Maternal and Child Obesity: The Causal Link

Implications of maternal obesity on fetal growth and the role of ultrasound

Over fifty percent of women entering pregnancy are overweight or obese. This has a significant impact on short and long term maternal and infant health outcomes, and the intergenerational effects of obesity are now a major public health problem globally. Areas covered: There are two major pathways contributing to fetal growth. Glucose and insulin directly affect growth, while other substrates such as leptin, adiponectin and insulin-like growth factors indirectly influence growth through structural and morphological effects on the placenta, uteroplacental blood flow, and regulation of placental transporters. Advances in ultrasonography over the past decade have led to interest in the prediction of the fetus at risk of overgrowth and adiposity utilizing both standard ultrasound biometry and fetal body composition measurements. However, to date there is no consensus regarding the definition of fetal overgrowth, its reporting, and clinical management. Expert commentary: Maternal dietary intervention targeting the antenatal period appear to be too late to sufficiently affect fetal growth. The peri-conceptual period and early pregnancy are being evaluated to determine if the intergenerational effects of maternal obesity can be altered to improve newborn, infant and child health.

Relationship Between Excessive Gestational Weight Gain and Neonatal Adiposity in Women With Mild Gestational Diabetes Mellitus

OBJECTIVE

To evaluate the relationships among excessive gestational weight gain, neonatal adiposity, and adverse obstetric outcomes in women with mild gestational diabetes mellitus.

METHODS

This is a secondary analysis of a multicenter randomized clinical trial of women with mild gestational diabetes mellitus. Based on self-reported prepregnancy body weight, gestational weight gain was categorized as excessive if it was greater than 2009 Institute of Medicine guidelines. Maternal outcomes and neonatal anthropomorphic characteristics were compared between women with excessive weight gain and those without excessive weight gain. Multiple linear and logistic regression analyses were performed to adjust for confounding factors.

RESULTS

We studied 841 women who participated in the main trial and had prepregnancy body mass index (BMI) and delivery information available (n=431 treatment group, n=410 no treatment). After adjustment for factors including treatment and prepregnancy BMI, excessive weight gain remained associated with large for gestational age (adjusted odds ratio [OR] 2.94, 95% confidence interval [CI] 1.81-4.93), birth weight greater than 4,000 g (adjusted OR 2.56, 95% CI 1.54-4.40), preeclampsia (adjusted OR 2.96, 95% CI 1.35-7.03), and cesarean delivery for labor arrest (adjusted OR 2.37, 95% CI 1.30-4.44). In addition, excessive weight gain was independently associated with increased total neonatal fat (P<.001) and birth weight (P<.001).

CONCLUSION

In women with both treated and untreated mild gestational diabetes mellitus, excessive gestational weight gain was independently associated with both greater birth weight and adiposity.

Maternal obesity and prenatal programming

Obesity is a significant and increasing public health concern in the United States and worldwide. Clinical and epidemiological evidence clearly shows that genetic and environmental factors contribute to the increased susceptibility of humans to obesity and its associated comorbidities; the interplay of these factors is explained by the concept of epigenetics. The impact of maternal obesity goes beyond the newborn period; fetal programming during the critical window of pregnancy, can have long term detrimental effects on the offspring as well as future generations. Emerging evidence is uncovering a link between the clinical and molecular findings in the offspring with epigenetic changes in the setting of maternal obesity. Research targeted towards reducing the transgenerational propagation and developmental programming of obesity is vital in reducing the increasing rates of disease.

Childhood body mass is positively associated with cesarean birth in Yucatec Maya subsistence farmers

OBJECTIVE

The epidemiologic link between cesarean birth and childhood obesity is unresolved, partly because most studies come from industrialized settings where many post-birth factors affect the risk for obesity. We take advantage of an unusual ethnographic situation where hospital and cesarean birth modes have recently been introduced among Yucatec Maya subsistence farmers, but young children have had minimal exposure to the nutritional transition. While we expect to find very low rates of childhood obesity, we predict that cesarean-born children will be larger and heavier than vaginally born children.

METHODS

Weight and height were collected monthly on 108 children aged 0-5 (3576 observations total). Birth mode and birthweight were collected by maternal interview. Data were analyzed using linear mixed models that compare child growth [Maya population-specific Z-scores for weight-for-age and body mass index-for-age (WAZ and BMIZ)] in cesarean and vaginally born children aged 0-5 years.

RESULTS

The cesarean rate was 20%, no children were obese, and 5% were overweight. Cesarean birth was a significant predictor of child WAZ and BMIZ after accounting for maternal effects, child birthweight, and sex. Children who were born by cesarean to mothers with high BMI had the highest WAZ of all children by 5 years of age, and the highest BMIZ of all children at all ages.

CONCLUSION

Cesarean-born Maya children had higher BMI than vaginally born children, even in the absence of many known confounding factors that contribute to childhood obesity. Child growth was most sensitive to birth mode when mothers had high BMI.

Healthy gestational weight gain prevalence and associated risk factors: A population-based study in the far South of Brazil

ABSTRACT Objective To measure and identify the factors associated with healthy weight gain during pregnancy in the municipality of Rio Grande, Rio Grande do Sul, Brazil. Methods This was a population-based, cross-sectional study that included all parturient women from the municipality who gave birth at its maternity hospitals in 2013. Information was collected by interview with the mothers in the first 48 hours following parturition and from the prenatal care cards. Healthy weight gain was evaluated according to the Institute of Medicine guidelines. Data analysis used Poisson regression with robust variance using previous hierarchical model. Results Among the 1,784 pregnant participants, 89% attended at least six prenatal care visits, and 32% had healthy weight gain during pregnancy. Higher education level and fewer children resulted in a higher prevalence ratio for healthy weight gain (p=0.003 and p=0.029, respectively). Underweight women at conception had a higher proportion of healthy weight gain (p<0.001). Despite extensive coverage, prenatal care did not affect healthy weight gain during pregnancy (p=0.104). Conclusion The low proportion of women with healthy gestational weight gain suggests a need of better prenatal care services. Women who are overweight, have lower education levels, and had had multiple pregnancies at conception need special attention.

Prepare, a randomized trial to promote and evaluate weight loss among overweight and obese women planning pregnancy: Study design and rationale

BACKGROUND

Women who are overweight or have obesity at pregnancy onset, and those who gain excessive weight during pregnancy, are at increased risk of pregnancy-related complications and large for gestational age infants.

OBJECTIVE

This report describes methodology for the Prepare study, a randomized, controlled clinical trial testing a preconception and pregnancy weight management program for women who are overweight or have obesity (BMI≥27kg/m(2)).

OUTCOMES

This trial examines multiple pregnancy and neonatal outcomes, with the primary outcome being gestational weight gain (GWG). Secondary outcomes include change in weight before conception, offspring birth weight adjusted for gestational age, offspring weight for length, and pregnancy diet quality and physical activity level.

METHODS

Nonpregnant women who anticipate becoming pregnant in the next 2years are randomly assigned to an intervention program or a usual care control condition. Intervention participants receive weight management counseling by telephone before and during pregnancy, with weekly contacts during the first 6months and monthly contacts for the next 18months. Intervention participants also have unlimited access to a study website that provides self-management tools. All participants who become pregnant are contacted at 20weeks' gestation to assess physical activity levels and dietary habits. All other outcome data are obtained from medical records. Intervention satisfaction is assessed via questionnaire.

