ภาวะน้ำหนักเกินและอ้วนในสตรีตั้งครรภ์: บทบาทที่ท้าทายของพยาบาลผดุงครรภ์
คำสำคัญ:
ภาวะน้ำหนักเกินและอ้วน, ประเด็นปัญหา, บทบาท, ผดุงครรภ์บทคัดย่อ
ภาวะน้ำหนักเกิน (Overweight) และอ้วน (Obesity) หมายถึง การสะสมของไขมันส่วนเกินที่ทำให้เกิดภาวะเสี่ยงต่อสุขภาพ1 ปัจจุบันภาวะน้ำหนักเกิน และอ้วนในสตรีวัยเจริญพันธุ์ได้กลายเป็นปัญหาสุขภาพที่สำคัญ ทั้งในระดับโลก และ ระดับประเทศ จากการสำรวจในปี ค.ศ. 2015-2016 พบสตรีวัยเจริญพันธุ์ชาวอเมริกันที่อายุมากกว่า 20 ปีขึ้นไป มีค่าดัชนีมวลกายเฉลี่ยเท่ากับ 29.6 กก./ม2 และมีภาวะอ้วน ร้อยละ 41.12 สอดคล้องกับการศึกษาของสตรีตั้งครรภ์ในแถบทวีปยุโรป พบอุบัติการณ์สตรีตั้งครรภ์ที่มีน้ำหนักเกิน และอ้วน คิดเป็นร้อยละ 33 และ 50 ตามลำดับ3 สำหรับประเทศไทย จากการสำรวจสุขภาพของประชากรไทย ของกรมควบคุมโรค กระทรวงสาธารณสุข พบอุบัติการณ์ของภาวะอ้วน (BMI ≥25 กก./ม2) ในประชากรเพศหญิงที่มีอายุตั้งแต่ 15 ปีขึ้นไป มีแนวโน้มเพิ่มขึ้นอย่างชัดเจน จากร้อยละ 40.7 ในปี 2552 เป็นร้อยละ 41.8 ในปี 25574 สอดคล้องกับการศึกษาสตรีตั้งครรภ์ที่มาฝากครรภ์ที่โรงพยาบาลศิริราชและโรงพยาบาลราชวิถีที่พบว่า มีน้ำหนักเกิน และอ้วน คิดเป็นร้อยละ 11.5-13 และ 3.15-4 ตามลำดับ5,6 สตรีตั้งครรภ์ที่มีน้ำหนักเกิน และอ้วนส่วนใหญ่มีน้ำหนักเพิ่มขึ้นขณะตั้งครรภ์เกินเกณฑ์ จากการศึกษาในกลุ่มสตรีตั้งครรภ์ในประเทศสหรัฐอเมริกา พบสตรีตั้งครรภ์ที่มีน้ำหนักเกิน และอ้วน มีน้ำหนักเพิ่มขึ้นขณะตั้งครรภ์เกินเกณฑ์ ร้อยละ 64.17 ในขณะที่ประเทศไทย พบสตรีตั้งครรภ์ที่มีน้ำหนักเกินและอ้วน มีน้ำหนักเพิ่มขึ้นขณะตั้งครรภ์เกินเกณฑ์ ร้อยละ 66.78
ปัจจุบันภาวะน้ำหนักเกิน และอ้วน เป็นปัญหาสาธารณสุขที่ทั่วโลกต่างให้ความสนใจ เนื่องจากเป็นสาเหตุหลักของการก่อให้เกิดกลุ่มโรคไม่ติดต่อเรื้อรัง (Non-Communicable Diseases: NCDs) ซึ่งเป็นสาเหตุการเสียชีวิตอันดับหนึ่งของประเทศ กลุ่มโรค NCDs เป็นโรคที่ป้องกันได้เมื่อมีพฤติกรรมสุขภาพที่ดี บทความนี้มีวัตถุประสงค์เพื่อนำเสนอปัญหาภาวะน้ำหนักเกิน และอ้วน สาเหตุของภาวะน้ำหนักเกินและอ้วน ในสตรีวัยเจริญพันธุ์และสตรีตั้งครรภ์ ผลกระทบต่อสุขภาพของสตรีและทารกตั้งแต่ระยะก่อนการตั้งครรภ์ ระยะตั้งครรภ์ ระยะคลอด จนกระทั่งระยะหลังคลอด รวมทั้งบทบาทของพยาบาลผดุงครรภ์ในการประเมิน ให้คำแนะนำ ดูแล ป้องกัน และควบคุมน้ำหนัก เพื่อส่งเสริมสุขภาพสตรีที่มีภาวะน้ำหนักเกินและอ้วน ตั้งแต่ระยะก่อนการตั้งครรภ์ จนกระทั่งระยะหลังคลอดให้มีคุณภาพชีวิตที่ดีต่อไป
References
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23. Ma RCW, Schmidt MI, Tam WH, McIntyre HD, Catalano PM. Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum. The lancet Diabetes & endocrinology. 2016;4(12):1037-49. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/27743977/
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25. Fallatah AM, Babatin HM, Nassibi KM, Banweer MK, Fayoumi MN, Oraif AM. Maternal and Neonatal Outcomes among Obese Pregnant Women in King Abdulaziz University Hospital: A Retrospective Single-Center Medical Record Review. Medical archives (Sarajevo, Bosnia and Herzegovina). 2019;73(6):425-32. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/32082014/
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2. Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. StatPearls. Treasure Island (FL): StatPearls Publishing
Copyright © 2020, StatPearls Publishing LLC.; 2020. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/31082114/
3. Flannery C, McHugh S, Kenny LC, O’Riordan MN, McAuliffe FM, Bradley C, et al. Exploring obstetricians’, midwives’ and general practitioners’ approach to weight management in pregnant women with a BMI ≥ 25 kg/m2: a qualitative study. BMJ open. 2019;9(1). Available from https://bmjopen.bmj.com/content/9/1/e024808.abstract
4. Sunsaneevithayakul P, Titapant V, Ruangvutilert P, Sutantawibul A, Phatihattakorn C, Wataganara T, et al. Relation between gestational weight gain and pregnancy outcomes. Journal of Obstetrics and Gynaecology Research. 2014;40(4):995-1001. Available from https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/jog.12293
5. Hanprasertpong T. Overweight and Obesity in Pregnancy. Thai Journal of Obstetrics and Gynaecology. 2020:2-5. Available from https://he02.tci-thaijo.org/index.php/tjog/article/view/227069
6. Deputy NP, Sharma AJ, Kim SY, Hinkle SN. Prevalence and characteristics associated with gestational weight gain adequacy. Obstetrics and gynecology. 2015;125(4):773. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425284/
7. Devlieger R, Ameye L, Nuyts T, Goemaes R, Bogaerts A. Reappraisal of Gestational Weight Gain Recommendations in Obese Pregnant Women: A Population-Based Study of 337,590 Births. Obesity Facts. 2020;13(4):333-48. Available from https://www.karger.com/Article/PDF/508975
