Maternal overweight and obesity during pregnancy: strategies to improve outcomes for women, babies, and children

ABSTRACT

Introduction

Women with overweight and obesity, and their children, are at increased risk of adverse pregnancy, birth, and longer term health outcomes, believed to be compounded by excessive gestational weight gain (GWG). Research to date has focused on interventions to reduce excessive GWG through changes to maternal diet and/or lifestyle.

Areas covered

Current clinical recommendations for GWG vary according to a woman’s early pregnancy body mass index, based on assumptions that associations between GWG and adverse pregnancy outcomes are causal in nature, and modifiable. While there are small differences in GWG following pregnancy interventions, there is little evidence for clinically relevant effects on pregnancy, birth, and longer term childhood outcomes. This review considers interventional studies targeting women with overweight or obesity to reduce GWG in an effort to improve maternal and infant health, and the current evidence for interventions prior to conception.

Expert opinion

GWG is not modifiable via diet and lifestyle change, and continued efforts to find the ‘right’ intervention for women with overweight and obesity during pregnancy are unjustified. Researchers should focus on gathering evidence for interventions prior to pregnancy to optimize maternal health and weight to improve pregnancy, birth, and longer term health outcomes associated with obesity.

KEYWORDS:

• Childhood obesity
• prevention
• dietary and lifestyle intervention
• preconception intervention for obesity
• pregnancy affected by overweight and obesity
• randomized controlled trials

Article highlights

• Women with overweight and obesity, and their infants, are at increased risk of adverse pregnancy, birth, and longer term health outcomes.

• This risk of adverse outcomes is compounded by excess gestational weight gain.

• Interventions to prevent excess gestational weight gain have been ineffective, with clinically insignificant effect on weight gain and no effect on important clinical outcomes in pregnancy, birth, and longer term health.

• Research focus should move toward evaluation of interventions prior to conception and the pregnancy, birth, and longer term health outcomes.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by the National Health and Medical Research Council of Australia (Investigator Grant ID 1196133).