SUMMARY

This clinical trial tests the efficacy of an intervention program designed to help overweight and obese women achieve healthy lifestyle changes that will result in a healthy weight prior to pregnancy and appropriate weight gain during pregnancy.

Effects of a Gestational Weight Gain Restriction Program for Obese Pregnant Women: Children's Weight Development during the First Five Years of Life

BACKGROUND

Maternal prepregnancy obesity (BMI ≥30 kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the children's BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age.

METHODS

This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy.

RESULTS

BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, <7 kg or ≥7 kg, did not affect the offspring's WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI.

CONCLUSION

Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.

Loss of anti-contractile effect of perivascular adipose tissue in offspring of obese rats

Rationale:

Maternal obesity pre-programmes offspring to develop obesity and associated cardiovascular disease. Perivascular adipose tissue (PVAT) exerts an anti-contractile effect on the vasculature, which is reduced in hypertension and obesity.

Objective:

The objective of this study was to determine whether maternal obesity pre-programmes offspring to develop PVAT dysfunction in later life.

Methods:

Female Sprague–Dawley rats were fed a diet containing 10% (control) or 45% fat (high fat diet, HFD) for 12 weeks prior to mating and during pregnancy and lactation. Male offspring were killed at 12 or 24 weeks of age and tension in PVAT-intact or -denuded mesenteric artery segments was measured isometrically. Concentration–response curves were constructed to U46619 and norepinephrine.

Results:

Only 24-week-old HFD offspring were hypertensive (P<0.0001), although the anti-contractile effect of PVAT was lost in vessels from HFD offspring of each age. Inhibition of nitric oxide (NO) synthase with 100 μMl-NMMA attenuated the anti-contractile effect of PVAT and increased contractility of PVAT-denuded arteries (P<0.05, P<0.0001). The increase in contraction was smaller in PVAT-intact than PVAT-denuded vessels from 12-week-old HFD offspring, suggesting decreased PVAT-derived NO and release of a contractile factor (P<0.07). An additional, NO-independent effect of PVAT was evident only in norepinephrine-contracted vessels. Activation of AMP-activated kinase (with 10 μM A769662) was anti-contractile in PVAT-denuded (P<0.0001) and -intact (P<0.01) vessels and was due solely to NO in controls; the AMPK effect was similar in HFD offspring vessels (P<0.001 and P<0.01, respectively) but was partially NO-independent.

Conclusions:

The diminished anti-contractile effects of PVAT in offspring of HFD dams are primarily due to release of a PVAT-derived contractile factor and reduced NO bioavailability.

Sexual Behavior and Contraceptive Use among 18- to 19-Year-Old Adolescent Women by Weight Status: A Longitudinal Analysis

OBJECTIVE

To describe the association between weight status and sexual practices among 18- to 19-year-old women.

STUDY DESIGN

We analyzed a population-based longitudinal study of 18- to 19-year-old women residing in a Michigan county at cohort inception. Weekly journal surveys measured sexual practices, including contraceptive behaviors. Outcomes included proportion of weeks with a partner, proportion of weeks with sexual intercourse, number of partners, average length of relationships, proportion of weeks with contraception use, and proportion of weeks where contraception was used consistently. We examined 26,545 journal surveys from 900 women over the first study year. Ordinary least squares regression models for each outcome examined differences by weight status, controlling for sociodemographic characteristics.

RESULTS

The mean proportion of weeks in which adolescents reported sexual intercourse was 52%; there was no difference by weight status. Among weeks in which adolescents reported sexual activity, obese adolescents had a lower proportion of weeks where any contraception was used compared with normal weight adolescents (84% vs 91%, P = .011). Among weeks in which adolescents reported sexual activity and contraceptive use, obese adolescents had a lower proportion of weeks with consistent contraceptive use (68% vs 78%, P = .016) and oral contraceptive pill use (27% vs 45%, P = .001) compared with normal weight adolescents. All other relationships by weight status were not statistically significant.

CONCLUSIONS

In this longitudinal study, obese adolescent women were less likely to use contraception, and less likely to use it consistently when compared with normal weight peers. Findings suggest obesity may be an important factor associated with adolescent women's sexual behavior.

Relationships between maternal overweight prior to pregnancy, feeding mode and infant feeding beliefs and practices

AIM

This study aimed to examine whether pre-pregnancy weight status was associated with maternal feeding beliefs and practices in the early post-partum period.

METHODS

This study uses secondary analysis of longitudinal data from Australian mothers. Participants (n = 486) were divided into two weight status groups based on self-reported pre-pregnancy weight and measured height: healthy weight (body mass index (BMI) <25 kg/m(2) ; n = 321) and overweight (BMI > 25 kg/m(2) ; n = 165). Feeding beliefs and practices were self-reported via an established questionnaire that assessed concerns about infant overeating and undereating, awareness of infant cues, feeding to a schedule and using food to calm.

RESULTS

Infants of overweight mothers were more likely to have been given solid foods in the previous 24 h (29% vs. 20%) and fewer were fully breastfed (50% vs. 64%). Multivariable regression analyses (adjusted for maternal education, parity, average infant weekly weight gain, feeding mode and introduction of solids) revealed that pre-pregnancy weight status was not associated with using food to calm, concern about undereating, awareness of infant cues or feeding to a schedule. However, feeding mode was associated with feeding beliefs and practices.

CONCLUSIONS

Although no evidence for a relationship between maternal weight status and early maternal feeding beliefs and practices was observed, differences in feeding mode and early introduction of solids were observed. The emergence of a relationship between feeding practices and maternal weight status may occur when the children are older, solid feeding is established and they become more independent in feeding.

Promoting weight loss methods in parenting magazines: Implications for women

Weight gain before and after pregnancy is important for women's health. The purpose of this study was to assess articles and advertisements related to weight loss in three widely read parenting magazines, "Parenting School Years," "Parenting Early Years," and "Parenting," which have an estimated combined readership of approximately 24 million (mainly women readers). Almost a quarter (23.7%, n = 32) of the 135 magazine issues over a four year period included at least one feature article on weight loss. A variety of topics were covered in the featured articles, with the most frequent topics being on losing weight to please yourself (25.2%), healthy ways to lose weight (21.1%), and how to keep the weight off (14.7%). Less than half (45.9%) of the articles displayed author credentials, such as their degree, qualifications, or expertise. A fifth (20.0%, n = 27) of the magazines included at least one prominent advertisement for weight loss products. Almost half (46.9%) of the weight loss advertisements were for weight loss programs followed by weight loss food products (25.0%), weight loss aids (21.9%), and only 6.2% of the advertisements for weight loss were on fitness. Parenting magazines should advocate for healthy weight loss, including lifestyle changes for sustained health.

Associations of maternal material hardships during childhood and adulthood with prepregnancy weight, gestational weight gain, and postpartum weight retention

BACKGROUND

We examined associations of material hardship with prepregnancy body mass index (BMI), gestational weight gain (GWG), and substantial postpartum weight retention (SPPWR; ≥5 kg at 1 year).

METHODS

We studied 2128 women in Project Viva, a Boston-area cohort with recruitment during1999-2002. At recruitment, women reported whether they experienced material hardship, defined as having ever received public assistance, welfare, or lacked basic necessities (food, rent, or medical care) during childhood, in adulthood before pregnancy, and/or in pregnancy. We used multivariable logistic models adjusted for age, race/ethnicity, and parity (and prepregnancy BMI for GWG and SPPWR) to examine associations of material hardship with the three weight-related outcomes (BMI, GWG, and SPPWR).

