Gebelik öncesi BKİ'ye göre diyet makro besin bileşimi ve perinatal sonuçlar: prospektif bir kohort çalışması

Year 2025, Volume: 8 Issue: 5, 770 - 774, 16.09.2025

Ayşe Çiğdem Bayrak , Recep Taha Ağaoğlu

https://doi.org/10.32322/jhsm.1707830

Abstract

Amaç: Bu çalışmanın amacı, normal kilolu ve obez gebelerde günlük diyetle alınan protein miktarı ve kaynağını karşılaştırmak, beslenme ve fiziksel aktivite alışkanlıklarını değerlendirmek ve bu farklılıkların perinatal sonuçlar üzerindeki etkilerini incelemektir.
Yöntem: Bu prospektif kohort çalışmaya, gebeliğin 24–28. haftasında oral glukoz tolerans testi (OGTT) yapılan toplam 120 gebe dahil edilmiş ve katılımcılar, gebelik öncesi vücut kitle indeksine (VKİ) göre iki gruba ayrılmıştır: normal kilolu (VKİ: 18–24,9 kg/m²) ve obez (VKİ: 30–39,9 kg/m²). OGTT sonuçlarına göre bozulmuş glukoz toleransı veya gestasyonel diyabet saptanan olgular ile metabolik hastalığı bulunanlar çalışmaya alınmamıştır. Katılımcıların günlük besin tüketimleri 72 saatlik kayıt yöntemiyle, fiziksel aktiviteleri ise standart anket aracılığıyla değerlendirilmiştir. Perinatal sonuçları karşılaştırmak amacıyla doğum haftası, doğum ağırlığı, 1. ve 5. dakika Apgar skorları ile yenidoğan yoğun bakım ünitesi (YYBÜ) ihtiyacı kaydedilmiştir.
Bulgular: Her grupta 60’ar katılımcı olmak üzere toplam 120 gebe çalışmaya dahil edilmiştir. Günlük ortalama enerji alımı obez grupta daha yüksek bulunmuş (2004,6 kcal vs. 2117,1 kcal) ve enerji gereksiniminin daha büyük bir kısmının karbonhidratlardan sağlandığı belirlenmiştir (%44,6 vs. %51,7; p=0,026). Obez grupta, gebelik süresince kilo artışı her üç trimesterde de normal kilolu gruba göre daha yüksek bulunmuştur. Her iki grupta da gebelik ilerledikçe fiziksel aktivite düzeyinde azalma gözlenmiş, ancak gruplar arasında anlamlı fark saptanmamıştır. Doğum haftası, doğum ağırlığı ve Apgar skorları açısından gruplar arasında anlamlı fark saptanmamış; ancak YYBÜ ihtiyacı normal kilolu grupta 2 olguda, obez grupta ise 9 olguda gelişmiştir (p=0,046).
Sonuç: Obez gebelerde enerji alımının karbonhidrat ağırlıklı olması ve gebelik süresince artan kilo alımı, olası metabolik risklerin habercisi olabilir. Beslenme danışmanlığında makro besin dağılımının dengelenmesi ve kilo artışının gebeliğin erken döneminden itibaren yakından izlenmesi, hem maternal hem de neonatal sağlık açısından önem arz etmektedir. Bulguların doğrulanması için daha geniş örneklemli prospektif çalışmalara ihtiyaç duyulmaktadır.

Keywords

Diyet proteinleri , maternal obezite , kilo alımı

Dietary macronutrient composition and perinatal outcomes according to pre-pregnancy BMI

Abstract

Aims: Dietary habits and nutritional balance during pregnancy have been linked to maternal and neonatal well-being. This study aimed to compare the quantity and distribution of dietary macronutrient intake among pregnant women with varying pre-pregnancy body mass index (BMI) categories, to evaluate their nutritional habits, and to explore the potential impact of these factors on perinatal outcomes.
Methods: This prospective study included 120 pregnant women between 24-28 weeks of gestation who underwent an oral glucose tolerance test. Participants were divided into two groups based on pre-pregnancy BMI: those with a BMI between 18.5 and 24.9 kg/m2, classified as having normal weight, and those with a BMI between 30 and 39.9 kg/m2, classified as having obesity. Women diagnosed with gestational diabetes, impaired glucose tolerance, or pre-existing metabolic disorders were excluded. Daily dietary intake was assessed using 72-hour food diaries, which included detailed information on the timing and content of six daily meals (three main and three snacks), the types and amounts of foods and beverages consumed, preparation methods, and the location of each meal. Perinatal outcomes, including gestational age at delivery, birth weight, Apgar scores, and neonatal intensive care unit (NICU) admission, were recorded and compared between groups.
Results: Sixty participants were included in each group. The mean daily energy intake was higher among women with obesity (2117.1 kcal vs. 2004.6 kcal), with a significantly greater proportion of energy derived from carbohydrates (51.7% vs. 44.6%; p=0.026). Weight gain during pregnancy was significantly higher in women with obesity across all trimesters. Based on participants’ self-reports, physical activity levels decreased with advancing gestation in both groups, though the difference between groups was not statistically significant. No significant differences were observed in gestational age at delivery, birth weight, or Apgar scores. However, NICU admission was more frequent among women with obesity (9 cases vs. 2 cases; p=0.046).
Conclusion: Pregnant women with higher pre-pregnancy BMI demonstrated greater carbohydrate intake and increased weight gain throughout pregnancy, potentially indicating elevated metabolic risk. Balanced macronutrient intake and early monitoring of gestational weight gain may be essential components of antenatal care. Larger prospective studies are needed to validate these findings and support tailored nutritional interventions in this population.

