Obesity is a worldwide epidemic with management implications that are more urgent than ever for obstetrics. The latest data from the U.S. Centers for Disease Control and Prevention show a prevalence of obesity that surpasses 35% in U.S. women of reproductive age.
Implications of Obesity
The potential maternal, fetal, peripartum, and neonatal complications in our obese pregnant patients are numerous. Studies have shown that the obese woman has a significantly increased risk of early miscarriage (an odds ratio of 1.2) and recurrent miscarriage (OR of 3.5), compared with a normal-weight woman after natural conception (Hum. Reprod. 2004;19:1644-6).
The risk of congenital anomalies also rises in obese women. In a recent meta-analysis, obese mothers were at significantly increased risk of having a child affected by a neural tube defect (OR 1.9), spina bifida (OR 2.2), cardiovascular anomalies (OR 1.3), and other anomalies, compared with body mass index (BMI)–appropriate mothers (JAMA 2009;301:636-50). In a prospective, multicenter study of more than 16,000 women, obese women and morbidly obese women were 2.5 and 3.2 times, respectively, more likely to develop gestational hypertension than nonobese women. They also were 1.6 and 3.3 times more likely, respectively, to develop preeclampsia. Gestational diabetes was 2.6 and 4 times more likely to occur in obese and morbidly obese women, compared with normal-weight pregnant women (Am. J. Obstet. Gynecol. 2004;190:1091-7).
Obesity also increases the risk of indicated preterm delivery, caused by related complications such as preeclampsia and diabetes. The risk of cesarean delivery and associated morbidities increases as well, as does the risk of macrosomia and fetal overgrowth (an increase in adipose tissue rather than lean body mass).
Macrosomia then perpetuates the problem of obesity in the offspring. Evidence clearly points toward an increase in adolescent and adult obesity in infants who are born either large for gestational age or who are macrosomic.
Excess maternal weight gain, particularly in average-weight women, is also a risk factor for excess birth weight (Obstet. Gynecol. 2008;112:999-1006).
There has been increasing awareness over the past decade, moreover, of the role that maternal obesity may play in unexplained antepartum fetal death. At least two studies – one in a Canadian population and one in a Danish National Birth Cohort – have shown that maternal pregravid weight increased the risk of unexplained fetal death, even in women without medical or obstetric complications (Obstet. Gynecol. 2000;95:215-21, and Obstet. Gynecol. 2005;106:250-9).
Managing the Obese Patient
Vigilant management of the obese pregnant woman is critical not only for the woman and her baby, but for future generations as well. We must increase our attentiveness to and surveillance for all the risks that obesity poses during pregnancy, and must think preventively during comprehensive preconceptional and postpartum care, with the goal of breaking the vicious cycle of obesity.
Until we gain a better understanding of underlying genetic predispositions, physiology, and mechanisms relating to maternal and fetoplacental interactions that affect fetal growth and development, all treatments in obese pregnant women must be empiric. However, we need to build upon the information we currently possess because waiting may not be an option.
Here are some of the key components of effective obesity management in pregnancy:
–Appreciate that obesity is treatable. Certainly, women should aim to conceive while at a normal body mass index (BMI). Our ability to manage obesity preconceptually is constrained by the fact that many pregnancies are unplanned. However, when given the opportunity, we must encourage and help facilitate weight loss before pregnancy.
With proper counseling, some obese women can indeed achieve meaningful weight loss before conception. We know that lifestyle measures involving both nutritional counseling and exercise are more beneficial than either approach alone. The American College of Obstetricians and Gynecologists has practical guidelines on how to assess and manage obesity in the nonpregnant woman (“The Role of the Obstetrician Gynecologist in the Assessment and Management of Obesity,” Committee Opinion Number 319, October 2005).
We also must treat obesity as a problem itself, with an individualized, patient-centered approach. This point was stressed in the report on weight gain in pregnancy issued last year by the U.S.-based Institute of Medicine and National Research Council (www.nap.edu, “Weight Gain During Pregnancy: Reexamining the Guidelines”).
As obstetricians we tend to hone in during pregnancy on the complications of obesity while overlooking the underlying problem. We also are less likely to think about individualized, patient-centered treatment for a woman who is overweight or obese as we would for a woman with a more straightforward problem like gestational diabetes. We need a change of mind set.