RESULTS

Mean age was 31.8 (standard deviation, 5.2) years; 66% of women were white, 16% were obese (prepregnancy BMI ≥30.0 kg/m(2)), 50% experienced excessive GWG, and 17% experienced SPPWR. Material hardship was most common during childhood (n=192, 9%), followed by adulthood (102, 5%), and pregnancy (41, 2%). Hardship in adulthood was associated with prepregnancy obesity (BMI ≥30 kg/m(2) vs. 18.5 to <25.0 kg/m(2)), odds ratio ([OR] 2.35, 95% confidence interval [CI] 1.29, 4.31), but hardship in childhood was not (OR 1.26, 95% CI 0.80, 1.98). Hardship in childhood was associated with excess GWG (OR 1.45, 95% CI 0.99, 2.14), but hardship in adulthood or during pregnancy was not. We saw trends among hardship in each of the periods and associations with SPPWR, but all confidence intervals included the null.

CONCLUSION

The timing of hardship exposure may differently influence weight before, during, and after pregnancy.

Exercise in pregnancies complicated by obesity: achieving benefits and overcoming barriers

An increasing number of women are entering pregnancy in an overweight or obese state. Obese women and their offspring are at increased risk of adverse perinatal outcomes, which may be improved by regular moderate-intensity antenatal exercise. Current guidelines recommend that all pregnant women without contraindications engage in ≥30 minutes of moderate-intensity exercise on a daily basis. However, obese women are usually less physically active and tend to further reduce activity levels during pregnancy. This commentary summarizes the potential short- and long-term benefits of antenatal exercise in obese pregnant women, highlights the challenges they face, and discusses means of improving their exercise levels. In addition, we make recommendations on exercise prescription for pregnancies complicated by obesity.

Mindfulness, Eating Behaviours, and Obesity: A Review and Reflection on Current Findings

Mindfulness and mindful eating have become popular in recent years. In this review, we first explore what mindfulness is in the context of psychological research, and why it offers promise for eating behaviours and weight loss. Second, we review the main empirical findings for weight loss in mindfulness-based intervention programmes. Third, contradictions in the findings are explored in more depth, and suggestions are made regarding why they may be occurring. Fourth, the benefits of adding self-compassion (and compassion) training to mindfulness practise to assist weight loss is discussed. Finally, the limitations of the research literature (and possible solutions) are explored. Overall, it is concluded that while mindfulness meditations that specifically focus on eating may be extremely helpful in promoting better eating behaviours, and assist in weight regulation, work is still needed to make such interventions appeal to a wider audience.

Associations of maternal BMI and gestational weight gain with neonatal adiposity in the Healthy Start study

BACKGROUND

Maternal obesity and weight gain during pregnancy are risk factors for child obesity. Associations may be attributable to causal effects of the intrauterine environment or genetic and postnatal environmental factors.

OBJECTIVE

We estimated associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) overall and in early pregnancy, midpregnancy, and late pregnancy with neonatal adiposity.

DESIGN

Participants were 826 women enrolled in a Colorado prebirth cohort who delivered term infants (2010-2013). GWG to 39 wk of gestation was predicted by using mixed models, and early pregnancy, midpregnancy, and late pregnancy rates of GWG (0-17, 17-27, and 27 wk to delivery) were calculated from repeated weight measures. Neonatal body composition was measured by using air-displacement plethysmography ≤3 d after birth.

RESULTS

Each1-kg/m(2) increase in maternal BMI was associated with increased neonatal fat mass (5.2 g; 95% CI: 3.5, 6.9 g), fat-free mass (7.7 g; 95% CI: 4.5, 10.9 g), and percentage of body fat (0.12%; 95% CI: 0.08%, 0.16%). Each 0.1-kg/wk increase in predicted GWG was associated with increased fat mass (24.0 g; 95% CI: 17.4, 30.5 g), fat-free mass (34.0 g; 95% CI: 21.4, 46.6 g), and percentage of body fat (0.55%; 95% CI: 0.37%, 0.72%). No interaction was detected between BMI and GWG in their effects on neonatal body composition. Early pregnancy, midpregnancy, and late pregnancy rates of GWG were independently associated with fat mass and percentage of body fat. Midpregnancy and late pregnancy GWGs were associated with fat-free mass. An observed GWG that exceeded recommendations was associated with higher neonatal fat mass and fat-free mass but not percentage of body fat relative to adequate GWG.

CONCLUSIONS

Maternal prepregnancy BMI and GWG, including period-specific GWG, were positively and independently associated with neonatal adiposity. Associations of early and midpregnancy weight gain with neonatal adiposity support the hypothesis that greater maternal weight gain during pregnancy, regardless of prepregnancy BMI, is directly related to offspring adiposity at birth. The Healthy Start study was registered as an observational study at clinicaltrials.gov as NCT02273297.

Impact of a walking intervention during pregnancy on post-partum weight retention and infant anthropometric outcomes

Few studies have investigated the impact of lifestyle interventions during pregnancy on post-partum weight retention and infant growth. Thirty seven previously non-exercising, overweight or obese pregnant women were randomly assigned to a walking intervention or non-intervention control. For the follow-up study, weight of the mother and weight, length and body composition of the infant were collected at 1 month post-partum (n=37) and 6 months post-partum (n=33). Analysis of variance and linear regression were conducted to determine the differences and association in maternal post-partum weight retention and child outcomes. At 6 months post-partum, weight retention of obese women in the intervention group (Int-OB) was -0.10±8.11 kg; while, obese women in the control group (Con-OB) was 6.35±7.47 kg. A significantly higher percentage of Con-OB women retained more than 5 kg at 6 months post-partum (P=0.046). Even though statistically non-significant between the groups, the growth trend observed among offspring of obese women in the control group was consistently higher than the offspring of obese women in the intervention group from birth to 6-months. Third trimester gestational weight gain rate significantly predicted 6-m weight-for-length z-score after controlling for birth weight, treatment group and pre-pregnancy body mass index (r 2=0.31, β=1.75, P=0.03). The reduced post-partum weight retention observed among the obese women in the intervention group may be explained in part by the lifestyle modification during pregnancy.

Gene-environment interactions controlling energy and glucose homeostasis and the developmental origins of obesity

Obesity and type 2 diabetes mellitus (T2DM) often occur together and affect a growing number of individuals in both the developed and developing worlds. Both are associated with a number of other serious illnesses that lead to increased rates of mortality. There is likely a polygenic mode of inheritance underlying both disorders, but it has become increasingly clear that the pre- and postnatal environments play critical roles in pushing predisposed individuals over the edge into a disease state. This review focuses on the many genetic and environmental variables that interact to cause predisposed individuals to become obese and diabetic. The brain and its interactions with the external and internal environment are a major focus given the prominent role these interactions play in the regulation of energy and glucose homeostasis in health and disease.

Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy

BACKGROUND

Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG.

METHODS

Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention's acceptability and suggested improvements.

RESULTS

Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine's upper limit of 9 kg GWG for obese women.

CONCLUSIONS

MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.

Optimizing Weight for Maternal and Infant Health - Tenable, or Too Late?

