``The critical weight``: features of pregnancy at obesity of
Obesity - not just excess of fat in an organism. This chronic recuring (proceeding with aggravations) a disease which promotes manifestation and development of many other chronic diseases. This illness also affects the course of pregnancy.
Natalya Alexandrova: “The main symptom of obesity is excess accumulation of fatty tissue in an organism. Fatty tissue - depot (the place of accumulation) of the arrived energy. The more fatty tissue, the amount of the “excess“ energy received from food and not spent is higher.“Factors of development of obesity are diverse
From where fatty “stocks“undertake
and can influence both in common, and separately. The most widespread of them are such as features of behavior (a hypodynamia - decrease in physical activity, an overeating), genetic predisposition, violations of endocrine system. As a result of numerous researches it is established that obesity in the childhood - the powerful contributing obesity factor at mature age, especially when one suffer from it or both parents. So, at the normal body weight of parents obesity occurs only at 9% of children, at obesity of one parent - at 50%, and at obesity of both parents - in 70% of cases.
In a brain the special center, gipotalamus, responsible for feeling of hunger and saturation is. The constant overeating leads to violation of work of a gipotalamus, and the normal quantity of the eaten food cannot quash feeling of hunger any more therefore to the person to have to eat more and more. The excess food is laid as if “in store“ in fatty depot that leads to increase in amount of fat in an organism, that is to development of obesity.What
weight - superfluous?degree of obesity can be determined by
In our country by Brock`s formula: body weight = growth in cm - 100. Excess of body weight to 30% is referred to the I degree of obesity, by from 30 to 50% - to the second, from 50 to 100% - to the third degree and more than 100% - to the fourth.
So, with a growth the 170th weight should not exceed 70 kg, the I degree of obesity arises weighing up to 91 kg, the II degree - to 105 kg, the III degree - to 140, the IV degree - more than 140 kg.the Western doctors prefer to use
the body weight index (BWI) which is defined as the body weight relation (in kg) to growth (in sq.m). Indicators of IMT from 25 to 30 kg/sq.m indicate excess body weight, and more than 30 kg/sq.m already allow to make the diagnosis “obesity“.
In economically developed countries of the world about a quarter of the population has the body weight exceeding norm for 15%. According to forecasts of experts of World Health Organization, at preservation of the existing growth rates of obesity its level by 2010 will increase on average for 8%, and by 2025 in the world there will be more than 300 million people with the diagnosis “obesity“. Results of a number of epidemiological researches demonstrate that in Europe the number of patients with obesity in population makes about 30%, and with excess body weight - about 25%. Similar indicators are registered also in Russia.
Pregnancy. during pregnancy create favorable conditions for development of fatty cellulose which biological sense consists in protection of future child. It is caused by hormonal reorganization in the woman`s organism, namely the increased synthesis of progesterone and a horionichesky gonadotrophin (the hormones supporting pregnancy) and deficiency of the estradiol developed by ovaries mainly out of pregnancy. Effect of these hormones also causes adjournment of fatty tissue mainly in mammary glands, buttocks, hips, a stomach.
At patients with obesity pregnancy seldom proceeds without complications. Carry gestational diabetes, or diabetes of pregnant women, an arterial hypertension, hyper coagulation (increase of coagulability of blood), violation of work of heart, toxicosis to the most widespread, gestoz (it is characterized by increase of arterial pressure, emergence of hypostases, protein in urine), infections of urinary tract, not incubation or perenashivany pregnancies (a state at which pregnancy lasts more than 41 - 42 weeks), premature izlity amniotic waters, the child`s birth with the big body weight (more than 4000 g).
the Most dangerous complication is the preeklampsiya - the most severe form of a gestoz which main signs are increase of systolic pressure over 140 mm of mercury., diastolic pressure over 80 mm of mercury., and also a proteinuria (loss with urine more than 3 g of protein a day). Except above-mentioned symptoms signs of defeat of other systems and bodies can be observed: emergence of headaches, belly-aches, sight violation. At laboratory researches reveal increase of level of hepatic enzymes, changes in the curtailing system of blood.Obesity exerts
impact and on development of the child. It is known that folic acid plays a key role in formation of nervous system, and at obesity its exchange in an organism of the pregnant woman changes that can lead to development of defects of nervous system in a fruit.
Childbirth. At women with obesity not only pregnancy, but also childbirth proceed with a number of features that is caused by hormonal reorganizations. The internal system starting childbirth at such women by the end of pregnancy remains imperfect, and lack of formation of a patrimonial dominant (the excitement center in a brain) leads to a pregnancy perenashivaniye, and subsequently - to weakness of patrimonial activity which weight increases in proportion to obesity degree.
