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Misra VK, Straughen JK, Trudeau S. Maternal serum leptin during pregnancy and infant birth weight: the influence of maternal overweight and obesity. Obesity (Silver Spring) 2013; 21:1064-9. [PMID: 23784911 PMCID: PMC3695413 DOI: 10.1002/oby.20128] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 09/04/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Few studies have examined whether the distinct metabolic patterns found in obese and nonobese pregnant women have different effects on the growing fetus. Our objective was to estimate the influence of longitudinal variation in maternal serum leptin levels on variation in infant birth weight in overweight/obese versus normal-weight women. DESIGN AND METHODS In a prospective cohort of 286 gravidas, maternal weight and serum leptin levels at 6-10, 10-14, 16-20, 22-26, and 32-36 weeks gestation were measured. Effects of leptin levels on infant birth weight adjusted for gestational age at delivery (aBW) were analyzed using a linear regression model that accounted for the relationship of time-varying predictors to the log-transformed leptin concentrations. RESULTS Different relationships of aBW to maternal serum leptin and its rate of change across pregnancy were exhibited by overweight/obese and normal-weight gravidas. For normal-weight women, aBW is not associated with either the magnitude of the logarithm of the leptin concentration or with its rate of change in either the first or second half of pregnancy. Conversely, for overweight/obese women, an increase in the rate of change in maternal serum leptin in the second half of pregnancy is significantly associated with a decrease in aBW. This effect is distinct from that of maternal weight. CONCLUSION Differences in the effect of maternal serum leptin on fetal growth between overweight/ obese and normal-weight women suggest metabolic and physiologic heterogeneity between these groups. Such differences may be involved in the long-term physiologic effects of the obese intrauterine environment on the health of the offspring.
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Affiliation(s)
- Vinod K Misra
- Department of Pediatrics, Division of Genetic and Metabolic Disorders, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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102
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Fall CHD. Fetal programming and the risk of noncommunicable disease. Indian J Pediatr 2013; 80 Suppl 1:S13-20. [PMID: 22829248 PMCID: PMC3793300 DOI: 10.1007/s12098-012-0834-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 06/15/2012] [Indexed: 01/01/2023]
Abstract
The "developmental origins of health and disease" (DOHaD) hypothesis proposes that environmental conditions during fetal and early post-natal development influence lifelong health and capacity through permanent effects on growth, structure and metabolism. This has been called 'programming'. The hypothesis is supported by epidemiological evidence in humans linking newborn size, and infant growth and nutrition, to adult health outcomes, and by experiments in animals showing that maternal under- and over-nutrition and other interventions (e.g., glucocorticoid exposure) during pregnancy lead to abnormal metabolism and body composition in the adult offspring. Early life programming is now thought to be important in the etiology of obesity, type 2 diabetes, and cardiovascular disease, opening up the possibility that these common diseases could be prevented by achieving optimal fetal and infant development. This is likely to have additional benefits for infant survival and human capital (e.g., improved cognitive performance and physical work capacity). Fetal nutrition is influenced by the mother's diet and body size and composition, but hard evidence that the nutrition of the human mother programmes chronic disease risk in her offspring is currently limited. Recent findings from follow-up of children born after randomised nutritional interventions in pregnancy are mixed, but show some evidence of beneficial effects on vascular function, lipid concentrations, glucose tolerance and insulin resistance. Work in experimental animals suggests that epigenetic phenomena, whereby gene expression is modified by DNA methylation, and which are sensitive to the nutritional environment in early life, may be one mechanism underlying programming.
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Affiliation(s)
- Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, Hampshire, SO16 6YD, UK.
