Prekonsepsiyonel, Gebelik ve Postpartum Döngüde Maternal Obeziteyi Önlemek

Üreme çağındaki çoğu kadın obeziteye doğru giden hızlandırılmış bir yoldadır. Gebelik ve postpartum dönem, kilo alımını artıran ve obeziteye neden olan yüksek riskli dönemlerdir. Prekonsepsiyonel dönemde yüksek beden kütle indeksi’ne sahip olan kadınlarda, gebe kaldığında maternal obezitenin hem anne hem de fetal sağlık üzerine olumsuz riskleri artmaktadır. Aynı zamanda, gestasyonel dönemde aşırı kilo alan kadınlarda da maternal obezitenin gebelik ve postpartum dönem üzerine riskleri artmaktadır. Gestasyonel dönemde aşırı kilo alan kadınların, postpartum kilo retansiyonu riski artmakta olup, postpartum kilo retansiyonu da kadının ilerleyen zamanlarında obezite ile karşı karşıya kalmasına neden olmaktadır. Tüm bu nedenlerden dolayı maternal obezitenin önemini ve risklerini anlamak önemli olup, obezitenin yönetimi prekonsepsiyonel dönemde başlayıp postpartum dönemde de devam etmelidir. Prekonsepsiyonel dönemde kadınlara danışmanlık yaparak, gebelikte obezitenin sonuçları ve yönetimi konusunda farkındalık yaratılmalıdır. Obezite yönetimi, bireysel beslenme, egzersiz, davranışsal veya cerrahi müdahaleler içeren kısa ve uzun vadeli yaklaşımlar gerektirmektedir. Sağlıklı beslenme ve diyet, kilo yönetimi, fiziksel aktivite, gebeliği planlamak, gebelik komplikasyonları için tarama yapılması, fiziksel, zihinsel, psikososyal sağlık, postpartum bakım ve emzirme prekonsepsiyonel, gebelik ve postpartum dönemlerde belirlenen önceliklerdir. Kadınların her döneminde yanında olan sağlık profesyonelleri olarak prekonsepsiyonel, gebelik ve postpartum dönemde kilo yönetimine farkındalık sağlanmalı ve etkili girişimlerde bulunulmalıdır. Bu çalışmanın amacı, prekonsepsiyonel, gebelik ve postpartum döngüde maternal obeziteyi önleme konusunu literatür doğrultusunda incelemektir.

Anahtar Kelimeler:

gebelik, obezite, önleme & kontrol, perinatal bakım, postpartum dönem

Preventing Maternal Obesity Across the Preconception, Pregnancy and Postpartum Cycle

Most women of reproductive age are on an accelerated path towards obesity. Pregnancy and postpartum period are high risk periods that increase weight gain and cause obesity. When women who had high body mass index during preconception period became pregnant with high body mass index, adverse effects and complications of maternal obesity on both mother and fetal health increases. At the same time, the risks of maternal obesity on pregnancy and postpartum period increase in women who gain excessive weight during the gestational period. Women who gain excessive gestational weight have an increased risk of postpartum weight retention, and postpartum weight retention also causes the woman to face obesity later in life. For all these reasons, it is important to understand the importance and risks of maternal obesity and management of obesity should start in the preconceptional period and continue in the postpartum period. Counseling should be provided to women in the preconceptional period and awareness should be raised about the consequences and management of obesity during pregnancy. Obesity management requires short and long-term approaches, including individual nutrition, exercise, behavioral or surgical interventions. Healthy nutrition and diet, weight management, physical activity, planning pregnancy, screening for pregnancy complications, physical, mental, psychosocial health, postpartum care and breastfeeding are priorities determined during preconceptional, pregnancy and postpartum periods. As healthcare professionals who accompany women in every period, awareness should be raised about weight management in preconceptional, pregnancy and postpartum period and effective attempts should be made. The aim of this study is to examine the issue of preventing of maternal obesity in preconceptional, pregnancy and postpartum cycle in accordance with the literature.

