Faculte de Medecine
~~
T
'T S E K I
BIBLIOTHEQUEll,..o CENTf\ALE
CORPULENCE MATERNELL E ET PREMATURITE
These en vue d'obtention d'un doctorat en Medecine
Prepare par : MIRY AM EL HELOU
Sous la direction de : Dr. M.C. F ADO US KHALIFE
Kaslik, Liban 2012
Soutenue le 4 Juin 2012 devant le jury compose de:
Dr M.C.F ADO US KHALIFE Directeur de these
Dr W. GHANAMEH President dujury
Dr M. EL AMM Rapporteur
Dr J. SAIBEH Me1nbre
Dr M. RAHAL Membre invite
Resume
Introduction:
La corpulence, le souci actuel de toute femme, est devenu recemment une source de debat entre les gynecologues et les femmes enceintes. C'est ainsi que certaines d'entre elles souffrent de surpoids ou d' obesite pendant leur grossesse aboutissant a plusieurs complications gestationnelles pouvant causer dommage a la mere ainsi qu'a son fretus, tel que le diabete gestationnel, I 'hypertension gravidique, la pre-eclampsie ...Alors que d'autres se laissent aller vers la maigreur qui elle-meme engendre des retentissements aussi graves sur la grossesse allant de la malnutrition et la carence vitaminique a l'anemie et meme au retard de croissance in utero.
Materiels et methodes:
Nous avons mene une etude prospective s'etalant de juillet 2011 jusqu'en mars 2012 au CHU-NDS, comprenant des femmes enceintes qui sont venues accoucher dans notre hopital. Leur poids est enregistre, les complications gestationnelles et le terme de leur accouchement.Une analyse statistique est effectuee par le programme SPSS en utilisant le test T et la correlation de Pearson.
Discussion:
Nos variables montrent qu'il n'y pas de relation statistique significative entre I' index de masse corporel matemel (IMC) au debut (pl = 0.230) eta la fin de la grossesse (p2= 0.729) des femmes libanaises etudiees et la survenue de prematurite. Cependant on a trouve une significativite entre la survenue de pathologies matemelles gestationnelles et la prematurite ; ainsi qu'une correlation faible mais positive entre un gain de plus que 10 kg pendant Ia grossesse et la naissance d'un plus gros bebe (p=0.048). L'age de lamere, contrairement ala litterature, ne s'est pas avere un facteur de risque de prematurite dans notre population.
Conclusion:
II s'avere plus important de coordonner les efforts entre gynecologues et specialistes de medecine fretale afin de prevenir les differentes pathologies survenant durant la grossesse, ou au moins, de les detecter precocement dans le but de limiter le taux de prematurite dans la population.Mots cles:
IMC, prematurite, pathologies de grossesse.Table des
matii~resPremiere Partie: Etude theorique
I. Introduction ... .... 11
II. Revue de la litterature ... . 11
II. 1. Resultats contradictoires de la litterature ... 11
IL2. Explications ... 12
III. Elaboration des differentes variables etudiees ... 13
III.l lndke de Masse Corporelle ... ... 14
HL 1.1. Classification ... 14
III.l.2. Outil de statistique ... ... ,16
III.1.3. Applications ... .. 16
IILI.3.1. L'obesite ... 17
III.l.3 .1.1. Les tacteurs de risques ... .... 17
III.l.3.1.2. Les complications ... 24
III .1 .3 .2. La Maigreur ... 26
III. 1.3 .2.1. F acteurs de risque ... . 26
Hl.l.3.2.2. Complications ... ... 27
HL 1.4. Limites de PIMC ... 29
IIL2. Prematurite ... . 30
III.2.1. Definition ... . 30
III.2.2. Causes des prematurites ... ... 30
III.2.2.1. Facteurs matemels ... .. 30
III.2.2.2. Facteurs gestationnels ... . 33
III.2.3. Complications des prematurites ... .. 35
II1.2.3 .1. Mortalite ... .. 35
IIL2.3 .2. Morbidite ... . 35
III.2.3.2.1. Complications
a
court terme . ... 36IIJ.2.3.2.2. Complications a long terme ... .41
Deuxieme partie : Etude Statistique I. Materiels et Methodes ... .. .42
II. Resultats ... ... 44
III. Discussion ... 50
IV. Conclusion generale ... . 54
BIBLIOGRAPHIE
1- Y ANOVSKl S, Y ANOVSKI J. Obesity Prevalence in the United States- Up, Down, or Sideways?, New England Journal of Medicine 201 1; 364:987- 989; March 17, 2011
2- LAURENS JA, BAUER CR. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics. Jan 2001;107(1):E1
3- The Association Between Pre-pregnancy BMI and Preterm Delivery in a Diverse Southern California Population q(Working Women, University of California, 2007 J University Hall, Berkeley, CA 94720-7360 USA
4- SMITH GC, PELL JP, DOBBIE R, Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study, BMJ,
2003;327:314
HENDLER I, GOLDENBERG RL, MERCER BM, IAMS JD, MEIS PJ, et al. The preterm prediction study: Association between maternal body mass index and spontaneous and indicated preterm birth. American Journal of Obstetrics and Gynecology. 2005;192(3):882-886.
