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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2022; 16(03): 141-148
DOI: 10.1055/a-1912-0669
Review

Adipositasprävention in den ersten 1000 Tagen

Obesity Prevention in the First 1000 Days
Roxana Raab
1   Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München
,
Kristina Geyer
1   Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München
,
Hans Hauner
1   Institut für Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technische Universität München, München
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Zusammenfassung

In den ersten 1000 Tagen werden die Weichen für die langfristige Gesundheit von Mutter und Kind gestellt. Übergewicht, eine exzessive Gewichtzunahme in der Schwangerschaft sowie ein ungünstiger Lebensstil wirken sich kurz- und langfristig negativ auf die Gesundheit von Mutter und Kind aus. Die hohe Prävalenz von Übergewicht und Adipositas bei Frauen im gebärfähigen Alter sowie die steigende Zahl von Kindern und Jugendlichen mit Übergewicht oder Adipositas stellen ein wachsendes Gesundheitsproblem dar. Die Prädisposition für die spätere Gewichtsentwicklung beginnt bereits im Mutterleib. Primärpräventive Maßnahmen sind daher besonders sinnvoll. Bisherige Studien zu Lebensstilinterventionen in der Schwangerschaft zeigten moderat positive Effekte auf Gewichts- und Gesundheitsparameter der Mutter, wirkten sich jedoch nicht auf die Gewichtsentwicklung der Kinder aus. Es sind daher neue Präventionskonzepte erforderlich, die früher beginnen, risikoadaptiert sind und sich flächendeckend in die Praxis implementieren lassen. Digitale Maßnahmen wie Smartphone-Applikationen (Apps) könnten hierbei eine sinnvolle Unterstützung bieten. Die Zahl an aussagekräftigen Studien zur Erprobung App-gestützter Interventionen ist noch dürftig, erste Ergebnisse deuten jedoch auf positive Effekte hin. Die Herausforderung für die kommenden Jahre wird sein, solche Ansätze zur Unterstützung einer gesunden Lebensweise rund um die Schwangerschaft zu entwickeln, zu evaluieren und zu implementieren, um die langfristige Gesundheit von Mutter und Kind wirksamer zu schützen.

Abstract

The first 1000 days determine the long-term health of mother and child. Overweight, excessive gestational weight gain, and adverse lifestyle behaviors have a negative impact on mother and child health in the short- and long-term. The high prevalence of overweight and obesity in women of childbearing age and the increasing number of children and adolescents with overweight or obesity represent a growing health problem. The predisposition for later weight development already begins in utero. Primary preventive actions are therefore particularly advisable. Previous studies on lifestyle interventions during pregnancy showed moderate positive effects on maternal weight and health parameters, but had no effects on child weight development. Early, risk-adapted interventions that can be easily implemented in practice are needed. Digital tools, such as smartphone applications (apps), could provide useful support in this regard. The number of studies reporting data on the effectiveness of app-based lifestyle interventions is still sparse, but initial results suggest positive effects. The challenge for the coming years will be to develop, evaluate and implement suitable approaches to support a healthy lifestyle around pregnancy and thus more effectively protect the long-term health of mother and child.

Schlüsselwörter

Adipositas - Prävention - Schwangerschaft - Lebensstil

Key words

obesity - prevention - pregnancy - lifestyle


Publication History

Article published online:
11 October 2022

© 2022. Thieme. All rights reserved.