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103
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Yang Z, Huffman SL. Nutrition in pregnancy and early childhood and associations with obesity in developing countries. MATERNAL AND CHILD NUTRITION 2013; 9 Suppl 1:105-19. [PMID: 23167588 DOI: 10.1111/mcn.12010] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Concerns about the increasing rates of obesity in developing countries have led many policy makers to question the impacts of maternal and early child nutrition on risk of later obesity. The purposes of the review are to summarise the studies on the associations between nutrition during pregnancy and infant feeding practices with later obesity from childhood through adulthood and to identify potential ways for preventing obesity in developing countries. As few studies were identified in developing countries, key studies in developed countries were included in the review. Poor prenatal dietary intakes of energy, protein and micronutrients were shown to be associated with increased risk of adult obesity in offspring. Female offspring seem to be more vulnerable than male offspring when their mothers receive insufficient energy during pregnancy. By influencing birthweight, optimal prenatal nutrition might reduce the risk of obesity in adults. While normal birthweights (2500-3999 g) were associated with higher body mass index (BMI) as adults, they generally were associated with higher fat-free mass and lower fat mass compared with low birthweights (<2500 g). Low birthweight was associated with higher risk of metabolic syndrome and central obesity in adults. Breastfeeding and timely introduction of complementary foods were shown to protect against obesity later in life in observational studies. High-protein intake during early childhood however was associated with higher body fat mass and obesity in adulthood. In developed countries, increased weight gain during the first 2 years of life was associated with a higher BMI in adulthood. However, recent studies in developing countries showed that higher BMI was more related to greater lean body mass than fat mass. It appears that increased length at 2 years of age was positively associated with height, weight and fat-free mass, and was only weakly associated with fat mass. The protective associations between breastfeeding and obesity may differ in developing countries compared to developed countries because many studies in developed countries used formula feeding as a control. Future research on the relationship between breastfeeding, timely introduction of complementary feeding or rapid weight gain and obesity are warranted in developing countries. The focus of interventions to reduce risk of obesity in later life in developing countries could include: improving maternal nutritional status during pregnancy to reduce low birthweight; enhancing breastfeeding (including durations of exclusive and total breastfeeding); timely introduction of high-quality complementary foods (containing micronutrients and essential fats) but not excessive in protein; further evidence is needed to understand the extent of weight gain and length gain during early childhood are related to body composition in later life.
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Affiliation(s)
- Zhenyu Yang
- National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China.
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104
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Ehrenthal DB, Maiden K, Rao A, West DW, Gidding SS, Bartoshesky L, Carterette B, Ross J, Strobino D. Independent relation of maternal prenatal factors to early childhood obesity in the offspring. Obstet Gynecol 2013; 121:115-21. [PMID: 23262935 DOI: 10.1097/aog.0b013e318278f56a] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine the independent contribution of risk factors developing during pregnancy to subsequent risk of obesity in young children. METHODS We conducted a historical cohort study using data from electronic medical records of mothers and their 3,302 singleton offspring born between 2004 and 2007 at a community-based obstetric facility who attended a 4-year well visit at a pediatric practice network. The child's body mass index (BMI) z score at age 4 years was studied in relation to the mother's gestational weight gain, gestational diabetes mellitus, gestational hypertension or preeclampsia, and prenatal tobacco use. Institute of Medicine categories defined excess and inadequate gestational weight gain at term. Analysis of variance and multiple linear regression were used to test their independent relation to BMI. RESULTS Mothers were white (39%), African American (46%), and of Hispanic ethnicity (11%); 46% were privately insured. The association of net gestational weight gain with the child's BMI z score was significant after adjustment for prepregnancy maternal factors (P<.001); gestational diabetes mellitus, gestational hypertension, and tobacco use were not significant in adjusted models. Children of mothers with excess gestational weight gain had a higher mean BMI z score (P<.001) but a significant association was observed only for inadequate gestational weight gain after adjusting for prepregnancy BMI and other covariates. Prepregnancy BMI (P<.001), Hispanic ethnicity (P<.001), and being married (P<.05) were independently associated with increasing BMI z score of the offspring. CONCLUSIONS Preconception maternal factors had a greater influence on child obesity than prenatal factors. The gestational weight gain category was independently related to BMI z score of 4 year olds, but this association was significant only for mothers with inadequate gestational weight gain. LEVEL OF EVIDENCE II.