If a woman enters pregnancy obese, limiting her weight gain to recommended levels will help lower her risk of various complications and reduce postpartum weight retention. Exercise and other lifestyle changes will also improve insulin use in women with diabetes.
In the postpartum period, we must help women meet the important goal of returning to their prepregnancy weight, and then encourage them to lower their weight before the next pregnancy, referring them to specialists if necessary to break the cycle of obesity.
Breastfeeding is an important tool to reducing postpartum weight retention – it increases caloric utilization by 500-800 calories per day and has short- and long-term benefits for both the mother and the baby. We must appreciate, however, that it is technically more difficult for an obese woman to breastfeed, compared to a nonobese woman. The obese patient may need special help from a lactation consultant.
–Think inflammation and insulin resistance. In the pregravid state, an obese woman has increased inflammation and more insulin resistance to begin with. Her inflammatory profile and level of insulin resistance then only increases in pregnancy. (There are significant 50%-60% decreases in maternal insulin sensitivity by the end of the third trimester.)
Increased insulin resistance in pregnancy, studies show, can drive an excess flow of nutrients to the fetus and lead to macrosomia. Insulin resistance also may increase the risk of preeclampsia and gestational diabetes.
Although insulin sensitizers such as metformin or thiazolidinediones theoretically may be useful for increasing insulin sensitivity, these agents cross the placenta and their fetal safety has not been documented. This brings us back to lifestyle interventions to improve insulin resistance – a calorie-appropriate diet that is low in saturated fat and high in complex carbohydrates, for instance, along with exercise that uses large skeletal muscles, such as walking and swimming.
The role of dietary supplements such as fish oil and vitamin D in decreasing inflammation and improving metabolic function are currently under investigation. While we do not believe either causes any harm, it is too early to make official recommendations. At this point, we must focus on lifestyle interventions as our primary management approach.
–Pursue early glucose testing, and tight glucose control in patients with gestational diabetes mellitus (GDM). Women who are obese should be considered for early glucose screening rather than waiting until the 24- to 28-week standard screening period. Such early screening enables the detection of undiagnosed type 2 diabetes, or overt diabetes, and is the new recommendation of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) for the diagnosis of GDM (Diabetes Care 2010;33:676-82).
When results from early screening are normal, testing should be repeated later. If either pregestational diabetes or gestational diabetes is detected, tight glucose control should be the goal.
A recent paper from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study suggests there are strong independent associations of fasting C-peptide (an index of insulin sensitivity) and BMI with preeclampsia. Maternal glucose levels in this study (levels below those found in diabetes mellitus) had weaker associations with preeclampsia (Am. J. Obstet. Gynecol. 2010;202:255e.1-7).
Other data show that tight glucose control in obese women with diabetes may decrease the risk of preeclampsia and other complications.
–Limit weight gain in pregnancy. Although pregravid weight, rather than weight gain during pregnancy, has the strongest correlation with the complications of maternal obesity in pregnancy and with birth weight, maternal weight gain during gestation still is positively correlated with excess birth weight and with various complications.
At minimum, we can work with women on limiting weight gain in pregnancy and following the new guidelines published last year by the Institute of Medicine and National Research Council. The report, which updates the previously published guidelines from 1990, specifies a new weight gain range for obese women, limiting their gain to 11-20 pounds during pregnancy.
Studies published after the previous guidelines were released in 1990 have consistently shown that women who gain weight within the recommended amounts have better outcomes. Women who do not gain excess weight also are less likely to retain extra pounds after birth.
Research also has shown, however, that a high proportion of women report that they were either given no advice on how much weight to gain or were advised to gain outside of their recommended range.
Indeed, an increasingly large proportion of women has gained in excess of the recommendations: From 1993-2003, the proportion of overweight women gaining in excess of the 1990 IOM recommendations increased to approximately 63%; approximately 46% of obese women gained excess weight.
Given the IOM’s lower weight gain recommendation for obese women, such proportions will likely rise unless we increase the counseling we give patients on weight, diet, and exercise, and unless we routinely record and discuss patients’ weight, height, and BMI.
More recent studies have focused on interventions to help women limit their weight gain during pregnancy. Although none of the four trials conducted in North American populations and reviewed by the IOM was completely successful in helping women limit their gestational weight gain and adhere to the 1990 guidelines, two European studies demonstrate that it’s possible to motivate obese pregnant women to limit their weight gain during pregnancy to 6-7 kg. The interventions involved individual dietary or motivational counseling, and in one of the studies, the provision of specially designed aqua aerobics classes.
