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Obesity, Diabetes and the Risk of Macrosomia
pregnancy weight gain and foetal growth restriction in obese pathways. Nevertheless, it should be noted that adequate glycaemic
women,
18,22,48,80
while increased weight gain in overweight and control in morbidly obese women may be more difficult to achieve.
91
obese women increases the risk of macrosomia. Moreover, increased
weight gain during pregnancy is a strong predictor for sustained weight Conclusion
retention, and thus contributes to the global epidemic of obesity.
81–83
Overall, it appears that maternal obesity, diabetes and, to a lesser
Accordingly, several authors have argued against current IOM degree, pregnancy weight gain are independent risk factors for foetal
recommendations for pregnancy weight gain in overweight and obese overgrowth. Despite conflicting results, maternal obesity, probably
women.
41,84
The IOM is currently re-examining these recommendations, owing to its increasing prevalence, exerts a greater impact on the
and updated recommendations are due in 2009/2010.
85,86
prevalence of macrosomia, especially when diabetes is well controlled.
Weight reduction prior to pregnancy and strict glycaemic control may
Glycaemic Control reduce the risk of macrosomia and interrupt the vicious cycle described
Numerous studies have shown that strict glycaemic control throughout above. Further studies are needed to determine the optimal weight gain
pregnancy in women with diabetes reduces the risk of macrosomia,
87
during pregnancy for obese women, as current recommendations may
although it remains unclear whether this also applies to obese diabetic contribute not only to the development of macrosomia, but also to the
women. Leikin and colleagues
88
found that non-obese GDM women with global epidemic of obesity. ■
fasting hyperglycaemia treated with diet and insulin had a frequency of
macrosomia no different than that of non-diabetic women, while diet
Nir Melamed is a Physician in the Department of
and insulin did not prevent excess macrosomia in women who were
Obstetrics and Gynaecology at the Helen Schneider
obese. However, no information regarding the degree of glycaemic Women’s Hospital, Rabin Medical Centre, Sackler
control in the obese group is provided, thus limiting the interpretation of
Faculty of Medicine, Tel Aviv University.
the results of this study. Similarly, Schaefer-Graf et al.
89
concluded that in
obese women, the high rate of foetal macrosomia does not appear be
normalised by therapy based on maternal euglycaemia. In contrast,
Langer et al.
90
found that obese and overweight GDM patients achieving
Moshe Hod is Director of the Maternal–Foetal Medicine
established levels of glucose control with insulin therapy showed no
Division of the Helen Schneider Women’s Hospital, Rabin
increased risk of macrosomia and LGA compared with normal-weight
Medical Centre, Sackler Faculty of Medicine, Tel Aviv
GDM patients. In contrast, even when diet-treated obese patients
University. He is a member of the Executive Board of the
European Association of Perinatal Medicine (EAPM) and
achieved good glycaemic control, there was no improvement in
Chairman of the Working Group on Diabetes and
pregnancy outcome compared with normal-weight patients. The
Pregnancy of the EAPM. Professor Hod is the author of
improved outcome in insulin-treated overweight and obese women may
more than 200 scientific publications.
be due to additional effects of insulin itself on other metabolic fuel
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