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105
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Ehrenthal DB, Maiden K, Rao A, West DW, Gidding SS, Bartoshesky L, Carterette B, Ross J, Strobino D. Independent Relation of Maternal Prenatal Factors to Early Childhood Obesity in the Offspring. Obstet Gynecol 2013. [DOI: http:/10.1097/aog.0b013e318278f56a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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106
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Josefson JL, Feinglass J, Rademaker AW, Metzger BE, Zeiss DM, Price HE, Langman CB. Maternal obesity and vitamin D sufficiency are associated with cord blood vitamin D insufficiency. J Clin Endocrinol Metab 2013; 98:114-9. [PMID: 23144468 PMCID: PMC3537089 DOI: 10.1210/jc.2012-2882] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT An inverse relationship between total serum 25-hydroxyvitamin D (25-OH D) and increased adiposity has been established in children, adolescents, and adults. However, the relationship between neonatal adiposity and vitamin D status has not been reported. Both maternal obesity and vitamin D deficiency in pregnancy are common and are associated with adverse pregnancy outcomes. OBJECTIVE The aim of the study was to determine the relationship between vitamin D levels in mothers and newborns, as influenced by maternal obesity, and evaluate these associations with neonatal adiposity. DESIGN, SETTING, AND PATIENTS Sixty-one maternal-neonatal pairs participated in this cross-sectional study at an academic medical center. Mothers had a prepregnancy body mass index that was normal or obese. OUTCOME MEASURES Maternal and cord blood sera were assayed for 25-OH D, and neonatal body composition was measured by air displacement plethysmography. RESULTS Mothers had similar and sufficient levels of 25-OH D when measured at 36-38 wk gestation, irrespective of body mass index category (normal weight, 46.05, vs. obese, 49.84 ng/ml; P = not significant). However, cord blood 25-OH D was higher in neonates of normal-weight mothers compared to neonates of obese mothers (27.45 vs. 20.81 ng/ml; P = 0.02). The variance in cord blood 25-OH D was explained by four factors: maternal 25-OH D level, the presence of maternal obesity, maternal age, and neonatal adiposity (r(2) = 0.66). CONCLUSION Obese women transfer less 25-OH D to offspring than normal-weight women, despite similar serum levels. Cord blood 25-OH D levels directly correlate to neonatal percentage body fat. These novel findings underscore the evolving relationships between maternal obesity, vitamin D nutritional status, and adiposity in the neonatal period that may influence subsequent childhood and adulthood vitamin D-dependent processes.
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Affiliation(s)
- Jami L Josefson
- Division of Pediatric Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611-2605, USA.
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107
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Interaction between maternal and offspring diet to impair vascular function and oxidative balance in high fat fed male mice. PLoS One 2012; 7:e50671. [PMID: 23227196 PMCID: PMC3515587 DOI: 10.1371/journal.pone.0050671] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/23/2012] [Indexed: 12/22/2022] Open
Abstract
AIMS To determine the impact of maternal and post-weaning consumption of a high fat diet on endothelium-dependent vasorelaxation and redox regulation in adult male mouse offspring. METHODS Female C57BL6J mice were fed an obesogenic high fat diet (HF, 45% kcal fat) or standard chow (C, 21% kcal fat) pre-conception and throughout pregnancy and lactation. Post-weaning, male offspring were continued on the same diet as their mothers or placed on the alternative diet to give 4 dietary groups (C/C, HF/C, C/HF and HF/HF) which were studied at 15 or 30 weeks of age. RESULTS There were significant effects of maternal diet on offspring body weight (p<0.004), systolic blood pressure (p = 0.026) and endothelium-dependent relaxation to ACh (p = 0.004) and NO production (p = 0.005) measured in the femoral artery. With control for maternal diet there was also an effect of offspring post-weaning dietary fat to increase systolic blood pressure (p<0.0001) and reduce endothelium-dependent relaxation (p = 0.022) and ACh-mediated NO production (p = 0.007). There was also a significant impact of age (p<0.005). Redox balance was perturbed, with altered regulation of vascular enzymes involved in ROS/NO signalling. CONCLUSIONS Maternal consumption of a HF diet is associated with changes in vascular function and oxidative balance in the offspring of similar magnitude to those seen with consumption of a high fat diet post-weaning. Further, this disadvantageous vascular phenotype is exacerbated by age to influence the risk of developing obesity, raised blood pressure and endothelial dysfunction in adult life.
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108
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Li S, Tse IM, Li ET. Maternal green tea extract supplementation to rats fed a high-fat diet ameliorates insulin resistance in adult male offspring. J Nutr Biochem 2012; 23:1655-60. [DOI: 10.1016/j.jnutbio.2011.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 11/22/2011] [Accepted: 11/23/2011] [Indexed: 12/22/2022]
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109
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González González NL, Plasencia W, González Dávila E, Padrón E, García Hernández JA, Di Renzo GC, Bartha JL. The effect of customized growth charts on the identification of large for gestational age newborns. J Matern Fetal Neonatal Med 2012; 26:62-5. [PMID: 23043627 DOI: 10.3109/14767058.2012.726298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the effect of using customized vs. standard population birthweight curves to define large for gestational age (LGA) infants. METHODS We analyzed data obtained from 2,097 singleton pregnancies using three different methods of classifying newborn birthweight: standard population curves, British or Spanish customized curves. We recorded maternal characteristics, proportion of LGA newborns when using each method, percentage of LGA according to one method but not for the others, and concordance between the different methods. RESULTS The proportion of LGA newborns according to Spanish customized curves was significantly lower than that calculated using either standard general population birthweight curves or British curves (p < 0.001). A third (33.9%) of the infants classified as LGA according to the general population method were adequate for gestational age (AGA) when the Spanish customized curves were used, and 18.5% of non-LGA were LGA according to customized curves (p < 0.001). Concordance between the different models high, but on excluding AGA the concordance coefficient was low (Cohen's κ <0.4). CONCLUSIONS The use of customized curves allows differentiation between constitutional LGA and cases of fetal overgrowth, leading to a decrease in the rate of both false-positives and negatives as well as the overall proportion of LGA babies.
