Yaşam Tarzı Müdahalelerinin Gestasyonel Vücut Ağırlığı Kazanımı ve Gebelik Komplikasyonları Üzerine Etkisi

Dünya’da, özellikle de doğurganlık çağındaki kadınlar arasında, obezite prevalansı artmaktadır. Gebelik öncesi fazla kilolu veya obez olan kadınlar sıklıkla Amerika Tıp Enstitüsü’nün gebeler için önerdiği vücut ağırlığı kazanımlarının üzerinde ağırlık kazanımı yaşamaktadırlar. Önerilerin üzerinde vücut ağırlığı kazanan gebeler gestasyonel diyabet, preeklampsi, eklampsi, hipertansiyon, tromboembolizm, obstetrik anestezi, sezaryen doğum, postpartum hemoraji, yara enfeksiyonları, emzirme başlangıcının gecikmesi, emzirme süresinin kısalması, postpartum vücut ağırlığı retansiyonu ve obezite gibi komplikasyonlarla karşı karşıya kalmaktadır. Aşırı gestasyonel vücut ağırlığı kazanımı yaşayan gebelerin bebekleri ise prematüre, ölü doğum, konjenital anomali, gestasyonel yaşına göre büyük bebek, makrozomi, omuz distosisi, neonatal hipoglisemi ve çocukluk çağında obezite açısından yüksek risk taşımaktadır. Literatürde diyet ve fiziksel aktiviteyi içeren yaşam tarzı müdahalelerin gestasyonel vücut ağırlığı kazanımını azalttığı ve gebelik komplikasyonları üzerinde olumlu etkilerinin olduğu ile ilgili çalışmalar bulunmaktadır. Sağlık bakım sistemlerinden düzenli olarak yararlanan gebeler, bebeklerinin sağlığı açısından yaşam tarzı değişikliklerine de daha olumlu yaklaştıkları için bu süreç yaşam tarzı ile ilgili müdahaleler için önemli bir dönemdir. Bu derlemede, gebelik döneminde yapılacak olan yaşam tarzı müdahalelerinin gestasyonel vücut ağırlığı kazanımı ve gebelik komplikasyonları üzerine etkisinin literatüre dayalı olarak tartışılması amaçlanmıştır.

Effects of Lifestyle Intervention on Gestational Body Weight Gain and Pregnancy Complications

Obesity prevalence is increasing in the world, especially among women of reproductive age. Women who are overweight or obese before pregnancy often experience weight gain above the recommendations of the American Institute of Medicine for pregnant women. Pregnant women who experience excessive gestational weight gain face problems such as gestational diabetes, pre-eclampsia, eclampsia, hypertension, thromboembolism, obstetric anesthesia, cesarean delivery, postpartum hemorrhage, wound infections, delayed breastfeeding onset, shortened breastfeeding period, postpartum body weight retention and obesity. Babies of pregnant women experience excessive gestational weight gain have high risk in terms of premature, stillbirth, congenital anomaly, large for gestational age, macrosomia, shoulder dystocia, neonatal hypoglycemia and obesity in childhood. There are many studies in the literature that lifestyle interventions involving diet and physical activity reduce gestational weight gain and have positive effects on pregnancy complications. This process is an important period for lifestyle-related interventions, as pregnant women who regularly benefit from health care systems are more positive about lifestyle changes in terms of their baby’s health. This review aimed to discuss the effects of lifestyle interventions during pregnancy on gestational weight gain and pregnancy complications based on literature.

