Purohit Aarti, Oyeka Chigolum Pamela, Khan Sadiya S, Toscano Marika, Nayak Shriddha, Lawson Shari M, Blumenthal Roger S, Sharma Garima
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Curr Obstet Gynecol Rep. 2023 Jun;12(2):129-137. doi: 10.1007/s13669-023-00356-9. Epub 2023 Apr 6.
Obesity is a chronic disease that is becoming increasingly prevalent, and more individuals of reproductive age have obesity prior to becoming pregnant. Obesity in pregnancy is associated with short- and long-term adverse consequences for both the birthing person and their offspring which have been associated with increased long-term cardiovascular morbidity and mortality. The goal of this review is to discuss what is currently understood about the relationship between maternal obesity and adverse pregnancy outcomes (APOs), the association between APOs and future cardiovascular disease (CVD) risk, and what evidence-based interventions can be implemented to prevent adverse outcomes in this population.
Maternal obesity has been associated with an increased risk of APOs such as gestational diabetes, hypertensive disorders of pregnancy, and preterm birth as well as an increased risk of future CVD, such as metabolic syndrome, chronic hypertension, coronary heart disease, and stroke. The impact of maternal obesity also extends beyond the pregnant individual to the offspring, increasing the risk of fetal, neonatal, and infant mortality, as well as of congenital malformations, prematurity, and long-term health problems such as insulin resistance and childhood obesity. Prevention guidelines are incorporating the increased risk of adverse outcomes from maternal obesity into formalized risk assessments to guide both prenatal and postpartum care. It is becoming evident that a multidisciplinary cardio-obstetrics team is an important part of providing comprehensive care for pregnant individuals with obesity and other cardiovascular risk factors, including preexisting CVD and a history of prior APOs. There remains a need for further studies to better understand the mechanisms underlying the relationship between maternal obesity and APOs, as well as the racial and ethnic disparities that have been noted in the prevalence of APOs and associated CVD risk and mortality.
There is increasing awareness that obesity in pregnancy is associated with various short- and long-term adverse maternal and offspring outcomes. There are multiple screening and prevention strategies that may be implemented before, during, and after pregnancy to prevent these adverse outcomes.
肥胖是一种日益普遍的慢性疾病，越来越多育龄期个体在怀孕前就已肥胖。孕期肥胖对分娩者及其后代均有短期和长期不良后果，这与长期心血管发病率和死亡率增加有关。本综述的目的是讨论目前对母体肥胖与不良妊娠结局（APO）之间关系的理解、APO与未来心血管疾病（CVD）风险之间的关联，以及可以实施哪些循证干预措施来预防该人群的不良结局。
母体肥胖与APO风险增加有关，如妊娠期糖尿病、妊娠高血压疾病和早产，以及未来CVD风险增加，如代谢综合征、慢性高血压、冠心病和中风。母体肥胖的影响还延伸到后代，增加了胎儿、新生儿和婴儿死亡风险，以及先天性畸形、早产和胰岛素抵抗及儿童肥胖等长期健康问题的风险。预防指南将母体肥胖导致不良结局风险增加纳入正式风险评估，以指导产前和产后护理。越来越明显的是，多学科心脏产科团队是为肥胖及其他心血管危险因素（包括既往存在的CVD和既往APO病史）的孕妇提供全面护理的重要组成部分。仍需要进一步研究，以更好地理解母体肥胖与APO之间关系的潜在机制，以及在APO患病率以及相关CVD风险和死亡率方面所观察到的种族和民族差异。
人们越来越意识到孕期肥胖与母体和后代的各种短期和长期不良结局有关。在怀孕前、期间和之后可实施多种筛查和预防策略来预防这些不良结局。