8. Pongcharoen T, Gowachirapant S, Wecharak P, Sangket N, Winichagoon P. Pre-pregnancy body mass index and gestational weight gain in Thai pregnant women as risks for low birth weight and macrosomia. Asia Pacific journal of clinical nutrition. 2016;25(4):810-7. Available from http://apjcn.nhri.org.tw/server/APJCN/25/4/810.pdf
9. WHO. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England). 2004;363(9403):157-163. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/14726171/
10. Institute of Medical Research and Technology Assessment, Department of Medical Services, Ministry of Public Health. Clinical practice guideline: Prevent and treatment of obesity. Bangkok: The Agricultural Co-operative Federation of Thailand, LTD; 2010.
11. Rasmussen KM, Yaktine AL. Weight gain during pregnancy : reexamining the guidelines: IOM (Institute of Medicine) and NRC (National Research Council), Washington, DC; 2009.
12. Ukah UV, Bayrampour H, Sabr Y, Razaz N, Chan W-S, Lim KI, et al. Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013. PLoS medicine. 2019;16(12):e1003009. Available from https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003009
13. Gettong N, Rujiraprarert N. The Relationships between knowledge about Overweight During
Pregnancy, Perceived Self-Efficacy and Health behaviors among Pregnant Women with Overweight. Srinagarind Med J. 2018;33(2):129-35. Available from http://www.smj.ejnal.com/e-journal/showdetail/?show_detail=T&art_id=2239
14. Loh AZH, Oen KQX, Koo IJY, Ng YW, Yap JCH. Weight management during pregnancy: a qualitative thematic analysis on knowledge, perceptions and experiences of overweight and obese women in Singapore. Global health action. 2018;11(1):1499199. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/30079824/
15. Relph S, Ong M, Vieira MC, Pasupathy D, Sandall J. Perceptions of risk and influences of choice in pregnant women with obesity. An evidence synthesis of qualitative research. PloS one. 2020;15(1):e0227325. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/31899773/
16. Whitaker KM, Wilcox S, Liu J, Blair SN, Pate RR. African American and White women׳s perceptions of weight gain, physical activity, and nutrition during pregnancy. Midwifery. 2016;34:211-20. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/26612000/
17. Pinitlertsakun O, Limruangrong P, Sinsuksai N, Boriboonhirunsarn D. A Self-Regulation Program on Dietary Consumption, Exercise, and Weight Gain for Overweight and Obese Pregnant Women. NURS SCI J THAIL. 2019;37(2):26-42.
18. Gordon NP, Banegas MP, Tucker-Seeley RD. Racial-ethnic differences in prevalence of social determinants of health and social risks among middle-aged and older adults in a Northern California health plan. PloS one. 2020;15(11):e0240822. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/33147232/
19. Lindsay AC, Wallington SF, Greaney ML, Tavares Machado MM, De Andrade GP. Patient-Provider Communication and Counseling about Gestational Weight Gain and Physical Activity: A Qualitative Study of the Perceptions and Experiences of Latinas Pregnant with their First Child. International journal of environmental research and public health. 2017;14(11). Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/29156548/
20. Paulino DS, Surita FG, Peres GB, do Nascimento SL, Morais SS. Association between parity, pre-pregnancy body mass index and gestational weight gain. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2016;29(6):880-4. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/25758613/
21. Dutton H, Borengasser SJ, Gaudet LM, Barbour LA, Keely EJ. Obesity in Pregnancy: Optimizing Outcomes for Mom and Baby. The Medical clinics of North America. 2018;102(1):87-106. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/29156189/
22. Mariona FG. Perspectives in obesity and pregnancy. Women's health (London, England). 2016;12(6):523-32. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/29334009/
23. Ma RCW, Schmidt MI, Tam WH, McIntyre HD, Catalano PM. Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum. The lancet Diabetes & endocrinology. 2016;4(12):1037-49. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/27743977/
24. Sun Y, Shen Z, Zhan Y, Wang Y, Ma S, Zhang S, et al. Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications. BMC pregnancy and childbirth. 2020;20(1):390. Available from https://pubmed-ncbi-nlm-nih-gov.ejournal.mahidol.ac.th/32631269/
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