Читать книгу Gestational Diabetes - Группа авторов - Страница 46

Maternal obesity is associated with a broad spectrum of adverse pregnancy outcomes, especially excessive fetal growth and adiposity and to hypertensive complications. Obesity may underlie GDM but the 2 conditions may also exist independently. Nonetheless, the development of common preventative and therapeutic strategies seems an attractive prospect.

Interventions commenced during pregnancy, especially after the first trimester, appear to have limited efficacy in preventing the complications of obesity. This aligns with the observation that, in obese women (in contrast to women of normal weight), prepregnancy weight is more closely associated with neonatal adiposity than weight gain during pregnancy [75]. Thus, preventative and therapeutic measures may need to be initiated preconception or in very early pregnancy to reap positive benefits. Current “medicalized” approaches involving diet, exercise, and medications appear simplistic in the face of the complex clinical and societal context of obesity, and new strategies are clearly required.

Future research should concentrate on the delineation of the pathogenesis of obesity through basic and clinical studies, the development of effective-population level and individual strategies before during and after pregnancy, and the promotion of overall women’s health issues on a life course basis.