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110
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Poston L. Maternal obesity, gestational weight gain and diet as determinants of offspring long term health. Best Pract Res Clin Endocrinol Metab 2012; 26:627-39. [PMID: 22980045 DOI: 10.1016/j.beem.2012.03.010] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review addresses the increasingly prolific literature from studies in man and animals suggesting that maternal obesity, a diet rich in calories or excess gestational weight gain may, through perturbation of the intrauterine environment, lead to lifelong risk of obesity and related disorders in the child. In addressing maternal- child obesity relationships it remains a challenge to distinguish the influence of the intrauterine environment from the contribution of shared genetic traits, and to adequately adjust for postnatal determinants of childhood obesity. Studies in genetically identical rodents convincingly show that maternal obesity, as well as elements of a hypercalorific diet can permanently influence offspring risk of obesity, and are these are supported by studies in larger mammals. Importantly, dissection of the mechanism in animals has led to description of novel interactive pathways between maternal environment and fetus which are amenable to investigation in humans.
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Affiliation(s)
- Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London, St. Thomas' Hospital, London, United Kingdom.
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111
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Hinkle SN, Sharma AJ, Swan DW, Schieve LA, Ramakrishnan U, Stein AD. Excess gestational weight gain is associated with child adiposity among mothers with normal and overweight prepregnancy weight status. J Nutr 2012; 142:1851-8. [PMID: 22955516 PMCID: PMC6498456 DOI: 10.3945/jn.112.161158] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There are inconsistencies in the literature regarding the association between gestational weight gain (GWG) and child adiposity. GWG is hypothesized to act on child adiposity directly through intrauterine programming and indirectly through birth weight. It is unclear if the relative importance of these pathways differs by prepregnancy BMI status. We analyzed data from 3600 participants of the nationally representative Early Childhood Longitudinal Study-Birth Cohort. Child BMI Z-score was calculated from height and weight measured at 5 y. Using linear regression, controlling for sociodemographics and family lifestyle, we examined prepregnancy BMI-specific associations between GWG and child BMI Z-score. There was a nonlinear association among normal (P < 0.001) and overweight mothers only (P = 0.013), such that GWG beyond the midpoint of the 2009 Institute of Medicine recommendations was associated with a significant increase in child BMI Z-score. After the addition of birth-weight-for-gestational-age and breastfeeding to the model, the association remained among normal-weight mothers (P = 0.005) and was slightly attenuated among overweight mothers (P = 0.09). No significant association was observed between GWG and child BMI Z-score among underweight or obese mothers. We used path analysis to decompose the total effect into direct and indirect effects. This indicated the presence of a stronger direct than indirect effect. In conclusion, low GWG is not associated with BMI Z-score among any prepregnancy BMI group. Excess GWG is associated with an increase in child BMI Z-score among normal and overweight mothers only. Prevention of excess GWG may be a strategy to prevent childhood obesity.
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Affiliation(s)
- Stefanie N. Hinkle
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA,National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Andrea J. Sharma
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA,National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA,United States Public Health Service Commissioned Corps, Atlanta, GA,To whom correspondence should be addressed. E-mail:
| | - Deanne W. Swan
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Laura A. Schieve
- National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Usha Ramakrishnan
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA,Rollins School of Public Health, Emory University, Atlanta, GA
| | - Aryeh D. Stein
- Nutrition and Health Sciences, Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA,Rollins School of Public Health, Emory University, Atlanta, GA
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112
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The associations between maternal pre-pregnancy body mass index or gestational weight change during pregnancy and body mass index of the child at 3 years of age. Int J Obes (Lond) 2012; 36:1325-31. [PMID: 22929211 DOI: 10.1038/ijo.2012.140] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To estimate the associations between maternal pre-pregnancy body mass index (BMI) or gestational weight change (GWC) during pregnancy and offspring BMI at 3 years of age, while taking several pre-and postnatal factors into account. DESIGN The Norwegian Mother and Child Cohort Study is a population-based pregnancy cohort study of women recruited from all geographical areas of Norway. SUBJECTS The study includes 31 169 women enrolled between 2000 and 2009 through a postal invitation sent to women at 17-18 weeks of gestation. Data collected from 5898 of the fathers were included. MAIN OUTCOME MESURES: Offspring BMI at 3 years was the main outcome measured in this study. RESULTS Mean maternal pre-pregnancy BMI was 24.0 kg m(-2) (s.d. 4.1), mean GWC in the first 30 weeks of gestation was 9.0 kg (s.d. 4.1) and mean offspring BMI at 3 years of age was 16.1 kg m(-2) (s.d. 1.5). Both maternal pre-pregnancy BMI and GWC were positively associated with mean offspring BMI at 3 years of age. Pre-pregnancy BMI and GWC also interacted, and the strength of the interaction between these two factors was strongly associated with the increase in offspring BMI among mothers who gained the most weight during pregnancy and had the highest pre-pregnancy BMI. Our findings show that results could be biased by not including pre-pregnant paternal BMI. CONCLUSION(S) This large population-based study showed that both maternal pre-pregnancy BMI and GWC were positively associated with mean offspring BMI at 3 years of age.
