Second Nordic Congress on Obesity in Gynecology and Obstetrics (<scp>NOCOGO</scp>)

摘要

About 200 experts, researchers and clinicians attended the 3-day 2nd Nordic Congress on Obesity in Gynecology and Obstetrics (NOCOGO) held at Hindsgavl Conference Center in Middelfart, Denmark, from 27 to 29 August 2015. Speakers and delegates attended from 20 different countries, mainly from the Nordic region, but also from the UK, Australia, Belgium, Netherlands, Germany, Austria, the USA, China and Egypt. The primary aim of the NOCOGO conference was to assemble experts in obstetrics and gynecology and related areas with an interest in obesity to provide an update on research, to discuss current knowledge as well as knowledge gaps, and to explore the evidence so that we could adjust our clinical approach to obese patients and their offspring. This is also relevant for future generations. The focus of NOCOGO was on the epidemiology of obesity globally and its influence on the pre-conceptional environment, on lifestyle interventions during pregnancy, challenges in communicating with obese women within the field of obstetrics and gynecology, on pre-gestational counseling, reproductive medicine, antenatal care, parturition, perinatal medicine, and polycystic ovarian syndrome (PCOS). Obesity from the perspective of anesthetists and neonatologists was also presented. The presentations were followed by discussions as well as “walk and talk” sessions and pro and con debates on hot topics such as: (i) weight management in pregnancy; (ii) discussions on whether there should be a BMI limit for fertility treatment and (iii) a debate on bariatric surgery and psychological treatment. There were 47 abstracts selected for poster presentations and 12 for oral presentations. Philip James (UK) set the scene with an overview of the globesity epidemic. While obesity rates continue to rise worldwide, it is the increase in the morbidly obese in high-income as well as in middle- and low-income countries that causes the greatest concern. Globally, 74 million people are obese and 287 million are overweight. In less than one generation, worldwide, the prevalence of overweight and obese children has risen substantially. In the USA, one-third of the country's children are overweight or obese and some low- and middle-income countries have reported similar or more rapid rises in childhood obesity, despite continuing high levels of undernutrition. Dr. James emphasized that the obesity epidemic will continue unless policies are introduced to reduce calorific intake from sugar and fat together with spontaneous increases in physical activity. Although obesity reflects, in his opinion, a failure of the free market, it has at the same time become a commercial success. Sven Cnattingius (Sweden) addressed the epidemiology of maternal obesity, preterm birth (PTB) and infant mortality. Severe obesity is associated with an increased risk of PTB and, due to pregnancy complications, obesity increases the risk of medically induced PTB. Data from the Swedish Medical Birth Register indicate that the risk of medically indicated extremely PTB (<27 weeks), very early PTB (28–31 weeks) and moderate PTB (32–36 weeks) increases directly with a rising maternal BMI. Infant mortality rates increase from 2.4/1000 in normal weight women (BMI 18.5–24.9 kg/m2) to 5.8/1000 in women with obesity grade III (BMI ≥40.0 kg/m2) and maternal BMI is related to infant mortality at term due to birth asphyxia. From the Danish National Birth Cohort, Ellen Nøhr (Denmark) presented data on the long-term consequences of maternal obesity focusing on maternal health 12–15 years after childbirth. This demonstrated an increased risk of hypertension associated with a pre-gestational BMI of ≥22 kg/m2, and a six- to eight-fold increased risk in extremely obese women. A two- to four-fold increased risk was seen in autoimmune diseases such as sarcoidosis, psoriasis, Type 1 diabetes and Crohn′s disease and in all BMI groups both excessive gestational weight gain (GWG) as well as high postpartum weight retenti