Maternal Obezite ile İlişkili Risklerin Kanıt Temelli Yönetimi

Obezite, vücut yağlarının aşırı artmasıyla karakterize Beden Kitle İndeksi (BMİ)’nin 30 kg/m2 veya daha fazla olması durumudur. Obezite prevalansının son yıllarda önemli ölçüde artış gösterdiği, dünyadaki 18 yaş ve üstü yetişkin kadınların %40'ının aşırı kilolu, %15'inin obez olduğu bildirilmektedir. Gebelikte obezite prevalansının %1,8 ila %25,3 arasında değiştiği, obezitenin pek çok maternal ve fetal riske neden olduğu bilinmektedir. Obezite sorunu annede; gestasyonel diyabet, hipertansiyon, preeklampsi, acil sezaryen, artışı ile; fetüste ise prematürite, ölü doğum, konjenital anomaliler, makrozomi ve çocukluk obezitesi artışı ile ilişkilidir. Ayrıca obez gebelerde vajinal veya sezaryen doğum sırasında ya da sonrasında çeşitli komplikasyonların geliştiği, anne ve bebeklerinin daha uzun süre hastanede kaldığı bilinmektedir. Gebelik öncesi, sırası ve sonrasında değiştirilebilir yaşam bicimi davranışları yoluyla kilonun kontrol altına alınması, obezite ile ilişkili maternal ve fetal risklerin önlenmesi için gerekli girişimlerin zamanında planlanması önemlidir. Bu derlemede, maternal obezite ile ilişkili risklerin kanıt temelli yönetiminin özetlenmesi amaçlandı.

Anahtar Kelimeler:

Maternal obezite, obezite riskleri, kanıt temelli bakım

Evidence-Based Management of Risks Associated with Maternal Obesity

Obesity is a medical problem which is characterized by excessive increase in body fat and negatively affects the health of the indivi-dual. The prevalence of obesity is increasing gradually among reproductive age women and pregnant women all over the world and in our country. 40% of adult women aged 18 and over in the world are overweight and 15% are obese. The prevalence of obe-sity in pregnancy varies between 1.8% and 25.3%. Maternal obe-sity before and during pregnancy affects both mother and newborn. Whin obesity problem causes gestational diabetes, preec-lampsia, cesarean section increase in mother;in fetus, it causes premature, stillbirth, congenital anomaly, macrosomia and increase in childhood obesity. However, in the obese pregnant women develop various complications after birth and it is known that mothers and their babies stay in hospital for longer. It is very important to know the effects and risks of obesity on maternal health and neonatal health. Multidisciplinary a care should be given to women in order to prevent and manage the risks associated with obesity before, during and after pregnancy. In this review, aimed to summarize the possible risks and evidence-based management of maternal obesity.

Keywords:

