Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
Semin Perinatol. 2012 Jun;36(3):213-21. doi: 10.1053/j.semperi.2012.05.001.
The incidence of obesity in pregnancy has increased over the past 2 decades, with nearly 50% of U.S. women aged 15-49 years classified as overweight or obese. Obesity (independent of diabetes) among gravidae poses unique risks that extend toward the fetus, with several large population-based analyses demonstrating independent increased risks for fetal malformations including neural tube defects, cardiac anomalies, and orofacial clefts, as well as stillbirth and macrosomia. Unfortunately, several lines of evidence also suggest that the quality of the prenatal fetal anatomic survey and certain aspects of prenatal diagnostic screening programs are significantly limited. The net effect is that among obese gravidae, the increased risk of fetal anomalies is further offset by a concomitant diminished ability to sonographically detect such malformations in the prenatal interval. The purpose of this summary review is to systematically examine the evidence suggesting an increased risk of fetal malformations in obese gravidae, the contributing role of diabetes, and the limitations of prenatal diagnostic and sonographic screening among this at-risk population.
在过去的 20 年中，孕期肥胖的发病率有所增加，近 50%的 15-49 岁美国女性超重或肥胖。肥胖（与糖尿病无关）在孕妇中带来了独特的风险，对胎儿也有影响，几项大型基于人群的分析表明，胎儿畸形的风险独立增加，包括神经管缺陷、心脏异常和口腔裂，以及死产和巨大儿。不幸的是，有几条证据线也表明，产前胎儿解剖检查的质量和某些产前诊断筛查计划的方面存在显著的局限性。其净效应是，在肥胖孕妇中，胎儿畸形的风险增加，同时超声检测这种畸形的能力也相应降低。本综述的目的是系统地检查肥胖孕妇胎儿畸形风险增加的证据、糖尿病的作用，以及该高危人群中产前诊断和超声筛查的局限性。