In general, interventions described in the literature have included counseling, the provision of unique physical activity classes, dietary prescription, and even daily recording of dietary intake.
–But do not encourage weight loss. Some investigators have recently proposed that obese women should consider weight loss during pregnancy in order to decrease adverse perinatal outcomes. It is my opinion that while women should avoid excessive weight gain, they should not be advised to lose weight until additional investigation shows that there are benefits and no adverse consequences to the mother and/or fetus.
There are obligatory physiological changes that for most women result in a “net maternal weight gain”: on average, 4-5 kg of weight at term represents the fetus, the placenta, and amniotic fluid.
For reasons that we don’t fully understand, some obese women do not gain weight during pregnancy, or may actually lose weight, and still have a healthy baby. These women may have a decrease in energy expenditure in pregnancy and a subsequent decrease in intake, and/or there may be other physiologic issues at work.
As long as such a patient is eating well, seeing a nutritionist, and does not have ketonemia/ketonuria, and her baby is growing well, I would not encourage excessive intake in order to meet a particular weight gain target. I would just monitor her carefully.
The bottom line: Until we learn more about the safety of intentional weight loss during pregnancy, we face a delicate balancing task. On one hand, we need to appreciate that some women do not gain weight during pregnancy and should not necessarily be urged to gain an arbitrary amount while, on the other hand, we should not encourage these women to lose weight.
–Consider bariatric surgery to be a tool in your armamentarium. Population studies and reports of long-term outcomes from the United States and Scandinavia suggest that bariatric surgery has potential long-term benefits – in terms of weight loss and improvement in metabolic function – for women of reproductive age who do not have success with lifestyle measures and medical treatments.
In our practice, we often refer women after delivery to see our obesity specialist, who institutes medical therapy and will move on to consideration of bariatric surgery if the medical therapy is not successful. Experts have determined that bariatric surgery may be considered in women with a BMI greater than 35 (class II obesity) who have significant medical problems such as hypertension or diabetes, or in women who have a BMI greater than 40 (class III obesity) and no obvious medical complications.
ACOG’s committee opinion No. 315 from 2005 includes various recommendations about how long to delay pregnancy after surgery (12-18 months after laparoscopic adjustable gastric banding, for example), and what vitamin supplementation is necessary. Women who have laparoscopic adjustable gastric banding should be monitored by both their obstetrician and bariatric surgeon during pregnancy, according to the ACOG committee’s recommendations (Obstet. Gynecol. 2005;106:671-5).
–Up the ante on kick counts. Because the risk of stillbirth is significantly increased in the obese pregnant woman (even the patients without hypertensive disorders or other complications), fetal monitoring with kick counts is all the more important.
The cost/potential benefit of more extensive evaluation is unclear for the obese woman without any medical or obstetric complications (and fetal assessment is more difficult in the obese patient), but certainly a lower threshold for more formal testing should be considered for women who do have complications and for women in whom a “red flag” is raised.
A patient whose baby appears to be very large on ultrasound or in the clinical exam, for instance, or a patient whose baby is well above the 90th percentile too early in gestation might benefit from more formal evaluation of fetal well-being, even if glucose and blood pressure tests are normal.
Dr. Patrick M. Catalano, professor and chair of the department of reproductive biology at Case Western Reserve University, Cleveland, is one of the world’s leading experts on the short- and long-term consequences of obesity for pregnant women and their offspring. He served on the Institute of Medicine committee that in 2009 reexamined guidelines on weight gain during pregnancy. He also is leading the effort to inform physicians and the public about the costly complications of obesity in pregnancy and in finding ways to prevent these complications from occurring in the first place. Dr. Catalano’s research focus is on insulin resistance and glucose metabolism in pregnancy and the role of placental cytokines in the regulation of fetal growth and adiposity.
Dr. Catalano said he has no disclosures or potential conflicts of interest to report related to the content of this feature.
Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
肥胖是全球流行病。在产科学中，管理肥胖的必要性比以往任何时候都更迫切。美国疾病预防控制中心(CDC)的最新数据显示，在美国的育龄女性中，肥胖患病率超过了35%。
肥胖的影响
在我们的妊娠期肥胖患者中，潜在的孕产妇、胎儿、围产期和新生儿并发症非常多见。 研究发现，自然受孕后，肥胖女性发生早期流产[比值比(OR) 1.2]和复发性流产(OR 3.5)的风险显著高于正常体重的女性(Hum. Reprod. 2004;19:1644-6)。
在肥胖女性中，胎儿先天异常的风险也较高。一项近期Meta分析显示，与体重指数(BMI)适中的母亲相比，肥胖母亲所生小孩发生神经管缺陷(OR 1.9)、脊柱裂(OR 2.2)、心血管异常(OR 1.3)和其他异常的风险明显更高(JAMA 2009;301:636-50)。一项入选16,000多名女性的前瞻性多中心研究显示，肥胖女性和病态肥胖女性的妊娠期高血压发生率分别是非肥胖女性的2.5倍和3.2倍，先兆子痫发生率分别是后者的1.6倍和3.3倍，并且妊娠期糖尿病发生率分别是后者的2.6倍和4倍(Am. J. Obstet. Gynecol. 2004;190:1091-7)。
肥胖还可增加如下风险：由先兆子痫和糖尿病等相关并发症引起的指征性早产风险、剖宫产和相关疾病的风险以及巨大儿和胎儿过度生长(脂肪组织增加而非瘦体重增加)的风险。
巨大儿可将肥胖问题遗传给后代。有证据明确显示，那些体型比实际胎龄大的出生婴儿或巨大儿在进入青少年期和成人期后，发生肥胖的风险较高。
孕妇体重增加过多也是新生儿体重过重的危险因素，这在原本体重正常的女性中尤为明显(Obstet. Gynecol. 2008;112:999-1006)。
此外，过去10年来，人们对孕期肥胖在不明原因产前胎儿死亡中作用的认识日益增加。 至少两项研究(一项入选加拿大人群，一项入选丹麦全国出生队列)显示，孕前体重可增加不明原因胎儿死亡的风险，甚至在无内科或产科并发症的女性中也是如此(Obstet. Gynecol. 2000;95:215-21, Obstet. Gynecol. 2005;106:250-9)。
肥胖患者的管理
对肥胖孕妇进行审慎管理不仅对该孕妇及其婴儿至关重要，而且对其后代也同样重要。我们必须加强关注和监测孕期肥胖引起的所有风险，并且在全面的孕前和产后护理期间采取预防措施，以打破肥胖的恶性循环为目标。
孕妇与胎儿胎盘之间的相互作用可影响胎儿的生长和发育。在进一步了解与这些相互作用相关的潜在遗传易感性、生理学和机制之前，对肥胖孕妇进行的所有治疗都必须为经验性治疗。然而，我们需要在目前所掌握信息的基础上进行推理分析，因为干等着新研究数据的出炉并非明智之举。
以下是有效管理妊娠期肥胖的要点：
—应认识到肥胖是可治的。当然，女性应尽可能在体重指数(BMI)正常的时候受孕。许多怀孕为意外怀孕，这限制了我们在孕前管理肥胖的能力。然而，在有机会的情况下，我们必须鼓励和帮助女性在怀孕前减肥。
在给予适当指导的情况下，一些肥胖女性的确能够在怀孕前使体重发生有意义的减轻。我们知道，营养指导与运动是两种通过调整生活方式来管理肥胖的措施，同时实施这两种措施的效果优于仅实施任何一种措施的效果。美国妇产科医师学会(ACOG)已发布了指导如何在非妊娠女性中评价和管理肥胖的实用指南(“The Role of the Obstetrician Gynecologist in the Assessment and Management of Obesity,” Committee Opinion Number 319, October 2005)。
我们还必须采用以患者为中心的个体化方法将肥胖作为一种自身疾病予以治疗。美国医学研究所和国家研究委员会去年发布的有关妊娠期体重增加的报告对这点进行了强调(www.nap.edu, “Weight Gain During Pregnancy: Reexamining the Guidelines”)。
