Die Prävalenz von Übergewicht und Adipositas steigt weltweit. Davon sind in zunehmendem Maße auch Frauen im gebärfähigen Alter sowie Kinder und Jugendliche betroffen. Wissenschaftliche Erkenntnisse weisen darauf hin, dass die Gesundheit des Kindes bereits im Mutterleib geprägt wird. Der Lebensstil der Mutter in der Schwangerschaft kann die spätere Körpergewichtsentwicklung des Kindes beeinflussen sowie das langfristige Risiko für die Entstehung kardiovaskulärer und metabolischer Erkrankungen mitbestimmen. Neben dem prägraviden Körpergewicht der Mutter sind die Gewichtszunahme während der Schwangerschaft und das Vorliegen eines Gestationsdiabetes wichtige Determinanten für den Verlauf der Schwangerschaft, aber auch für die spätere Gesundheit von Mutter und Kind. Eine ausgewogenen Ernährung, regelmäßige körperliche Bewegung sowie der Verzicht auf Rauchen wirken sich nicht nur positive auf die Gesundheit der werdenden Mutter, sondern auch auf die des Kindes aus. Die Entwicklung von Übergewicht beim Kind sowie Adipositas-assoziierte Erkrankungen könnten durch effektive Interventionsstrategien während der Schwangerschaft vermieden werden. Ebenso wie pränatale Faktoren, können auch verschiedene postnatale Faktoren, insbesondere im ersten Lebensjahr, das Übergewichtsrisiko beeinflussen. Hierbei warden Faktoren wie das Stillen, eine übermäßige Proteinzufuhr und der Zeitpunkt der Beikosteinführung diskutiert.
Summary
The prevalence of overweight and obesity rises worldwide. Increasingly, also women in reproductive age as well as children and adolescents are affected. Scientific evidence supports the concept of fetal programming as the origin of a number of diseases in later life. The maternal lifestyle during pregnancy can be linked to both weight development of the infants as well as long-term development of cardiovascular and metabolic diseases. Maternal pregravid weight, excessive gestational weight gain and gestational diabetes mellitus contribute to pregnancy complications and influence the health status of both mother and child. Recent studies have shown that adequate intervention strategies during pregnancy, including a well-balanced diet, regular physical activity and the avoidance of smoking, can prevent negative health outcomes such as overweight and obesity in later life. Also postnatal influences especially in the first year of life like breastfeeding, excessive protein intake, and infant feeding practices are discussed to have impact on the risk of overweight.
Schlüsselwörter
Fötale Prägung -
Frühkindliche Ernährung -
Adipositas -
Gewichtszunahme in der Schwangerschaft
Keywords
Fetal programming -
early nutrition -
obesity -
gestational weight gain
Literatur
1
Agostoni C,
Baselli L,
Mazzoni MB.
Early nutrition patterns and diseases of adulthood: A plausible link?. European Journal of Internal Medicine 2013; 24: 5-10.
2
Agostoni C,
Decsi T,
Fewtrell M.
et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 2008; 46: 99-110.
6
Benton D.
Role of parents in the determination of the food preferences of children and the development of obesity. Int J Obes Relat Metab Disord 2004; 28: 858-869.
8
Bever JBabendure,
Reifsnider E,
Mendias E.
et al. Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions. Int Breastfeed J 2015; 10: 483.
9
Melnik BC.
The potential mechanistic link between allergy and obesity development and infant formula feeding. Allergy Asthma Clin Immunol 2014; 10: 37.
10
Brunner S,
Stecher L,
Ziebarth S.
et al. Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis. Diabetologia. 2015 doi: 10.1007/fis00125–015–3686–5.
11
Catalano P,
deMouzon SH.
Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes. International journal of obesity (2005) 2015; 39: 642-649.
12
Crume TL,
Ogden L,
Daniels S.
et al. The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: the EPOCH study. Journal of pediatrics 2011; 158: 941-946.
13
Crume TL,
Ogden L,
West NA.
et al. Association of exposure to diabetes in utero with adiposity and fat distribution in a multiethnic population of youth: the Exploring Perinatal Outcomes among Children (EPOCH) Study. Diabetologia 2011; 54: 87-92.
15
Dabelea D,
Mayer-Davis EJ,
Lamichhane AP.
et al. Association of intrauterine exposure to maternal diabetes and obesity with type 2 diabetes in youth: the SEARCH Case-Control Study. Diabetes care 2008; 31: 1422-1426.
17
Dodd JM,
Cramp C,
Sui Z.
et al. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial. BMC medicine 2014; 12: 161.
18
Dodd JM,
Turnbull D,
McPhee AJ.
et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ (Clinical research ed) 2014; 348: g1285.
19
Dulloo AG,
Jacquet J,
Seydoux J,
Montani J.
The thrifty ‘catch-up fat’ phenotype: its impact on insulin sensitivity during growth trajectories to obesity and metabolic syndrome. International journal of obesity (2005) 2006, 30 (Suppl. 04) S23-35.
20
Ferrari N,
Mallmann P,
Brockmeier K,
Strüder HK,
Graf C.
Secular trends in pregnancy weight gain in German women and their influences on foetal outcome: a hospital-based study. BMC pregnancy and childbirth 2014; 14: 228.
23
Harder T,
Bergmann R,
Kallischnigg G,
Plagemann A.
Duration of breastfeeding and risk of overweight: a meta-analysis. American journal of epidemiology 2005; 162: 397-403.
