Übergewicht und Adipositas in der Geburtshilfe

Zusammenfassung

Übergewicht oder Adipositas können die Schwangerschaft in zahlreichen Aspekten beeinflussen. Über die Risikoerhöhung für Präeklampsie, Gestationsdiabetes oder Makrosomie führt Adipositas nicht nur zu einem erhöhten Aufwand bei der Schwangerschaftsbetreuung, sondern beeinflusst auch direkt deren Ausgang. Zusätzlich erhöht eine zurückliegende bariatrische Operation die Risiken für die Schwangerschaft, indem ein solcher Eingriff einen Nährstoffmangel durch Malabsorption verursachen oder bei einer internen Herniation sogar lebensgefährlich werden kann. Übergewicht und insbesondre Adipositas führen durch deren Risiken und Auswirkungen auf die Schwangerschaft zu einer häufigeren Indikation einer Geburtseinleitung und einer höheren Rate an Schnittentbindungen. Somit muss die Betreuung bei einer adipösen Schwangeren in vielen Aspekten angepasst werden und eventuell auch ein Perinatalzentrum in diese involviert werden. Zuletzt ist auch unter der Geburt eine entsprechende Expertise von großer Bedeutung, da sowohl eine Anästhesie als auch operative Maßnahmen bei ausgeprägter Adipositas herausfordernd sein können.

Abstract

Overweight and obesity can influence a pregnancy in several aspects. Obesity increases the risk for preeclampsia, gestational diabetes and fetal macrosomy, thus intensifying the needed obstetric care and influencing the outcome of the pregnancy. Additionally, a previous bariatric surgery could lead to more complications, such as nutritional deficiencies due to malabsorption, and may even be fatal in the case of internal herniation. Overweight and especially obesity increase the odds for an induction of labor and cesarean section due to their risks for the pregnancy and the birth. Thus, obstetric care in obese women must be adjusted in several ways and a tertiary obstetric care center may be involved. Lastly, obstetric care during birth should have adequate expertise, as both anesthesia and surgery may be challenging in cases of marked obesity.