6- SEBIRE NJ, JOLLY M, HARIS J, JOFF M, BEARD R, et al. Maternal obesity and pregnancy outcome: A study of287, 213 pregnancies in London.
International Journal qf Obesity and Related Metabolic Disorder.
2001;25(8):1175-1182. doi: 10.1038/sj.ijo.0801661.
7- CNATTIN S, BERGSTROM R, LIPWORTH L. Prepregnancy weight and the risk of adverse pregnancy outcomes. New England Journal of Medicine.
1998;338(3): 147-152. doi: 1 0.1056/NEJMl 998011533803
8- WEIS JL, MALON FD, BALL RH, COMSTOK CH, et al. Obesity, obstetric complications and cesarean delivery rate--a population-based screening study. American Journal of Obstetrics and Gynecology.
2004;190( 4): 1091-1097. doi: 1 0.1016/j.ajog.2003.09
9- BAETEN S, KOSA JL, PEARL M, GRAHAM S, GOODMAN J,
KHARRAZI M. Juggling work and breastfeeding: Effects of maternity leave and occupational characteristics. Pediatrics. 2009;123( 1 ):e38-e46. doi:
1 0.1542/peds.2008-2245
1 0- KUMAR! AS. Pregnancy outcome in women with morbid obesity.
International Journal ofGynaecology and Obstetrics. 2001;73(2):101-107.
doi: 1 0.10 16/S0020-7292( 00 )003 91
11- National Heart Lung and Blood Institute (NHLBI). ( 1998). Clinical guidelines on the identification, evaluation, and treatment of ovenveight and obesity in adults. National Heart Lung and Blood Institute (NHLBI).
12 - World Health Organization. ( 1998). Obesity-Preventing and managing the global epidemic. World Health Organization.
13- WHO. ( 1995). Physical status: The use and interpretation of
anthropometry. Report of a WHO Expert Committee. Geneva: World Health Organization.
14- VASAN RS, PENCINA MJ, COBAIN M, FREIBERG MS. Estimated risks for developing obesity in the Framingham Heart Study. Ann Intern Med.
2005;143:473-480
15- OMS, 1995, OMS, 2000 et OMS 2004.
16- DANIEL B, The worldwide obesity epidemic: a review, (a 15,000 years' unsolved disease), 1992-2007
17- DynaMed Editorial Team. Obesity in children and adults. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what.php. Updated June 23, 2010.
Accessed June 25,2010
18- MARTINEZ G, ALFREDO M, HU F, GIBNEY MJ, KEARNEY J.
Physical inactivity, sedentary lifestyle and obesity in the European Union, Department of Epidemiology and Public Health, University of Navarra, Pamplona, Spain, Department of Physiology and Nutrition, University of Navarra, Pamplona, Spain, Department of Nutrition, Harvard School of Public Health, Boston, MA USA, Institute of European Food Studies, Trinity College, Dublin, Ireland Benefits and risks of physical activity for pregnant women, Riva Rahl, MD., USA.,2004 Feb 9; 164(3):249-5
19- Lithium: The First Mood Stabilizer, Part 4: Why Does Lithium Cause Weight Gain? Marcia Purse, October 11, 2010, Health's Disease and Condition reviewed by the Medical Review Board
20- Obesity and the facts, New Study Questions True Prevalence of Childhood Obesity, Health Survey for England 2003, Department of Health, Oxford- based Social Issues Research Centre, December 14th 2004.