Obesity in pregnancy is the leading cause of maternal and fetal morbidity, and gestational weight gain (GWG) is one modifiable risk factor that improves pregnancy outcomes. Most pregnant women gain more than the 2009 Institute of Medicine recommendations, particularly overweight and obese women. GWG even less than the 2009 IOM guidelines in obese women may improve pregnancy outcomes and reduce large-for-gestational-age (LGA) infants, an independent risk factor for childhood obesity, without increasing small-for-gestational-age (SGA) infants. Unfortunately, despite the fact that over 50 interventional trials designed to decrease excess GWG have been conducted, these interventions have been only modestly effective, and interventions designed to facilitate weight postpartum weight loss have also been disappointing. Successful interventions are of paramount importance not only to improve pregnancy outcomes but also for the future metabolic health of the mother and her infant, and may be key in attenuating the trans-generational risk on childhood obesity.

Overweight in infancy: which pre- and perinatal factors determine overweight persistence or reduction? A birth cohort followed for 11 years

BACKGROUND

A considerable proportion of children with early-life overweight attain a normal weight. To recognize infants at risk of persistent overweight, we compared early-life factors of children with a longitudinal pattern of persistent overweight to children with a pattern of overweight in early but not in later childhood.

METHODS

In 3,550 children participating in a birth cohort that started in 1996/1997 in the Netherlands, body mass index was repeatedly assessed until age 11 and dichotomized into with/without overweight. Latent class growth modeling was used to distinguish trajectories. Our analysis was focused on the comparison of early-life factors in children in a persistent overweight pattern with those in an overweight reduction pattern using multivariable log-binomial regression analyses.

RESULTS

Children (n = 133) in the persistent overweight pattern were more likely to have overweight parents [relative risk (RR)mother: 1.85, 95% CI: 1.37-2.49: RRfather: 1.75, 95% CI: 1.21-2.55] than children in the overweight reduction pattern (n = 303). Maternal education, child's gender, ethnicity, birth weight, breast-feeding and maternal smoking during pregnancy did not differ between the trajectories.

CONCLUSION

Health care practitioners should focus on high-weight infants with overweight parents, as these children are less likely to resolve their overweight.

Impact of maternal and paternal preconception health on birth outcomes using prospective couples' data in Add Health

PURPOSE

Retrospective studies of preconception health have demonstrated that parents' health conditions and behaviors can impact a newborn's birth outcomes and, subsequently, future health status. This study sought to examine the impact of preconception health, measured prospectively, among both mothers and fathers, on two important birth outcomes: birthweight and gestational age.

METHODS

Data came from Add Health (the National Longitudinal Study of Adolescent Health), which included interviews with original participants and a subsample of their partners in 2001-02. In 2008, the original respondents again completed an interview for Add Health. For 372 eligible infants born to these couples, birth outcomes (measured in 2008) were regressed on preconception health conditions and behaviors among non-pregnant heterosexual partners (measured in 2001-02).

RESULTS

Mean birthweight was 3,399 g, and mean gestational age was 39 weeks. Birthweight was higher for infants born to mothers with diabetes or high blood pressure, and for mothers who drank alcohol at least once per month, and lower for infants born to fathers with diabetes (p < 0.05). Infant gestational age was marginally lower for infants born to mothers with higher levels of depression (p < 0.10), and lower for infants born to fathers with diabetes and with higher levels of fast food consumption (p < 0.05).

CONCLUSIONS

Both maternal and paternal preconception health conditions and behaviors influenced infant birth outcomes. Interventions to promote preconception health should focus on prevention of diabetes and high blood pressure, as well as minimizing consumption of alcohol and fast food.

Cord blood C-peptide, insulin, HbA1c, and lipids levels in small- and large-for-gestational-age newborns

Background

Small- and large-for-gestational-age (SGA, LGA) newborns are associated with metabolic syndrome in their later life. Cord blood C-peptide, insulin, glycosylated hemoglobin (HbA1c), and lipids levels may be altered in SGA and LGA newborns; however, the results are conflicting. Therefore, this study aimed to determine the effect of cord blood markers on SGA and LGA newborns.

Material/Methods

This was a prospective cohort study and included 2873 term newborns of non-diabetic women. Among these newborns, 83 (2.9%) were SGA, 2236 (77.8%) were appropriate-for-gestational-age (AGA), and 554 (19.3%) were LGA newborns. Cord blood C-peptide, insulin, HbA1c, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were measured. The chi-square, Kruskal-Wallis, and Mann-Whitney tests were used to analyze categorical variables and continuous variables, respectively. Multinomial logistic regression analysis was used to determine the independent effect of these variables on SGA and LGA newborns.

Results

Cord serum TG level was significantly higher in the SGA group than in AGA and LGA groups (p<0.05). The LGA group had significantly higher cord serum insulin level than AGA and SGA groups (p<0.05). After adjustment for confounding variables, including maternal age, parity, pre-pregnancy body mass index (BMI), education, annual household income, pregnancy-induced hypertension (PIH), mode of delivery, and newborn sex, high TG and insulin levels remained significantly associated with SGA and LGA newborns, respectively (p<0.05).

Conclusions

High cord serum TG and insulin levels are independently associated with SGA and LGA newborns, respectively.

Growing healthy muscles to optimise metabolic health into adult life

The importance of skeletal muscle for metabolic health and obesity prevention is gradually gaining recognition. As a result, interventions are being developed to increase or maintain muscle mass and metabolic function in adult and elderly populations. These interventions include exercise, hormonal and nutritional therapies. Nonetheless, growing evidence suggests that maternal malnutrition and obesity during pregnancy and lactation impede skeletal muscle development and growth in the offspring, with long-term functional consequences lasting into adult life. Here we review the role of skeletal muscle in health and obesity, providing an insight into how this tissue develops and discuss evidence that maternal obesity affects its development, growth and function into adult life. Such evidence warrants the need to develop early life interventions to optimise skeletal muscle development and growth in the offspring and thereby maximise metabolic health into adult life.

Developmental trajectories of Body Mass Index from infancy to 18 years of age: prenatal determinants and health consequences

BACKGROUND

Knowledge on the long-term development of adiposity throughout childhood/adolescence and its prenatal determinants and health sequelae is lacking. We sought to (1) identify trajectories of Body Mass Index (BMI) from 1 to 18 years of age, (2) examine associations of maternal gestational smoking and early pregnancy overweight with offspring BMI trajectories and (3) determine whether BMI trajectories predict health outcomes: asthma, lung function parameters (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio), and blood pressure, at 18 years.

METHODS

The Isle of Wight birth cohort, a population-based sample of 1456 infants born between January 1989 and February 1990, was prospectively assessed at ages 1, 2, 4, 10 and 18 years. Group-based trajectory modelling was applied to test for the presence of latent BMI trajectories. Associations were assessed using log-binomial and linear regression models.

RESULTS

Four trajectories of BMI were identified: 'normal', 'early persistent obesity', 'delayed overweight', and 'early transient overweight'. Risk factors for being in the early persistent obesity trajectory included maternal smoking during pregnancy (RR 2.16, 95% CI 1.02 to 4.68) and early pregnancy overweight (3.16, 1.52 to 6.58). When comparing the early persistent obesity to the normal trajectory, a 2.15-fold (1.33 to 3.49) increased risk of asthma, 3.2% (0.4% to 6.0%) deficit in FEV1/FVC ratio, and elevated systolic 11.3 mm Hg (7.1 to 15.4) and diastolic 12.0 mm Hg (8.9 to 15.1) blood pressure were observed at age 18 years.

CONCLUSIONS

Maternal prenatal exposures show prolonged effects on offspring's propensity towards overweight-obesity. Distinct morbid BMI trajectories are evident during the first 18 years of life that are associated with higher risk of asthma, reduced FEV1/FVC ratio, and elevated blood pressure.