Schlüsselwörter

Adipositas - Übergewicht - Schwangerschaft - Geburt

Keywords

obesity - overweight - pregnancy - obstetrics

• Literatur

• 1 Chen C, Xu X, Yan Y. Estimated global overweight and obesity burden in pregnant women based on panel data model. PLoS One 2018; 13: e0202183
• 2 Pettersen-Dahl A, Murzakanova G, Sandvik L. et al Maternal body mass index as a predictor for delivery method. Acta Obstet Gynecol Scand 2018; 97: 212-8
• 3 Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363:157–163
• 4 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V. (DGGG). S3-Leitlinie Adipositas und Schwangerschaft; 2019. https://register.awmf.org/assets/guidelines/015-081l_S3_Adipositas-Schwangerschaft_2020_06.pdf; Stand: 02.09.2024
• 5 Tan MY, Syngelaki A, Poon LC. et al. Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeksʼ gestation. Ultrasound Obstet Gynecol 2018; 52: 186-195
• 6 Rolnik DL, Wright D, Poon LC. et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med 2017; 377: 613-622
• 7 Block-Abraham DM, Turan OM, Doyle LE. et al. First-trimester risk factors for preeclampsia development in women initiating aspirin by 16 weeks of gestation. Obstet Gynecol 2014; 123: 611-617
• 8 Poon LC, Wright D, Rolnik DL. et al. Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history. Am J Obstet Gynecol 2017; 217: 585.e1-585.e5
• 9 Torloni MR, Betrán AP, Horta BL. et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009; 10: 194-203
• 10 Major CA, deVeciana M, Weeks J. et al. Recurrence of gestational diabetes: who is at risk?. Am J Obstet Gynecol 1998; 179: 1038-1042
• 11 Deutsche Diabetes Gesellschaft (DDG), Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. S3-Leitlinie Gestationsdiabetes mellitus (GDM), Diagnostik, Therapie und Nachsorge; 2018. https://register.awmf.org/assets/guidelines/057-008l_S3_Gestationsdiabetes-mellitus-GDM-Diagnostik-Therapie-Nachsorge_2019-06-abgelaufen.pdf; Stand: 02.09.2024
• 12 Langer O, Yogev Y, Xenakis EMJ. et al. Overweight and obese in gestational diabetes: the impact on pregnancy outcome. Am J Obstet Gynecol 2005; 192: 1768-1676
• 13 Sovio U, Murphy HR, Smith GCS. Accelerated Fetal Growth Prior to Diagnosis of Gestational Diabetes Mellitus: A Prospective Cohort Study of Nulliparous Women. Diabetes Care 2016; 39: 982-987
• 14 Schaefer-Graf UM, Heuer R, Kilavuz O. et al. Maternal obesity not maternal glucose values correlates best with high rates of fetal macrosomia in pregnancies complicated by gestational diabetes. J Perinat Med 2002; 30: 313-321
• 15 Stothard KJ, Tennant PWG, Bell R. et al. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301: 636-650
• 16 Becerra JE, Khoury MJ, Cordero JF. et al. Diabetes mellitus during pregnancy and the risks for specific birth defects: a population-based case-control study. Pediatrics 1990; 85: 1-9
• 17 Hötzel D. Suboptimal nutritional status in obesity (selected nutrients). Bibl Nutr Dieta 1986; 37: 36-41
• 18 Thornburg LL, Miles K, Ho M. et al. Fetal anatomic evaluation in the overweight and obese gravida. Ultrasound Obstet Gynecol 2009; 33: 670-675
• 19 Thornburg LL, Mulconry M, Post A. et al. Fetal nuchal translucency thickness evaluation in the overweight and obese gravida. Ultrasound Obstet Gynecol 2009; 33: 665-669
• 20 Ashoor G, Syngelaki A, Poon LCY. et al. Fetal fraction in maternal plasma cell-free DNA at 11-13 weeksʼ gestation: relation to maternal and fetal characteristics. Ultrasound Obstet Gynecol 2013; 41: 26-32
• 21 Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005; 294: 1909-1917
• 22 Hsu JL, Ismail S, Hodges MM. et al. Bariatric surgery: trends in utilization, complications, conversions and revisions. Surg Endosc 2024; 38: 4613-4623
• 23 Shawe J, Ceulemans D, Akhter Z. et al. Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care. Obes Rev 2019; 20: 1507-1522
• 24 Vannevel V, Jans G, Bialecka M. et al. Internal Herniation in Pregnancy After Gastric Bypass: A Systematic Review. Obstet Gynecol 2016; 127: 1013-1020
• 25 Dave DM, Clarke KO, Manicone JA. et al. Internal hernias in pregnant females with Roux-en-Y gastric bypass: a systematic review. Surg Obes Relat Dis 2019; 15: 1633-1640
• 26 Johansson K, Wikström A-K, Söderling J. et al. Risk of pre-eclampsia after gastric bypass: a matched cohort study. BJOG 2022; 129: 461-471
• 27 Sebire NJ, Jolly M, Harris JP. et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25: 1175-1182
• 28 Crane SS, Wojtowycz MA, Dye TD. et al. Association between pre-pregnancy obesity and the risk of cesarean delivery. Obstet Gynecol 1997; 89: 213-216
• 29 Chu SY, Kim SY, Schmid CH. et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007; 8: 385-394
• 30 Kominiarek MA, Vanveldhuisen P, Hibbard J. et al. The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol 2010; 203: 264.e1-7
• 31 Brost BC, Goldenberg RL, Mercer BM. et al. The Preterm Prediction Study: association of cesarean delivery with increases in maternal weight and body mass index. Am J Obstet Gynecol 1997; 177: 333-337 discussion 337-41
• 32 Jennewein L, Agel L, Hoock SC. et al. Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT cohort study. Arch Gynecol Obstet 2024; 310: 285-292
• 33 Juhasz G, Gyamfi C, Gyamfi P. et al. Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery. Obstet Gynecol 2005; 106: 741-716
• 34 Kumari AS. Pregnancy outcome in women with morbid obesity. Int J Gynaecol Obstet 2001; 73: 101-107
• 35 O'Dwyer V, O'Kelly S, Monaghan B. et al. Maternal obesity and induction of labor. Acta Obstet Gynecol Scand 2013; 92: 1414-1418
• 36 Nohr EA, Bech BH, Davies MJ. et al. Prepregnancy obesity and fetal death: a study within the Danish National Birth Cohort. Obstet Gynecol 2005; 106: 250-259
• 37 Ellis JA, Brown CM, Barger B. et al. Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta-Analysis. J Midwifery Womens Health 2019; 64: 55-67
• 38 Maughan BC, Marin M, Han J. et al. Venous Thromboembolism During Pregnancy and the Postpartum Period: Risk Factors, Diagnostic Testing, and Treatment. Obstet Gynecol Surv 2022; 77: 433-444
• 39 Kvalvik SA, Rasmussen S, Thornhill HF. et al. Risk factors for surgical site infection following cesarean delivery: A hospital-based case-control study. Acta Obstet Gynecol Scand 2021; 100: 2167-2175
• 40 Hamm RF, Teefey CP, Dolin CD. et al. Risk of Cesarean Delivery for Women with Obesity Using a Standardized Labor Induction Protocol. Am J Perinatol 2021; 38: 1453-1458