Department

Letter to the Editor

A Call for Intervention in Pregnancy to Prevent Maternal and Child Obesity

Des recommandations de prise de poids gestationnelle idéale ont été proposées en 2009 pour l’institute of Medecine En cas d’IMC > 30 kg/m², la prise de poids recommandée doit se situer entre 5 et 9 kg. Cependant, ces recommandations ne distinguent pas les différents grades d’obésité. Des données récentes suggèrent que les recommandations de l’IOM ne sont pas assez restrictives pour les femmes enceintes obèses et qu’elles doivent être adaptées au grade de l’obésité.

Guidelines for adequate gestational weight gain were proposed in 2009 by the Institute of Medicine. In case of a BMI > 30 kg/m², the recommended gestational weight gain should be between 5 and 9 kg. However, these recommendations do not distinguish between different grades of obesity. Recent data suggest that the IOM recommendations are not restrictive enough for obese pregnant women and should be adapted to the grade of obesity.

The Institute of Medicine (IOM) recommended a gestational weight gain for full-term twin pregnancies of 17–25 kg for normal Body mass Index patients’, and characterize its guidelines on during twin pregnancies as “provisional”. Indeed, they are exclusively based on observational epidemiological data.

The objective of this study was to investigate whether the IOM’s gestational weight gain guidelines are optimal for maternal and neonatal.

We included all consecutive twin pregnancies delivering two live births retrospectively. Monoamniotic pregnancies, major congenital abnormalities, twin-to-twin transfusion syndrome, patients with missing gestational weight gain data in the last month before delivery, and patients with a body mass index (BMI) ≤18.5 were excluded. To control for gestational length, we divided the total weight gain by the gestational age in weeks at the last weight measurement to obtain the weight gain per week. Patients were classified as having low gestational weight gain, adequate gestational weight gain, or excessive gestational weight gain, with the results adjusted for BMI and tobacco use.

There were 878 patients in our level-III university hospital maternity ward who met the inclusion criteria in 1997–2013. Excessive gestational weight gain women had greater rates of preeclampsia than adequate gestational weight gain women did. Low gestational weight gain women showed a lower rate of gestational hypertension than AGWG women did. Delivery before 37 weeks of gestation (26.9% vs. 17.3%, p = 0.009), birth weight <2500 g, respiratory distress syndrome, and transfer to the neonatal intensive care unit were more frequent in the LGWG group compared with the AGWG group. Apgar score <7 at 5 min were more frequent in the EGWG group.

Adequate gestational weight gain was associated with better outcomes. Our results suggest that the IOM guidelines for twin pregnancy are appropriate and therefore should be routinely used.

Évaluer la pertinence des recommandations de prise de poids (PDP) pour les grossesses gémellaires publiées en 2009 par l’Institute of Medicine (IOM).

Recherche bibliographique à partir de la base de données Medline et Cochrane database Library. Les articles sélectionnés devaient comparer les devenirs obstétricaux et néonataux des grossesses gémellaires selon la prise de poids en fonction de l’indice de masse corporel définie par les nouvelles recommandations de l’IOM en 2009. Cinq critères cliniques ont été principalement étudiés : complications hypertensives de la grossesse (hypertension artérielle gravidique et prééclampsie), diabète gestationnel, prématurité et poids de naissance.

Nous avons identifié 8 articles concernés. Les études disponibles souffrent de faiblesses méthodologiques (effectifs limités, schéma rétrospectif et difficultés de relevés des PDP). Une prise de poids excessive était associée à une augmentation des complications hypertensives de la grossesse. Les résultats étaient discordants pour le diabète gestationnel (DG), suggérant une faible association entre la survenue du DG et la PDP. La prématurité et un faible poids de naissance étaient plus fréquents en cas de PDP insuffisante.

Bien que reposant sur de faibles preuves scientifiques, les recommandations IOM de 2009 pour la PDP pour les grossesses gémellaires peuvent être utilisées pour conseiller les patientes.

Our objective was to evaluate the relevance of the Institute of medicine (IOM) guidelines of weight gain during twin pregnancies, published in 2009.

We systematically reviewed the data from Medline and the Cochrane Library databases. We only selected the articles which studied the neonatal and maternal outcomes according to maternal gestational weight gain (GWG), depending on the prepregnancy BMI (body mass index). Five clinical parameters had been mainly studied: gestational hypertensive disorders (gestational hypertension and preeclampsia), gestational diabetes mellitus (GDM), preterm births, and birth weights.

We identified 8 articles, corresponding to our inclusion criteria. They all present methodological weaknesses (observational retrospective design, small population samples and there were sometimes issues to properly determine the GWG). An excessive weight gain was associated with an increasing of gestational hypertensive disorders. Regarding GDM, the results were inconsistent, suggesting a poor correlation between GWG and occurrence of GDM. Preterm births and low birth weights were more frequent when the GWG did not reach the recommendations.

Although based on low scientific evidence, the IOM recommendations for GWG in twin pregnancies should be used in daily practice.

Excessive gestational weight gain has been shown to relate to high-postpartum weight retention and the development of overweight and obesity later in life. Because many women are concerned about the health of their babies during pregnancy and are in frequent contact with their healthcare providers, pregnancy may be an especially powerful “teachable moment” for the promotion of healthy eating and physical activity behaviors among women. Initial research suggests that helping women gain the recommended amount during pregnancy through healthy eating and physical activity could make a major contribution to the prevention of postpartum weight retention. However, more randomized controlled trials with larger sample sizes are needed to identify the most effective and disseminable intervention. Providers have the potential to prevent high postpartum weight retention and future obesity by monitoring weight gain during pregnancy and giving appropriate advice about recommended amounts of gestational weight gain.