Correlations Among Parental and Neonatal Anthropometric Parameters, Feeding Practices and Infant Obesity

BACKGROUND AND AIMS

Infant and adult obesity is becoming a real public health concern in Romania, similar to other countries of the European Union. Maternal obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child. The protective role of the breastfeeding against obesity has also been demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could or not protect the newborn from becoming a future obese infant and child. Our study aims to describe the characteristics of a group of macrosomic newborns, in relation to the mothers' weight gain during pregnancy, mode of delivery, birth weight, complications at birth, time of first feeding and type of feeding during maternity stay.

PATIENTS AND METHODS

We conducted a retrospective study on 179 newborns with birth weights >4000 grams, born over a period of three months (March-May) in 6 large maternity hospitals in Romania.

RESULTS

the newborns had a mean gestational age of 39.5 weeks and a mean birth weight of 4195 grams. Male newborns were prevalent (74%). More than half were born by Cesarian section and had Apgar scores with a median of 9. Macrosomes are prone to complications at birth and in our study those were mainly hypoglycemia and birth trauma. Time at first feeding was 95 minutes (mean), with a high percentage of formula/mixed feeding (68%).

CONCLUSION

Macrosomia itself attracts the risk of birth by cesarean section (54% of study group), birth trauma and a low rate of exclusive breast milk feeding (32% of study group) at discharge.

Changing perspectives in pre-existing diabetes and obesity in pregnancy: maternal and infant short- and long-term outcomes

PURPOSE OF REVIEW

Climbing obesity rates in women have propelled the increasing prevalence of type 2 diabetes mellitus (T2DM) in pregnancy, and an increasing number of women with type 1 diabetes mellitus (T1DM) are also affected by obesity. Increasing recognition that an intrauterine environment characterized by obesity, insulin resistance, nutrient excess, and diabetes may be fueling the obesity epidemic in children has created enormous pressure to re-examine the conventional wisdom of our current approaches.

RECENT FINDINGS

Compelling data in pregnancies complicated by diabetes, in particular those accompanied by insulin resistance and obesity, support a fetal programming effect resulting in increased susceptibility to metabolic disease for the offspring later in life. Recent data also underscore the contribution of obesity, lipids, and lesser degrees of hyperglycemia on fetal fat accretion, challenging the wisdom of current gestational weight gain recommendations with and without diabetes. The risks of adverse pregnancy outcomes in T2DM are at least as high as in T1DM and there remains controversy about the ideal glucose treatment targets, the benefit of different insulin analogues, and the role of continuous glucose monitoring in T1DM and T2DM.

SUMMARY

It has become unmistakably evident that achieving optimal outcomes in mothers with diabetes is clearly impacted by ideal glycemic control but goes far beyond it. The intrauterine metabolic environment seems to have long-term implications on the future health of the offspring so that the effectiveness of our current approaches can no longer be simply measured by whether or not maternal glucose values are at goal.

The association of maternal adult weight trajectory with preeclampsia and gestational diabetes mellitus

BACKGROUND

Preeclampsia (PE) and gestational diabetes mellitus (GDM) adversely affect pregnancy outcomes and the subsequent health of both mother and infant. It is known that elevated pre-pregnancy body mass index (BMI) is associated with increased risk of these obstetrical complications. However, little is known about the role of adult weight patterns prior to pregnancy.

METHODS

Self-reported weight at ages prior to the current pregnancy was recorded in a prospective cohort study of 3567 pregnant women, allowing assessment of longitudinal pre-pregnancy weight trajectories and their association with subsequent PE and GDM in the study pregnancy.

RESULTS

Women who would subsequently experience PE or GDM in the study pregnancy experienced on average almost double the rate of adult weight gain than other women [PE: additional 0.30 kg/year, 95% confidence interval (CI) 0.09, 0.51 and GDM: additional 0.34 kg/year, 95% CI 0.21, 0.48]. Women with mean adult annual weight gain above the 90th percentile (1.4 kg/year) had elevated risk of subsequent PE and GDM independent of their BMI at age 18 and of their obesity status at the time of the study pregnancy. Finite mixture trajectory modelling identified four monotonely ordered, increasing mean weight trajectories. Relative to the second lowest (most common) weight trajectory, women in the highest trajectory were at greater risk of PE [odds ratio (OR) 5.0, 95% CI 2.9, 8.8] and GDM (OR 2.8, 95% CI 1.7, 4.5).

CONCLUSIONS

These results indicate that higher adult weight gain trajectories prior to pregnancy may play a role in predisposing women to PE or GDM.

Maternal high-fat diet induces insulin resistance and deterioration of pancreatic β-cell function in adult offspring with sex differences in mice

Intrauterine environment may influence the health of postnatal offspring. There have been many studies on the effects of maternal high-fat diet (HFD) on diabetes and glucose metabolism in offspring. Here, we investigated the effects in male and female offspring. C57/BL6J mice were bred and fed either control diet (CD) or HFD from conception to weaning, and offspring were fed CD or HFD from 6 to 20 wk. At 20 wk, maternal HFD induced glucose intolerance and insulin resistance in offspring. Additionally, liver triacylglycerol content, adipose tissue mass, and inflammation increased in maternal HFD. In contrast, extending previous observations, insulin secretion at glucose tolerance test, islet area, insulin content, and PDX-1 mRNA levels in isolated islets were lower in maternal HFD in males, whereas they were higher in females. Oxidative stress in islets increased in maternal HFD in males, whereas there were no differences in females. Plasma estradiol levels were lower in males than in females and decreased in offspring fed HFD and also decreased by maternal HFD, suggesting that females may be protected from insulin deficiency by inhibiting oxidative stress. In conclusion, maternal HFD induced insulin resistance and deterioration of pancreatic β-cell function, with marked sex differences in adult offspring accompanied by adipose tissue inflammation and liver steatosis. Additionally, our results demonstrate that potential mechanisms underlying sex differences in pancreatic β-cell function may be related partially to increases in oxidative stress in male islets and decreased plasma estradiol levels in males.

Intergenerational impact of maternal obesity and postnatal feeding practices on pediatric obesity

The postnatal feeding practices of obese and overweight mothers may place their children at increased risk for the development of obesity through shared biology and family environments. This article reviews the feeding practices of obese mothers, describes the potential mechanisms linking maternal feeding behaviors to child obesity risk, and highlights the potential avenues of intervention. Strategies important for improving the quality of the eating environment and preventing the intergenerational transmission of obesity include supporting breastfeeding, improving the food choices of obese women, and encouraging the development of feeding styles that are responsive to hunger and satiety cues.

Changes in family income status and the development of overweight and obesity from 2 to 15 years: a longitudinal study

Background

An emerging body of research suggests the trajectory of a family’s income affects children’s health and development more profoundly than the often-measured income at a single time point. The purpose of this study was to examine the associations between changes in family income status, early-life risk factors, and body mass index (BMI) z-score trajectory from age 2 to 15 years.

Methods

This longitudinal study employed a birth cohort (n = 595) located in a rural region of New York State. Data were collected through an audit of medical records and mailed questionnaires. Family low-income and BMI z-score trajectories were identified using latent-class modeling techniques that group children based on similar trends across time. We examined five early-life risk factors in relation to income and BMI z-score trajectories: maternal overweight/obesity, maternal gestational weight gain, maternal smoking during pregnancy, breastfeeding duration, and early-life weight gain trajectory. We used multinomial logistic regression models to estimate the odds of being in a BMI z-score trajectory group based on income trajectory and early-life risk factors.