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  • Literatur

  • 1 G. B. D. Obesity Collaborators, . Afshin A, Forouzanfar MH. et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med 2017; 377: 13-27 DOI: 10.1056/NEJMoa1614362.
    CrossrefPubMedGoogle Scholar
  • 2 WHO European Regional Obesity Report 2022. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NC-SA 3.0 IGO
    PubMed
  • 3 Deutsche Adipositas Gesellschaft, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin. 2022. Folgen der Pandemie: Wie Corona das Gesundheitsverhalten von Kindern und Jugendlichen verändert hat https://t1p.de/yzwcg (Zugriff am 26.06.2022). Pressekonferenz zur Vorstellung einer repräsentativen Forsa-Umfrage unter Eltern Minderjähriger Kinder
    PubMed
  • 4 Santos S, Voerman E, Amiano P. et al. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. BJOG 2019; 126: 984-995 DOI: 10.1111/1471-0528.15661.
    CrossrefPubMedGoogle Scholar
  • 5 Heslehurst N, Vieira R, Akhter Z. et al. The association between maternal body mass index and child obesity: A systematic review and meta-analysis. PLoS Med 2019; 16: e1002817 DOI: 10.1371/journal.pmed.1002817.
    CrossrefPubMedGoogle Scholar
  • 6 Voerman E, Santos S, Patro Golab B. et al. Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: An individual participant data meta-analysis. PLoS Med 2019; 16: e1002744 DOI: 10.1371/journal.pmed.1002744.
    CrossrefPubMedGoogle Scholar
  • 7 Kunath J, Gunther J, Rauh K. et al. Effects of a lifestyle intervention during pregnancy to prevent excessive gestational weight gain in routine care – the cluster-randomised GeliS trial. BMC Med 2019; 17: 5 DOI: 10.1186/s12916-018-1235-z.
    CrossrefPubMedGoogle Scholar
  • 8 Dalrymple KV, Uwhubetine O, Flynn AC. et al. Modifiable Determinants of Postpartum Weight Loss in Women with Obesity: A Secondary Analysis of the UPBEAT Trial. Nutrients 2021; 13 DOI: 10.3390/nu13061979.
    CrossrefPubMedGoogle Scholar
  • 9 Teulings N, Masconi KL, Ozanne SE. et al. Effect of interpregnancy weight change on perinatal outcomes: systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19: 386 DOI: 10.1186/s12884-019-2566-2.
    CrossrefPubMedGoogle Scholar
  • 10 McKinley MC, Allen-Walker V, McGirr C. et al. Weight loss after pregnancy: challenges and opportunities. Nutr Res Rev 2018; 31: 225-238 DOI: 10.1017/S0954422418000070.
    CrossrefPubMedGoogle Scholar
  • 11 Fleming TP, Watkins AJ, Velazquez MA. et al. Origins of lifetime health around the time of conception: causes and consequences. The Lancet 2018; 391: 1842-1852 DOI: 10.1016/s0140-6736(18)30312-x.
    CrossrefPubMedGoogle Scholar
  • 12 Langley-Evans SC. Early life programming of health and disease: The long-term consequences of obesity in pregnancy. J Hum Nutr Diet 2022; DOI: 10.1111/jhn.13023.
    CrossrefPubMedGoogle Scholar
  • 13 Strauss A, Rochow N, Kunze M. et al. Obesity in pregnant women: a 20-year analysis of the German experience. Eur J Clin Nutr 2021; 75: 1757-1763 DOI: 10.1038/s41430-021-00981-8.
    CrossrefPubMedGoogle Scholar
  • 14 Robert Koch-Institut (RKI). 2020. AdiMon-Themenblatt: Schwangerschaft (Stand: 8. Oktober 2020) www.rki.de/adimon
    PubMed
  • 15 Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol 2009; 21: 521-526 DOI: 10.1097/GCO.0b013e328332d24e.
    CrossrefPubMedGoogle Scholar
  • 16 Goldstein RF, Abell SK, Ranasinha S. et al. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA 2017; 317: 2207-2225 DOI: 10.1001/jama.2017.3635.
    CrossrefPubMedGoogle Scholar
  • 17 LifeCycle Project-Maternal O, Childhood Outcomes Study G, Voerman E et al. Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. JAMA 2019; 321: 1702-1715 DOI: 10.1001/jama.2019.3820.
    CrossrefPubMedGoogle Scholar