21- MANDES E, Obesity Peaks in Middle Age, Washington D.C., August 31, 2010
22- JAMMES WPT, TRA YHUM P, An integrated view of the metabolic and genetic basis for obesity, Lancel II(7989): 770-772, 1977
23- JAMMES WPT, TRA YHUM P, Genetic component of obesity, Lancel
~8012):653-654, 1977
24- GRUEN RK, GREENWOOD MR., Early development and maintenance of obesity: environmental and genetics factors. In. Controversies in obesity, NY. 1 983.pp58-90
25- WILLIAM RR, The role of genetic analysis in characterizing obesity, Int J. Obes 8(5): 551-559, 1984
26- STUNKARD AJ, An adoption study of human obesity., N Engl J Med314(4): 193-198,1986
27- MANDES E, Obesity Peaks in Middle Age, Washington D.C., August 31, 2010
28- COLDITZ GA, WILLET WC, MANSON JE., Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995; 122:481-
6.
29- CHAN JM, RIMM EB, COLDITZ GA, STAMP FER MJ. Obesity and fat distribution and weight gain as risk factors for clinical diabetes in men.
Diabetes Care 1994;17:961-9.
30- KNOWLER WC, PETTITT DJ, SAAD MF, CHARLES MA, NELSON RG, HWARD BV, et al. Obesity in the Pima Indians: its magnitude and relationship to diabetes. AmJ Clin Nutr 1991;53: 15438-53.
31- EZZATI M, LOPEZ AD, RODGERS A, MURRAY CJL, KALAMARA E, SHA YEGI M, RIGBY NJ, et al. Overweight and obesity (high body mass index). In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, editors.
Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors,. vol. 1. Geneva: WHO;
2004. p. 497-596.
32- DIETL J. Maternal obesity and complications during pregnancy. J Perinat 1\;/ed 2005; 33:100-5
33- PubMed.gov: Oxidative Stress and Immune Response in Eumenorrheic Underweight Patients, 2006
34- ROBINSON S, Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London, British Journal of Obstetrics and Gynaecology. January 2001, VoL 108, pp. 61±66
35- WRO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia: Melbourne, 2000.
36- JAMES WPT, INOUE S. Appropriate Asian body mass index, Obesity Review, 2002; 3:139.
37- WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The
Lancet, 2004; 157-164.
38-
MARTIUS JA, STECK T, OEHLER MK, WULF KH (1998). "Risk factors associated with preterm and early preterm birth : univariate andmultivariate analysis of 106 345 singleton births from the 1994 statewide perinatal survey of Bavaria". European Journal of Obstetrics & Gynecology and Reproductive Biology 80 (2): 183-188.
39- COLBERT JF, lAMS JD, ROMERO R (2008). "Epidemiology and causes ofpreterm birth". The Lancet 371 (9606): 75-84.
40- Merck 0. "Risk factors present before pregnancy". Merck Manual Home Edition. Merck Sharp & Dohme.
http://www.merck.com/mmhe/sec22/ch258/ch258b.html.
4 I-HEINZ I, MERCER BM, et al. (2005). "The preterm prediction study:
association between maternal body mass index (BMI) and spontaneous preterm birth11• American Journal of Obstetrics & Gynecology 192 (3): 882- 888.
42-GOLD JD, MERCER BM, et al. (1998). "The preterm prediction study:
the value of new vs standard risk factors in predicting early and all
spontaneous preterm births. NICHD MFMU Network". American Journal of Public Health 88 (2): 233-238.
43- TOMS, SKENTOU CA, ROYSTON P, NICOLAIDES KH (2006).
"Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study". Ultrasound in Obstetrics & Gynecology 27 (4): 362-369.
44- FONSECA EB, CELIK E, PARRA M, SINGH M, Fetal Medicine
Foundation Second Trimester Screening Group (2007). "Progesterone and the risk of preterm birth among women with a short cervix". New England
Journal ofMedicine 357 (5): 462-469.
45- ROMERO R (2007). "Prevention of sponatneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from
progesterone treatment". Ultrasound in Obstetrics & Gynecology 30 (5): 675- 688.
46- ANCIEN P (1993). "Reproductive performance of women with uterine malformations". Human Reproduction 8 (1): 122-126.
4 7 -MERCER BM, MOA WAD AH, et al. ( 1999). "The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome". American Journal of Obstetrics & Gynecology 181 (5 Pt
1): 1216-1231.
