Gebelikte egzersiz ve beslenme

Yıl 2023, , 97 - 105, 28.12.2023

Asena Kübra Akbaba , Fırat Akça

https://doi.org/10.46969/EZH.1392225

Öz

Sedanter yaşam tarzındaki artış daha fazla kadının hamileliğe aşırı kilolu veya obez olarak girmesine yol açmakta ve birçoğu hamilelik sırasında da aşırı kilo almaktadır. 2011-2014 yılları arasında yapılan bir araştırmada doğurganlık çağındaki (20-39 yaş arası) ABD’li kadınların %34,4’ünün fazla kilolu veya obez olduğu görülmüştür. 2016 yılında doğum yapan 18 - 24 yaşları arasındaki kadınların %21’i, 25 -34 yaşları arasındaki kadınların %23’ü ve 35 - 44 yaşları arasındaki kadınların %24’ünün obez olduğu bildirilmiştir. Gebelikte aşırı kilo alımı kronik hastalık yükünü artırırken anne ve bebek sağlığını riske atmaktadır. Bu potansiyel risklerden bazıları; gestasyonel hipertansiyon, preeklampsi, gestasyonel diyabet ve erken doğumdur. 2009 IOM yönergelerine göre; düşük kilolu kadınlar için önerilen gestasyonel ağırlık kazanımı (BMI <18.5 kg/m2) 12,5-18 kg, normal kilolu kadınlar için (BMI:18,5-24,9 kg / m2) 11,5 -16 kg, fazla kilolu kadınlar için (BMI: 25,0-29,9 kg/m2) 7-11,5 kg ve obez kadınlar için (BMI >30,0 kg/m2) 5-9 kg’dır. Literatürde gebelikte aşırı kilo alımını önlemek için yalnızca beslenme, yalnızca egzersiz veya beslenme ile eş zamanlı egzersiz müdahalesi çalışmaları olduğu görülmektedir. Gebelerde yalnızca beslenme müdahalesi çalışmaları istatistiksel olarak anlamlı derecede düşük gestasyonel ağırlık kazanımı ile ilişkilendirilmiştir. Kılavuzlardaki gestasyonel ağırlık kazanımı oranlarına ulaşmaya yardımcı olma olasılığı en yüksek yöntemin beslenme olduğu bildirilmiştir (p = 0,013). Sadece egzersiz (p = 0,069) ve beslenme ve egzersiz (p = 0,056) müdahaleleri gestasyonel ağırlık kazanımını kontrol etme potansiyeline sahiptir ancak birçok çalışmada sonuçlar istatistiksel anlamlılığa ulaşamamıştır. Çalışmalardaki farklı beslenme stratejilerine rağmen müdahaleler evrensel olarak; meyve ve sebze tüketiminin artırılmasını, yüksek yağ ve şeker tüketiminin azaltılmasını önermektedir.

Anahtar Kelimeler

gebelik, egzersiz, beslenme

Exercise and nutrition in pregnancy

Öz

The increase in sedentary lifestyles means that more and more women are overweight or obese at the start of pregnancy, and many also gain excessive weight during pregnancy. A study conducted between 2011 and 2014 found that 34.4% of women in the United States of childbearing age (20-39 years) were overweight or obese. In 2016, 21% of women aged 18-24, 23% of women aged 25-34 and 24% of women aged 35-44 who gave birth were classified as obese. Excessive weight gain during pregnancy increases the burden of chronic disease and jeopardizes maternal and infant health. Some of these potential risks include gestational hypertension, preeclampsia, gestational diabetes and preterm labor. According to the 2009 International Organization for Migration (IOM) guidelines, the recommended weight gain during pregnancy is 12.5-18 kg for underweight women (body mass index (BMI) < 18.5 kg/m2), 11.5-16 kg for normal weight women (BMI: 18.5-24.9 kg/m2), 7-11.5 kg for overweight women (BMI: 25.0-29.9 kg/m2) and 5-9 kg for obese women (BMI > 30.0 kg/m2). There are studies in the literature looking at diet only, exercise only or diet and exercise to prevent excessive weight gain during pregnancy. In pregnant women, diet-only studies resulted in statistically significantly less weight gain during pregnancy. Diet was the method most likely to help achieve pregnancy weight gain guidelines (p = 0.013). Exercise alone (p = 0.069) and diet and exercise (p = 0.056) have the potential to control weight gain during pregnancy, but the results did not reach statistical significance in many studies. Despite the different dietary strategies in the individual studies, it is generally recommended to increase the consumption of fruit and vegetables and reduce the consumption of fat and sugar.