  • 18 Rong K, Yu K, Han X. 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 DOI: 10.1017/S1368980014002523.
    CrossrefPubMedGoogle Scholar
  • 19 Nehring I, Schmoll S, Beyerlein A. et al. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr 2011; 94: 1225-1231 DOI: 10.3945/ajcn.111.015289.
    CrossrefPubMedGoogle Scholar
  • 20 Melchior H, Kurch-Bek D, Mund M. The Prevalence of Gestational Diabetes. Dtsch Arztebl Int 2017; 114: 412-418 DOI: 10.3238/arztebl.2017.0412.
    CrossrefPubMedGoogle Scholar
  • 21 Gunther J, Hoffmann J, Stecher L. et al. How does antenatal lifestyle affect the risk for gestational diabetes mellitus? A secondary cohort analysis from the GeliS trial. Eur J Clin Nutr 2022; 76: 150-158 DOI: 10.1038/s41430-021-00910-9.
    CrossrefPubMedGoogle Scholar
  • 22 Deutsche Diabetes Gesellschaft und Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. S3-Leitlinie Gestationsdiabetes (GDM), Diagnostik, Therapie und Nachsorge. In: AWMF Registernummer. 2018: 057-008
    Google Scholar
  • 23 Mei-Dan E, Walfisch A, Weisz B. et al. The unborn smoker: association between smoking during pregnancy and adverse perinatal outcomes. J Perinat Med 2015; 43: 553-558 DOI: 10.1515/jpm-2014-0299.
    CrossrefPubMedGoogle Scholar
  • 24 Clifford A, Lang L, Chen R. Effects of maternal cigarette smoking during pregnancy on cognitive parameters of children and young adults: a literature review. Neurotoxicol Teratol 2012; 34: 560-570 DOI: 10.1016/j.ntt.2012.09.004.
    CrossrefPubMedGoogle Scholar
  • 25 Albers L, von Kries R, Sobotzki C. et al. Differences in maternal smoking across successive pregnancies – dose-dependent relation to BMI z-score in the offspring: an individual patient data (IPD) meta-analysis. Obes Rev 2018; 19: 1248-1255 DOI: 10.1111/obr.12698.
    CrossrefPubMedGoogle Scholar
  • 26 Gomes D, Le L, Perschbacher S. et al. Predicting the earliest deviation in weight gain in the course towards manifest overweight in offspring exposed to obesity in pregnancy: a longitudinal cohort study. BMC Med 2022; 20: 156 DOI: 10.1186/s12916-022-02318-z.
    CrossrefPubMedGoogle Scholar
  • 27 Kuntz B, Zeiher J, Starker A. et al. Smoking during pregnancy. Results of the cross-sectional KiGGS Wave 2 study and trends. J Health Monit 2018; 3: 45-51 DOI: 10.17886/RKI-GBE-2018-026.
    CrossrefPubMedGoogle Scholar
  • 28 Rito AI, Buoncristiano M, Spinelli A. et al. Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative – COSI 2015/2017. Obes Facts 2019; 12: 226-243 DOI: 10.1159/000500425.
    CrossrefPubMedGoogle Scholar
  • 29 Vogelezang S, Santos S, Toemen L. et al. Associations of Fetal and Infant Weight Change With General, Visceral, and Organ Adiposity at School Age. JAMA Netw Open 2019; 2: e192843 DOI: 10.1001/jamanetworkopen.2019.2843.
    CrossrefPubMedGoogle Scholar
  • 30 Zheng M, Lamb KE, Grimes C. et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev 2018; 19: 321-332 DOI: 10.1111/obr.12632.
    CrossrefPubMedGoogle Scholar
  • 31 Hashemi-Nazari SS, Hasani J, Izadi N. et al. The effect of pre-pregnancy body mass index on breastfeeding initiation, intention and duration: A systematic review and dose-response meta-analysis. Heliyon 2020; 6: e05622 DOI: 10.1016/j.heliyon.2020.e05622.
    CrossrefPubMedGoogle Scholar
  • 32 Incollingo Rodriguez AC, Nagpal TS. The WOMBS Framework: A review and new theoretical model for investigating pregnancy-related weight stigma and its intergenerational implications. Obes Rev 2021; 22: e13322 DOI: 10.1111/obr.13322.
    CrossrefPubMedGoogle Scholar
  • 33 Yan J, Liu L, Zhu Y. et al. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health 2014; 14: 1267 DOI: 10.1186/1471-2458-14-1267.
    CrossrefPubMedGoogle Scholar
