Petrella Elisabetta, Tamborrino Valeria, Di Cerbo Lidia, Neri Isabella, Facchinetti Fabio
Unit of Obstetrics and Gynecology, Department of Maternal and Child Health, Polyclinic Hospital, University of Modena and Reggio Emilia, Modena, Italy.
Unit of Obstetrics and Gynecology, Department of Maternal and Child Health, Polyclinic Hospital, University of Modena and Reggio Emilia, Modena, Italy -
Minerva Ginecol. 2018 Jun;70(3):254-260. doi: 10.23736/S0026-4784.17.04156-9. Epub 2017 Oct 27.
To determine whether the prescription and follow-up of a behavioral program (customized nutritional advices and a constant physical activity) influences the occurrence of unfavorable maternal/neonatal outcomes among overweight/obese women.
A case-control study (1:3) included single pregnant women with Body Mass Index (BMI) ≥25 kg/m2, enrolled at 1st trimester. Cases (N.=95) were prescribed (by both the dietitian and gynecologist) a low-glycemic-index diet with an average intake of 1700/1800 kcal/day plus 30 minutes of walking at least 3 times/week (with four follow-up visits until delivery). Controls (N.=275) received a nutritional booklet about a healthy lifestyle, then attended their scheduled visits until delivery by the obstetricians in charge.
Gestational weight gain was similar between groups, despite obese women were higher in cases (67.4%) than in controls (54.5%, P=0.029). The occurrence of gestational diabetes mellitus (GDM) was lower in cases (21.5%) than in controls (32.7%; P=0.041). Such reduction remained related with the group of intervention (P=0.004) after correcting for confounders (BMI≥30 kg/m2, a family history of diabetes, age ≥35 and ethnicity). A higher number of controls developed pregnancy induced hypertension (PIH) (11.6% vs. 1.1% in cases, P<0.001). Preterm birth (PTB) occurred in one case and in 28 controls (10.2%; P=0.004). In half of them, PTB was spontaneous while medically indicated for intrauterine growth restriction, hemorrhage, PIH, GDM/macrosomia, Rh isoimmunization in the remnant.
An early behavioral intervention among overweight/obese pregnant women reduces unfavorable pregnancy outcomes.
确定一项行为计划（定制营养建议和持续体育活动）的处方及随访是否会影响超重/肥胖女性不良母婴结局的发生情况。
一项病例对照研究（1:3）纳入了孕早期体重指数（BMI）≥25 kg/m²的单胎孕妇。病例组（N = 95）由营养师和妇科医生共同开具低升糖指数饮食处方，平均每日摄入量为1700/1800千卡，外加每周至少3次、每次30分钟的步行（直至分娩进行4次随访）。对照组（N = 275）收到一本关于健康生活方式的营养手册，然后由负责的产科医生安排定期产检直至分娩。
两组间孕期体重增加情况相似，尽管肥胖女性在病例组中的比例（67.4%）高于对照组（54.5%，P = 0.029）。病例组妊娠期糖尿病（GDM）的发生率（21.5%）低于对照组（32.7%；P = 0.041）。在校正混杂因素（BMI≥30 kg/m²、糖尿病家族史、年龄≥35岁和种族）后，这种降低仍与干预组相关（P = 0.004）。更多对照组孕妇发生了妊娠高血压综合征（PIH）（病例组为1.1%，对照组为11.6%，P < 0.001）。1例病例和28例对照组孕妇发生了早产（PTB）（10.2%；P = 0.004）。其中一半早产为自发性早产，其余因胎儿宫内生长受限、出血、PIH、GDM/巨大儿、Rh血型不合免疫等医学指征导致早产。
超重/肥胖孕妇早期进行行为干预可减少不良妊娠结局。
