Robertson Nicole, Ladlow Bridget
Dietetics Department, West Gippsland Healthcare Group, Warragul, Australia.
Aust N Z J Obstet Gynaecol. 2018 Jun;58(3):274-277. doi: 10.1111/ajo.12711. Epub 2017 Sep 26.
Maternal obesity and excessive gestational weight gain (GWG) are prevalent in Australia and associated with an increased risk of birth complications, gestational diabetes and caesarean delivery.
To assess the effect of a pilot dietetic intervention in supporting the achievement of appropriate GWG.
Pregnant women with a pre-pregnancy body mass index (BMI) ≥ 35 kg/m (n = 174, mean BMI 40.6 ± 4.3 kg/m ) were referred for individual assessment and dietary counselling conducted by a dietitian with subsequent reviews. Education was based on the Australian Guide to Healthy Eating (AGTHE), encouraged nutritional adequacy and promoted GWG in line with current Institute of Medicine (IOM) guidelines.
The intervention was associated with a significant reduction (P = 0.00) in gestational weight gain (3.57 ± 5.37 kg) when compared to previous pregnancies (14.31 ± 11.23 kg). Women who attended three or more appointments gained significantly less weight compared with those who attended the initial assessment only (P < 0.05). Rates of caesarean delivery and macrosomia were lower among participants compared to obese populations in comparable studies.
Dietetic intervention in obese pregnant women can assist in achieving and limiting gestational weight gain to within current IOM guidelines and reduced rates of gestational diabetes and caesarean section.
孕妇肥胖和孕期体重过度增加（GWG）在澳大利亚很普遍，并且与出生并发症、妊娠期糖尿病和剖宫产风险增加相关。
评估一项试点营养干预措施对实现适当孕期体重增加的效果。
孕前体重指数（BMI）≥35 kg/m²（n = 174，平均BMI 40.6±4.3 kg/m²）的孕妇被转介进行营养师的个体评估和饮食咨询，并随后进行复查。教育基于《澳大利亚健康饮食指南》（AGTHE），鼓励营养充足，并根据当前医学研究所（IOM）的指南促进孕期体重增加。
与前次妊娠（14.31±11.23 kg）相比，该干预措施与孕期体重增加显著减少（P = 0.00）（3.57±5.37 kg）相关。参加三次或更多次预约的女性比仅参加初次评估的女性体重增加显著更少（P < 0.05）。与可比研究中的肥胖人群相比，参与者的剖宫产率和巨大儿发生率较低。
对肥胖孕妇进行营养干预可有助于实现并将孕期体重增加限制在当前IOM指南范围内，并降低妊娠期糖尿病和剖宫产率。