  • 34 Gingras V, Aris IM, Rifas-Shiman SL. et al. Timing of Complementary Feeding Introduction and Adiposity Throughout Childhood. Pediatrics 2019; 144 DOI: 10.1542/peds.2019-1320.
    CrossrefPubMedGoogle Scholar
  • 35 Koletzko B, Cremer M, Flothkotter M. et al. Diet and Lifestyle Before and During Pregnancy – Practical Recommendations of the Germany-wide Healthy Start – Young Family Network. Geburtshilfe Frauenheilkd 2018; 78: 1262-1282 DOI: 10.1055/a-0713-1058.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Hauner H. Stoffwechsel und Ernährung in der Schwangerschaft. Monatsschrift Kinderheilkunde 2022; 170: 116-124 DOI: 10.1007/s00112-021-01383-7.
    CrossrefPubMedGoogle Scholar
  • 37 International Weight Management in Pregnancy Collaborative G. 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 j3119 DOI: 10.1136/bmj.j3119.
    CrossrefPubMedGoogle Scholar
  • 38 Louise J, Poprzeczny AJ, Deussen AR. et al. The effects of dietary and lifestyle interventions among pregnant women with overweight or obesity on early childhood outcomes: an individual participant data meta-analysis from randomised trials. BMC Med 2021; 19: 128 DOI: 10.1186/s12916-021-01995-6.
    CrossrefPubMedGoogle Scholar
  • 39 Teede HJ, Bailey C, Moran LJ. et al. Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis. JAMA Intern Med 2022; 182: 106-114 DOI: 10.1001/jamainternmed.2021.6373.
    CrossrefPubMedGoogle Scholar
  • 40 Raab R, Michel S, Gunther J. et al. Associations between lifestyle interventions during pregnancy and childhood weight and growth: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18: 8 DOI: 10.1186/s12966-020-01075-7.
    CrossrefPubMedGoogle Scholar
  • 41 Michel S, Raab R, Drabsch T. et al. Do lifestyle interventions during pregnancy have the potential to reduce long-term postpartum weight retention? A systematic review and meta-analysis. Obes Rev 2019; 20: 527-542 DOI: 10.1111/obr.12809.
    CrossrefPubMedGoogle Scholar
  • 42 Phelan S, Clifton RG, Haire-Joshu D. et al. One-year postpartum anthropometric outcomes in mothers and children in the LIFE-Moms lifestyle intervention clinical trials. Int J Obes (Lond) 2020; 44: 57-68 DOI: 10.1038/s41366-019-0410-4.
    CrossrefPubMedGoogle Scholar
  • 43 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 Childbirth 2013; 13: 151 DOI: 10.1186/1471-2393-13-151.
    CrossrefPubMedGoogle Scholar
  • 44 Geyer K, Spies M, Gunther J. et al. Effects of a Prenatal Lifestyle Intervention in Routine Care on Maternal Health Behaviour in the First Year Postpartum-Secondary Findings of the Cluster-Randomised GeliS Trial. Nutrients 2021; 13 DOI: 10.3390/nu13041310.
    CrossrefPubMedGoogle Scholar
  • 45 Gunther J, Hoffmann J, Kunath J. et al. Effects of a Lifestyle Intervention in Routine Care on Prenatal Dietary Behavior-Findings from the Cluster-Randomized GeliS Trial. J Clin Med 2019; 8 DOI: 10.3390/jcm8070960.
    CrossrefPubMedGoogle Scholar
  • 46 Hoffmann J, Gunther J, Geyer K. et al. Effects of a lifestyle intervention in routine care on prenatal physical activity – findings from the cluster-randomised GeliS trial. BMC Pregnancy Childbirth 2019; 19: 414 DOI: 10.1186/s12884-019-2553-7.
    CrossrefPubMedGoogle Scholar
  • 47 Hoffmann J, Gunther J, Stecher L. et al. Infant growth during the first year of life following a pregnancy lifestyle intervention in routine care-Findings from the cluster-randomised GeliS trial. Pediatr Obes 2021; 16: e12705 DOI: 10.1111/ijpo.12705.
    CrossrefPubMedGoogle Scholar
  • 48 Spies M, Geyer K, Raab R. et al. Child Anthropometrics and Neurodevelopment at 2 and 3 Years of Age Following an Antenatal Lifestyle Intervention in Routine Care – A Secondary Analysis from the Cluster-Randomised GeliS Trial. J Clin Med 2022; 11 DOI: 10.3390/jcm11061688.
