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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2007; 01(01): 17-24
DOI: 10.1055/s-0037-1617726
Adipositas und Schwangerschaft
Schattauer GmbH

Möglichkeiten der Ernährungstherapie bei übergewichtigen schwangeren Frauen

Options in nutritional therapy in obese pregnant women
U. Amann-Gassner
1   Technische Universität München, Freising-Weihenstephan
,
H. Hauner
2   Else Kröner-Fresenius-Zentrum für Ernährungsmedizin (Direktor: Prof. Dr. med. H. Hauner)
› Author Affiliations
Further Information

Publication History

Publication Date:
21 December 2017 (online)

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Zusammenfassung

Übergewicht und Adipositas bei Frauen in gebährfähigem Alter sowie eine übermäßige Gewichtszunahme während der Schwangerschaft sind eindeutig assoziiert mit Schwan gerschaftskomplikationen (Präeklampsie, Gestationsdiabetes), Makrosomie und dem Risiko für das Neugeborene, im späteren Leben chronische Erkrankungen zu entwickeln. In diesem Zusammenhang ist nicht nur das Körpergewicht, sondern auch die kindliche Fettmasse bei Geburt ein wich-tiger prädiktiver Faktor für die Entstehung von Adipositas im Erwachsenenalter. Aktuelle Studien belegen, dass eine Lebensstilintervention bestehend aus einer Ernährungstherapie und körperlicher Betätigung günstige Effekte auf das mütterliche und kindliche Outcome haben. Die Empfehlungen zur Gewichtszunahme während der Schwangerschaft orientieren sich am Body-Mass-Index (BMI) vor der Schwangerschaft. Für eine adäquate Behandlung des Ge stationsdiabetes wäre die Einführung frühzeitiger Scree-ningmaßnahmen im Rahmen der Mutterschaftsrichtlinien wünschenswert. Aktuelle Ernährungsempfehlungen basieren derzeit auf wenigen Studiendaten, eine ausgewogene Ernährungsweise mit niedrigem glykämischen Index, die zu einem moderaten Gewichtsanstieg von maximal sechs bis acht Kilogramm führt, scheint bei adipösen schwangeren Frauen jedoch vorteilhaft zu sein.

Summary

Overweight and obesity in women of childbearing age as well as an excessive weight gain during pregnancy are clearly associated with complications during pregnancy (preeclampsia, gestational diabetes mellitus), macrosomia and the risk for the newborn of developing chronic diseases in later life. Therefore not only the body weight of the newborn, but also the neonatal fat mass has an impact for the onset of obesity. Recent studies suggest the beneficial effect of life style intervention programmes as a combination of nutritional medical therapy and physical activity. In future recommendations, weight gain during pregnancy, based on pre-pregnant BMI, has to be considered more consequently. An implementation of early screening tools within the maternity guidelines would be desirable for an adequate treatment of gestational diabetes mellitus. Evidence-based dietary recommendations for obese pregnant women are not available at the moment, but a balanced, low glycaemic index diet, which leads to a moderate weight gain of 6-8 kg during pregnancy, diet could be beneficial for obese pregnant women.

Schlüsselwörter

Übergewicht - Adipositas - Schwangerschaft - Gewichtszunahme - pränatale und neonatale Komplikationen - Ernährungsempfehlungen

Keywords

Overweight - obesity - pregnancy - weight gain - prenatal and neonatal complications - dietary recommendations
 

