Bogaerts A, Devlieger R, Van den Bergh B R H, Witters I
Department of Health Care, Midwifery, KHLim, Limburg Catholic University College, Hasselt, Belgium. ; Department of Nursing and Midwifery Sciences, University of Antwerp, Belgium.
Department of Obstetrics & Gynaecology, Division Mother & Child, University Hospitals Leuven, Belgium.
Facts Views Vis Obgyn. 2014;6(2):81-95.
Maternal obesity is a growing public health concern in Belgium as well as in other European countries and is now becoming the most common risk factor associated with pregnancy complications with impact on the health of the women and her offspring. At this moment, there is no specific management strategy for obese pregnant women and mothers, focusing on physical health and psychological well-being.
We aimed (1) to study the influence of socio-demographic and obstetrical correlates on pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in different regions of Flanders, Belgium, (2) to review the literature on the onset and progression of labour in normal weight and obese pregnant women, (3) to compare levels and evolution of anxiety and depressed mood during pregnancy between obese women and normal-weight women, (4) to examine whether a prenatal lifestyle intervention programme, based on principles of motivational interviewing, in obese pregnant women reduces GWG and lowers levels of anxiety and depressed mood during pregnancy, (5) to examine associations between inter-pregnancy weight change from the first to the second pregnancy and the risk for adverse perinatal outcomes during the second pregnancy and finally (6) to study predictors of postpartum weight retention (PPWR) in obese mothers at six months after delivery in order to provide clues for the design of interventions aimed at preventing weight retention related to childbearing.
We performed an epidemiological study, an intervention study during pregnancy with postpartum follow up and a literature review.
One in three Flemish women start pregnancy being overweight or obese and this prevalence has slowly been rising since 2009 in the Flanders. We identified women at risk for a high pre-pregnancy BMI and excessive GWG, both being important predictors for increased pregnancy and birth related complications. In a literature review, we showed that the combination of a higher incidence of post-term deliveries and increased inadequate contraction pattern during the first stage of labour in obese women suggests an influence of obesity on myometrial activity. Given the low compliance for adequate GWG in obese women in the general Flemish population and their increased psycho-social vulnerability compar-ed to the normal weight pregnant women, counselling obese pregnant women can lead to a reduced GWG and increased psychological comfort. Stabilizing inter-pregnancy maternal weight for all women is an important target for reducing adverse perinatal outcomes in the subsequent pregnancy. Psychological discomfort during pregnancy does impact on PPWR in obese mothers six months after delivery.
Focusing on weight management in obese women before, during and after a pregnancy has advantages for both the mother and her infant. Theoretical and practice based training modules should be developed and focus on: (1) awareness of techniques for identifying the clearly identified risk groups with a high pre-pregnancy BMI and excessive GWG, (2) the increased perinatal risks, (3) an adapted perinatal management and (4) counselling techniques for an adequate weight management and psychological wellbeing in obese pregnant women. To achieve better care for the future, we must focus on tackling maternal obesity. This means that obese women should be reached before they get pregnant for the first time. Targeting primary and community based care, promotion and education are challenging, but the psychosocial context should be acknowledged.
在比利时以及其他欧洲国家,孕产妇肥胖正日益引起公众对健康问题的关注,目前已成为与妊娠并发症相关的最常见风险因素,对女性及其后代的健康产生影响。目前,针对肥胖孕妇和产妇,尚无专注于身体健康和心理健康的具体管理策略。
我们旨在(1)研究社会人口统计学和产科相关因素对比利时弗拉芒不同地区孕前体重指数(BMI)和孕期体重增加(GWG)的影响;(2)回顾关于正常体重和肥胖孕妇分娩发动及进展的文献;(3)比较肥胖孕妇和正常体重孕妇孕期焦虑和抑郁情绪的水平及变化;(4)研究基于动机性访谈原则的肥胖孕妇产前生活方式干预方案是否能减少GWG并降低孕期焦虑和抑郁情绪水平;(5)研究首次妊娠到第二次妊娠期间妊娠间隔体重变化与第二次妊娠不良围产期结局风险之间的关联;最后(6)研究肥胖母亲产后6个月体重滞留(PPWR)的预测因素,以便为设计旨在预防与生育相关体重滞留的干预措施提供线索。
我们进行了一项流行病学研究、一项孕期干预研究及产后随访,并进行了文献综述。
三分之一的弗拉芒女性怀孕时超重或肥胖,自2009年以来,这一患病率在弗拉芒地区一直在缓慢上升。我们确定了孕前BMI高和GWG过高的风险女性,这两者都是妊娠及分娩相关并发症增加的重要预测因素。在文献综述中,我们表明,肥胖女性过期产发生率较高以及分娩第一产程宫缩模式异常增加,这表明肥胖对子宫肌层活动有影响。鉴于弗拉芒普通人群中肥胖女性对适当GWG的依从性较低,且与正常体重孕妇相比其心理社会脆弱性增加,为肥胖孕妇提供咨询可减少GWG并提高心理舒适度。稳定所有女性的妊娠间隔体重是降低后续妊娠不良围产期结局的重要目标。孕期的心理不适确实会影响肥胖母亲产后6个月的PPWR。
关注肥胖女性孕前、孕期及产后的体重管理对母亲及其婴儿均有益。应开发基于理论和实践的培训模块,重点关注:(1)识别孕前BMI高和GWG过高的明确风险人群的技术意识;(2)增加的围产期风险;(3)适应性围产期管理;(4)肥胖孕妇适当体重管理和心理健康的咨询技术。为了实现更好的未来护理,我们必须专注于解决孕产妇肥胖问题。这意味着应在肥胖女性首次怀孕前就对其进行干预。针对初级和社区护理、推广和教育具有挑战性,但应认识到心理社会背景。