作为产科医师，我们往往会关注妊娠期肥胖并发症，而忽略肥胖这个本质问题。对于具有妊娠期糖尿病这类更为直接问题的女性，我们通常会实施以患者为中心的个体化治疗，但对于超重或肥胖的女性，我们可能就很少会考虑实施个体化治疗。我们需要改变思维模式。
将妊娠期肥胖女性的体重增加限制在建议水平，有助于降低其发生各种并发症的风险，并减少产后体重滞留。运动和其他生活方式改变也可改善胰岛素在糖尿病女性患者中的应用。
我们必须帮助产后女性达到恢复至孕前体重的重要目标，并鼓励她们在下次怀孕前减肥，并在必要时寻求专家诊治，以打破肥胖循环。
哺乳是减少产后体重滞留的重要措施，其每天可消耗500~800卡路里，并对孕妇和婴儿双方均有短期和远期益处。然而，我们必须认识到，从技术层面上看，肥胖女性实施哺乳的难度大于非肥胖女性。肥胖患者可能需要来自哺乳咨询师的专门帮助。
—考虑炎症和胰岛素抵抗。怀孕前，肥胖女性一开始会出现炎症增加和胰岛素抵抗增强的现象。随后在妊娠期间，炎症和胰岛素抵抗水平只会增加(而无降低趋势)(妊娠晚期结束时，孕妇的胰岛素敏感性显著降低了50%~60%)
研究显示，妊娠期间的胰岛素抵抗增加能够导致过多营养被输送至胎儿，从而导致巨大儿。胰岛素抵抗还可能增加发生先兆子痫和妊娠期糖尿病的风险。
尽管二甲双胍或噻唑烷二酮类药物等胰岛素增敏剂理论上有助于增加胰岛素敏感性，但是这些药物可通过胎盘，并且它们对胎儿的安全性尚不明确。因此，我们还是要回到生活方式干预，以改善胰岛素抵抗——例如，摄取饱和脂肪含量低、复合碳水化合物含量高的热量适合的膳食，并同时进行步行和游泳等需要运用到大骨骼肌的运动。
目前正对鱼油和维生素D等膳食补充剂在减少炎症和改善代谢功能方面的作用进行研究。 尽管我们不认为任一因素可造成任何伤害，但现在做出正式建议还为时尚早。因此，我们必须重点将生活方式干预作为我们的主要管理方法。
—对妊娠期糖尿病(GDM)患者进行早期血糖检测，并严格控制血糖。对于肥胖女性，血糖筛查应及早进行，而不要等到24~28周标准筛查期才进行。这种早期筛查能够检出未诊断的2型糖尿病或显性糖尿病。国际糖尿病与妊娠研究协会(IADPSG)最近也建议在GDM诊断中进行这种早期筛查(Diabetes Care 2010;33:676-82)。
如果早期筛查的结果正常，那么应在晚些时候重复进行检测。如果检出妊娠前糖尿病或妊娠期糖尿病，就应将严格控制血糖作为目标。
高血糖与不良妊娠结局(HAPO)研究的最新报告表明，空腹C肽(胰岛素敏感性指标)和BMI与先兆子痫之间存在强独立关联。在该研究中，孕妇血糖水平(低于见于糖尿病患者的水平)与先兆子痫的关联较弱(Am. J. Obstet. Gynecol. 2010;202:255e.1-7)。
其他数据显示，对糖尿病合并肥胖女性患者进行严格血糖控制可降低发生先兆子痫和其他并发症的风险。
—限制孕期体重增加。尽管孕前体重(而非孕期体重增加)与妊娠期肥胖并发症和出生体重的相关性最强，但孕期体重增加仍与出生体重过高和多种并发症呈正相关。
至少，我们能够与女性同胞们在遵循美国医学研究所(IOM)和国家研究委员会去年发布的最新指南的情况下合力限制妊娠期体重增加。该报告对1990年以来发布的既往指南进行了更新，并提出了一个针对肥胖女性的最新体重增加范围，即妊娠期体重增加应限制在11~20磅范围内。
继1990年发布的既往指南之后发表的研究均一致发现，体重增加在所推荐范围内的女性其转归较好。体重增加不多的女性其产后滞留过多体重的可能性也较低。
然而，研究还发现，有较大比例的女性称，她们要么未获得任何有关增重多少的建议，要么就是被建议增重超出所推荐范围。
的确，体重增加超出推荐范围的女性比例越来越大：1993~2003年，体重增加超出上述1990年IOM推荐范围的超重女性比例已增至约63%；约46%的肥胖女性其体重增加过多。
考虑到IOM对肥胖女性提出的体重增加推荐范围较低，这一比例将仍可能会增加，除非我们在体重、膳食和运动方面加强对患者进行指导，并对患者的体重、身高和BMI进行常规记录和讨论。