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113
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Ferraro ZM, Gruslin A, Adamo KB. An active pregnancy for fetal well-being? The value of active living for most women and their babies. Br J Sports Med 2012; 47:813-4. [PMID: 22872682 DOI: 10.1136/bjsports-2012-091452] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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114
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Alberga AS, Sigal RJ, Goldfield G, Prud'homme D, Kenny GP. Overweight and obese teenagers: why is adolescence a critical period? Pediatr Obes 2012; 7:261-73. [PMID: 22461384 DOI: 10.1111/j.2047-6310.2011.00046.x] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/07/2011] [Accepted: 12/16/2011] [Indexed: 01/19/2023]
Abstract
This paper discusses the critical period of adolescence and its potential role in the development and persistence of obesity. The adolescent years are characteristic of changes in body composition (location and quantity of body fat), physical fitness and decreased insulin sensitivity during puberty. This period of growth and maturation is also marked with behavioural changes in diet, physical activity, sedentary behaviour and psychological health. Physical activity and sport participation decline during adolescence especially in teenage girls, while sedentary behaviour, risk for depression and body esteem issues increase during the teenage years. These physiological and behavioural changes during adolescence warrant the attention of health practitioners to prevent the onset and continuation of obesity throughout the lifespan.
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Affiliation(s)
- A S Alberga
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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115
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Effect of atypical antipsychotics on fetal growth: is the placenta involved? J Pregnancy 2012; 2012:315203. [PMID: 22848828 PMCID: PMC3401548 DOI: 10.1155/2012/315203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/18/2012] [Indexed: 01/08/2023] Open
Abstract
There is currently considerable uncertainty regarding prescribing practices for pregnant women with severe and persistent psychiatric disorders. The physician and the mother have to balance the risks of untreated psychiatric illness against the potential fetal toxicity associated with pharmacological exposure. This is especially true for women taking atypical antipsychotics. Although these drugs have limited evidence for teratological risk, there are reports of altered fetal growth, both increased and decreased, with maternal atypical antipsychotic use. These effects may be mediated through changes in the maternal metabolism which in turn impacts placental function. However, the presence of receptors targeted by atypical antipsychotics in cell lineages present in the placenta suggests that these drugs can also have direct effects on placental function and development. The signaling pathways involved in linking the effects of atypical antipsychotics to placental dysfunction, ultimately resulting in altered fetal growth, remain elusive. This paper focuses on some possible pathways which may link atypical antipsychotics to placental dysfunction.
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116
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The potential impact of physical activity during pregnancy on maternal and neonatal outcomes. Obstet Gynecol Surv 2012; 67:99-110. [PMID: 22325300 DOI: 10.1097/ogx.0b013e318242030e] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pregnancy is a critical period of body weight regulation. Maternal obesity and excessive gestational weight gain have become increasingly common and contribute to poor obstetrical outcomes for mother and baby. Regular participation in physical activity may improve risk profiles in pregnant women. PURPOSE AND METHODS Our objectives were to provide an overview of maternal-fetal exercise physiology, summarize current evidence on the effects of physical activity during pregnancy on maternal-fetal outcomes, and review the most recent clinical practice guidelines. In addition, we summarize the findings in the context of the current obesity epidemic and discuss implications for clinical practice. A literature review was completed in which we queried OVID (Medline), EMBASE, and PSYCHINFO databases with title words "exercise or physical activity" and "pregnancy or gestation" from 1950 to March 1, 2010. A total of 212 articles were selected for review. RECOMMENDATIONS Care providers should recommend physical activity to most pregnant women (i.e., those without contraindications) and view participation as a safe and beneficial component of a healthy pregnancy. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After participating in this CME activity, physicians should be better able to classify the potential impact of physical activity on maternal glycemic control and fetal growth outcomes. Assess maternal lifestyle and provide recommendations on appropriate gestational weight gain, evaluate pregnant women for contraindications to physical activity participation, make individualized recommendations for exercise participation, and educate patients on the merits of physical activity for health benefit.