Keywords:

pregnancy, obesity, prevention & control, perinatal care, postpartum period,

PDF

___

Referans1. Our World in Data https://ourworldindata.org/obesity
Referans2. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. Jama. 2010;303(3):235-241.
Referans3. https://www.statista.com/statistics/236823/prevalence-of-obesity-among-adults-by-country/
Referans4. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü 2018 Türkiye Nüfus ve Sağlık Araştırması. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Kalkınma Bakanlığı ve TÜBİTAK, Ankara
Referans5. Daşıkan Z, Kavlak O. Maternal Obesity: Pregnancy Complications and Management of Pregnant Woman: Review. Turkiye Klinikleri Journal of Nursing Sciences. 2009;1(1): 39-46.
Referans6. Sabounchi NS, Hovmand PS, Osgood ND, Dyck RF, Jungheim ES. A novel system dynamics model of female obesity and fertility. Am. J. Public Health. 2014;104:1240–1246.
Referans7. Harrison CL, Skouteris H, Boyle J, Teede HJ. Preventing obesity across the preconception, pregnancy and postpartum cycle: implementing research into practice. Midwifery. 2017;52:64-70.
Referans8. Johnson J, Clifton RG, Roberts JM, Myatt L, Hauth JC, Spong CY, et al. Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine Guidelines. Obstetrics & Gynecology. 2013;121:969–975.
Referans9. UNDP Sürdürülebilir Kalkınma Amaçları (Erişim Tarihi: 20.03.2021, https://www.tr.undp.org/content/turkey/tr/home/sustainable-development-goals.html)
Referans10. World Health Organization (WHO). Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and Morbidity; World Health Organization: Geneva, Switzerland, 2013;14-16 https://apps.who.int/iris/handle/10665/78067 Erişim Tarihi: 20.03.2021
Referans11. Delcore L, Lacoursiere DY. Preconception care of the obese woman. Clinical Obstetrics and Gynecology. 2016;59(1):129-139.
Referans12. Lewis MA, Mitchell EW, Levis DM, Isenberg K, Kish-Doto J. Couples' notions about preconception health: implications for framing social marketing plans. American Journal of Health Promotion. 2013;27:p20–27.
Referans13. NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19· 2 million participants. The Lancet. 2016;387(10026):1377-1396.
Referans14. Driscoll AK, Gregory EC. Increases in Prepregnancy Obesity: United States, 2016-2019. NCHS Data Brief. 2020;(392):1-8.
Referans15. Hollis JL, Crozier SR, Inskip HM, et al. Modifiable risk factors of maternal postpartum weight retention: an analysis of their combined impact and potential opportunities for prevention. Int J Obes. 2017;41(7):1091–1098
Referans16. Chee WF, Si YM, Siew CY. Factors associated with rates of gestational weight gain among pregnant women in Batu Pahat district of Johor state, Malaysia. Malaysian Journal of Medicine and Health Sciences. 2019; 15 (1): 33–39.
Referans17. Hill B, Skouteris H, Teede HJ, Bailey C, Baxter JAB, Bergmeier HJ, et al. Health in Preconception, Pregnancy and Postpartum Global Alliance: International network preconception research priorities for the prevention of maternal obesity and related pregnancy and long-term complications. Journal of Clinical Medicine. 2019;8(12): 2119.
Referans18. Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, et al. Before the beginning: Nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018;391:1830–1841, doi:10.1016/S0140-6736(18)30311-8.
Referans19. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis. J. Am. Med. Assoc. 2017;317:2207–2225, doi:10.1001/jama.2017.3635.
Referans20. McIntyre D, Gibbons KS, Flenady VJ, Callaway LK. Overweight and obesity in Australian mothers: epidemic or endemic?. Med J Aust. 2012;196:184–188.
Referans21. Godfrey KM, Reynolds RM, Prescott SL, Nyirenda M, Jaddoe VW, Eriksson JG. et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol. 2017;5:53–64, doi:10.1016/s2213-8587(16)30107-3
Referans22. Saben JL, Boudoures AL, Asghar Z, Thompson A, Drury A, Zhang W, et al. Maternal metabolic syndrome programs mitochondrial dysfunction via germline changes across three generations. Cell Reports. 2016;16:1–8.
Referans23. Dreisbach C, Prescott S, Alhusen J. Influence of maternal prepregnancy obesity and excessive gestational weight gain on maternal and child gastrointestinal microbiome composition: A systematic review. Biological Research for Nursing. 2020;22(1):114-125.