更多的最新研究对通过干预方式帮助女性限制其孕期体重增加进行了重点探讨。尽管IOM审查的入选北美人群的4项试验均未能完全成功帮助女性限制妊娠期体重增加，并且均未遵循上述1990年指南，但两项欧洲研究显示，激励肥胖孕妇将妊娠期体重增加限制至6~7 kg是可能的。干预方式包括个体化膳食和激励性咨询指导，其中一项研究还为受试者提供了特别设计的水中有氧运动课程。
一般而言，文献中描述的干预方式包括咨询指导、提供独特的体育课程、膳食处方、以及甚至每日记录膳食摄入情况。
—但不要鼓励减肥。最近，一些研究者提出，肥胖女性应考虑在妊娠期减肥，以减少不良围产期结局。在我看来，尽管女性应避免增重过多，但不应建议其减肥，除非进一步研究显示，减肥对孕妇和(或)胎儿有益且无任何不良影响。
大部分女性可因不可避免的生理改变而出现“净体重增加”：平均而言，足月时4~5 kg的体重代表的是胎儿、胎盘和羊水的重量。
一些肥胖女性并未在妊娠期出现体重增加，或可能实际上出现体重下降，但胎儿仍很健康，这方面的原因我们尚不完全清楚，有可能是这些女性在妊娠期的能量消耗量降低，因而食物摄入量也随之减少，和(或)是其他生理因素发挥了作用。
只要这样的患者平时注意膳食营养均衡、经常咨询营养师，并且无酮血/酮尿，同时胎儿生长良好，那么我就不鼓励通过增加饮食来达到特别的体重增加目标。我只会对其进行密切监测。
底线：在我们对妊娠期干预性减肥的安全性有更多了解之前，我们需要小心平衡增重与减肥问题。一方面，我们需要认识到，一些女性并未在妊娠期出现体重增加，没有必要鼓励其任意增重，另一方面，我们也不应鼓励其减肥。
—考虑将减肥手术作为治疗策略。来自美国和斯堪的纳维亚的人群研究和远期转归报告表明，在减肥和改善代谢功能方面，减肥手术可使经生活方式干预和医学治疗失败的育龄女性获得潜在远期益处。
在我们的临床实践中，我们经常建议产后女性去找我们的肥胖专家。肥胖专家会对这些女性先采取内科治疗，如内科治疗失败，则会进一步考虑进行减肥手术。专家已证实，对于BMI>35(II级肥胖)且具有高血压或糖尿病等明显内科疾病的女性，或对于BMI>40(III级肥胖)但无明显内科并发症的女性，可考虑进行减肥手术。
2005年ACOG的委员会观点(编号315)包括各种建议，涉及应在术后多久怀孕(例如，腹腔镜可调节胃束带术后12~18个月)和应服用何种维生素补充剂等问题。根据ACOG委员会的建议，产科医师和减肥手术医师应对行腹腔镜可调节胃束带术的女性进行妊娠期监测(Obstet. Gynecol. 2005;106:671-5)。
—重视胎动计数。由于肥胖孕妇发生死胎的风险显著增加(甚至无高血压疾病或其他并发症的患者也是如此)，因此通过胎动计数的方式来对胎儿进行监测显得尤为重要。
对无任何内科或产科并发症的肥胖女性，采取昂贵评估方法进行检查的成本/潜在效益尚不清楚(并且在肥胖患者中进行胎儿评估也较为困难)，但对患有并发症的女性和出现“危险信号”的女性，当然应考虑降低对其进行更正式的(昂贵)检查的门槛。
例如，在超声或临床检查中检出巨大儿的患者，或妊娠极早期的妊娠图宫高在第90百分位以上的患者可从更正式的胎儿评估检查中获益，即使血糖和血压检查结果正常。
克利夫兰凯斯西保留地大学生殖生物学系主任Patrick M. Catalano教授/博士是世界知名专家，擅长研究肥胖对孕妇及其后代的短期和远期影响。他是2009年重新审查妊娠期体重增加指南的医学研究所委员会的成员。他还带头致力于向医生和公众普及对妊娠期肥胖并发症(相关检查治疗费用昂贵)的认识，并探索可从源头上防止这些并发症发生的方法。Catalano博士的研究重点是妊娠期胰岛素抵抗和葡萄糖代谢，以及胎盘细胞因子在调节胎儿生长和肥胖中的作用。
Catalano博士声明没有与本新闻稿内容相关的任何潜在经济利益冲突。
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