25
Hesse V,
Voigt M,
Sälzler A.
et al. Alterations in height, weight, and body mass index of newborns, children, and young adults in eastern Germany after German reunification. J Pediatrics 2003; 142: 259-262.
28
Jeffries K,
Shub A,
Walker SP,
Hiscock R,
Permezel M.
Reducing excessive weight gain in pregnancy: a randomised controlled trial. The Medical journal of Australia 2009; 191: 429-433.
33
Koletzko B,
Bauer CP,
Bung P.
et al. Nutrition in pregnancy. Practice recommendations of the Network “Healthy Start – Young Family Network”. Dtsch Med Wochenschr 2012; 1366-1372.
34
Laitinen J,
Jääskeläinen A,
Hartikainen A.
et al. Maternal weight gain during the first half of pregnancy and offspring obesity at 16 years: a prospective cohort study. BJOG: an international journal of obstetrics and gynaecology 2012; 119: 716-723.
36
Lau EY,
Liu J,
Archer E.
et al. Maternal weight gain in pregnancy and risk of obesity among offspring: a systematic review. J Obesity 2014; 2014: 524939.
38
Mamun AA,
Mannan M,
Doi SAR.
Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis. Obesity reviews: an official journal of the International Association for the Study of Obesity 2014; 15: 338-347.
39
Mamun AA,
O’Callaghan MJ,
Williams GM.
et al. Breastfeeding is protective to diabetes risk in young adults: a longitudinal study. Acta Diabetol. 2014
40
Margerison Zilko,
Claire E,
Rehkopf D,
Abrams B.
Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. American journal of obstetrics and gynecology 2010; 202: 574 e1–8..
41
Martin RM,
Patel R,
Kramer MS.
et al. Effects of promoting longer-term and exclusive breastfeeding on adiposity and insulin-like growth factor-I at age 11.5 years: a randomized trial. JAMA 2013; 309: 1005-1013.
44
Michaelsen KF,
Larnkjaer A,
Molgaard C.
Early diet, insulin-like growth factor-1, growth and later obesity. World review of nutrition and dietetics 2013; 106: 113-118.
45
Monteiro POA,
Victora CG.
Rapid growth in infancy and childhood and obesity in later life--a systematic review. Obesity reviews: an official journal of the International Association for the Study of Obesity 2005; 06: 143-154.
46
Muktabhant B,
Lawrie TA,
Lumbiganon P,
Laopaiboon M.
Diet or exercise, or both, for preventing excessive weight gain in pregnancy. The Cochrane database of systematic reviews 2015; 06: CD007145.
47
Nehring I,
Chmitorz A,
Reulen H,
Kries vonR,
Ensenauer R.
Gestational diabetes predicts the risk of childhood overweight and abdominal circumference independent of maternal obesity. Diabetic medicine: a journal of the British Diabetic Association 2013; 30: 1449-1456.
49
Oken E,
Levitan EB,
Gillman MW.
Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. International journal of obesity (2005) 2008; 32: 201-210.
50
Oken E,
Taveras EM,
Kleinman KP,
Rich-Edwards JW,
Gillman MW.
Gestational weight gain and child adiposity at age 3 years. American journal of obstetrics and gynecology 2007; 196: 322 e1–8..
51
Olson CM,
Strawderman MS,
Dennison BA.
Maternal weight gain during pregnancy and child weight at age 3 years. Maternal and child health journal 2009; 13: 839-846.
53
Owen CG.
Effect of Infant Feeding on the Risk of Obesity Across the Life Course: A Quantitative Review of Published Evidence. Pediatrics 2005; 115: 1367-1377.
54
Poston L,
Bell R,
Croker H.
et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. The Lancet Diabetes & Endocrinology. 2015 doi: 10.1016/S2213–8587(15)00227–2.
56
Rasmussen KM,
Catalano PM,
Yaktine AL.
New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Current opinion in obstetrics & gynecology 2009; 21: 521-526.
58
Rauh K,
Gabriel E,
Kerschbaum E.
et al. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial. BMC pregnancy and childbirth 2013; 13: 151.
59
Rauh K,
Kunath J,
Rosenfeld E.
et al. Healthy living in pregnancy: a cluster-randomized controlled trial to prevent excessive gestational weight gain – rationale and design of the GeliS study. BMC pregnancy and childbirth 2014; 14: 119.
60
Ravelli GP,
Stein ZA,
Susser MW.
Obesity in young men after famine exposure in utero and early infancy. The New England journal of medicine 1976; 295: 349-353.
61
Schack-Nielsen L,
Michaelsen KF,
Gamborg M.
et al. Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood. Int J Obesity (2005) 2010; 34: 67-74.
63
Suzuki K,
Ando D,
Sato M.
et al. The association between maternal smoking during pregnancy and childhood obesity persists to the age of 9–10 years. Journal of epidemiology 2009; 19: 136-142.
64
Thangaratinam S,
Rogozińska E,
Jolly K.
et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health technology assessment. 2012 16. iii-iv, 1–191.
65
van der Willik EM,
Vrijkotte TGM,
Altenburg TM.
et al. Exclusively breastfed overweight infants are at the same risk of childhood overweight as formula fed overweight infants. Archives of Disease in Childhood. 2015 doi: 10.1136/archdischild-2015– 308386.
66
Weissmann-Brenner A,
Simchen MJ,
Zilberberg E.
et al. Maternal and neonatal outcomes of macrosomic pregnancies. Medical science monitor 2012; 18: PH77-81.
68
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 Obesity (2005) 2008; 32: 495-501.
