24Drs好健康報:懷孕時減重好嗎？
好健康熱頭條 ─ 懷孕時減重好嗎？ Can Pregnancy Weight Loss Be Good?
好健康小單字 – 妊娠糖尿病 (Gestational Diabetes Mellitus,GDM)
好健康熱頭條 ─ 懷孕時減重好嗎？
在懷孕期間減重，可以改善罹患妊娠糖尿病的肥胖婦女其所生嬰孩的健康。
習慣上醫生們不喜歡看到孕婦減重，即使是肥胖的女性也是如此，事實上，醫學研究所(IOM)的1990年指導手冊中建議，肥胖的女性在懷孕過程中應該增加15到25磅。
但是肥胖婦女所生的孩子神經管缺陷、先天性心臟缺陷、及其他嚴重問題的風險增加，大多數婦女無法減掉懷孕期間所增加的體重，而這增加了婦女原來對抗肥胖的健康風險。
這導致一些醫生懷疑肥胖婦女在懷孕期間保持體重，甚至減肥是否會更好，其中包括聖路易大學醫學院婦產科系與婦女健康系教授兼系主任Raul Artal醫師在內，開始研究這個問題時，Artal醫師和同事們針對96位肥胖或罹患妊娠糖尿病的病態肥胖孕婦進行研究。
妊娠糖尿病是指懷孕前沒有糖尿病的女性，在懷孕期間產生糖尿病，通常懷孕後就會消失。
研究中的婦女們被允許選擇只減少飲食中的熱量，或是吃維持原來體重的飲食加上運動，運動是指每餐飯後步行至少20分鐘；結果顯示，有運動的婦女中，將近一半保持原先的體重或減重，然而只有節食的婦女中，有五分之四變胖。
Artal醫師向WebMD表示，在懷孕期間維持原來體重或是減重的婦女，以及有運動的婦女，會比只節食的婦女併發症少；我們確實看到這些婦女生下正常大小的嬰兒，而這代表併發症較少有幫助。
這是否證明肥胖婦女在懷孕期間減肥是安全的？紐約羅契斯特大學婦產科教授J. Christopher Glantz醫師說：不。他指出，Artal醫師的研究樣本太少範圍太小，不適用於所有懷孕期間肥胖的婦女。
但是沒有參與Artal醫師研究的Glantz醫師表示，研究顯示要重新檢視「懷孕期間體重增加一定是好的」這個信條。
Glantz醫師向WebMD表示，他自己的經驗是，不論肥胖的婦女沒有增加體重或是依照醫學研究所的建議增加15磅，嬰兒都很棒；至於對更肥胖的婦女來說，即使減肥也不是問題。
Artal醫師強調在懷孕期間運動的重要性，尤其是肥胖的女性；他表示，我們知道每個人在懷孕期間運動都是安全的，當談到運動時，我們只是談到散步這種安全的運動，如果是肥胖的孕婦，以中等速度的步伐散步可能更有益，而且要保持低熱量飲食。
結論是，所有人都必須要拋棄懷孕時不要動和多吃的觀念，他表示，要表達的訊息應該是，懷孕不是分娩狀態，你不應該吃兩人份。
Artal醫師和同事們表示，他們的調查結果將刊載在6月號的應用生理學、營養、和新陳代謝 (Applied Physiology, Nutrition, and Metabolism) 期刊。
Can Pregnancy Weight Loss Be Good?
Losing weight during pregnancy may improve the health of babies born to obese women with gestational diabetes.
Traditionally, doctors haven't liked to see pregnant women lose weight, even if the women are obese. Indeed, the 1990 guidelines of the Institute of Medicine (IOM) suggest that obese women should gain 15 to 25 pounds over the course of a pregnancy.
Yet children born to obese women have increased risk of neural tube defects, congenital heart defects, and other serious problems. And most women don't lose all the weight they gain during pregnancy -- adding to the health risks of women already battling obesity.
This has led some doctors to question whether it might be better for obese women to maintain their weight -- or even lose weight -- during pregnancy.
One of those doctors is Raul Artal, MD, professor and chairman of the department of obstetrics, gynecology, and women's health at Saint Louis University School of Medicine. To begin studying the issue, Artal and colleagues worked with 96 obese or morbidly obese pregnant women with gestational diabetes.
Gestational diabetes is diabetes that occurs during pregnancy in a woman who didn't have diabetes before pregnancy; it usually goes away after pregnancy.
The women in the study were allowed to choose either a reduced-calorie diet alone or a weight-maintenance diet plus exercise -- walking for at least 20 minutes after each meal.
Nearly half the women in the exercise group maintained their weight or lost weight, while four out of five women in the diet-only group gained weight.
"Women who either maintain weight in pregnancy or lose weight -- and exercise -- have fewer complications than those on diets alone," Artal tells WebMD. "We definitely see these women deliver normal-size babies, which means that this plays a role in fewer complications."
Does this prove it's safe for obese women to lose weight during pregnancy?
No, says J. Christopher Glantz, MD, MPH, professor of obstetrics and gynecology at the University of Rochester, N.Y. He notes that the Artal study was too small and too limited in scope to apply to all obese women during pregnancy.
But the study does suggest that the dogma "weight gain during pregnancy is always good" should be re-examined, says Glantz, who was not involved in the Artal study.
"My own experience is the babies do well whether obese women gain zero pounds or the 15 pounds the IOM recommended," Glantz tells WebMD. "For women in the higher obesity categories, it isn't a problem even if they lose weight."
Artal stresses the importance of exercise during pregnancy -- particularly for obese women.
"We know that exercise in pregnancy is safe for everybody," Artal says. "When we talk exercise, we talk about just walking -- a safe form of exercise. If obese, pregnant women can engage in walking at a moderate pace, it is probably more beneficial. And maintaining a lower-calorie diet is beneficial."
The bottom line, Artal says, is that we all must get over the idea that pregnancy is a time for inactivity and overeating.
"The message should be that pregnancy is not a state of confinement -- and you should not eat for two," he says.
Artal and colleagues report their findings in the June issue of Applied Physiology, Nutrition, and Metabolism.
SOURCES: Artal, R. Applied Physiology, Nutrition, and Metabolism, June 2007; vol 32: pp 596-601. News release, Saint Louis University. Raul Artal, MD, professor and chairman, department of obstetrics, gynecology, and women's health, Saint Louis University School of Medicine. J. Christopher Glantz, MD, MPH, professor of obstetrics and gynecology, University of Rochester, N.Y.
WebMD Medical News
By Daniel J. DeNoon
Reviewed by Louise Chang, MD
好健康小單字 – 妊娠糖尿病 (Gestational Diabetes Mellitus,GDM)
妊娠糖尿病是指懷孕之前未罹患糖尿病，於懷孕期間發生或首次診斷出不同程度之葡萄糖耐受性不良現象，有此問題的孕婦較容易發生產科合併症，如流產、早產、妊娠高血壓、羊水過多、早期破水、高血糖、子宮胎盤血管病變、低血糖及酮酸血症、陰道念珠菌及泌尿道感染等，也可能造成胎兒生長遲滯、早產、巨嬰，導致難產或生產傷害，或是新生兒易有低血糖、黃疸、呼吸窘迫症候群。
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