  • Literatur

  • 1 Mensink G, Lampert T, Bergmann E. ÜJberge-wicht und Adipositas in Deutschland 1984-2003. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2005; 48: 1348-1356.
    CrossrefPubMedGoogle Scholar
  • 2 Rosenberg T, Garbers S, Chavkin W, Chiasson M. Prepregnancy weight and adverse perinatal outcomes in an ethically diverse population. Obstet Gynecol 2003; 102: 1022-1027.
    PubMedGoogle Scholar
  • 3 Abrams B, Laros R. Prepregnancy weight gain and birth weight. Am J Obstet Gynecol 1986; 154: 503-509.
    CrossrefPubMedGoogle Scholar
  • 4 Bergmann K, Bergmann R, Ellert U, Dudenhausen J. Perinatal risk factors for long-term health. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2007; 50: 670-676.
    CrossrefPubMedGoogle Scholar
  • 5 Lumey L, Ravelli A, Wiessing G. The Dutch Famine Birth Cohort Study: Design, validation of exposure, and selected characteristics of subjects after 43 years follow-up. Pediatr Perinatal Epidemiol 1993; 07: 354-367.
    CrossrefPubMedGoogle Scholar
  • 6 Holemans K, Aerts L, van Assche F. Fetal growth and long-term consequences in animal models of growth retardation. Eur J Obstet Gynecol Reprod Biol 1998; 12: 149-156.
    PubMedGoogle Scholar
  • 7 Ravelli G, Stein Z, Susser M. Obesity in young men after famine exposure in utero and early infancy. New Engl J Med 1976; 295: 349-353.
    CrossrefPubMedGoogle Scholar
  • 8 Cnattingius S, Bergström R, Lipworth L, Kramer M. Prepregnancy weight and the risk of adverse pregnancy outcome. N Engl J Med 1998; 338: 147-152.
    CrossrefPubMedGoogle Scholar
  • 9 Usha TKiran, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a women with an increased body mass index. BJOG 2005; 112: 768-772.
    CrossrefPubMedGoogle Scholar
  • 10 Kabali C, Werler M. Pre-pregnant body mass index, weight-gain and the risk of delivering large babies among non-diabetic mothers. Int J Gynaecol Obstet 2007; 97: 100-104.
    CrossrefPubMedGoogle Scholar
  • 11 Sewell M, Huston-Presley L, Super D, Catalano P. Increased neonatal fat mass, not lean body mass, is associated with maternal obesity. Am J Obstet Gynecol 2006; 195: 1100-1103.
    CrossrefPubMedGoogle Scholar
  • 12 Soltani K, Bruce C, Fraser R. Observational study of maternal anthropometry and fetal insulin. Arch Dis Child Fetal Neonatal Ed 1999; 81: 122-124.
    CrossrefPubMedGoogle Scholar
  • 13 Merzouk H, Meghelli-Bouchenak M, Loukidi B. et al. Impaired serum lipids and lipoproteins in fetal macrosomia related to maternal obesity Biol Neonate. 2000; 77: 17-24.
    PubMedGoogle Scholar
  • 14 Moreira P, Padez C, Mourao-Carvalhal I, Rosado V. Maternal weight gain during pregnancy and overweight in Portugese children. Int J Obes Relat Metab Disord 2007; 31: 608-614.
    CrossrefPubMedGoogle Scholar
  • 15 Institute of Medicine. Nutrition during pregnancy. Part I: Weight gain Part II: Supplement. National Academy Press; Washington DC: 1990
    Google Scholar
  • 16 Jain N, Denk C, Kruse L, Dandalu V. Maternal obesity: can pregnancy weight gain modify risk of selected adverse pregnancy outcomes?. Am J Perinatal 2007; 24: 291-298.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Naeye R. Maternal body weight and pregnancy outcome. Am J Clin Nutr 1990; 52: 273-279.
    CrossrefPubMedGoogle Scholar
  • 18 Shaw G, Velie E, Schaffer D. Risk of neural tube defect-affected pregnancies among obese women. JAMA 1996; 275: 1093-1096.
    CrossrefPubMedGoogle Scholar
  • 19 Werler M, Louik C, Shapiro S, Mitchell A. Pre-pregnant weight in relation to risk of neural tube defects. JAMA 1996; 275: 1089-1092.
    CrossrefPubMedGoogle Scholar
  • 20 Kallen K. Maternal smoking, body mass index, and neural tube defects. Am J Epidemiol 1998; 147: 1103-1111.
    CrossrefPubMedGoogle Scholar
  • 21 Watkins M, Rasmussen S, Honein M, Botto L. Maternal obesity and risk for birth defects. Pediatrics 2003; 111: 1152-1158.
    PubMedGoogle Scholar
  • 22 Ray J, Wyatt P, Vermeulen M. et al. Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification. Obstet Gynecol 2005; 105: 261-265.
    CrossrefPubMedGoogle Scholar
  • 23 Waller D, Daawson T. Relationship between maternal obesity and adverse pregnancy outcomes. In Hornstra G, Uauy R, Yang X. Hrsg. The Impact of Maternal Nutrition on the Offspring. Basel, Schweiz: Karger: 2004: 197-212.
