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肥胖女性产科和妇科并发症的管理:优化结局和降低风险的循证策略

Managing obstetric and gynecologic complications in obese women: Evidence-Based Strategies for Optimizing Outcomes and Reducing Risks.

作者信息

Jatin Chunawala Prachi, Jatin Chunawala Purvi, Beniwal Shreya Singh, Pithalla Likhitha Bhavani, Dwivedi Ayush, Shetty Vaishnavi Rajesh, Desai Arusha

机构信息

All India institute of medical sciences (AIIMS), Parapipaliya, Khandheri, Rajkot, Gujarat.

Lady Hardinge Medical College, New Delhi, India.

出版信息

Ann Med Surg (Lond). 2025 May 21;87(6):3586-3595. doi: 10.1097/MS9.0000000000003300. eCollection 2025 Jun.

Abstract

INTRODUCTION

Obesity among reproductive-aged women increases the risk of gestational diabetes, preeclampsia, menstrual disorders, infertility, and delivery complications. Despite rising global obesity rates, clinical guidelines often lack comprehensive management strategies. This review examines evidence-based approaches to optimize maternal and gynecologic outcomes through multidisciplinary care.

METHODS

A comprehensive literature review was conducted on obesity-related obstetric and gynecologic complications, including national and international guidelines, clinical trials, and observational studies. Key management strategies such as preconception care, lifestyle interventions, pharmacologic therapies, surgical treatments, and digital health solutions were analyzed.

RESULTS

Obesity is linked to multiple adverse maternal outcomes, including increased rates of gestational diabetes, preeclampsia, prolonged labor, postpartum hemorrhage, and fetal complications. Gynecologic conditions such as polycystic ovary syndrome, endometrial hyperplasia, and infertility are also exacerbated by obesity-related metabolic changes. Effective management strategies involve a combination of preconception weight loss interventions, structured gestational monitoring, pharmacologic treatments, and surgical approaches like bariatric surgery for high-risk cases. Telehealth interventions and digital health solutions provide an opportunity to bridge the gap in healthcare access, particularly in rural areas. However, challenges remain due to provider bias, adherence issues, and evolving clinical guidelines.

CONCLUSIONS

Integrating medical, surgical, and digital health strategies is essential for improving outcomes in obese women. Expanding telehealth, enhancing provider training, and developing culturally tailored interventions will promote equitable healthcare. Future research should focus on region-specific solutions to optimize maternal and fetal health.

摘要

引言

育龄妇女肥胖会增加患妊娠期糖尿病、先兆子痫、月经紊乱、不孕和分娩并发症的风险。尽管全球肥胖率不断上升,但临床指南往往缺乏全面的管理策略。本综述探讨通过多学科护理优化孕产妇和妇科结局的循证方法。

方法

对与肥胖相关的妇产科并发症进行了全面的文献综述,包括国家和国际指南、临床试验及观察性研究。分析了诸如孕前护理、生活方式干预、药物治疗、手术治疗和数字健康解决方案等关键管理策略。

结果

肥胖与多种不良孕产妇结局相关,包括妊娠期糖尿病、先兆子痫、产程延长、产后出血和胎儿并发症的发生率增加。多囊卵巢综合征、子宫内膜增生和不孕等妇科疾病也因肥胖相关的代谢变化而加重。有效的管理策略包括孕前体重减轻干预、结构化的孕期监测、药物治疗以及针对高危病例的减肥手术等手术方法。远程医疗干预和数字健康解决方案为弥合医疗服务可及性差距提供了契机,尤其是在农村地区。然而,由于医疗服务提供者的偏见、依从性问题以及不断演变的临床指南,挑战依然存在。

结论

整合医疗、手术和数字健康策略对于改善肥胖女性的结局至关重要。扩大远程医疗、加强医疗服务提供者培训以及制定符合文化背景的干预措施将促进医疗公平。未来的研究应聚焦于针对特定地区的解决方案,以优化母婴健康。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c4a/12140740/9c295c694e30/ms9-87-3586-g001.jpg

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