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117
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Barbour LA. Weight gain in pregnancy: is less truly more for mother and infant? Obstet Med 2012; 5:58-64. [PMID: 27579137 DOI: 10.1258/om.2012.120004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2012] [Indexed: 11/18/2022] Open
Abstract
Although more than 50% of women gain weight above the Institute of Medicine (IOM) guidelines for weight gain in pregnancy and excessive weight gain is an independent risk factor for significant maternal and neonatal morbidity and offspring obesity, there is little consensus over the ideal weight gain during pregnancy. Surprisingly, the 2009 IOM guidelines varied minimally from the 1990 IOM guidelines, and many critics advocate lower weight gain recommendations. This review explores the energy costs of pregnancy, the relationship between gestational weight gain and birth weight, and considers what gestational weight gain minimizes both large-for-gestational age as well as small-for-gestational age infants. An extensive examination of the current data leads this author to question whether the current weight gain recommendations are too liberal, especially for obese pregnant women.
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Affiliation(s)
- Linda A Barbour
- Divisions of Endocrinology, Diabetes and Metabolism and Maternal-Fetal Medicine, University of Colorado School of Medicine , 12801 E 17th Ave, RC1 South Room 7103, Aurora, CO 80045 , USA
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118
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Maternal Recreational Exercise during Pregnancy in relation to Children's BMI at 7 Years of Age. Int J Pediatr 2012; 2012:920583. [PMID: 22548089 PMCID: PMC3324144 DOI: 10.1155/2012/920583] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/20/2012] [Accepted: 01/26/2012] [Indexed: 12/16/2022] Open
Abstract
Exposures during fetal life may have long-term health consequences including risk of childhood overweight. We investigated the associations between maternal recreational exercise during early and late pregnancy and the children's body mass index (BMI) and risk of overweight at 7 years. Data on 40,280 mother-child pairs from the Danish National Birth Cohort was used. Self-reported information about exercise was obtained from telephone interviews around gestational weeks 16 and 30. Children's weight and height were reported in a 7-year follow-up and used to calculate BMI and overweight status. Data was analyzed using multiple linear and logistic regression models. Recreational exercise across pregnancy was inversely related to children's BMI and risk of overweight, but all associations were mainly explained by smoking habits, socioeconomic status, and maternal pre-pregnancy BMI. Additionally, we did not find exercise intensity or changes in exercise habits in pregnancy related to the children's BMI or risk of overweight.
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119
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Olson G. Obesity and implications for future generations. Am J Obstet Gynecol 2012; 206:255-7. [PMID: 22381598 DOI: 10.1016/j.ajog.2012.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/09/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Gayle Olson
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX 77555-0587, USA.
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120
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Abstract
Pregnancy is now considered to be an important risk factor for new or persistent obesity among women during the childbearing years. High gestational weight gain is the strongest predictor of maternal overweight or obesity following pregnancy. A growing body of evidence also suggests that both high and low gestational weight gains are independently associated with an increased risk of childhood obesity, suggesting that influences occurring very early in life are contributing to obesity onset. In response to these data, the US Institute of Medicine (IOM) revised gestational weight gain guidelines in 2009 for the first time in nearly two decades. However, less than one third of pregnant women achieve guideline-recommended gains, with the majority gaining above IOM recommended levels. To date, interventions to optimize pregnancy weight gains have had mixed success. In this paper, we summarize the evidence from human and animal studies linking over-nutrition and under-nutrition in pregnancy to maternal and child obesity. In addition, we discuss published trials and ongoing interventions to achieve appropriate gestational weight gain as a strategy for obesity prevention in women and their children.