At weakness of the patrimonial activity which is not giving in to medicamentous correction, doctors are forced to resort to an operational rodorazresheniye (Cesarean section or imposing of obstetric nippers) to avoid sharp oxygen starvation at the newborn. But it is possible that need of operation of Cesarean section will be caused by discrepancy of the sizes of a basin of mother and a fruit as at pregnant women with obesity as it was already mentioned above, children with big body weight are born more often.
In turn, surgery is also accompanied by a large number of complications as expressiveness of a podkozhnozhirovy layer worsens healing of postoperative hems
you can get the smart scales analyzing the mass of fat, muscles, bones. During pregnancy these scales can be used only for weighing as they did not “learn“ to consider still the mass of a fruit, placenta, amniotic waters.
6 - 30% of women in labor with obesity at the time of delivery, and also in the postnatal period have a bleeding which reasons both violation of sokratitelny ability of a uterus, and change in the curtailing system of blood are.
Should be remembered also that the women having obesity are included into risk group of development of violations of a carbohydrate exchange, that is developing of diabetes therefore in 2 months after the delivery or after the termination of a lactation they need to pass inspection on determination of level of glucose in blood.
How to reduce risk?
Despite existence of a large number of complications, obesity is not contraindication to pregnancy. By preparation for conception the woman needs to consult not only with the obstetrician - the gynecologist, but also with the endocrinologist; throughout all pregnancy an indispensable condition is implementation of all recommendations of doctors.
First of all the woman has to control the weight. At pregnant women with normal body weight the body weight gain for pregnancy should not exceed 10 - 12 kg from which about 4 kg are the share of increase in mass of fatty tissue, and at pregnant women with obesity and the more so with obesity of heavy degree, the increase of body weight should not be more than 5 - 6 kg.
to Most of pregnant women with obesity already on the first visit to the obstetrician - the gynecologist needs to pass a test for tolerance (stability) to glucose. The test consists in determination of level of glucose of blood in 1 hour after intake of 50 g of glucose. At identification of violations it is necessary to adhere to a special diet, and in some cases the doctor can even appoint insulin injections.to
For decrease in excitability of the food center recommends frequent meal (8 - 6 times a day), at the same time the food has to be low-calorie, but occupy large volume in a stomach that promotes elimination of feeling of hunger. It is necessary to exclude from a diet the flavoring substances increasing excitability of the food center and increasing appetite (hot, salty dishes, broths) and also substances which quickly are soaked up and digested (confectionery, sweets, sweet fruit).
Protein content in a diet of the pregnant woman has to be sufficient, make 20% of a daily diet. The recommended share of fats makes about 30%, and carbohydrates - 50% of a daily diet. That is food has to be rational, it is not necessary to place emphasis only on meat or only on dairy products as well as only on vegetables and fruit, well and, of course, it is not necessary to abuse sweets. The menu of the pregnant woman has to be various: 6 - 11 parts in it make grain, 3 - 5 parts - vegetables, 2 - 4 parts - fruit, 3 - 5 parts - dairy products, 2 - 3 parts - meat products, bean or nuts, 1 part - sweets. The power value of a diet depends on IMT, but is on average equal to 2500 kcal a day.
to Women with obesity should reduce the power value of food, but no more than by 10%, otherwise the arriving food will not provide the normal growth and development of a fruit. It is necessary to notice that pregnant women with obesity cannot starve at all as at the same time there is a ketonemiya, that is in blood of the woman metabolism products - ketones, the exerting adverse impact on development of a fruit are found.to
Pregnant with obesity of 1 - 2 time a week recommends carrying out fasting days. Here some of them (the volume of the eaten food needs to be divided into 5 - 6 receptions).
Cottage cheese: in day eats 400 g of skim cheese, 2 - 3 glasses of tea without sugar (it is possible with a lemon) or dogrose broth are in addition allowed.
Apple: 1,5 kg of crude or baked apples. 2 glasses of tea without sugar are allowed.
Cucumber: 1,5 kg of fresh cucumbers, 2 glasses of tea without sugar. Caloric content of cucumbers is exclusively low (twice less, than cabbage and 3 times less, than apples).
Salad: salad from 1,2 - 1,5 kg of various crude vegetables (cabbage, a garden radish, carrots, salad, cucumbers) with addition of vegetable oil and 1 - 2 spoons of sour cream. > it is better for p to Begin
from cottage cheese day as cottage cheese creates more expressed feeling of satiety, than vegetables and fruit. For control of change of body weight it is useful to keep the schedule of results of systematic weighing.to
Besides limited on caloric content, but the balanced food, for prevention of excess adjournment of fat recommends remedial gymnastics which value consists in increase in energy consumption promoting mobilization of fat from depot. The set of exercises for pregnant women is selected individually depending on the term of pregnancy, obesity degree. During pregnancy it is necessary to remember that the main objective - not to reduce amount of fatty tissue, but not to gather additional, at the same time providing the normal growth and development of a fruit.