Obezite ve Kadın Üreme Sağlığı

Obezite dünyadaki en büyük sağlık sorunlarından biridir. Vücut kitle indeksinin obezite sınırları içinde olması kadın üreme sağlığını hem jinekolojik hem de obstetrik açıdan etkilemektedir. Jinekolojik açıdan değerlendirildiğinde obezite menstrüel siklus düzensizlikleri, polikistik over sendromu, infertilite, jinekolojik kanserler, psikolojik sorunlar ve cinsel fonksiyon bozuklukları ile ilişkilidir. Obstetrik açıdan değerlendirilde ise obezite abor-tuslar, konjenital anomaliler, gestasyonel diyabet, makrozomik bebek, ölü doğum, hipertansiyon, venöz tromboemboli, doğum ve cerrahi komplikas-yonlarla ilişkilidir.

Obesity and Reproductive Health of the Women

Obesity is one of the biggest health concerns in the worldwide. Body mass index within the limits of obesity affects reproductive health of the women with both gynaecological and obstetrical problems. When assessed from a gynecological perspective, obesity is associated with menstrual cycle disorders, polycystic over syndrome, infertility, gynecological cancers, psychological problems, and sexual dysfunction. When assessed from obstetric point of view, obesity is associated with abortions, congenital anomalies, gestational diabetes, macrosomic baby, stillbirth, hypertension, venous thromboembolism, delivery and surgical complications.

