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Creado el : 17 Feb 2008
Alterado em : 24 Dec 2008

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Ficha bibliográfica (sin autores) :

I. Repeated measurement of maternal weight during pregnancy. Is this a useful practice? II. Patterns of maternal weight gain in pregnancy. BJOG: An International Journal of Obstetrics and Gynaecology 98 (10) , 1055–1056.

Autores :

D. F. Hawkins Professor

Año de publicación :

1991

URL(s) :

http://www.blackwell-synergy.com/doi/full/10.1111/…
https://doi.org/10.1111/j.1471-0528.1991.tb15347.x

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Abstract (English)  :

I. Repeated measurement of maternal weight during pregnancy. Is this a useful practice? II. Patterns of maternal weight gain in pregnancy

* D. F. Hawkins Professor11Department of Obstetrics & Gynaecology Hammersmith Hospital London W12 OHS

*
1Department of Obstetrics & Gynaecology Hammersmith Hospital London W12 OHS

Dear Sir,

Dawes & Grudzinskas [Br J Obstet Gynaecol (1991) 98, 189–194 & 195–201] have made a brave attempt to tilt at this windmill. Their findings are of interest, but do not justify the conclusion that routine recording of maternal weight gain in pregnancy should be abandoned in women with a normal weight at booking.

Maternal weight changes in late pregnancy have two components, dietary and fluid retention. The former may be beneficial or it may have adverse consequences; the latter may reflect oestrogen levels and hence placental function or it may be the harbinger of pre-eclampsia (Dieckmann 1952). With such interactions it is not surprising that the changes should have limited predictive value for small for gestational age babies, except in pregnancies with essential hypertension or pregnancy induced hypertension (Elder et al. 1970). The question that has not been answered is what is the significance of these changes in relation to growth retarded babies, as distinct from ‘small for gestational age’ babies? In a recent study from Norwich, Fay et al. (1991) found that only 40% of babies with birthweights less than the 10th centile had the features of intrauterine growth retardation when assessed by neonatal paediatricians.

The hazards to mother and baby of obesity in pregnancy are emphasized in three recent studies (Narayansingh et al. 1988; Frentzen et al. 1988; Lucas et al. 1988). How much of the problem is due to pathology consequent on the obesity, and how much to the diagnostic and management difficulties to which the overweight woman is predisposed is far from clear. About half the cases of damaged babies that have come my way for medicolegal opinions in recent years have been associated with maternal obesity causing difficulty in ascertaining gestational age, fetal lie, presentation and position, and engagement of the head; and in fetal monitoring. There has also been undue reluctance to induce labour or perform caesarean section. These consequences are the same if the excess weight was acquired before or during pregnancy. There is thus a case for monitoring and discouraging excess weight gain in pregnancy.

In an important proportion of women in their 40s and 50s attending medical outpatient departments, the underlying diagnosis is obesity. The story is commonly one of successive gains in weight in relation to pregnancy (Sheldon 1949) and failure to lose the extra weight after the pregnancy is over. This alone is enough for discouragement of excessive weight gain during pregnancy, which requires monitoring of maternal weight.

When all these factors are considered, I do not think Dr Dawes and Professor Grudzinskas have made an adequate case.

D. F. Hawkins Professor

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Autor de este registro :

Emmanuelle Phan — 17 Feb 2008