Targeting pregnancy as a time to treat obesity

Abstract

Maternal obesity is recognized as one of the largest contributors to compromised health during pregnancy. Lifestyle interventions in obese pregnant women may be able to reduce gestational weight gain (GWG) but have shown limited success in improving pregnancy and neonatal outcomes. Lack of statistical power, poor compliance and inconsistency in inclusion BMI and setting across studies may be some of the reasons. Since pregestational BMI is the single most important predictor of obesity-related complications, the metabolic profile in the first trimester of pregnancy may play a very important role. Observational studies have shown that interpregnancy weight loss reduces the risk of macrosomia in a subsequent pregnancy. Future lifestyle randomized controlled trials should target the prepregnant state and examine the effect on maternal and neonatal outcomes.

Keywords:

• gestational weight gain
• interpregnancy
• intervention
• lifestyle
• obesity
• pregnancy
• RCT

Financial & competing interests disclosure

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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Maternal obesity is recognized as one of the largest contributors to compromised health during pregnancy.

• Overweight and obesity affect about 50% of women entering pregnancy in developed countries.

• Obesity increases the risk of gestational diabetes, preeclampsia, preterm birth, stillbirth and macrosomia.

• Lifestyle intervention trials in pregnancy have been shown to reduce gestational weight gain (GWG).

• Limited success of such lifestyle intervention trials was found on clinical pregnancy and neonatal outcomes.

• Results from large ongoing lifestyle intervention trials in pregnancy, and individual patient data meta-analyses are still awaited.

• Follow-up in the offspring of mothers participating in lifestyle intervention trials in pregnancy are important to demonstrate the impact and safety on long-term outcomes.

• Early maternal metabolic conditions program placental function and gene expression from the time of conception.

• Future intervention trials in prepregnant obese women are needed to examine the effect on maternal and neonatal outcomes in a subsequent pregnancy.