Reproductive Endocrinology and Women's Health, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
Maternal and Fetal Medicine, Woman's Hospital, Baton Rouge, Louisiana, USA.
J Clin Invest. 2019 Aug 1;129(11):4682-4690. doi: 10.1172/JCI130341.
In women with obesity, excess gestational weight gain (≥270 g/week) occurs in two out of three pregnancies and contributes to metabolic impairments in both mother and baby. To improve obstetrical care, objectively assessed information on energy balance is urgently needed. The objective of this study was to characterize determinants of gestational weight gain in women with obesity.
This was a prospective, observational study of pregnant women with obesity. The primary outcome was energy intake calculated by the energy intake-balance method. Energy expenditure was measured by doubly-labeled water and whole-room indirect calorimetry and body composition as 3-compartment model by air displacement plethysmography and isotope dilution in early (13-16 weeks) and late pregnancy (35-37 weeks).
In pregnant women with obesity (n=54), recommended weight gain (n=8, 15%) during the second and third trimesters was achieved when energy intake was 125±52 kcal/d less than energy expenditure. In contrast, women with excess weight gain (67%) consumed 186±29 kcal/d more than they expended (P<0.001). Energy balance affected maternal adiposity (recommended: -2.5±0.8 kg fat mass, excess: +2.2±0.5, inadequate: -4.5±0.5, P<0.001), but not fetal growth. Weight gain was not related to demographics, activity, metabolic biomarkers, or diet quality. We estimated that energy intake requirements for recommended weight gain during the second and third trimesters were not increased as compared to energy requirements early in pregnancy (34±53 kcal/d, P=0.83).
We here provide the first evidence-based recommendations for energy intake in pregnant women with obesity. Contrary to current recommendations, energy intake should not exceed energy expenditure.
This study was funded by the National Institutes of Health (R01DK099175; Redman, U54GM104940 and P30DK072476; Core support).
clinicaltrials.gov: NCT01954342.
在肥胖女性中，三分之二的妊娠会出现过度的孕期体重增加（≥270g/周），这会导致母婴代谢受损。为了改善产科护理，迫切需要获得关于能量平衡的客观评估信息。本研究的目的是描述肥胖孕妇孕期体重增加的决定因素。
这是一项对肥胖孕妇进行的前瞻性观察性研究。主要结局指标为能量摄入平衡法计算的能量摄入。能量消耗通过双标记水和全室间接测热法测量，并通过空气置换体描记法和同位素稀释法在孕早期（13-16 周）和孕晚期（35-37 周）进行 3 compartment 模型测量身体成分。
在肥胖孕妇（n=54）中，当能量摄入比能量消耗低 125±52kcal/d 时，第二和第三孕期的推荐体重增加（n=8，15%）即可实现。相比之下，体重增加过多的女性（67%）消耗的能量比消耗的多 186±29kcal/d（P<0.001）。能量平衡影响母体肥胖（推荐：-2.5±0.8kg 脂肪量，过多：+2.2±0.5kg，不足：-4.5±0.5kg，P<0.001），但不影响胎儿生长。体重增加与人口统计学、活动、代谢生物标志物或饮食质量无关。我们估计，与妊娠早期相比，第二和第三孕期推荐体重增加所需的能量摄入没有增加（34±53kcal/d，P=0.83）。
本研究首次为肥胖孕妇提供了基于证据的能量摄入建议。与目前的建议相反，能量摄入不应超过能量消耗。
本研究由美国国立卫生研究院（R01DK099175；Redman，U54GM104940 和 P30DK072476；核心支持）资助。
clinicaltrials.gov：NCT01954342。
