Mehmet Sühha BOSTANCI, Murat BAKACAK, Bülent KÖSTÜ, Önder ERCAN, Fazıl AVCI, Zeyneb BAKACAK, Salih SERİN, Hakan KIRAN

Gebeliğin İlk Haftalarındaki Maternal Vücut Kitle İndeksinin Olumsuz Maternal Perinatal Sonuçlara Etkisi

Amaç: Bu çalışmanın amacı gebelikteki kötü maternal perinatal sonuçlar ve artmış vücut kitle indeksi BMI arasında ilişkiyi araştırmaktır.Gereç ve Yöntemler: Kliniğimizde Ocak 2013 - Temmuz 2014 tarihlerinde tekil doğum yapan 329 gebe kadının tıbbi kayıtları retrospektif olarak değerlendirildi. Gebe kadınlar BMI’ ne göre 4 gruba ayrıldı: grup 1-BMI 19.9 veya daha az düşük kilolu , grup 2-BMI 20-24.9 normal kilolu , grup 3- BMI 25-29.9 aşırı kilolu , grup 4- BMI 30 veya daha fazla. Artmış BMI ile gestasyonel diabetes mellitus, preeklampsi, kan transfüzyon ihtiyacı gelişimi ve fetal doğum ağırlıkları karşılaştırıldı.Bulgular: 329 hastada, artmış BMI ̓nin hem fetal doğum ağırlığı ve gestasyonel diabetes mellitus gelişme riski arasında ilişki saptanmadı. Preeklampsi gelişme riski ve kan transfüzyon ihtiyacı ile artmış BMI arasında pozitif korelasyon bulundu.Sonuç: Artmış BMI, artmış preeklampsi gelişme insidansı ile ve doğum sırasında kan transfüzyonu ihtiyacıyla ilişkilendirilebilir. Bu nedenle, klinisyenler gebelik planlayan üreme çağı kadınlara gebelikte obezite ilişkili maternal problemlerden sakınmak için gebelik öncesinde ideal kilolarına ulaşmalarını önermelidir.

Anahtar Kelimeler:

Vücut kitle indeksi, maternal sonuç, gebelik

Effects Of Maternal Body Mass Index In The Early Weeks Of Pregnancy On Unfavorable Maternal Perinatal Outcomes

Aim: The aim of this study was to investigate the association in pregnancy between increased body mass index BMI and unfavorable maternal perinatal outcomes.Material and Methods: The medical records of 329 pregnant women who delivered singleton infants from January 2013 to July 2014 at our clinic were retrospectively evaluated. The pregnant women were grouped into 4 groups according to BMI measurements: Group 1, BMI ≤ 19.9 underweight , Group 2, 20-24.9 normal weight , Group 3, 25-29.9 over weight , Group 4, ≥ 30 or more. Increased BMI and pregnancy outcomes according to gestational diabetes mellitus, pre-eclampsia, requirement of blood transfusion and fetal birth weight were compared.Results: In all 329 participants, no association was determined between increased BMI and both fetal birth weight and risk of developing gestational diabetes mellitus. A positive correlation was determined between the risk of developing pre-eclampsia and requirement of blood transfusion and increased BMI.Conclusion: Increased maternal BMI index can be considered to be related to increased pre-eclampsia and a need for blood transfusion during delivery. The refore, physicians should recommend that women of reproductive age who are planning to get pregnant should attain ideal weight in the pre-pregnancy period to avoid obesity-related maternal problems.

Keywords:

Body mass index, maternal outcome, pregnancy,

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Overweight and obesity. World Health Organization fact sheet number 311. Geneva (Switzerland): World Health Organization; May 2012.
World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva (Switzerland): World Health Organization; 2000. WHO technical report series 894.
Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol. 1998; 91: 97-102.
Kumari AS. Pregnancy outcome in women with morbid obesity. Int J Gynecol Obstet. 2001; 73: 101-7.
Nuthalapaty FS, Rouse DJ. The impact of obesity on obstetrical practice and outcome. Clin Obstet Gynecol. 2004; 47: 898-913.
Lu GC, Rouse DJ, DuBard M, Cliver S, Kimberlin D, Hauth JC. The effect of the increasing prevalence of maternal obesity on perinatal morbidity. Am J Obstet Gynecol. 2001; 185:845-9.
Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy out- come: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001; 25: 1175-82.
Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol. 2004; 191: 928- 32.
Ehrenberg HM, Dierker LRN, Milluzzi C, Mercer BM. Low maternal weight failure to thrive in pregnancy and adverse perinatal outcomes. Am J Obs- tet Gynecol. 2003; 189: 1726-30.
Lewis G, ed. Why mothers die 2000e2002. Confidential Enquiries into Maternal Deaths in the United Kingdom. London (UK): Royal College of Obstetricians and Gynaecologists; 2004.
Langer O, Yogev Y, Xenakis EM, Brustman L. Overweight and obese in gestational diabetes. The impact on pregnancy outcomes. Am J Obstet Gynecol. 2005; 192: 1768-76.
Cnattingius S, Bergstrom R, Lipworth L, Kramer MS. Prepregnancy we- ight and the risk of adverse pregnancy outcomes. N Engl J Med. 1998; 338: 147-52.
Cedergren MI. Maternal morbid obesity and the risk of adverse pregnan- cy outcome. Obstet Gynecol. 2004; 103: 219-24.
Raatikainen K, Heiskanen N, Heinonen S. Transition from overweight to obesity worsens pregnancy outcome in a BMI dependent manner. Obe- sity. 2006; 14: 165-71.
Galtier Dereure F, Boegner C, Bringer J. Obesity and pregnancy: compli- cations and cost. Am J Clin Nutr. 2000; 71: 1242-8.
Belogolovkin V, Eddleman KA, Malone FD, Sullivan L, Ball RH, Nyberg DA, Comstock CH, Hankins GD et al., The effect of low body mass index on the development of gestational hypertension and preeclampsia. J Ma- tern Fetal Neonatal Med. 2007; 20: 509-13.
O’Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic review. Epidemiology. 2003; 14: 368-74.
Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S. Effect of Body Mass Index on pregnancy outcomes in nulliparous women delive- ring singleton babies. BMC Public Health. 2007; 7: 168.
Roberts JM, Pearson G, Lindheimer M. Summary of the NHLBIworking group on research on hypertension during pregnancy. Hypertension 2003; 4: 437–45.
Walsh S. Obesity: a risk factor for pre-eclampsia. Trends Endocrinol Me- tab 2007; 18: 365–70.
Fretts RC. Etiology and prevention of stillbirth. Am J Obstet Gynecol 2005; 193: 1923–35.
Chu SY, Kim SY, Lau J, Schmid CH, Dietz PM, Callaghan WM, Curtis KM. Maternal obesity and risk of stillbirth: a metaanalysis. Am J Obstet Gynecol. 2007; 197: 223-8.
Mantakas A, Farrell T. The influence of increasing BMI in nulliparous women on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2010; 153: 43-6.
Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes (Lond) 2008; 32: 495-501.