Global Journal of Medical Research, E: Gynecology and Obstetrics, Volume 21 Issue 3

We concluded then: “IOM-2009 recommendations are adequate for normal and over- weighted women but not for thin and obese women: a thin woman (17 kg/m²) should gain 21.6 ± 2 kg (instead of 12.5-18). An obese 32 kg/m² should gain 3.6 kg (instead of 5-9). Very obese 40 kg/m² should lose 6 kg.” [4] See Table 1. We have put an online calculator consultable on smart phone at REPERE.RE (REseau PErinatal REunion), in three languages (French, Spanish and English) [5], adapted to the Reunionese women. We encourage any reader to validate these findings adapted to their own populations (it is easy to do if you know the specific SGA/LGA curves of your term -37-42 weeks gestation- newborns). I. T he C ontroversies on G estational W eight G ain. [4] Knowing the optimal gestational weight gain (GWG, from conception to birth) among the annual 135 million of human pregnancies is considered to be one of the “Holy Grails” to achieve for maternity health care providers and for women themselves. Extensive literature exists on the subject with, in background, the current international cornerstone which is the 2009-IOM recommendations [6] based on the WHO-BMI classification standardized in 2000 [7]: Since then a lot of controversies aroused on these recommendations, for example Asian people claim that their women are leaner than Caucasians, and that the International recommendations are too low. On the other hand, for obese women, the major controversies concerns the debate if severe and morbid obese women should lose weight during their pregnancy [8-14] (our results suggest that it should be the case, see Table 1). We already extensively discussed these controversies in another paper [4]. II. L owering I mportant M aternal/fetal M orbidities by A chieving an O ptimal G estational W eight G ain (optGWG) We have recently retrospectively tested the effect of achieving optGWG (± 2kg) in our reunionnese population by a mathematical simulation on a 18 -year (2001-2018) [15] and 19-year historical cohort. (2001- 2019) [16] on 57,000, and then 59,000 term pregnancies. Achieving an optGWG in overweight-obese women should on the mother side almost halve the incidence of preeclampsia (major complication of human pregnancies, hypertension plus proteinuria) [15,16,17], diminish by some 30% the rate of caesarean sections and probably lower the rate of gestational diabetes mellitus (GDM) [16]. For newborns, while reaching a 10% rate of large for gestational age (the very definition of the linear equation), it would lower by 30 to 40% the rate of the harmful macrosomic babies (≥ 4 kg), prone to neonatal complications, and following morbidities in later life (cardiovascular diseases, obesity, type 2 diabetes, metabolic syndrome etc…) as well as tranfers of these babies in neonatal department [16]. Besides having significant health (and cost) benefits by lowering all these maternal/foetal complications, such interventions should convince and induce major changes of behaviour in these women during their pregnancies. III. P hysicians and H ealth W orkers’ F uture D ialogue with O verweight/obese W omen Women as they attempt to navigate pregnancy in a food environment that favors over-consumption of unhealthy foods and a world where the demands of life limit the amount of time available for physical activity. Therefore, it is well-known how it is difficult to make obese people losing weight (diet counselling, physical exercises etc…[2, 18-19 ]). We propose that the perspective to have a “newborn in good shape” may be that time highly motivating to women with obesity. If we take the example of a severe obese 36 kg/m² (see Table 1), she should not take any pound or kilogram during her pregnancy. After delivering the baby (and the placenta), she would lose some 10-15 kg as compared to her basic state before pregnancy. We have shown recently that very severe obese should even lose weight during their pregnancy [21]. These two very encouraging achievements (“good-shaped baby” and personal loss of weight) would probably motivate these women to extend the new behaviours acquired during pregnancy. IV. C onclusion Being overweight/obese may not have to result in a higher risk of developing important maternal/fetal morbidities by establishing targeted and strictly monitored interventions on adequate GWG. We have certainly an achievable pathway to actively counterbalance the morbid effects of high BMIs; an approach urgently requiring adequately powered prospective trials. Lowering by 30-40% such major complications like caesarean sections, late onset preeclampsia, and, concerning newborns the harmful 32 Year 2021 Global Journal of Medical Research Volume XXI Issue III Version I ( D ) E © 2021 Global Journals Women and Pregnancies as an Immediate Target against the Obesity Epidemic Obese pregnant women being somewhere “captive” of a 9-month follow-up management of the problem may be caught at the root. First of all, and very important: our calculator [5] does not classify women in “guilty categories” (underweight/normal weight/ overweight/obese class I/obese class II or III). It simply counsels to each single woman (considered simply as a single plot on a curve) a personal goal of gestational weight gain to possibly achieve to have a “newborn in good shape” (neither too small, nor too big) since the first prenatal visit in the first trimester of pregnancy.