Keywords

Dietary proteins , maternal obesity , weight gain

References

• Villalobos JA. Obesity: the real pandemic of the 21st century. Cir Cir (Engl Ed). 2016;84(5):351-355. doi:10.1016/j.circen.2016.08.013
• World Health Organization. Obesity and overweight. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed May 25, 2025.
• An R, Guan C, Liu J, Chen N, Clarke C. Trade openness and the obesity epidemic: a cross-national study of 175 countries during 1975-2016. Ann Epidemiol. 2019;37:31-36. doi:10.1016/j.annepidem.2019.07.002
• Reed J, Case S, Rijhsinghani A. Maternal obesity: perinatal implications. SAGE Open Med. 2023;11:20503121231176128. doi:10.1177/205031212311 76128
• Mohammadi M, Maroufizadeh S, Omani-Samani R, Almasi-Hashiani A, Amini P. The effect of prepregnancy body-mass index on birth weight, preterm birth, cesarean section, and preeclampsia. J Matern Fetal Neonatal Med. 2019;32(22):3818-3823. doi:10.1080/14767058.2018. 1473366
• Howell KR, Powell TL. Effects of maternal obesity on placental function and fetal development. Reproduction. 2016;153(3):R97-R106. doi:10. 1530/REP-16-0495
• Schmatz M, Madan J, Marino T, Davis J. Maternal obesity: the interplay between inflammation, mother and fetus. J Perinatol. 2010;30(7):441-446. doi:10.1038/jp.2009.182
• Vaughan OR, Rosario FJ, Powell TL, Jansson T. Regulation of placental amino acid transport and fetal growth. Prog Mol Biol Transl Sci. 2017; 145:217-251. doi:10.1016/bs.pmbts.2016.12.008
• Kelly AC, Powell TL, Jansson T. Placental function in maternal obesity. Clin Sci (Lond). 2020;134(8):961-984. doi:10.1042/CS20190266
• Herring CM, Bazer FW, Johnson GA, Wu G. Impacts of maternal dietary protein intake on fetal survival, growth, and development. Exp Biol Med (Maywood). 2018;243(6):525-533. doi:10.1177/1535370218758275
• Godfrey KM, Barker DJ. Fetal programming and adult health. Public Health Nutr. 2001;4(2B):611-624. doi:10.1079/phn2001145
• Jahan-Mihan A, Rodriguez J, Christie C, Sadeghi M, Zerbe T. The role of maternal dietary proteins in development of metabolic syndrome in offspring. Nutrients. 2015;7(11):9185-9217. doi:10.3390/nu7115460
• Most J, Dervis S, Haman F, Adamo KB, Redman LM. Energy intake requirements in pregnancy. Nutrients. 2019;11(8):1812. doi:10.3390/nu 11081812
• Barker DJ, Thornburg KL. The obstetric origins of health for a lifetime. Clin Obstet Gynecol. 2013;56(3):511-519. doi:10.1097/GRF.0b013e31829 cb9ca
• Lapehn S, Paquette AG. The placental epigenome as a molecular link between prenatal exposures and fetal health outcomes. Curr Environ Health Rep. 2022;9(3):490-501. doi:10.1007/s40572-022-00354-8
• Leddy MA, Power ML, Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol. 2008;1(4):170-175.
• Gilmore LA, Klempel-Donchenko M, Redman LM. Pregnancy as a window to future health: excessive gestational weight gain and obesity. Semin Perinatol. 2015;39(4):296-303. doi:10.1053/j.semperi.2015.05.009
• Chen TL, Wu CH, Gau ML, Cheng SF. Prediction of the ideal gestational weight gain for reducing the risk of macrosomia/large for gestational age in women with gestational diabetes mellitus. Midwifery. 2025;140:104211. doi:10.1016/j.midw.2024.104211
• Zhu Y, Zheng Q, Pan Y, et al. Association between prepregnancy BMI or gestational weight gain and pregnancy outcomes in Chinese women with gestational diabetes: a systematic review. BMJ Open. 2024;14(2): e075226. doi:10.1136/bmjopen-2023-075226
• Minschart C, Lammertyn A, Van Crombrugge P, et al. Low gestational weight gain in women with gestational diabetes is safe with better metabolic profile postpartum. J Clin Endocrinol Metab. 2023;108(3):665-679. doi:10.1210/clinem/dgac599
• Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes. Pediatrics. 2005;115(3):e290–e296. doi:10.1542/peds.2004-1808
• Yaktine AL, Rasmussen KM, eds. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: National Academies Press; 2010.
• Kominiarek MA, Saade G, Mele L, et al. Association between gestational weight gain and perinatal outcomes. Obstet Gynecol. 2018;132(4):875-881. doi:10.1097/AOG.0000000000002854
• Borodulin KM, Evenson KR, Wen F, Herring AH, Benson AM. Physical activity patterns during pregnancy. Med Sci Sports Exerc. 2008;40(11): 1901-1908. doi:10.1249/MSS.0b013e31817f1957