Referans24. American College of Obstetricians and Gynecologists (ACOG). Motivational interviewing: a tool for behavioral change. ACOG Committee Opinion No. 423. 2009; 113:243–6.
Referans25. Özcan A, Töz E, Özvatan SH, Vural T, Sancı M. Management of obese pregnancies. İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi. 2016;26(1):1-9.
Referans26. Wax JR, Cartin A, Wolff R, Lepich S, Pinette MG, Blackstone J. Pregnancy following gastric bypass for morbid obesity: effect of surgery-to-conception interval on maternal and neonatal outcomes. Obesity Surgery. 2008;18(12):1517-1521.
Referans27. Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, et al. Recommendations to improve preconception health and Health Care—United States: report of the CDC/ATSDR preconception care work group and the select panel on preconception care. Morbidity and Mortality Weekly Report: Recommendations and Reports. 2006;55(6)
Referans28. Institute of Medicine (IOM). Weight Gain during Pregnancy: Reexamining the Guidelines. Washington, D.C:The National Academies Press. 2009; 45-50 https://pubmed.ncbi.nlm.nih.gov/20669500/ Erişim Tarihi: 20.03.2021
Referans29. National Institute for Health and Care Excellence (NICE). Weight Management Before, During, and After Pregnancy (PH27). National Institute for Health and Care Excellence: London, UK. 2010; 8-20 https://www.nice.org.uk/guidance/ph27 Erişim Tarihi: 20.03.2021
Referans30. Public Health Agency of Canada. Family-Centred Maternity and Newborn Care: National Guidelines. Chapter 2: Preconception Care; Public Health Agency of Canada: Ottawa, ON, Canada. 2017; 6-20 https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/maternity-newborn-care/maternity-newborn-care-guidelines-chapter-2-eng.pdf Erişim Tarihi: 20.03.2021
Referans31. Opray N, Grivell R, Deussen A, Dodd J. Directed preconception health programs and interventions for improving pregnancy outcomes for women who are overweight or obese. Cochrane Database of Systematic Reviews. 2015;14.
Referans32. Forsum E, Brantsæter AL, Olafsdottir AS, Olsen SF, Thorsdottir I. Weight loss before conception: a systematic literature review. Food & Nutrition Research. 2013;57(1).
Referans33. Daşıkan Z. Gebelikte kilo alımı: gebe kadınlar prenatal bakımda doğru kilo alım önerisi alıyor mu? (Ödemiş/İzmir). Journal of Clinical Obstetrics & Gynecology. 2015;25(1):32-38.
Referans34. Harrison C, Lombard CB, Teede HJ. Understanding health behaviours in a cohort of pregnant women at risk of gestational diabetes mellitus: an observational study. BJOG: An International Journal of Obstetrics & Gynaecology. 2012;119:731–738.
Referans35. Deputy N, Sharma AJ, Kim S. Gestational weight gain-United States, 2012 and 2013. MMWR Morbidity and Mortality Weekly Report. 2015;64:1215–1220.
Referans36. Salmon C, Sauve RS, LeJour C, Fenton T, Metcalfe A. A single gestational weight gain recommendation is possible for all classes of pregnant women with obesity. Obesity Research & Clinical Practice. 2020;14(1):66-72.
Referans37. Nurul-Farehah S, Rohana AJ. Maternal obesity and its determinants: A neglected issue?. Malaysian family physician: The Official Journal of The Academy of Family Physicians Of Malaysia. 2020;15(2):34–42.
Referans38. Nikolopoulos H, Mayan M, MacIsaac J, Miller T, Bell RC. Women’s perceptions of discussions about gestational weight gain with health care providers during pregnancy and postpartum: a qualitative study. BMC pregnancy and childbirth. 2017;17(1):1-9.
Referans39. Ferrari RM, Siega-Riz AM. Provider advice about pregnancy weight gain and adequacy of weight gain. Maternal and Child Health Journal. 2013;17(2):256-264.
Referans40. Whitaker KM, Wilcox S, Liu J, Blair SN, Pate RR. Provider advice and women’s intentions to meet weight gain, physical activity, and nutrition guidelines during pregnancy. Maternal and Child Health Journal. 2016;20(11):2309-2317.
Referans41. Truong YN, Yee LM, Caughey AB, Cheng YW. Weight gain in pregnancy: does the Institute of Medicine have it right?. American Journal of Obstetrics And Gynecology. 2015;212(3):362