    CrossrefPubMedGoogle Scholar
  • 49 Krebs F, Lorenz L, Nawabi F. et al. Effectiveness of a Brief Lifestyle Intervention in the Prenatal Care Setting to Prevent Excessive Gestational Weight Gain and Improve Maternal and Infant Health Outcomes. Int J Environ Res Public Health 2022; 19 DOI: 10.3390/ijerph19105863.
    CrossrefPubMedGoogle Scholar
  • 50 Knight-Agarwal C, Davis DL, Williams L. et al. Development and Pilot Testing of the Eating4two Mobile Phone App to Monitor Gestational Weight Gain. JMIR Mhealth Uhealth 2015; 3: e44 DOI: 10.2196/mhealth.4071.
    CrossrefPubMedGoogle Scholar
  • 51 Bogaerts A, Bijlholt M, Mertens L. et al. Development and Field Evaluation of the INTER-ACT App, a Pregnancy and Interpregnancy Coaching App to Reduce Maternal Overweight and Obesity: Mixed Methods Design. JMIR Form Res 2020; 4: e16090 DOI: 10.2196/16090.
    CrossrefPubMedGoogle Scholar
  • 52 Darvall JN, Wang A, Nazeem MN. et al. A Pedometer-Guided Physical Activity Intervention for Obese Pregnant Women (the Fit MUM Study): Randomized Feasibility Study. JMIR Mhealth Uhealth 2020; 8: e15112 DOI: 10.2196/15112.
    CrossrefPubMedGoogle Scholar
  • 53 Sandborg J, Soderstrom E, Henriksson P. et al. Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial. JMIR mHealth uHealth 2021; 9: e26091 DOI: 10.2196/26091.
    CrossrefPubMedGoogle Scholar
  • 54 Roland CB, Knudsen SD, Alomairah SA. et al. Structured supervised exercise training or motivational counselling during pregnancy on physical activity level and health of mother and offspring: FitMum study protocol. BMJ Open 2021; 11: 11 DOI: 10.1136/bmjopen-2020-043671.
    CrossrefPubMedGoogle Scholar
  • 55 Li LJ, Aris IM, Han WM. et al. A Promising Food-Coaching Intervention Program to Achieve Optimal Gestational Weight Gain in Overweight and Obese Pregnant Women: Pilot Randomized Controlled Trial of a Smartphone App. JMIR Form Res 2019; 3: e13013 DOI: 10.2196/13013.
    CrossrefPubMedGoogle Scholar
  • 56 Davis D, Davey R, Williams LT. et al. Optimizing Gestational Weight Gain With the Eating4Two Smartphone App: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7: e146 DOI: 10.2196/resprot.9920.
    CrossrefPubMedGoogle Scholar
  • 57 Coughlin JW, Martin LM, Henderson J. et al. Feasibility and acceptability of a remotely-delivered behavioural health coaching intervention to limit gestational weight gain. Obes Sci Pract 2020; 6: 484-493 DOI: 10.1002/osp4.438.
    CrossrefPubMedGoogle Scholar
  • 58 O’Reilly SL, Burden C, Campoy C. et al. Bump2Baby and Me: protocol for a randomised trial of mHealth coaching for healthy gestational weight gain and improved postnatal outcomes in high-risk women and their children. Trials 2021; 22: 963 DOI: 10.1186/s13063-021-05892-4.
    CrossrefPubMedGoogle Scholar
  • 59 Bogaerts A, Ameye L, Bijlholt M. et al. INTER-ACT: prevention of pregnancy complications through an e-health driven interpregnancy lifestyle intervention – study protocol of a multicentre randomised controlled trial. BMC Pregnancy Childbirth 2017; 17: 154 DOI: 10.1186/s12884-017-1336-2.
    CrossrefPubMedGoogle Scholar
  • 60 Gonzalez-Plaza E, Bellart J, Arranz A. et al. Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10: e28886 DOI: 10.2196/28886.
    CrossrefPubMedGoogle Scholar
  • 61 Effertz T, Garlichs D, Gerlach S. et al. Wirkungsvolle Prävention chronischer Krankheiten. Prävention und Gesundheitsförderung 2014; 10: 95-100
    CrossrefPubMedGoogle Scholar
  • 62 Bundesministerium für Ernährung und Landwirtschaft. Nationale Strategie zur Stillförderung. 2021. Im Internet: https://www.bmel.de/SharedDocs/Downloads/DE/Broschueren/nationale-stillstrategie.pdf?__blob=publicationFile&v=10Stand: 26.06.2022
    PubMed