Anahtar Kelimeler

pregnancy, exercise, nutrition

Kaynakça

• Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 2003;37: 6–12
• American College of Obstetricians and Gynecologists. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol 2002;99:171–73
• Collings P.J, Farrar D, Gibson J, West J, Barber S.E, Wright J. Associations of Pregnancy Physical Activity with Maternal Cardiometabolic Health, Neonatal Delivery Outcomes and Body Composition in a Biethnic Cohort of 7305 Mother–Child Pairs: The Born in Bradford Study. Sports Med 2020; 50:615–628
• Niño Cruz G.I, Ramirez Varela A, da Silva I.C.M, Hallal P.C, Santos I.S. Physical activity during pregnancy and offspring neurodevelopment: A systematic review. Paediatr Perinat Epidemiol 2018;32: 369–379
• Lane R.H. Fetal programming, epigenetics, and adult onset disease. Clin. Perinatol 2014; 41:815–831
• Wei Y, Schatten H, Sun QY. Environmental epigenetic inheritance through gametes and implications for human reproduction. Hum Reprod Update 2015; 21:194–208
• Zheng J, Xiao X, Zhang Q, Yu M. DNA methylation: The pivotal interaction between early-life nutrition and glucose metabolism in later life. Br J Nutr 2014; 112:1850-1857
• Lillycrop K.A., Burdge G.C. Epigenetic mechanisms linking early nutrition to long term health. Best Pract Res Clin Endocrinol Metab 2012; 26:667-676.
• Godfrey KM, Reynolds RM, Prescott SL et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol 2017; 5:53–64.
• Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. Am J Prev Med 2016;50:761–779
• Bianco ME, Josefson JL. Hyperglycemia During Pregnancy and Long-Term Offspring Outcomes. Curr Diab Rep 2019;19:143.
• Smith J, Cianflone K, Biron S et al. Effects of maternal surgical weight loss in mothers on intergenerational transmission of obesity. J Clin Endocrinol Metab 2009; 94:4275-4283.
• Georgieff M.K. Nutrition and the developing brain: Nutrient priorities and measurement. Am J Clin Nutr 2007; 85:614s–620s
• Elshenawy S, Simmons R. Maternal obesity and prenatal programming. Molecular and Cellular Endocrinology 2016: 435; 2-6.
• Lemes, SF, de Souza ACP, Payolla TB, et al. Maternal Consumption of High-fat Diet in Mice Alters Hypothalamic Notch Pathway, NPY Cell Population and Food Intake in Offspring. Neuroscience 2018; 371: 1-15.
• Chang G, Gaysinskaya V, Karatayev O, Leibowitz SF. Maternal high-fat diet and fetal programming: increased proliferation of hypothalamic peptide-producing neurons that increase risk for overeating and obesity. Journal of Neuroscience 2008; 28 (46): 12107-12119.
• Ong ZY, Muhlhausler B. Maternal “junk-food” feeding of rat dams alters food choices and development of the mesolimbic reward pathway in the offspring. The FASEB Journal 2011, 25 (7): 2167-2179.
• Maslova E, Rytter D, Bech BH, Henriksen, T.B., Rasmussen, M.A., Olsen, S.F. ve ark. (2014). ‘Maternal protein intake during pregnancy and offspring overweight 20 y later’. Am J Clin Nutr, 100 (4), 1139-1148.
• Zhang, C.; Liu, S.; Solomon, C.G.; Hu, F.B. Dietary Fiber Intake, Dietary Glycemic Load, and the Risk for Gestational Diabetes Mellitus. Diabetes Care 2006, 29, 2223–2230.
• Schoenaker DA, Mishra GD, Callaway LK, Soedamah-Muthu SS. The role of energy, nutrients, foods, and dietary patterns in the development of gestational diabetes mellitus: A systematic review of observational studies. Diabetes Care 2016;39(1):16-23.
• Donazar-Ezcurra M, Lopez-del Burgo C, MartinezGonzalez MA, Basterra-Gortari FJ, de Irala J, Bes-Rastrollo M. Pre-pregnancy adherences to empirically derived dietary patterns and gestational diabetes risk in a Mediterranean cohort: The Seguimiento Universidad de Navarra (SUN) Project. British Journal of Nutrition 2017;118(9):715-21.