PDF

___

1. World Health Organization. WHO fact sheet on overweight and obesity. Updated April 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/ obesity-and-overweight. Accessed June 28, 2020.
2. Türkiye Endokrinoloji ve Metabolizma Derneği. Obezite tanı ve tedavi kılavuzu. Ankara: BAYT; 2019. 18 p.
3. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. 2018 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TUBİTAK. Ankara, Türkiye.
4. Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. Obesity and weight gain in pregnancy and postpartum: an evidence review of lifestyle interventions to inform maternal and child health policies. Front Endocrinol [Internet]. 2019 March. Available at: https://www. frontiersin.org/articles/10.3389/fendo.2019.00163/full. doi:10.3389/fendo.2018.00546.
5. Campbell EE, Dworatzek P, Penava D, de Vrijer B, Gilliland JA. Factors that influence excessive gestational weight gain: Moving beyond assessment and counselling. J Matern Fetal Neonatal Med. 2016;29(21):3527-31.
6. Poston L, Caleyachetty R, Cnattingius S, Corvalán C, Uauy R, Herring S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4(12):1025-36.
7. Whitaker K, Wilcox S, Liu J, Blair S, Pate R. Patient and provider perceptions of weight gain, physical activity and nutrition counseling during pregnancy: a qualitative study. Women’s Health Issues. 2016;26(1):116-22.
8. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. Washington: DC; 2012.
9. Cole K, Gudzune K, Bleich S, Bennett W, Cheskin L, Henderson J, et al. Influence of the 5A’s counseling strategy on weight gain during pregnancy: An observational study. Journal of Women’s Health. 2017;26(10):1123-30.
10. Kominiarek M, Peaceman A. Gestational weight gain. Am J Obstet Gynecol. 2017;217(6):642-51.
11. Lim C, Mahmood T. Obesity in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2015;29:309-19.
12. Abrams B, Altman SL, Pickett KE. Pregnancy weight gain: Still controversial. Am J Clin Nutr. 2000;71(5):1233- 41.
13. Committee on Nutritional Status During Pregnancy and Lactation, Institute of Medicine. Nutrition during pregnancy. Part I: weight gain; Part II: nutrient supplements. National Academies Press; Washington, DC: 1990.
14. Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. National Academies Press; Washington: DC; 2009.
15. Johnson JL, Farr SL, Dietz PM, Sharma AJ, Barfield WD, Robbins CL. Trends in gestational weight gain: the pregnancy risk assessment monitoring system, 2000- 2009. Am J Obstet Gynecol. 2015;212:806-21.
16. QuickStats: Gestational weight gain among women with full-term, singleton births, compared with recommendations 48 States and the District of Columbia, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(40):1121. Available at: https://www.cdc.gov/mmwr/volumes/65/ wr/mm6540a10.htm. Accessed June 28, 2020.
17. One in a Million. Born Ontario Biennial Report 2016- 2018. Available at: https://www.bornontario.ca/en/ publications/resources/Documents/BORN-Biennial-Report-2016-18.pdf. Accessed June 28, 2020.
18. Schack-Nielsen L, Michaelsen KF, Gamborg M, Mortensen EL, Sorensen TI. Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood. Int J Obes. 2010;34:67-74.
19. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015;(6): CD007145. DOI: 10.1002/14651858.CD007145. pub3. Available at: https://www.cochranelibrary. com/cdsr/doi/10.1002/14651858.CD007145.pub3/epdf/ abstract. Accessed September 08, 2020.
20. Shirazian T, Monteith S, Friedman F, Rebarber A. Lifestyle modification program decreases pregnancy weight gain in obese women. Am J Perinatol. 2010;27:411-4.
21. Olafsdottir AS, Skuladottir GV, Thorsdottir I, Hauksson A, Steingrimsdottir L. Maternal diet in early and late pregnancy in relation to weight gain. Int J Obes 2006;30:492-9.
22. Lagiou P, Tamimi RM, Mucci LA, Adami HO, Hsieh CC, Trichopoulos D. Diet during pregnancy in relation to maternal weight gain and birth size. Eur J Clin Nutr. 2004;58(2):231-7.
23. Institute of Medicine. Dietary reference intakes: the essential guide to nutrient requirements. National Academy Press: Washington DC; 2006.
24. American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. Clin Obstet Gynecol. 2003;46:496-9.
25. Gregg VH, Ferguson JE. Exercise in pregnancy. Clin Sports Med. 2017;36(4):741-52.
26. Hui A, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, et al. Effects of lifestyle intervention on dietary intake, physical activity level and gestational weight gain in pregnant women with different pre-pregnancy body mass index in a randomized control trial. BMC Pregnancy Childbirth. 2014;14:331-9.
27. Mottola M, Gıroux I, Gratton R, Hammond JA, Hanley A, Harris S, et al. Nutrition and exercise prevent excess weight gain in overweight pregnant women. Med Sci Sports Exerc. 2010;42(2):265-72.
28. Guelinckx I, Devlieger R, Mullie P, Vansant G. Effect of lifestyle intervention on dietary habits, physical activity and gestational weight gain in obese pregnant women: a randomized controlled trial. Am J Clin Nutr. 2010;91:373-80.
29. Polley BA, Wing RR, Sims CJ. Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes Relat Metab Disord. 2002;26:1494-502.
30. Phelan S, Phipps M, Abrams B, Darroch F, Schaffner A, Wing R. Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the fit for delivery study. Am J Clin Nutr. 2011;93:772-9.
31. Huang T, Yeh C, Tsai Y. A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Midwifery. 2011;27:257-64.
32. Asbee S, Jenkins T, Butler J, White J, Elliot M, Rutledge A. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling. Obstetrics Gynecology. 2009;113:305-12.
33. Savitz DA, Stein CR, Siega-Riz AM, Herring AH. Gestational weight gain and birth outcome in relation to prepregnancy body mass index and ethnicity. Ann Epidemiol. 2011;21:78-85.
34. Abdel-Aziz S, Hegazy I, Mohamed D, Abu EL Kasem M, Haga S. Effect of dietary counseling on preventing excessive weight gain during pregnancy. Public Health. 2018;154:172-81.
35. Margerison CE, Shrimali BP, Eskenazi B, Lahiff M, Lindquist AR, Abrams BF. Trimester of maternal gestational weight gain and offspring body weight at birth and age five. Matern Child Health J. 2012;16:1215- 23.
36. Drehmer M, Duncan BB, Kac G, Schmidt MI. Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes. PLoS One. 2013;8(1):e54704. Available at: https://journals. plos.org/plosone/article/file?id=10.1371/journal. pone.0054704&type=printable. Accessed June 28, 2020.
37. Davenport MH, Ruchat SM, Giroux I, Sopper MM, Mottola MF. Timing of excessive pregnancy-related weight gain and offspring adiposity at birth. Obstet Gynecol. 2013;122:255-61.
38. Jiang M, Gao H, Vinyes-Pares G, Yu K, Ma D, Qin X, et al. Association between breastfeeding duration and postpartum weight retention of lactating mothers: A meta-analysis of cohort studies. Clinical Nutrition. 2018;37:1224-31.
39. Devine CM, Bove CF, Olson CM, Continuity and change in women’s weight orientations and lifestyle practices through pregnancy and the postpartum period: the influence of life course trajectories and transitional events. Social Science and Medicine. 2000;50:567-82.