Galtier-Dereure F, Boegner C, Bringer J
Service d'Endocrinologie, Hôpital Lapeyronie, CHU Montpellier, France.
Am J Clin Nutr. 2000 May;71(5 Suppl):1242S-8S. doi: 10.1093/ajcn/71.5.1242s.
The prevalence of obesity is currently rising in developed countries, making pregravid overweight one of the most common high-risk obstetric situations. Although the designs and populations of published studies vary widely, most authors agree that pregravid overweight increases maternal and fetal morbidity. Even moderate overweight is a risk factor for gestational diabetes and hypertensive disorders of pregnancy, and the risk is higher in subjects with overt obesity. Compared with normal weight, maternal overweight is related to a higher risk of cesarean deliveries and a higher incidence of anesthetic and postoperative complications in these deliveries. Low Apgar scores, macrosomia, and neural tube defects are more frequent in infants of obese mothers than in infants of normal-weight mothers. The regional distribution of fat modulates the effects of weight on carbohydrate tolerance, hemodynamic adaptation, and fetal size. Maternal obesity increases perinatal mortality. Long-term complications include worsening of maternal obesity and development of obesity in the infant. The average cost of hospital prenatal and postnatal care is higher for overweight mothers than for normal-weight mothers, and infants of overweight mothers require admission to neonatal intensive care units more often than do infants of normal-weight mothers. Preconception counseling, careful prenatal management, tight monitoring of weight gain, and long-term follow-up could minimize the social and economic consequences of pregnancies in overweight women.
目前，肥胖症在发达国家的患病率正在上升，使得孕前超重成为最常见的高危产科情况之一。尽管已发表研究的设计和研究人群差异很大，但大多数作者一致认为，孕前超重会增加孕产妇和胎儿的发病率。即使是中度超重也是妊娠期糖尿病和妊娠高血压疾病的一个危险因素，而在明显肥胖的人群中风险更高。与正常体重相比，孕产妇超重与剖宫产风险增加以及这些分娩中麻醉和术后并发症的发生率较高有关。肥胖母亲所生婴儿的阿氏评分低、巨大儿和神经管缺陷比正常体重母亲所生婴儿更常见。脂肪的区域分布调节体重对碳水化合物耐受性、血流动力学适应和胎儿大小的影响。孕产妇肥胖会增加围产期死亡率。长期并发症包括孕产妇肥胖加剧和婴儿肥胖的发生。超重母亲产前和产后住院护理的平均费用高于正常体重母亲，超重母亲的婴儿比正常体重母亲的婴儿更常需要入住新生儿重症监护病房。孕前咨询、仔细的产前管理、严格监测体重增加以及长期随访可以将超重女性怀孕的社会和经济后果降至最低。
