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Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes
Open accessAbstract
Obesity during pregnancy is associated with an increased risk of short- and long-term metabolic dysfunction in the mother and her offspring. Both higher maternal pregravid body mass index (kg m(-2)) and excessive gestational weight gain (GWG) have been associated with adverse pregnancy outcomes such as gestational diabetes, preeclampsia and fetal adiposity. Multiple lifestyle intervention trials consisting of weight management using various diets, increased physical activity and behavioral modification techniques have been employed to avoid excessive GWG and improve perinatal outcomes. These randomized controlled trials (RCTs) have achieved modest success in decreasing excessive GWG, although the decrease in GWG was often not within the current Institute of Medicine guidelines. RCTs have generally not had any success with decreasing the risk of maternal gestational diabetes (GDM), preeclampsia or excessive fetal growth often referred to as macrosomia. Although the lack of success for these trials has been attributed to lack of statistical power and poor compliance with study protocols, our own research suggests that maternal pregravid and early pregnancy metabolic condition programs early placenta function and gene expression. These alterations in maternal/placental function occur in the first trimester of pregnancy prior to when most intervention trials are initiated. For example, maternal accrural of adipose tissue relies on prior activation of genes controlling lipogenesis and low-grade inflammation in early pregnancy. These metabolic alterations occur prior to any changes in maternal phenotype. Therefore, trials of lifestyle interventions before pregnancy are needed to demonstrate the safety and efficacy for both the mother and her offspring.
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“Several other lifestyle factors appear to interact with diet to influence adiposity. These include TV watching, sleep duration, circadian alignment, and possibly maternal-fetal (e.g., placental) influences.28, 41, 67-70”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [70]
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Metadata
- Authors
- Catalano, P., & deMouzon, S. H.
- Affiliations
- MetroHealth Medical Center (US)
- Corresponding author
- Catalano, P
- ORCID
- Catalano, P
- Venue
- International Journal of Obesity
- Published
- 2015-02-05
- Volume
- 39
- Issue
- 4
- Pages
- 642-649
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- PMC
- PMC4700513
- OpenAlex
- W2055861509
- Cited by
- 243
- References
- 80
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 10 · 2023: 16 · 2022: 27 · 2021: 22 · 2020: 30 · 2019: 28 · 2018: 24 · 2017: 26 · 2016: 27 · 2015: 9
- FWCI
- 4.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Obesity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000439)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD-22965-19, R01HD022965)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- maternal obesity, gestational weight gain, lifestyle intervention, gestational diabetes mellitus, preeclampsia, macrosomia, fetal adiposity, placental function, early pregnancy, lipogenesis, low-grade inflammation, placental gene expression
- MeSH terms
- Adult, Birth Weight, Blood Glucose, Body Composition, Female, Humans, Male, Mothers, Obesity, Pregnancy, Pregnancy Complications, United States, Weight Gain, Body Mass Index, Randomized Controlled Trials as Topic, Diabetes, Gestational, Risk Reduction Behavior
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