___

  • WHO Obesity and overweight. Fact sheet No:311, World Health Organization, Geneva (2015) World Health Organization. Obesity and overweight. Facts about overweight and obesity [monograph on the Internet]. Fact sheet No. 311. Geneva, 2015. Available from: http://www.who.int/mediacentre/factsheets/fs311/en.
  • Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Bur-den of Disease Study 2013 Lancet 2014; 384: 766-81.
  • NCD Risk Factor Collaboration (NCD-RisC). Trends in adult bodymass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet 2016; 387: 1377-96.
  • Sadia S, Waqar F, Akhtar T, et al. Characteris-tics of infertile patients with ovulatory dysfunc-tion and their relation to body mass índex. J Ayub Med Coll Abbottabad 2009; 21: 12-6.
  • Nelson-DeGrave VL, Wickenheisser JK, Hend-ricks KL, et al. Alterations in mitogen-activated protein kinase and extracellular regulated kinase signaling in theca cells contribute to excessive androgen production in polycystic ovary synd-rome. Mol Endocrinol 2005; 19: 379-90.
  • Parihar M. Obesity and infertility. Reviews in Gynecological Practice 2003; 3: 120-6.
  • Pasquali R, Patton L, Gambineri A. Obesity and infertility. Curr Opin Endocrinol Diabetes Obes 2007; 14: 482-7.
  • Balen AH, Anderson RA; Policy & Practice Committee of the BFS. Impact of obesity on female reproductive health: British Fertility So-ciety, Policy and Practice Guidelines. Hum Fer-til (Camb) 2007; 10: 195-206.
  • Diamanti-Kandarakis E, Dunaif A. New pers-pectives in polycystic ovary syndrome. Trends Endocrinol Metab 1996; 7: 267-71.
  • Cırık DA, Dilbaz B. What do we know about metabolic syndrome in adolescents with PCOS? J Turk Ger Gynecol Assoc 2014; 15: 49-55.
  • Morgante G, Massaro MG, Di Sabatino A, et al. Therapeutic approach for metabolic disorders and infertility in women with PCOS. Gynecol Endocrinol 2018; 34: 4-9.
  • Hart R, Hickey M, Franks S. Definitions, preva-lence and symptoms of polycystic ovaries and polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004; 18: 671-83.
  • Al-Azemi M, Omu FE, Omu AE. The effect of obesity on the outcome of infertility manage-ment in women with polycystic ovary syndro-me. Arch Gynecol Obstet 2004; 270: 205-10.
  • Gosman GG, Katcher HI, Legro RS. Obesity and the role of gut and adipose hormones in fe-male reproduction. Hum Reprod Update 2006; 12: 585-601.
  • Kumbak B, Oral E, Bukulmez O. Female obe-sity and assisted reproductive technologies. Se-min Reprod Med 2012; 30: 507-16.
  • Luke B, Brown MB, Stern JE, Missmer SA, et al. SART Writing Group. Female obesity adver-sely affects assisted reproductive technology (ART) pregnancy and live birth rates. Hum Reprod 2011; 26: 245-52.
  • Arcidiacono B, Iiritano S, Nocera A, et al. Insu-lin resistance and cancer risk: an overview of the pathogenetic mechanisms. Exp Diabetes Res 2012; 2012: 789174. Doi:10.1155/2012/789174.
  • Reeves GK, Pirie K, Beral V, et al. Million Women Study Collaboration. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study BMJ 2007; 335: 1134-45.
  • Shaw E, Farris M, McNeil J, et al. Obesity and endometrial cancer. Recent Results Cancer Res 2016; 208: 107-36.
  • Tworoger SS, Huang T. Obesity and ovarian cancer. Recent Results Cancer Res 2016; 208: 155-76.
  • Guh DP, Zhang W, Bansback N, et al. The inci-dence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009: 25; 9: 88.
  • Puhl RM, Brownell KD. Confronting and co-ping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring) 2006; 14: 1802-15.
  • Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systema-tic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67: 220-9.
  • Wardle J, Cooke L. The impact of obesity on psychological well-being. Best Pract Res Clin Endocrinol Metab 2005; 19: 421-40.
  • Rowland DL, McNabney SM, Mann AR. Sexual function, obesity, and weight loss in men and women. Sex Med Rev 2017; 5: 323-38.
  • Esposito K, Ciotola M, Giugliano F, et al. Asso-ciation of body weight with sexual function in women. Int J Impot Res 2007; 19: 353-7.
  • Kolotkin RL, Binks M, Crosby RD, et al. Obe-sity and sexual quality of life. Obesity (Silver Spring) 2006; 14: 472-9.
  • Marchi J, Berg M, Dencker A, et al. Risks asso-ciated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev 2015; 16: 621-38.
  • Kalliala I, Markozannes G, Gunter MJ, et al. Obesity and gynaecological and obstetric condi-tions: umbrella review of the literature. BMJ 2017; 26: 359- 51.
  • Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous concep-tion: a systematic review. Semin Reprod Med 2011; 29: 507-13.
  • Waller DK, Shaw GM, Rasmussen SA, et al. National Birth Defects Prevention Study. Prep-regnancy obesity as a risk factor for structural birth defects. Arch Pediatr Adolesc Med 2007; 161: 745-50.
  • O‘Sullivan JB. Subsequent morbidity among gestational diabetic women. In: Sutherland HW, Stowers JM, editors. Carbohydrate Metabolism in Pregnancy and the Newborn. Edingburgh, UK: Churchill Livingstone 1984: 174-80.
  • Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Re-lat Metab Disord 2001; 25: 1175-82.
  • Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate a population-based screening study. Am J Obstet Gynecol 2004; 190: 1091-7.
  • Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gy-necol 2004; 103: 219-24.
  • Vernini JM, Moreli JB, Magalhaes CG, et al. Maternal and fetal outcomes in pregnancies complicated by overweight and obesity. Reprod Health 2016; 27: 13-100.
  • Cnattingius S, Bergstrom R, Lipworth L, et al. Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998; 338: 147-52.
  • Knight M, Kurinczuk JJ, Spark P, et al. UK Obstetric Surveillance System. Extreme obesity in pregnancy in the United Kingdom. Obstet Gynecol 2010; 115: 989-97.
  • Bodnar LM, Catov JM, Klebanoff MA, Ness RB, Roberts JM. Prepregnancy body mass index and the occurrence of severe hypertensive di-sorders of pregnancy. Epidemiology 2007; 18: 234-9.
  • Eichinger, S, Hron G Bialonczyk et al. Overwe-ight, obesity and the risk of recurrent venous thromboembolism. Arch Intern Med 2008; 168: 1678- 83.
  • Larsen T.B, Sorensen H.T, Gislum M, et al. Maternal smoking, obesity and risk of venous thromboembolism during pregnancy and the pu-erperium: a population-based nested case–control study. Thromb Res 2007; 120:505-9.
  • Usha Kiran TS, Hemmadi S, Bethel J et al. Outcome of pregnancy in a woman with an inc-reased body mass index. BJOG 2005; 112:768-72.
  • Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol 2004; 191: 928-32.