Results

Children who remain low-income throughout childhood were more likely to maintain overweight (AOR = 2.55, 95% CI = 1.03, 5.42) and children who moved into low-income during childhood were more likely to be obese (AOR = 2.36, 95% CI = 1.12, 5.93) compared to children who were never low-income. Maternal overweight/obesity was significantly associated with a child become obese (AOR = 8.31, 95% CI = 3.80, 18.20), become overweight (AOR = 2.37, 95% CI = 1.34, 4.22), and stay overweight (AOR = 1.79, 95% CI = 1.02, 3.14). Excessive gestational weight gain was associated with increased likelihood of a child becoming overweight trajectory (AOR = 2.01, 95% CI = 1.01, 4.00).

Conclusions

Our findings further supports the growing evidence that there are several preventable early-life risk factors that could be targeted for intervention. This study provides new evidence that remaining in low-income and moving into low-income increases risk for adolescent overweight and obesity.

Maternal pre-pregnancy BMI and intelligence quotient (IQ) in 5-year-old children: a cohort based study

BACKGROUND

An association between maternal pre-pregnancy BMI and childhood intelligence quotient (IQ) has repeatedly been found but it is unknown if this association is causal or due to confounding caused by genetic or social factors.

METHODS

We used a cohort of 1,783 mothers and their 5-year-old children sampled from the Danish National Birth Cohort. The children participated between 2003 and 2008 in a neuropsychological assessment of cognitive ability including IQ tests taken by both the mother and the child. Linear regression analyses were used to estimate the associations between parental BMI and child IQ adjusted for a comprehensive set of potential confounders. Child IQ was assessed with the Wechsler Primary and Preschool Scales of Intelligence--Revised (WPPSI-R).

RESULTS

The crude association between maternal BMI and child IQ showed that BMI was adversely associated with child IQ with a reduction in IQ of -0.40 point for each one unit increase in BMI. This association was attenuated after adjustment for social factors and maternal IQ to a value of -0.27 (-0.50 to -0.03). After mutual adjustment for the father's BMI and all other factors except maternal IQ, the association between paternal BMI and child IQ yielded a regression coefficient of -0.26 (-0.59 to 0.07), which was comparable to that seen for maternal BMI (-0.20 (-0.44 to 0.04)).

CONCLUSION

Although maternal pre-pregnancy BMI was inversely associated with the IQ of her child, the similar association with paternal BMI suggests that it is not a specific pregnancy related adiposity effect.

Gestational weight gain in twin pregnancies and maternal and child health: a systematic review

Our objective was to systematically review the data interrogating the association between gestational weight gain (GWG) and maternal and child health among women with twin gestations. We identified 15 articles of twin gestations that studied GWG in relation to a maternal, perinatal or child health outcome and controlled for gestational age at delivery and prepregnancy body mass index. A positive association between GWG and fetal size was consistently found. Evidence on preterm birth and pregnancy complications was inconsistent. The existing studies suffer from serious methodological weaknesses, including not properly accounting for the strong correlation between gestational duration and GWG and not controlling for chorionicity. In addition, serious perinatal outcomes were not studied, and no research is available on the association between GWG and outcomes beyond birth. Our systematic review underscores that GWG in twin gestations is a neglected area of research. Rigorous studies are needed to inform future evidence-based guidelines.

Maternal chocolate and sucrose soft drink intake induces hepatic steatosis in rat offspring associated with altered lipid gene expression profile

AIM

According to the World Diabetes Foundation, there is an urgent need to investigate the impact of maternal health and nutrition during pregnancy to understand the background for the accelerating incidence of obesity and type 2 diabetes. In this study, we specifically concentrated on the role of overfeeding during different developmental periods.

METHODS

Sprague-Dawley rats were offered chow or high-fat/high-sucrose diet (chow plus chocolate and soft drink) during gestation and lactation. At birth, offspring were randomly cross-fostered within each dietary group into small and normal litter sizes until weaning, giving four dietary groups.

RESULTS

At postnatal day 1, offspring from high-fat/high-sucrose-fed dams were heavier and had increased hepatic triglycerides (TG), hepatic glycogen, blood glucose and plasma insulin compared with offspring from chow-fed dams. Hepatic genes involved in lipid oxidation, VLDL transport and insulin receptor were down-regulated, whereas FGF21 expression was up-regulated. Independent of postnatal litter size, offspring from high-fat/high-sucrose-fed dams aged 21 days had still increased hepatic TG and up-regulated FGF21 expression, while plasma insulin started to decrease. Litter size reduction in offspring from high-fat/high-sucrose-fed dams further increased body weight and adiposity, and up-regulated genes involved in hepatic mitochondrial lipid oxidation and VLDL transport compared with all other groups. Litter size reduction did not have any impact on body weight gain and adiposity in offspring born to chow-fed dams.

CONCLUSION

Our results suggest that supplementation of chocolate and soft drink during gestation and lactation contributes to early onset of hepatic steatosis associated with changes in hepatic gene expression and lipid handling.

The microvasculature: a target for nutritional programming and later risk of cardio-metabolic disease

There is compelling evidence that microvascular deficits affecting multiple tissues and organs play an important role in the aetiopathogenesis of cardio-metabolic disease. Furthermore, both in humans and animal models, deficits in small vessel structure and function can be detected early, often before the onset of macrovascular disease and the development of end-organ damage that is common to hypertension and obesity-associated clinical disorders. This article considers the growing evidence for the negative impact of an adverse maternal diet on the long-term health of her child, and how this can result in a disadvantageous vascular phenotype that extends to the microvascular bed. We describe how structural and functional modifications in the offspring microcirculation during development may represent an important and additional risk determinant to increase susceptibility to the development of cardio-metabolic disease in adult life and consider the cell-signalling pathways associated with endothelial dysfunction that may be 'primed' by the maternal environment. Published studies were identified that reported outcomes related to the microcirculation, endothelium, maternal diet and vascular programming using NCBI PubMed.gov, MEDLINE and ISI Web of Science databases from 1980 until April 2013 using pre-specified search terms. Information extracted from over 230 original reports and review articles was critically evaluated by the authors for inclusion in this review.

Childhood cardiometabolic outcomes of maternal obesity during pregnancy: the Generation R Study

Maternal prepregnancy obesity is associated with impaired cardiometabolic health in offspring. Whether these associations reflect direct intrauterine causal mechanisms remains unclear. In a population-based prospective cohort study among 4871 mothers, fathers, and their children, we examined the associations of both maternal and paternal prepregnancy body mass index (BMI) with childhood body fat distribution and cardiometabolic outcomes and explored whether any association was explained by pregnancy, birth, and childhood factors. We measured childhood BMI, total body and abdominal fat distribution, blood pressure, and blood levels of lipids, insulin, and C-peptide at the age of 6 years. We observed that higher maternal and paternal prepregnancy BMI were associated with higher childhood BMI, total body and abdominal fat mass measures, systolic blood pressure, and insulin levels and lower high-density lipoprotein cholesterol levels (P<0.05). Stronger associations were present for maternal than paternal BMI, with statistical support for heterogeneity between these associations. The associations for childhood fat mass and cardiometabolic outcomes attenuated after adjustment for childhood current BMI. Compared with children from normal-weight mothers, those from obese mothers had increased risks of childhood overweight (odds ratio, 3.84 [95% confidence interval, 3.01-4.90]) and clustering of cardiometabolic risk factors (odds ratio, 3.00 [95% confidence interval, 2.09-4.34]). Smaller effect estimates for these outcomes were observed for paternal obesity. In conclusion, higher maternal and paternal prepregnancy BMI were associated with an adverse cardiometabolic profile in offspring, with stronger associations present for maternal prepregnancy BMI. These findings suggest that maternal prepregnancy BMI may influence the cardiometabolic health of offspring through direct intrauterine mechanisms.