    Google Scholar
  • 24 Grundy S. Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab 2004; 89: 2595-2600.
    CrossrefPubMedGoogle Scholar
  • 25 Volcik K, Shaw G, Zhu H. et al. Risk factors for neural tube defects: association between uncoupling protein 2 polymorphisms and spina bifida. Birth defects Res A Clin Mol Teratol 2003; 67: 158-161.
    CrossrefPubMedGoogle Scholar
  • 26 Williams L, Evans S, Newham J. Prospective cohort study of factors influencing the relative weights of the placenta and the newborn infant. Br Med J 1997; 314: 1864-1868.
    CrossrefPubMedGoogle Scholar
  • 27 Walsh S. Maternal-placental interactions of oxidative stress and antioxidants in preeclampsia. Semin Reprod Endocrinol 1998; 16: 93-104.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Olafsdottir A, Skuladottir G, Thorsdottir I. et al. Maternal diet in early and late pregnancy in relation to weight gain. Int J Obes Relat Metab Disord 2006; 30: 492-199.
    CrossrefPubMedGoogle Scholar
  • 29 Jovanovic L. Achieving eugycaemia in women with gestational diabetes mellitus. Drugs 2004; 64: 1401-1417.
    CrossrefPubMedGoogle Scholar
  • 30 King J. Maternal obesity, metabolism, and pregnancy outcome. Annu Rev Nutr 2006; 26: 271-291.
    CrossrefPubMedGoogle Scholar
  • 31 Magee M, Knopp R, Benedetti T. Metabolic effects of 1200-kcaldiet in obese pregnant women with gestational diabetes. Diabetes 1990; 39: 234-240.
    CrossrefPubMedGoogle Scholar
  • 32 Knopp R, Magee M, Raisys V. Hypokaloric diets and ketogenesis in the management of obese gestational dabetic women. J Am Coll Nutr 1991; 10: 649-667.
    CrossrefPubMedGoogle Scholar
  • 33 FDA Obesity Working Group. Calories count-report of the Working Group on Obesity. 2004. Rockville, MD: U.S. Food and Drug Administration; http://www.cfsan.fda.gov/∼dms/owg-toc.html.
    Google Scholar
  • 34 Scialli A. Public Affairs Committee of the Teratology Society. Teratology public affairs committee position paper: maternal obesity and pregnancy. Birth Defects Res A Clin Mol Teratol 2006; 76: 73-77.
    CrossrefPubMedGoogle Scholar
  • 35 Cogswell M, Scanlon K, Fein S, Schieve L. Medically advised, mothers’s personel target, and actual weight gain during pregnancy. Obstet Gynecol 1999; 94: 616-622.
    PubMedGoogle Scholar
  • 36 Pivarnik J. Potential effects of maternal activity on birth weight: brief review. Med Sci Sports Exer 1998; 30: 400-406.
    CrossrefPubMedGoogle Scholar
  • 37 Kardel KR, Kase T. Training in pregnant women: effects on fetal development and birth. Am J Obstet Gynecol 1998; 178: 280-286.
    CrossrefPubMedGoogle Scholar
  • 38 Dye T, Knox K, Artal R. et al. Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol 1997; 146: 961-965.
    CrossrefPubMedGoogle Scholar
  • 39 Artal R, Catanzaro R, Gavard J. et al. A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus. Appl Physiol Nutr Metab 2007; 32: 596-601.
    CrossrefPubMedGoogle Scholar
  • 40 Yogev Y, Langer O. Pregnancy outcome in obese and morbidly obese gestational diabetic women. Eur J Obstet Gynecol Reprod Biol. 2007 May, 19 [Epub ahead of print]..
    PubMedGoogle Scholar
  • 41 Weiner R, Blanco-Engert R, Weiner S. et al. Outcome after laparoscopic adjustable gastric ban-ding-8 years experience. Obes Surg 2003; 13: 427-134.
    CrossrefPubMedGoogle Scholar
  • 42 Skull A, Slater G, Duncombe J, Fielding G. Laparoscopic adjustable banding in pregnancy: safety, patient tolerance and effect on obesity-related pregnancy outcomes. Obes Surg 2004; 14: 230-235.
    CrossrefPubMedGoogle Scholar
  • 43 Arenz S, Rückerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity-a systematic review. Int J Obes Relat Metab Disord 2004; 28: 1247-1256.
    CrossrefPubMedGoogle Scholar
  • 44 Sichieri R, Field AE, Rich-Edwards J, Willett WC. Prospective assessment of exclusive breastfeeding in relation to weight change in women. Int J Obes Relat Metab Disord 2003; 27: 815-820.
    CrossrefPubMedGoogle Scholar
  • 45 American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Obesity in pregnancy. Obstet Gynecol 2005; 106: 671-675.
    CrossrefPubMedGoogle Scholar