Læknablaðið - 15.11.2010, Blaðsíða 32

F R Æ Ð I G R E I
Y F I R L I T
N A R
16. Crane SS, Wojtowycz MA, Dye TD, Aubry RH, Artal R.
Association between pre-pregnancy obesity and the risk of
cesarean delivery. Obstet Gynecol 1997; 89: 213-6.
17. Uvena-Celebrezze J, Catalano PM. The infant of the woman
with gestational diabetes mellitus. Clin Obstet Gynecol
2000; 43:127-39.
18. Yang X, Zhang H, Dong L, Yu S, Guo Z, Hsu-Hage
BH. The effect of glucose levels on fetal birth weight: a
study of Chinese gravidas in Tianjin, China. J Diabetes
Complications 2004; 18: 37-41.
19. Landon MB, Catalano pM, Gabbe SG. Diabetes Mellitus
Complicating Pregnancy. In: Gabbe SG, editor. Gabbe:
Obstetrics: Normal and Problem Pregnancies, 5th ed:
Churchill Livingstone, New York 2007.
20. Berard J, Dufour P, Vinatier D, et al. Fetal macrosomia: risk
factors and outcome. A study of the outcome conceming
100 cases >4500 g. Eur J Obstet Gynecol Reprod Biol 1998;
77: 51-9.
21. Stotland NE, Caughey AB, Breed EM, Escobar GJ.
Risk factors and obstetric complications associated with
macrosomia. Int J Gynaecol Obstet 2004; 87: 220-6.
22. Whitaker RC. Predicting preschooler obesity at birth: the
role of matemal obesity in early pregnancy. Pediatrics 2004;
114: e29-36.
23. Murtaugh MA, Jacobs DR, Jr., Moran A, Steinberger J,
Sinaiko AR. Relation of birth weight to fasting insulin,
insulin resistance, and body size in adolescence. Diabetes
Care 2003; 26:187-92.
24. Robinson H, Tkatch S, Mayes DC, Bott N, Okun N. Is
maternal obesity a predictor of shoulder dystocia? Obstet
Gynecol 2003; 101: 24-7.
25. Kaiser PS, Kirby RS. Obesity as a risk factor for cesarean in
a low-risk population. Obstet Gynecol 2001; 97: 39-43.
26. Ehrenberg HM, Dumwald CP, Catalano P, Mercer BM. The
influence of obesity and diabetes on the risk of cesarean
delivery. Am J Obstet Gynecol 2004; 191: 969-74.
27. Roberts J. Pregnancy-Related Hypertension. 5th ed:
Saunders; 2004.
28. Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia
and associated risk factors with macrosomic infants bom in
Califomia. Am J Obstet Gynecol 1998; 179: 476-80.
29. Maresh M, Beard RW, Bray CS, Elkeles RS, Wadsworth
J. Factors predisposing to and outcome of gestational
diabetes. Obstet Gynecol 1989; 74:342-6.
30. Metwally M, Ong KJ, Ledger WL, Li TC. Does high
body mass index increase the risk of miscarriage after
spontaneous and assisted conception? A meta-analysis of
the evidence. Fertil Steril 2008; 90: 714-26.
31. Gifford RWJ, August PAMD, Cunningham GMD, et al.
Working group report on high blood pressure in pregnancy:
National Institute of Health 2000,2008.
32. WHO. Definition and diagnosis of diabetes mellitus and
intermediate hyperglycemia: World Health Organization
2006.
33. Femando R, Sultan AH, Kettle C, Thakar R, Radley S.
Methods of repair for obstetric anal sphincter injury.
Cochrane Database Syst Rev 2006; 3: CD002866.
34. Mogren IM, Pohjanen AI. Low back pain and pelvic pain
during pregnancy: prevalence and risk factors. Spine 2005;
30: 983-91.
35. Medicine Io. Food and Nutrition Board Committee on
Nutritional Status During Pregnancy, part I: Nutritional
Status and Weight Gain 2000.
36. íslenska fæðingarskráin. 2009.
37. Harðardóttir H, Jóhannesson A, Guðmundsdóttir A,
Hreiðarsson A, Geirsson R. Klínískar leiðbeiningar um
meðgöngusykursýki. 2008.
38. Harder T, Rodekamp E, Schellong K, Dudenhausen JW,
Plagemann A. Birth weight and subsequent risk of type 2
diabetes: a meta-analysis. Am J Epidemiol 2007; 165:849-57.
39. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic
syndrome in childhood: association with birth weight,
matemal obesity, and gestational diabetes mellitus.
Pediatrics 2005; 115: e290-6.
40. Sin DD, Spier S, Svenson LW, et al. The relationship between
birth weight and childhood asthma: a population-based
cohort study. Arch Pediatr Adolesc Med 2004; 158: 60-4.
41. Kolderup LB, Laros RK Jr, Musci TJ. Incidence of persistent
birth injury in macrosomic infants: association with mode of
delivery. Am J Obstet Gynecol 1997; 177: 37-41.
42. Ahlgren M, Sorensen T, Wohlfahrt J, Haflidadottir A, Holst
C, Melbye M. Birth weight and risk of breast cancer in a
cohort of 106,504 women. Int J Cancer 2003; 107: 997-1000.
43. Landlæknir. Meðgönguvemd heilbrigðra kvenna í eðlilegri
meðgöngu. Klínískar leiðbeiningar. www.landlaeknir.is/
lisalib/getfile.aspx?itemid=4407. 2008.
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The effect of maternal weight on pregnancy outcome
Objective: To examine the frequency of adverse outcome
during pregnanoy and delivery and neonatal complications
among normal weight, overweight and obese women at the
beginning of pregnancy.
Material and methods: The study is a retrospective cohort
study of 600 women, divided in 3 groups on the basis
of maternal body mass index (BMI) at the beginning of
pregnancy; 300 normal weight women (BM119.0-24.9), 150
overweight women (BMI 25.0-29.9) and 150 obese women
(BMI&30). Maternal and neonatal complications were
compared between groups.
Results: Obese women have a significantly increased risk
of; essential hypertension prior to pregnancy (p<0.001),
developing gestational hypertension (p=0.03), pre-
eclampsia (p=0.007), gestational diabetes (p<0.001),
musculoskeletal symptoms (p=0.04), requiring induction of
labour (p=0.006) and being delivered by cesarean section
(p<0.001), both emergent (p=0.012) and elective (p=0.008)
compared to mothers of normal weight and overweight.
Neonates of obese mothers have significantly higher birth
weight (p=0.004), larger head circumference (p<0.001)
and are more likely to require admission to neonatal ward
compared with neonates of normal weight and overweight
mothers (p=0.004).
Conclusions: Obesity carries a significant risk to
maternal and neonatal health. During pregnancy maternal
complications are increased causing adverse effects for
both mother and infant. Women of reproductive age need
counselling regarding the adverse effects of obesity on
pregnancy outcome.
Eliasdottir OJ, Hardardottir H, Thorkelsson Th.
The effect of maternal weight on pregnancy outcome. Icel Med J 2010; 96: 691-6
Key words: pregnancy, delivery, overweight, obesity, neonate.
Correspondence: Hildur Harðardóttir, hhard@iandspitaii.is
696 LÆKNAblaðið 2010/96
Barst: 12. mars 2010, - samþykkt til birtingar: 14. september 2010
Hagsmunatengsl: Engin