Overweight and Obesity before, during and after Pregnancy

 

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Abstract

Overweight and obesity before conception as well as excessive weight gain during pregnancy are associated with endocrinological changes of mother and fetus. Insulin resistance physiologically increases during pregnancy, additional obesity further increases insulin resistance. In combination with reduced insulin secretion this leads to gestational diabetes which may develop into type-2-diabetes. The adipose tissue produces TNF-alpha, interleukins and leptin and upregulates these adipokines. Insulin resistance and obesity induce inflammatory processes and vascular dysfunction, which explains the increased rate of pregnancy-related hypertension and pre-eclampsia in obese pregnant women. Between 14 and 28 gestational weeks, the fetal adipose tissue is generated and the number of fat lobules is determined. Thereafter, an increase in adipose tissue is arranged by an enlargement of the lobules (hypertrophy), or even an increase in the number of fat cells (hyperplasia). Human and animal studies have shown that maternal obesity “programmes” the offspring for further obesity and chronic disease. Pregnant women, midwives, physicians and health care politicians should be better informed about prevention, pathophysiological mechanisms, and the burden for society caused by obesity before, during and after pregnancy.

Zusammenfassung

Übergewicht und Adipositas vor der Konzeption sowie überhöhte Gewichtszunahme während der Schwangerschaft sind mit einer Reihe von Veränderungen des endokrinen Systems von Mutter und Kind verbunden. In der Schwangerschaft steigt die Insulinresistenz ohnehin, bei zusätzlicher Adipositas wird eine schon vorhandene Insulinresistenz verstärkt. Zusammen mit einer verminderten Insulinsekretion führt dies zu einem Gestationsdiabetes, der in einen manifesten Typ-2-Diabetes mellitus konvertieren kann. Das Fettgewebe produziert TNF-alpha, Interleukine und Leptin und sorgt für eine Hochregulierung dieser Adipokine. Insulinresistenz und Adipositas sind mit inflammatorischen Prozessen und vaskulärer Dysfunktion assoziiert, die auch die erhöhte Rate von schwangerschaftsassoziiertem Hypertonus und Präeklampsie adipöser Schwangerer erklärt. Beim Feten entsteht Fettgewebe zwischen den Schwangerschaftswochen 14 und 28. In dieser Zeitspanne wird die Zahl der Fettlobulae festgelegt. Eine spätere Zunahme des Fettgewebes erfolgt durch Vergrößerung der Läppchen (Hypertrophie). Bei Entwicklung einer Adipositas kann es jedoch auch zu einer Zunahme der Zahl der Fettzellen (Hyperplasie) kommen. Studien an Mensch und Tier haben gezeigt, dass mütterliche Adipositas die Nachkommenschaft bereits in der Schwangerschaft für Adipositas und chronische Erkrankungen „programmiert“. Hierüber sollten nicht nur die betroffenen Mütter, sondern auch Hebammen, Ärzte und Gesundheitspolitiker informiert sein, um Risiken zu verhindern und die damit verbundenen Kosten zu limitieren.

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