48- WINKVIST A, MORGAN I, HOGBERG U (1998). "Familial patterns in birth characteristics: impact on individual and population risks". International Journal of Epidemiology 27 (2): 248-256
49- PORTER TF, FRASER AM, HUNTER CY, WARD RH, VARNER WM ( 1997). "The risk of preterm birth across generations". Obstetrics &
Gynecology 90 (1): 63-67.
50- BHATT ARSHA Y S, AMALRAJ R, RUIZ E, CAMPBELL M, (20 1 0).
"Inherited Predisposition to Spontaneous Preterm Delivery". Obstetrics &
Gynecology 115 (6): 1125.
51- Gardner MO, Goldenberg RL, Cliver SP, Tucker JM, Nelson KG, Copper RL ( 1995). "The origin and outcome of preterm twin pregnancies". Obstetrics
& Gynecology 85 (4): 553-557.
52- BANHIDY F, PUHO EH, CZEIZEL AE (2007). "Pregnancy
complications and birth outcomes of pregnant women with urinary tract infections and related drug treatments". Scandinavian Journal of Irifectious Diseases 39 (5): 390-398.
53·- ROSE TJ, GARBERS, LIPKIND H, CHIASSON MA (2005). "Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes:
differences among 4 racial/ethnic groups". American Journal ofPublic Health 95 (9): 1545-1562.
54- KRUPA FG, FALTIN D, CECATTI JG, SURITA FG, SOUZA JP (2006).
"Predictors ofpretenn birth". International Journal of Gynecology &
Obstetrics 94 ( 1 ): 5-12.
55- SHIONO PH, KLEBANOFF MA, NUGENT RP, COTCH MF, WILKINS DG, ROLLINS D, CAREY C, BEHRMAN R (1995). "Fetus-Placenta-
Newborn: the Impact of Cocaine and Marijuana Use on Low Birth Weight and Preterm Birth: a Multicenter Study". American Journal of Obstetrics &
Gynecology 172 (1 Pt 1 ): 19-26.
56- PARAZZINI F, CHATENOUD L, SURACE M, TOZZI L, SALERIO B, BETTON! G (2003). "Moderate Alcohol Drinking and Risk ofPreterm Birth".
European Journal of Clinical Nutrition 57 (10): 1344.
57- DOLA SM, GROSS S, MERKATZ R, et al. (2007). "The Contribution of Birth Defects to Preterm Birth and Low Birth Weight". Obstetrics &
Gynecology 110: 318-334.
58- HAUTH JC, ANDREWS W (2000). "Intrauterine infection and preterm delivery". New England Journal of Medicine 342 (20): 1500-1507.
59- "Reducing Perinatal and Neonatal Mortality". Child Health Research Project Special Report. 1999.
http://www .reproline.jhu.edu/ english/2mnh/perinatal. pdf theis.
60- MATHEW TJ, MCDORMAN MF (2006). "Infant Mortality Statistics from the 2003 Period Linked Birth/Infant Death Data Set". National Vital Statistics Reports 54 (16).
61- EICHENHARK EC, Stark AR. Management and outcomes of very low birth weight. N Engl J Med 2008; 358:1701.
62- American Academy ofPediatrics Section on Opthalmology. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2001;108:809-811
63-MICHAEL I. The mode of development of the vascular system of the retina with some observations in its significance for certain retinal diseases. Trans Ophthalmol Soc UK 1948;68:137-180.
64-ASHTON N, \V ARD B, SERPELL G. Effect of oxygen on developing retinal vessels with particular reference to the problem of retrolental fibroplasias. Br J Ophthalmol1954;38:397-432.
65- ROBERTSON CM, HOWARTH TM, BORK DL. Permanent bilateral sensory and neural hearing loss of children after neonatal intensive care because of extreme prematurity: a thirty-year study. Pediatrics. May 2009; 123(5):e797 -807.
66- VOHR BR, MSALL ME. Neuropsychological and functional outcomes of very low birth weight infants. Semin Perinatal. Jun 1997;21(3):202-20.
67- KHASHAN AS, KENNY LC. The effects of maternal body mass index on pregnancy outcome. European Journal of Epidemiology. 2009;24(11 ):697- 705. doi: 10.1 007/s1 0654-009-9373