Referans42. Polinski KJ, Liu J, Boghossian NS, Mclain AC. Maternal obesity, gestational weight gain, and asthma in offspring. Prev Chronic Dis. Nov. 2017;9;14:E109. doi: 10.5888/pcd14.170196
Referans43. Freeman DJ. Effects of maternal obesity on fetal growth and body composition: implications for programming and future health. Semin Fetal Neonatal Med. 2010;15:113-8.
Referans44. Kabaran S. Fetal Programming of Obesity: Maternal Obesity and Excessive Weight Gain. TAF Preventive Medicine Bulletin. 2014;13(5).
Referans45. Hill B, Skouteris H, Boyle JA, Bailey C, Walker R, Thangaratinam S, et al. Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Pregnancy Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications. Journal of Clinical Medicine. 2020;9(3):822.
Referans46. Phelan S. Pregnancy: a “teachable moment” for weight control and obesityprevention. American Journal of Obstetrics and Gynecology. 2010;202 (135.e131-135.e138).
Referans47. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12:709–23.
Referans48. American College of Obstetricians and Gynecologists (ACOG). Committee on Obstetric Practice. Guidelines for perinatal care. American Academy of Pediatrics 2012. https://ebooks.aappublications.org/content/guidelines-for-perinatal-care-7th-edition Erişim Tarihi: 20.03.2021
Referans49. American College of Obstetricians and Gynecologists (ACOG). Weight gain during pregnancy. Committee opinion no. 548. Obstet Gynecol 2013;121:210-2.
Referans50. Kominiarek MA, Peaceman AM. Gestational weight gain. American Journal of Obstetrics and Gynecology. 2017;217(6):642-651.
Referans51. The International Weight Management in Pregnancy (i-WIP) Collaborative Group Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: Meta-analysis of individual participant data from randomised trials. BMJ. 2017;358 doi: 10.1136/bmj.j3119.
Referans52. Thangaratinam S, Rogozińska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: metaanalysis of randomised evidence. British Medical Journal. 2012;344 e2088. http://dx.doi.org/10.1136/bmj.e2088.
Referans53. Muktabhant B, Lumbiganon P, Ngamjarus C, Dowswell T. Interventions for preventing excessive weight gain during pregnancy. The Cochrane Database of Systematic Reviews. 2012; (4CD007145).
Referans54. Hill B, Skouteris H, Fuller-Tyszkiewicz M. Interventions designed to limit gestational weight gain: a systematic review of theory and meta-analysis of intervention components. Obesity Reviews. 2013;14:435–450
Referans55. Van der Pligt P, Willcox J, Hesketh KD, Ball K, Wilkinson S, Crawford D, et al. Systematic review of lifestyle interventions to limit postpartum weight retention: Implications for future opportunities to prevent maternal overweight and obesity following childbirth. Obesity Reviews. 2013;14:792–805
Referans56. Daşıkan Z. Gebelikte Sağlıklı Kilo Alımında Beş Aşamalı (5A) Motivasyonel Danışmanlık Modeli. In: Evereklioğlu C, İrkin R. Sağlık Bilimlerinde Araştırma ve Değerlendirmeler. Gece Kitaplığı, 2021, p.410-432.
Referans57. Daşıkan Z. The effect of theory-based individual counseling on weight management in pregnancy. [doctoral thesis]. İzmir: Ege University, Health Sciences Institute; 2012; 178-182.
Referans58. Kothe E, Bailey C, Weiner C, Nagle C, Nowson C, Hill B, et al. An investigation of Australian midwifery curricula for obesity management and health behaviour change training. Nurse Educ. Pract. 2019;36:54–57. doi: 10.1016/j.nepr.2019.03.003.
Referans59. Rong K, Yu K, Han X, Szeto IM, Qin X, Wang J, et al. Pre-pregnancy BMI, gestational weight gain and postpartum weight retention: A meta-analysis of observational studies. Public Health Nutr. 2015;18:2172–2182.
Referans60. Ketterl TG, Dundas NJ, Roncaioli SA, Littman AJ, Phipps AI. Association of pre-pregnancy BMI and postpartum weight retention before second pregnancy, Washington state, 2003–2013. Maternal and Child Health Journal. 2018;22(9):1339-1344.
Referans61. Endres LK, Straub H, McKinney C, Plunkett B, Mınkovıtz CS, Schetter CD. et al. Postpartum weight retention risk factors and relationship to obesity at 1 year. Obstet Gynecol. 2015;125(1):144‐152.
Referans62. Daşıkan Z, Emlek-Sert Z. Gestational weight gain and weight retention at postpartum 12th month. Cukurova Medical Journal. 2021;46(1):46-54.