• Zaragoza-Martí A. Adherence to the Mediterranean Diet in Pregnancy and Its Benefits on Maternal-Fetal Health: A Systematic Review of the Literature, Front Nutr 2022 Sec. Nutritional Epidemiology Volume 9.
• Beckhaus AA, Garcia-Marcos L, Forno E, Pacheco-Gonzalez RM., Celedón JC, Castro-Rodriguez JA. Maternal nutrition during pregnancy and risk of asthma, wheeze, and atopic diseases during childhood: a systematic review and meta-analysis. Allergy 2015 ;70(12): 1588–1604.
• Wyness L. Nutrition in early life and the risk of asthma and allergic disease. British Journal of Community Nursing 2014; 19(7): S28–S32.
• Miles EA, Calder PC. Maternal diet and its influence on the development of allergic disease. Clinical & Experimental Allergy 2014; 45(1): 63–74.
• Godfrey KM, Reynolds RM, Prescott SL,et al. Influence of maternal obesity on the long-term health of offspring. Lancet Diabetes Endocrinol 2017;5:53–64
• Hack M, Youngstrom EA, Cartar L, et al. Behavioral outcomes and evidence of psychopathology among very low birth weight infants at age 20 years. Pediatrics 2004; 114:932–940
• Rodriguez A. Maternal pre-pregnancy obesity and risk for inattention and negative emotionality in children. J Child Psychol Psychiatry 2010;51:134–143
• Fall CHD. Fetal programming and the risk of noncommunicable disease. Indian J. Pediatrics. 2013;80(Suppl. 1):S13–S20.
• Daly N, Mitchell C, Farren M, Kennelly MM, Hussey J, Turner MJ. Maternal obesity and physical activity and exercise levels as pregnancy advances: an observational study. Ir J Med Sci 2016;185:357–70.
• Cambos S, Rigalleau V, Blanco L. A Medically Supervised Pregnancy Exercise Intervention in Obese Women. Obstetrics & Gynecology 2018; 131(3): 599.
• Wang C, Zhu W, Wei Y, Feng H, Su R, Yang H. Exercise intervention during pregnancy can be used to manage weight gain and improve pregnancy outcomes in women with gestational diabetes mellitus, BMC Pregnancy and Childbirth 2015;(15):255-263
• Elliott-Sale K.J, Barnett CT, Sale C. Exercise interventions for weight management during pregnancy and up to 1 year postpartum among normal weight, overweight and obese women: a systematic review and meta-analysis. British Journal of Sports Medicine 2014; 49(20): 1336–1342.
• Hawkins M, Braun B, Marcus BH, Stanek E, Markenson G, Chasan-Taber L. The impact of an exercise intervention on C-reactive protein during pregnancy: a randomized controlled trial. BMC Pregnancy and Childbirth 2015;15(1).
• Charkamyani F, Hosseinkhani A, Neisani Samani L, Khedmat L. Reducing the Adverse Maternal and Fetal Outcomes in IVF Women by Exercise Interventions During Pregnancy. Research Quarterly for Exercise and Spor 2019: 1–11.
• Craemer K, Sampene E, Safdar N, Antony K, Wautlet C. Nutrition and Exercise Strategies to Prevent Excessive Pregnancy Weight Gain: A Meta-analysis. American Journal of Perinatology Reports 2019; 09(1): e92–e120.
• Ho A, Flynn, A, Pasupathy D. Nutrition in pregnancy, Obstetrics, Gynaecology & Reproductive Medicine 2016;26(9): 259-264.
• ACSM’s resources for the personal trainer. — 3rd ed. (2010), Chapter 20 Special Populations, page:444-445.
• Craemer K, Sampene E, Safdar N, Antony K, Wautlet C. Nutrition and Exercise Strategies to Prevent Excessive Pregnancy Weight Gain: A Meta-analysis. American Journal of Perinatology Reports 2019; 09(1): e92–e120.
• Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews(2015)
• Fernández-Gómez E, Luque-Vara T, Moya-Fernández PJ, López-Olivares M, Gallardo-Vigil MÁ, Enrique-Mirón C. (2020). Factors Influencing Dietary Patterns during Pregnancy in a Culturally Diverse Society. Nutrients 2020; 12(11): 3242.