McGiveron A, Foster S, Pearce J, Taylor M A, McMullen S, Langley-Evans S C
Lincolnshire Community Health Services NHS Trust, Lincoln, UK.
J Hum Nutr Diet. 2015 Jan;28 Suppl 1:29-37. doi: 10.1111/jhn.12240. Epub 2014 May 9.
Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the prepregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health.
The hospital-based Bumps and Beyond intervention invited all pregnant women with a body mass index (BMI) >35 kg m(-2) to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of seven sessions with healthy lifestyle midwives and advisors (intervention) versus a group of 89 women who chose not to attend (non-intervention).
Mean (SD) weight gain in the intervention group [4.5 (4.6) kg] was less than in the non-intervention group [10.3 (4.4) kg] between antenatal booking and 36 weeks of gestation (< 0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced by 55%). The impact of the intervention on gestational weight gain was greater in women with BMI >40 kg m(-2) at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy.
Intensive, personalised weight management intervention may be an effective strategy for the prevention of hypertensive disorders during pregnancy.
孕期肥胖与妊娠并发症及不良产科结局相关。尽管大多数关于孕期体重的指导都集中在孕前阶段，但孕期通常被视为女性愿意改变生活方式以优化健康的时期。
基于医院的“孕期与产后健康干预”项目邀请了所有体重指数（BMI）>35 kg/m² 的孕妇参加围绕饮食和运动的健康教育项目，并伴有一对一的饮食改变指导和监测。这项服务评估将89名完成了由健康生活方式助产士和顾问指导的七节课程的女性（干预组）与89名选择不参加的女性（非干预组）进行了比较。
在产前登记至妊娠36周期间，干预组的平均（标准差）体重增加[4.5（4.6）kg]低于非干预组[10.3（4.4）kg]（<0.001）。这与孕期妊娠高血压风险降低95%以及妊娠并发症总体减少相关。除产后出血（减少55%）外，该干预对妊娠期糖尿病或分娩并发症没有影响。干预对妊娠体重增加的影响在登记时BMI>40 kg/m² 的女性中更大。该干预没有不良影响，尽管21%的干预组女性在孕期体重减轻。
强化的、个性化的体重管理干预可能是预防孕期高血压疾病的有效策略。
