Pandemic of Pregnant Obese Women: Is It Time to Re-Evaluate Antenatal Weight Loss?
Abstract
:1. A Rising Pregnancy Health Problem
Classification | Principal Cut-off Points |
---|---|
Underweight | BMI < 18.5 kg/m2 |
Normal | BMI 18.5–24.99 kg/m2 |
Overweight/pre-obese | BMI 25–29.99 kg/m2 |
Obese class 1 | BMI 30–34.99 kg/m2 |
Obese class 2 | BMI 35–39.99 kg/m2 |
Obese class 3 | BMI ≥ 40 kg/m2 |
2. Objective
2.1. What History Tells Us: Recent Systematic Reviews and Meta-Analyses
2.2. Non-Randomized Controlled Trials
2.3. Metabolism during Pregnancy Compounded by Obesity
Enzyme/Hormone | Function | Changes Associated with Obesity |
---|---|---|
Aromatase | Converts androgens to estrogens | No change with obesity, but increased fat mass results in greater total conversion |
17-β-hydroxysteroid hydrogenase | Converts estrone to estradiol and androstendione to testosterone | No change |
5-α-reductase | Inactivates cortisol | No change |
11-β-hydroxysteroid dehydrogenase type 1 | Converts cortisone to cortisol | Activity is increased in obese women |
Leptin | Affects food intake, timing of puberty, bone development, and immune function | Circulating leptin levels are increased in obese women |
Tumor necrosis α factor (TNFα) | Represses genes involved in the uptake and storage of nonesterfied fatty acids and glucose | Expression of TNFα is increased in the adipose tissue of obese women |
Adiponectin | Enhances insulin action | Circulating levels of adiponectin are decreased in obese women |
3. Weight Loss during Pregnancy
3.1. The Dutch Famine
Time Period | Calories | Protein | Carbohydrate | Fat |
---|---|---|---|---|
September 1944 | 1924 (64%) | 61 (73%) | 295 (68%) | 50 (42%) |
February 1945 | 836 (28%) | 35 (42%) | 136 (31%) | 16 (14%) |
April 1945 | 862 (29%) | 35 (41%) | 144 (33%) | 14 (14%) |
Pregnancy Reference§ | 3000 | 84 | 432 | 102 |
3.2. Fasting
3.3. Hyperemesis Gravidarum
3.4. Eating Disorders in Pregnancy
4. Weight Loss Diets for Obese Pregnant Women and Gestational Diabetes
Author | Sample | Dietary Treatment | Outcome(s) |
---|---|---|---|
Obese Pregnancy | |||
Badrawi 1993 [89] | 100 obese multiparous Egyptian women age 25–35 years. | Treatment: balanced low-energy (1500–2000 kcal/day) diet. Control: normal diet according to WHO energy recommendations (2300–3000 kcal/day). | Gestational weight gain, Birth weight, and PIH |
Campbell 1975 [87] | 153 primiparous Scottish women with high gestational weight gain (>1.25 lb. or 570 g per week) between 20 and 30 weeks. | Intervention: low-energy (1200 kcal/day), low-carbohydrate diet beginning at 30 weeks. Control: no intervention. | Gestational weight gain, PIH, and pre-eclampsia |
Campbell 1983 [88] | 182 obese (>75th centile weight-for-height) Scottish primiparous women with normal IVGTT | Intervention: low-energy (1250 kcal/day) diet. Control: no intervention. | Gestational weight gain, birth weight, birth length at 28 weeks gestational age, preterm birth, pre-eclampsia. |
Gestational Diabetes (GDM) | |||
Knopp 1991 [90] | 12 overweight GDM | 1200 kcal (50% restriction) vs. 2400 kcal 150 g (50%) vs. 300 g CHO/d (50%) | 1200 kcal improved (randomized) glucose; elevated ketones |
Knopp 1991 [91] | 6 overweight GDM (randomized) | 1600–1800 (30%–33% restriction) vs. 2500 kcal plus prophylactic insulin; 200 g (50%) vs. 300 g CHO/d (50%) | 1600–1800 kcal restriction improved glucose and trig with no marked ketonuria |
Algert 1985 [94] | 22 obese (non-randomized) | 1700–1800 kcal; 212–225 g CHO/d (50%–60%) | Lower weight gain, higher; mean birth weight, no ketonuria |
Magee 1990 [92] | 12 obese (randomized) | 1200 kcal (50% restriction) vs. 2400 kcal (usual intake); 150 g (50%) vs. 300 g CHO/d) (50%) | 1.200 kcal lowered mean glucose, no change in fasting plasma glucose, Increased ketonemia |
Rae 2000 [93] | 66 intervention vs. control with insulin (randomized) | 1590–1776 kcal (30% restriction) vs. 2010–2220 kcal; 210–244 g (51%) vs. 240–274 g CHO/d (46%) | No difference in frequency of insulin use; lower kcal had lower dose; no increase in ketones |
5. Beyond Necessary Research
6. Conclusions
Conflicts of Interest
References
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Davis, A.M. Pandemic of Pregnant Obese Women: Is It Time to Re-Evaluate Antenatal Weight Loss? Healthcare 2015, 3, 733-749. https://doi.org/10.3390/healthcare3030733
Davis AM. Pandemic of Pregnant Obese Women: Is It Time to Re-Evaluate Antenatal Weight Loss? Healthcare. 2015; 3(3):733-749. https://doi.org/10.3390/healthcare3030733
Chicago/Turabian StyleDavis, Anne M. 2015. "Pandemic of Pregnant Obese Women: Is It Time to Re-Evaluate Antenatal Weight Loss?" Healthcare 3, no. 3: 733-749. https://doi.org/10.3390/healthcare3030733