serious pregnancy complications. These complications include increased risk of miscarriage, stillbirth, having a fetus that is too large leading to cesarean section or birth injuries for mom and baby from vaginal delivery, and death of the infant in the newborn period. More than 1/3 of women in the U.S. are now starting their pregnancies with a body mass index or 30 or greater, a condition that was unusual to rare 50 years ago. Given the serious consequences of added weight gain during pregnancy for obese women, such as gestational diabetes, pre-eclampsia, or cesarean delivery, the best strategy during their pregnancy may be to maintain a steady weight rather than gaining 15 pounds or more. Unfortunately, there is little research on the efficacy and feasibility of minimizing weight gain during pregnancy. This study is designed to address that problem. Two hundred women with BMIs of 30 or greater at the start of their pregnancy will be recruited for this feasibility test. All participants will be members of a non-profit managed care organization that provides high-quality obstetrics care. Patients who volunteer to participate will be randomly assigned to either a weight maintenance intervention or to usual care. Participants assigned to the intervention will participate in a weight maintenance program designed to help them eat a nutritionally balanced diet and to also control energy intake to minimize weight gain during their pregnancy. Participants (and their babies) in both groups will participate in follow- up assessments at 2 weeks postpartum, 6 months postpartum and one year postpartum. The primary outcome measures will be mothers' weight gain during pregnancy, the amount of weight retained after delivery, and the proportion of large for gestational age infants. Secondary outcomes will include multiple safety measures of the mothers and their babies. In addition to measures of safety, our secondary analyses will address the feasibility and acceptability of a weight management intervention among obese pregnant women.