Die Schwangere über 25 (BMI) – Herausforderung in der antenatalen und peripartalen Überwachung

D. R. Hartge; A. Dawson; M. K. Bohlmann; K. Diedrich; J. Weichert

doi:10.1055/s-0030-1249948

Geburtshilfe und Frauenheilkunde, Table of Contents

Geburtshilfe Frauenheilkd 2010; 70(6): 463-471
DOI: 10.1055/s-0030-1249948

Originalarbeit

Die Schwangere über 25 (BMI) – Herausforderung in der antenatalen und peripartalen Überwachung

Gravidas with a BMI above 25: Challenges in Antenatal and Peripartal MonitoringD. R. Hartge¹ , A. Dawson¹ , M. K. Bohlmann¹ , K. Diedrich¹ , J. Weichert¹

¹Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck

Abstract

Zusammenfassung

Die weltweite Zunahme von Übergewicht und Adipositas sowohl in den westlichen Industrienationen als auch in den Entwicklungsländern ist unumstritten. Der Trend dieses von der WHO als globale Epidemie eingestuften Phänomens zeigt sich bereits bei jungen Erwachsenen und insbesondere auch bei Frauen im fertilen Alter. Den neuesten Daten der Centers of Disease Control and Prevention (CDC) zufolge wird die Prävalenz der Adipositas bei Frauen mit 30,2 % und die der übergewichtigen Frauen mit 56,7 % angegeben. In Deutschland sind nach Angaben des Statistischen Bundesamts 42 % der Frauen übergewichtig und davon 13 % sogar (stark) adipös [1]. Maternales Übergewicht ist mit einer Reihe von relevanten Risiken für die Schwangere und den Fetus vergesellschaftet und stellt für den Geburtshelfer eine besondere Herausforderung in der Betreuung dieser Schwangeren dar. Generell sind die diagnostischen Möglichkeiten (z. B. im Rahmen der pränatalen Diagnostik) aufgrund z. T. drastisch eingeschränkter Sichtbedingungen limitiert. Die Folge ist eine potenziell verminderte Detektionsrate kongenitaler Auffälligkeiten des Fetus. In aktuellen Metaanalysen konnte darüber hinaus gezeigt werden, dass gerade bei adipösen Frauen die Rate an feto-maternalen Komplikationen vorgeburtlich als auch peri- und postpartal deutlich erhöht ist. Im Rahmen dieser Übersichtsarbeit sollen zum einen sowohl klinische als auch technische Schwierigkeiten im Zuge der vorgeburtlichen Überwachung und zum anderen die Auswirkungen maternaler Adipositas auf das geburtshilflich-peripartale Vorgehen diskutiert werden.

Abstract

Pandemic obesity is a global public health concern as the incidence of obesity has increased substantially over the past decades even among adolescents and women of childbearing age. Recent data from the Centers of Disease Control and Prevention (CDC) revealed a prevalence of obesity among women of 30.2 %, with 56.7 % of women classified as overweight. In the German female population 42 % were found to be overweight, and 13 % fulfilled the criteria for morbid adiposity [1]. This prevalence of overweight and obesity is a major challenge in obstetrical practice, because increased maternal weight is associated with a number of pregnancy complications affecting both the mother and the developing fetus. Diagnostic modalities, such as obstetrical ultrasound imaging are adversely affected by obesity with a negative impact on the detection rate of congenital anomalies. It is known and has been previously confirmed by several meta-analyses that maternal obesity poses an elevated risk for feto-maternal complications both antenatally, peri- and postnatally. This review aims to present relevant data on the prenatal surveillance of obese pregnant women and to discuss clinical and technical issues affecting the obstetrical management of the obese gravida.

Schlüsselwörter

Schwangerschaft - Fettleibigkeit - pränatal - Ultraschall - Überwachung

Key words

pregnancy - obesity - prenatal - ultrasound - surveillance

Full Text

References

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Dr. Jan Weichert

Klinik für Frauenheilkunde und Geburtshilfe
Bereich Pränatalmedizin und Spezielle Geburtshilfe
Universitätsklinikum Schleswig-Holstein
Campus Lübeck

Ratzeburger Allee 160

23538 Lübeck

Email: jan.weichert@uk-sh.de