Page Charlotte M, Ginsburg Elizabeth S, Goldman Randi H, Zera Chloe A
Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 USA.
Fertil Res Pract. 2017 Jan 13;3:3. doi: 10.1186/s40738-016-0030-9. eCollection 2017.
Obesity is associated with impaired fertility and pregnancy complications, and preconception weight loss may improve some of these outcomes. The purpose of this study was to evaluate the quality and effectiveness of Maternal Fetal Medicine (MFM) preconception consults for obese women.
We performed a retrospective chart review examining 162 consults at an academic medical center from 2008 to 2014. The main outcome measures included consultation content - e.g. discussion of obesity-related pregnancy complications, screening for comorbidities, and referrals for weight loss interventions - and weight loss.
Screening for diabetes and hypertension occurred in 48% and 51% of consults, respectively. Discussion of obesity-related pregnancy complications was documented in 96% of consults. During follow-up (median 11 months), 27% of patients saw a nutritionist, 6% saw a provider for a medically supervised weight loss program, and 6% underwent bariatric surgery. The median weight change was a loss of 0.6% body weight.
In this discovery cohort, a large proportion of MFM preconception consultations lacked appropriate screening for obesity-related comorbidities. While the vast majority of consultations included a discussion of potential pregnancy complications, relatively few patients achieved significant weight loss. More emphasis is needed on weight loss resources and delaying pregnancy to achieve weight loss goals.
肥胖与生育能力受损及妊娠并发症相关，孕前体重减轻可能改善其中一些结局。本研究的目的是评估母胎医学（MFM）为肥胖女性提供的孕前咨询的质量和效果。
我们对2008年至2014年在一家学术医疗中心进行的162次咨询进行了回顾性病历审查。主要结局指标包括咨询内容，例如肥胖相关妊娠并发症的讨论、合并症筛查以及减肥干预转诊，还有体重减轻情况。
分别有48%和51%的咨询进行了糖尿病和高血压筛查。96%的咨询记录了肥胖相关妊娠并发症的讨论。在随访期间（中位时间11个月），27%的患者看了营养师，6%的患者因医学监督的减肥计划看了医疗服务提供者，6%的患者接受了减肥手术。体重变化中位数是体重减轻0.6%。
在这个发现队列中，很大一部分MFM孕前咨询缺乏对肥胖相关合并症的适当筛查。虽然绝大多数咨询包括了对潜在妊娠并发症的讨论，但相对较少的患者实现了显著的体重减轻。需要更加强调减肥资源以及推迟妊娠以实现减肥目标。