Maternal obesity, obesity risks, evidence - based care,

PDF

___

1-Institute of Medicine (IOM). Weight gain during pregnancy: reexamining the guidelines. Washington, DC:The National Academies Press. IOM. 2009. https://www.cbsnews.com/htdocs/pdf/052809_pregnancy.pdf. Erişim tarihi 12 Haziran 2018.
2-Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD). Obezite Tanı ve Tedavi Kılavuzu. Obezite tedavisinde bilişsel davranışçı terapi. 6. Baskı. Ankara, Miki Matbaacılık San. ve Tic. Ltd. Şti.; 2018 s:77-79. http://www.temd.org.tr/admin/uploads/tbl_gruplar/20180525144116-2018-05-25tbl_gruplar144108.pdf. Erişim tarihi 12 Temmuz 2018.
3-World Health Organization (WHO). Body mass index – BMI. http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Erişim tarihi 12 Haziran 2018.
4-American College of Obstetricians and Gynecologists (ACOG). Obesity in pregnancy. ACOG Practice Bulletin No. 156. Obstet Gynecol. 2015;126(6):e112-126. doi:10.1097/AOG.0000000000001211
5-Ng M, Fleming T, Robinson M, ve ark. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766-81.
6-Türkiye Hanehalkı Sağlık Araştırması (THSA). Bulaşıcı olmayan hastalıkların risk faktörleri prevalansı 2017 (STEPS). Dünya Sağlık Örgütü Türkiye Ofisi, Ankara, 2018. https://www.who.int/ncds/surveillance/steps/WHO_Turkey_Risk_ Factors_A4_TR_19.06.2018.pdf . Erişim tarihi 12 Temmuz 2019.
7-Poston L, Caleyachetty R, Cnattingius S, ve ark. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4:1025-1036. doi:org/10.1016/S2213-8587(16)30217-0
8-Yanıkkerem E, Selviye M. Maternal obezitenin sonuçları ve önleme stratejileri. TAF Prev Med Bull. 2012;11(3):353-364. doi:10.5455/pmb.1-1325850422
9-Leung TY, Leung TN, Sahota DS, Chan OK, Chan LW, Fung TY, Lau TK. Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of chinese women. BJOG. 2008;115:1529-1537. doi:10.1111/j.1471-0528.2008.01931.x
10-The Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG). Management of obesity in pregnancy. RANZCOG College Statement C-Obs 49. 2017;2-19. https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's Health/Statement and guidelines/Clinical-Obstetrics/Management-of-obesity-(C-Obs-49)-Review-March-2017.pdf?ext=.pdf. Erişim tarihi 09 Temmuz 2018.
11-Kulie T, Slattengren A, Redmer J, Counts H, Eglash A, Schrager S. Obesity and women's health: an evidence-based review. J Am Board Fam Med. 2011;24(1):75-85. doi:org/10.3122/jabfm.2011.01.100076
12-Lee CY, Koren G. Maternal obesity: effects on pregnancy and the role of pre-conception counselling. J Obstet Gynaecol. 2010; 30(2):101-106. doi:10.3109/01443610903474355
13-Wise LA, Rothman KJ, Mikkelsen EM, Sorensen HT, Riis AH, Hatch EE. A prospective cohort study of physical activity and time to pregnancy. Fertil Steril. 2012; 97: 1136-1142. doi:org/10.1016/j.fertnstert.2012.02.025
14-Metwally M, Li TC, Ledger WL. The impact of obesity on female reproductive function. Obesity Reviews. 2007;8: 515-523. doi:10.1111/j.1467-789X.2007.00406.x
15-Tedik SE. Fazla kilo/obezitenin önlenmesinde ve sağlıklı yaşamın desteklenmesinde hemşirenin rolü. Türkiye Diyabet ve Obezite Dergisi. 2017;2:54-62. doi:10.25048/tjdo.2017.9
16-Esmer Çorbacıoğlu A. Gebelik ve obezite. Türkiye Maternal Fetal Tıp ve Perinatoloji Derneği. 2016; Erişim adresi:http://tmftp.org/webkontrol/uploads/files/. Erişim tarihi 22 Haziran 2018.
17-Hildebrand E, Källén B, Josefsson A, Gottvall T, Blomberg M. Maternal obesity and risk of Down syndrome in the offspring. Prenat Diagn. 2014;34:310-315. doi: 10.1002/pd.4294
18-Athukorala C, Rumbold AR, Willson KJ, Crowther CA. The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy and Childbirth. 2010; 10 (56):2-8. doi:org/10.1186/1471-2393-10-56
19-Ma RCW, Schmidt MI, Tam WH, McIntyre HD, Catalano PM. Clinical management of pregnancy in the obese mother:before conception, during pregnancy and post partum. Lancet Diabetes Endocrinol. 2016;4:1037-1049. doi:org/10.1016/S2213-8587(16)30278-9.
20-Dashe JS, McIntire DD, Twickler DM. Effect of maternal obesity on the ultrasound detection of anomalous fetuses. Obstet Gynecol. 2009;113:1001-1007. http://dx.doi.org/10.1097/AOG.0b013e3181a1d2f5
21-Hill B, McPhie S, Moran LJ, Harrison P, Huang TT, Teede H, Skouteris H. Lifestyle intervention to prevent obesity during pregnancy: Implications and recommendations for research and implementation. Midwifery. 49 2017;13-18. doi:org/10.1016/j.midw.2016.09.017
22-Shaikh H, Robinson S, Teoh TG. Management of maternal obesity prior to and during pregnancy. Semin Fetal Neonatal Med. 2010;15(2):77-82. doi:10.1016/j.siny.2009.10.003
23-Jevitt C. Pregnancy complicated by obesity:midwifery management. J Midwifery Womens Health. 2009;54(6):445-451. doi:10.1016/j.jmwh.2009.02.002
24-Oğuz G, Karabekiroğlu A, Kocamanoğlu B, Sungur MZ. Obezite ve bilişsel davranışçı terapi. Psikiyatride Güncel Yaklaşımlar. 2016;8(2):133-144. doi:10.18863/pgy.02951
25-Jolly MC, Sebire NJ, Harris JP, Regan L, Robinson S. Risk factors for macrosomia and its clinical consequences: a study of 350,311 pregnancies. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2003;111(1):9-14. doi:10.1016/s0301-2115(03)00154-4
26-Dodd JM, Briley AL. Managing obesity in pregnancy – an obstetric and midwifery perspective. Midwifery. 2017;49,7-12. doi:org/10.1016/j.midw.2017.03.0011
27-McGuire W, Dyson L, Renfrew M. Maternal obesity:consequences for children, challenges for clinicians and carers. Semin Fetal Neonatal Med. 2010;15(2):108-112. doi:10.1016/j.siny.2009.09.005
28-Jarlenski MP, Bennett WL, Bleich SN, Barry CL, Stuart EA. Effects of breastfeeding on postpartum weight loss among US women. Preventive Medicine. 2014;69, 146-150. doi:10.1016/j.ypmed.2014.09.018
29-Queensland Clinical Guidelines (QCG). Obesity in pregnancy. Health Professionals in Queensland Public and Private Maternity and Neonatal Services. No:MN15.14-V5.R20 2015;2-20. https://www.health.qld.gov.au/data/assets/pdf_file/0019/142309/g-obesity.pdf. Erişim tarihi 09 Temmuz 2019.
30-The Royal College of Obstetricians and Gynaecologists (RCOG). Care of women with obesity in pregnancy. Green-top Guideline No. 72. BJOG 2018. https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.15386. Erişim tarihi 09 Temmuz 2019.