Tissue-specific Leptin promoter DNA methylation is associated with maternal and infant perinatal factors

Leptin a regulator of body weight is involved in reproductive and developmental functions. Leptin promoter DNA methylation (LEP) regulates gene expression in a tissue-specific manner and has been linked to adverse pregnancy outcomes. In non-pathologic human pregnancies, we assessed LEP methylation, genotyped the single nucleotide polymorphism (SNP) rs2167270 in placental (n=81), maternal and cord blood samples (n=60), and examined the association between methylation, genotype, and perinatal factors. Maternal blood LEP methylation was lower in pre-pregnancy obese women (P=0.01). Cord blood LEP methylation was higher in small for gestational age (SGA) (P=4.6×10(-3)) and A/A genotype (P=1.6×10(-4)), lower (-1.47, P=0.03) in infants born to pre-pregnancy obese mothers and correlated (P=0.01) with maternal blood LEP. Gender was associated with placental LEP methylation (P=0.05). These results suggest that LEP epigenetic control may be influenced by perinatal factors including: maternal obesity, infant growth, genotype and gender in a tissue-specific manner and may have multigenerational implications.

Excessive gestational weight gain and obesity contribute to altered expression of maternal insulin-like growth factor binding protein-3

BACKGROUND

Excessive gestational weight gain (GWG) increases risk of large for gestational age neonates and subsequent tracking of excess weight throughout the life course for both mother and child. Although the physiological mechanisms underlying these associations are incomplete, the insulin-like growth factor (IGF) axis has garnered attention for its role in fetal growth and development. Our purpose was to characterize the IGF axis protein expression patterns in mother-infant dyads in respect of excessive GWG.

METHODS

WE OBTAINED FASTING SERUM SAMPLES AND CORRESPONDING CORD BLOOD FROM EIGHT CONTROLS (ADHERE GROUP: ie, those who gained in accordance with 2009 Institute of Medicine GWG recommendations) and 13 exceeders (EXCEED group: ie, those who exceeded Institute of Medicine GWG recommendations). At study completion, we examined protein expression of IGF-I, IGF-II, IGF binding protein (IGFBP)-1, IGFBP-3, IGFBP-4, and hormone concentrations in both maternal and cord blood.

RESULTS

Between-group comparisons were made and revealed elevated maternal leptin (P ≤ 0.05) concentrations in gravidas who exceeded recommendations. There was a significantly higher number of obese women in the EXCEED group (P < 0.05). After adjustment, maternal leptin levels were positively correlated with maternal homeostasis model of assessment for insulin resistance score and excessive GWG (P ≤ 0.01). However, serum IGFBP-3 expression in the EXCEED mothers was greater than that in the ADHERE group (P ≤ 0.05).

CONCLUSION

These findings provide preliminary evidence suggesting that small deviations in IGFBP-regulated IGF bioavailability arising from excessive GWG/positive energy balance may affect adipocyte differentiation through subclinical insulin resistance.

Late-onset exercise in female rat offspring ameliorates the detrimental metabolic impact of maternal obesity

Rising rates of maternal obesity/overweight bring the need for effective interventions in offspring. We observed beneficial effects of postweaning exercise, but the question of whether late-onset exercise might benefit offspring exposed to maternal obesity is unanswered. Thus we examined effects of voluntary exercise implemented in adulthood on adiposity, hormone profiles, and genes involved in regulating appetite and metabolism in female offspring. Female Sprague Dawley rats were fed either normal chow or high-fat diet (HFD) ad libitum for 5 weeks before mating and throughout gestation/lactation. At weaning, female littermates received either chow or HFD and, after 7 weeks, half were exercised (running wheels) for 5 weeks. Tissues were collected at 15 weeks. Maternal obesity was associated with increased hypothalamic inflammatory markers, including suppressor of cytokine signaling 3, TNF-α, IL-1β, and IL-6 expression in the arcuate nucleus. In the paraventricular nucleus (PVN), Y1 receptor, melanocortin 4 receptor, and TNF-α mRNA were elevated. In the hippocampus, maternal obesity was associated with up-regulated fat mass and obesity-associated gene and TNF-α mRNA. We observed significant hypophagia across all exercise groups. In female offspring of lean dams, the reduction in food intake by exercise could be related to altered signaling at the PVN melanocortin 4 receptor whereas in offspring of obese dams, this may be related to up-regulated TNF-α. Late-onset exercise ameliorated the effects of maternal obesity and postweaning HFD in reducing body weight, adiposity, plasma leptin, insulin, triglycerides, and glucose intolerance, with greater beneficial effects in offspring of obese dams. Overall, hypothalamic inflammation was increased by maternal obesity or current HFD, and the effect of exercise was dependent on maternal diet. In conclusion, even after a significant sedentary period, many of the negative impacts of maternal obesity could be improved by voluntary exercise and healthy diet.

A qualitative study of factors affecting pregnancy weight gain in African American women

African Americans and overweight or obese women are at increased risk for excessive gestational weight gain (GWG) and postpartum weight retention. Interventions are needed to promote healthy GWG in this population; however, research on exercise and nutritional barriers during pregnancy in African American women is limited. The objective of this qualitative study is to better inform intervention messages by eliciting information on perceptions of appropriate weight gain, barriers to and enablers of exercise and healthy eating, and other influences on healthy weight gain during pregnancy in overweight or obese African American women. In-depth interviews were conducted with 33 overweight or obese African American women in Columbia, South Carolina. Women were recruited in early to mid-pregnancy (8-23 weeks gestation, n = 10), mid to late pregnancy (24-36 weeks, n = 15), and early postpartum (6-12 weeks postpartum, n = 8). Interview questions and data analysis were informed using a social ecological framework. Over 50 % of women thought they should gain weight in excess of the range recommended by the Institute of Medicine. Participants were motivated to exercise for personal health benefits; however they also cited many barriers to exercise, including safety concerns for the fetus. Awareness of the maternal and fetal benefits of healthy eating was high. Commonly cited barriers to healthy eating include cravings and availability of unhealthy foods. The majority of women were motivated to engage in healthy behaviors during pregnancy. However, the interviews also uncovered a number of misconceptions and barriers that can serve as future intervention messages and strategies.

Changes in adipose tissue distribution during pregnancy in overweight and obese compared with normal weight women

OBJECTIVE

Differences in body fat distribution contribute to the metabolic abnormalities associated with overweight and obesity; however, such differences have not been adequately explored during pregnancy. Our aim was to compare longitudinal trends in maternal abdominal adipose tissue deposition during pregnancy in overweight/obese compared with normal weight women.

STUDY DESIGN

Pregnant women, classified as normal weight (body mass index (BMI) <25 kg m(-2); N=61) or overweight/obese (BMI 25 kg m(-2); N=57), were enrolled in a prospective cohort study starting in the first trimester. Maternal subcutaneous (smin) and preperitoneal (pmax) fat were measured by ultrasound at five time points starting between 6 and 10 weeks gestation. The abdominal fat index (AFI), an established marker of visceral adipose tissue, was calculated as the ratio of pmax to smin. The trajectories of smin, pmax, cumulative fat index (smin plus pmax) and the AFI across pregnancy were analyzed using mixed linear models.

