Knoxville, TN.
Am J Obstet Gynecol. 2018 Jun;218(6):581-589. doi: 10.1016/j.ajog.2018.03.014. Epub 2018 Mar 23.
The obesity and diabetes epidemic is an unintended consequence of economic, social, and technological changes. In nonpregnancy, people identified as high risk to develop type 2 diabetes may delay progression by 30-70% with lifestyle interventions and pharmacological agents. In pregnancy, lifestyle interventions have been the primary focus to prevent fetal short- and long-term complications that may evolve into substantial weight gain and gestational diabetes mellitus. The dilemma for obstetricians is whether diabetes and obesity can be prevented and not simply treated after the fact. Interventions after women become pregnant may be too late to see the kinds of meaningful improvements in child and maternal health because there is a short interval from gestational diabetes mellitus diagnosis to delivery. Therefore, future efforts need to incorporate quality research, lifestyle interventions that designate time of initiation and duration during pregnancy, the preventative intervention of a prepregnant "fourth trimester," coupled with the concept of precision medicine so that there is the potential to make the impossible dream a reality.
肥胖和糖尿病的流行是经济、社会和技术变革带来的意外后果。在非妊娠期间，通过生活方式干预和药物治疗，被认为有发展为 2 型糖尿病高风险的人群可将疾病进展延缓 30-70%。在妊娠期间，生活方式干预一直是预防胎儿短期和长期并发症的主要方法，这些并发症可能导致体重显著增加和妊娠糖尿病。产科医生面临的困境是，糖尿病和肥胖是否可以预防，而不仅仅是在发生后进行治疗。女性怀孕后进行干预可能为时已晚，无法看到儿童和产妇健康的显著改善，因为从妊娠糖尿病的诊断到分娩的时间间隔很短。因此，未来的努力需要纳入高质量的研究、指定妊娠期间起始时间和持续时间的生活方式干预、备孕期“第四孕期”的预防性干预，以及精准医学的概念，这样才有可能使不可能的梦想成为现实。