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Affiliation(s)
- S J Herring
- Center for Obesity Research and Education, Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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121
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Scott JA, Ng SY, Cobiac L. The relationship between breastfeeding and weight status in a national sample of Australian children and adolescents. BMC Public Health 2012; 12:107. [PMID: 22314050 PMCID: PMC3311145 DOI: 10.1186/1471-2458-12-107] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 02/07/2012] [Indexed: 12/29/2022] Open
Abstract
Background Breastfeeding has been shown consistently in observational studies to be protective of overweight and obesity in later life. This study aimed to investigate the association between breastfeeding duration and weight status in a national sample of Australian children and adolescents. Methods A secondary analysis of the 2007 Australian National Children's Nutrition and Physical Activity Survey data involving 2066, males and females aged 9 to 16 years from all Australian states and territories. The effect of breastfeeding duration on weight status was estimated using multivariate logistic regression analysis. Results Compared to those who were never breastfed, children breastfed for ≥6 months were significantly less likely to be overweight (adjusted odds ratio: 0.64, 95%CI: 0.45, 0.91) or obese (adjusted odds ratio: 0.51, 95%CI: 0.29, 0.90) in later childhood, after adjustment for maternal characteristics (age, education and ethnicity) and children's age, gender, mean energy intake, level of moderate and vigorous physical activity, screen time and sleep duration. Conclusions Breastfeeding for 6 or more months appears to be protective against later overweight and obesity in this population of Australian children. The beneficial short-term health outcomes of breastfeeding for the infant are well recognised and this study provides further observational evidence of a potential long-term health outcome and additional justification for the continued support and promotion of breastfeeding to six months and beyond.
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Affiliation(s)
- Jane A Scott
- Department of Nutrition and Dietetics, School of Medicine, Flinders University, Adelaide, South Australia.
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122
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Abstract
AbstractObjectiveThe present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics.DesignCross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia.SettingBogotá, Colombia.SubjectsPregnant adolescents aged 13–19 years (n 430) and pregnant women aged 20–49 years (n 1272).ResultsThe gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % CI 0·34, 0·91, P < 0·02) had lower odds of being underweight. Women who received prenatal care (POR = 2·17; 95 % CI 1·48, 3·09, P < 0·001) and were multiparous (POR = 2·10; 95 % CI 1·43, 3·15, P < 0·0 0 1) had higher odds of being overweight. Women in extended families (POR = 0·63; 95 % CI 0·50, 0·95, P < 0·025) had lower odds of being overweight.ConclusionsUnderweight in pregnant adolescents and overweight in adult women coexist as a double burden in Colombia. Factors associated with malnutrition among pregnant women and adolescents should be considered for future interventions in countries experiencing nutritional transition.
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123
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Metabolic programming of obesity in utero: is there sufficient evidence to explain increased obesity rates? J Dev Orig Health Dis 2011. [DOI: 10.1017/s2040174411000705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Branum AM, Parker JD, Keim SA, Schempf AH. Prepregnancy body mass index and gestational weight gain in relation to child body mass index among siblings. Am J Epidemiol 2011; 174:1159-65. [PMID: 21984656 DOI: 10.1093/aje/kwr250] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There is increasing evidence that in utero effects of excessive gestational weight gain may result in increased weight in children; however, studies have not controlled for shared genetic or environmental factors between mothers and children. Using 2,758 family groups from the Collaborative Perinatal Project, the authors examined the association of maternal prepregnancy body mass index (BMI) and gestational weight gain on child BMI at age 4 years using both conventional generalized estimating equations and fixed-effects models that account for shared familial factors. With generalized estimating equations, prepregnancy BMI and gestational weight gain had similar associations with the child BMI z score (β = 0.09 units, 95% confidence interval (CI): 0.08, 0.11; and β = 0.07 units, 95% CI: 0.04, 0.11, respectively. However, fixed effects resulted in null associations for both prepregnancy BMI (β = 0.03 units, 95% CI: -0.01, 0.07) and gestational weight gain (β = 0.03 units, 95% CI: -0.02, 0.08) with child BMI z score at age 4 years. The positive association between gestational weight gain and child BMI at age 4 years may be explained by shared family characteristics (e.g., genetic, behavioral, and environmental factors) rather than in utero programming. Future studies should continue to evaluate the relative roles of important familial and environmental factors that may influence BMI and obesity in children.
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Affiliation(s)
- Amy M Branum
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD 20782, USA.
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125
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Maternal behaviors during pregnancy impact offspring obesity risk. EXPERIMENTAL DIABETES RESEARCH 2011; 2011:985139. [PMID: 22110475 PMCID: PMC3205727 DOI: 10.1155/2011/985139] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/05/2011] [Accepted: 08/06/2011] [Indexed: 01/12/2023]
Abstract
This study investigated the effects of maternal changes during pregnancy in diet, exercise, and psychosocial factors on offspring weight parameters at birth and 6 months. In overweight/obese (OW/OB; n = 132) mothers, greater % kcal from sweets early in pregnancy was the strongest, independent predictor of higher weight for age (WFA) (beta = 0.19; P = 0.004), higher odds of macrosomia (OR = 1.1 (1.0-1.2); P = 0.004) and WFA >90th percentile at birth (OR = 1.2 (1.1-1.3); P = 0.002) and higher WFA at 6 months (beta = 0.30; P = 0.002). In normal weight (n = 153) mothers, higher intake of soft drinks was the strongest predictor of higher offspring WFA at birth (beta = 0.16; P = 0.04) but not at 6 months. Prenatal physical activity, depressive symptoms, and sleep-related variables did not significantly predict offspring weight outcomes. Mothers' eating behaviors during pregnancy, especially intake of sweets in OW/OB mothers, may have a lasting effect on child weight.