RESULTS

The rate of maternal weight gain during pregnancy was significantly lower for overweight/obese women compared with their non-overweight counterparts (P<0.05). Accordingly, the rate of change of pmax and smin differed significantly in normal weight compared with overweight/obese women (P=0.0003 and 0.01, respectively). The cumulative fat index did not change across gestation in normal weight women, whereas it decreased for overweight/obese women (P=0.0005). The log AFI increased across pregnancy in both strata, but significantly more rapidly for normal weight compared with overweight/obese women (P=0.06).

CONCLUSIONS

Adipose tissue is preferentially deposited in the more metabolically active visceral compartment as pregnancy progresses. However, this process differs in normal weight compared with overweight/obese women and may contribute to metabolic differences between these groups. Our study is a step toward a more refined description of obesity and its consequences during pregnancy.

Do in utero events contribute to current health disparities in reproductive medicine?

Health disparities exist in reproductive medicine as discussed in detail in the subsequent articles of this issue; however, in most cases, the exact cause of these differences is unknown. Some of these disparities can be linked to environmental exposures such as alcohol and other hazardous toxic exposures (polycarbonate, pesticides, nicotine) in adults. In addition, low socioeconomic status, behavioral risk factors, and lack of education have been linked to poor obstetric and reproductive outcomes in minority groups. Aside from these various environmental exposures later in life, there is evidence that adverse events in utero could contribute to poor reproductive outcome in specific minority groups. We will focus on the developmental origins of health and disease as a possible causal mechanism for health disparities in reproductive diseases, as this perspective may suggest tractable solutions of how to address and eliminate these health disparities.

The beneficial effects of early short-term exercise in the offspring of obese mothers are accompanied by alterations in the hypothalamic gene expression of appetite regulators and FTO (fat mass and obesity associated) gene

Maternal overnutrition is implicated in the development of adult metabolic disease, and has been shown to alter the expression of genes involved in energy homeostasis. In the present study, we aimed to test whether a short period of voluntary exercise, followed by a sedentary period, would regulate hypothalamic markers involved in appetite. Adult female Sprague-Dawley rats were fed either normal chow or high-fat diet (HFD) ad lib. for 5 weeks, mated and continued on their assigned diet during gestation/lactation. At weaning males, were separated into chow or HFD groups; half were exercised (running wheels), whereas the remainder were sedentary. At week 10, wheels were removed and rats remained sedentary for 5 weeks, prior to tissue collection. Maternal obesity increased offspring adiposity at 15 weeks and this was exacerbated by postnatal HFD (P < 0.05). Body weight and fat mass were reduced in offspring of obese mothers if they exercised, and this was maintained even after 5 weeks without exercise. At 15 weeks, fasting plasma insulin, leptin and triglyceride concentrations were significantly reduced by exercise in offspring of lean and obese mothers consuming chow, with little benefit in those consuming HFD. Hypothalamic mRNA expression of pro-opiomelanocortin was increased by exercise but only in offspring of lean mothers. Exercise reduced hypothalamic FTO (fat mass and obesity associated) mRNA in offspring of lean dams regardless of diet. A short period of exercise early in life had lasting beneficial effects on body weight, adiposity and hormone profile of male offspring from obese and lean dams, despite being followed by a period of inactivity. The effects of exercise on hypothalamic appetite regulators were more marked in offspring of lean dams.

[Construction of model for calculating and recording neonatal weight percentiles]

OBJECTIVES

To construct a model for calculating optimal foetal and neonatal weight curves with a method that allows automatic calculation of the percentile and sequential recording of results.

MATERIAL AND METHODS

A model was constructed for calculating optimal weight and the corresponding percentiles for gestational age and sex from a sample of 23,578 newborns, after excluding cases with diseases. Birth weight was modelled using stepwise multiple regression analysis. Newborns were classified as small or large for gestational age (SGA or LGA) using the proposed model. The resulting classification was compared with those derived from other models designed for Spanish children.

RESULTS

Optimal weight model: 3,311.062+68.074 *sex+143.267 *GE40 -13.481 *GE40(2) - 0.797 *GE40(3)+sex* (5.528 *GE40 - 0.674 *GE40(2) - 0.064 *GE40(3)). (GE, gestational age). Weight percentiles were obtained from standardized data using the coefficient of variation of the optimal weight. The degree of agreement between our model classification and those of the Carrascosa model and Ramos model, with empirical and smooth percentiles, was "almost perfect" (κ=0.866, κ=0.872, and κ=0.876 (P<.001), respectively), and between our model and that proposed by Figueras it was "substantial" (κ=0.720, P<.001).

CONCLUSIONS

The new model is comparable to those used for Spanish children and allows accurate, updated automatic percentile calculation for gestational age and sex. The results can be digitally stored to track longitudinal foetal growth. Free access to the model is offered, together with the possibility of automatic calculation of foetal and neonatal weight percentiles.

Identification of distinct body mass index trajectories in Australian children

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Recent studies have identified distinct trajectories of obesity development in children, but more research is required to further explore these trajectories. Several socio-demographic variables such as parental education and obesity are associated with these trajectories.

WHAT THIS STUDY ADDS

This study further demonstrates that there are distinct trajectories of body mass index in children. The use of raw body mass index values is more sensitive to changes in body composition compared with body mass index categories (e.g. lean vs. overweight). Hence the present results provide a more detailed insight into development patterns of obesity. The socio-demographic predictors of the trajectories offer potential avenues for future obesity interventions.

BACKGROUND

A limited number of studies have demonstrated that there may be distinct developmental trajectories of obesity during childhood.

OBJECTIVE

To identify distinct trajectories of body mass index (BMI) in a large sample of Australian children.

METHODS

Participants included 4601 children aged 4-5 years at baseline, who were followed up at ages 6-7 years, 8-9 years and 10-11 years. Height and weight were measured at each of these time points, and used to calculate BMI. Growth Mixture Modelling was used to identify the presence of distinct BMI trajectories.

RESULTS

Four distinct trajectories were identified (i) High Risk Overweight; (ii) Early Onset Overweight; (iii) Later Onset Overweight and (iv) Healthy Weight. Further analyses indicated that factors such as parental overweight, parent education, parent smoking and child birth weight were significant predictors of these trajectories.

CONCLUSION

These findings indicate that different patterns of BMI development exist in children, which may require tailored interventions.

American rural women's exercise self-efficacy and awareness of exercise benefits and safety during pregnancy

Though the positive link between physical activity and maternal health is well documented, physical activity declines during pregnancy and, internationally, rural mothers are less likely than urban mothers to engage in physical activity. Some evidence suggests that self-efficacy is related to sustained engagement in physical activity. The purpose of this study was to examine self-efficacy, perceived benefits, and knowledge of safe exercise among 88 rural pregnant women in a southeastern region of the United States. Exercise self-efficacy was significantly related to maternal age and gestation. Women over age 26 years, and those in the second and third trimesters, scored significantly higher than younger women or those in the first trimester. Fifty-two percent (n = 46) of participants perceived that activity would decrease energy levels, 37.5% (n = 33) did not know that exercise can decrease the risk of gestational diabetes, and 47.6% (n = 41) were unaware that a mother who is overweight is more likely to have an overweight child. Results confirm a need for education to improve women's knowledge about health benefits and safety information related to physical activity during pregnancy.