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126
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Increased cardiovascular reactivity to acute stress and salt-loading in adult male offspring of fat fed non-obese rats. PLoS One 2011; 6:e25250. [PMID: 22043281 PMCID: PMC3197190 DOI: 10.1371/journal.pone.0025250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/30/2011] [Indexed: 11/19/2022] Open
Abstract
Diet-induced obesity in rat pregnancy has been shown previously to be associated with consistently raised blood pressure in the offspring, attributed to sympathetic over-activation, but the relative contributions to this phenotype of maternal obesity versus raised dietary fat is unknown. Sprague-Dawley female rats were fed either a control (4.3% fat, n = 11) or lard-enriched (23.6% fat, n = 16) chow 10 days prior to mating, throughout pregnancy and lactation. In conscious adult (9-month-old) offspring cardiovascular parameters were measured (radiotelemetry). The short period of fat-feeding did not increase maternal weight versus controls and the baseline blood pressure was similar in offspring of fat fed dams (OF) and controls (OC). However, adult male OF showed heightened cardiovascular reactivity to acute restraint stress (p<0.01; Δ systolic blood pressure (SBP) and Δheart rate (HR)) with a prolonged recovery time compared to male OC. α1/β-adrenergic receptor blockade normalised the response. Also, after dietary salt-loading (8%-NaCl ad libitum for 1 week) male OF demonstrated higher SBP (p<0.05) in the awake phase (night-time) and increased low/high frequency ratio of power spectral density of HR variability versus OC. Baroreflex gain and basal power spectral density components of the heart rate or blood pressure were similar in male OF and OC. Minor abnormalities were evident in female OF. Fat feeding in the absence of maternal obesity in pregnant rats leads to altered sympathetic control of cardiovascular function in adult male offspring, and hypertension in response to stressor stimuli.
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127
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Caruso V, Chen H, Morris MJ. Early hypothalamic FTO overexpression in response to maternal obesity--potential contribution to postweaning hyperphagia. PLoS One 2011; 6:e25261. [PMID: 21980407 PMCID: PMC3182187 DOI: 10.1371/journal.pone.0025261] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 08/30/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Intrauterine and postnatal overnutrition program hyperphagia, adiposity and glucose intolerance in offspring. Single-nucleotide polymorphisms (SNPs) of the fat mass and obesity associated (FTO) gene have been linked to increased risk of obesity. FTO is highly expressed in hypothalamic regions critical for energy balance and hyperphagic phenotypes were linked with FTO SNPs. As nutrition during fetal development can influence the expression of genes involved in metabolic function, we investigated the impact of maternal obesity on FTO. METHODS Female Sprague Dawley rats were exposed to chow or high fat diet (HFD) for 5 weeks before mating, throughout gestation and lactation. On postnatal day 1 (PND1), some litters were adjusted to 3 pups (vs. 12 control) to induce postnatal overnutrition. At PND20, rats were weaned onto chow or HFD for 15 weeks. FTO mRNA expression in the hypothalamus and liver, as well as hepatic markers of lipid metabolism were measured. RESULTS At weaning, hypothalamic FTO mRNA expression was increased significantly in offspring of obese mothers and FTO was correlated with both visceral and epididymal fat mass (P<0.05); body weight approached significance (P = 0.07). Hepatic FTO and Fatty Acid Synthase mRNA expression were decreased by maternal obesity. At 18 weeks, FTO mRNA expression did not differ between groups; however body weight was significantly correlated with hypothalamic FTO. Postnatal HFD feeding significantly reduced hepatic Carnitine Palmitoyltransferase-1a but did not affect the expression of other hepatic markers investigated. FTO was not affected by chronic HFD feeding. SIGNIFICANCE Maternal obesity significantly impacted FTO expression in both hypothalamus and liver at weaning. Early overexpression of hypothalamic FTO correlated with increased adiposity and later food intake of siblings exposed to HFD suggesting upregulation of FTO may contribute to subsequent hyperphagia, in line with some human data. No effect of maternal obesity was observed on FTO in adulthood.
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Affiliation(s)
- Vanni Caruso
- Department of Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Hui Chen
- Department of Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Medical and Molecular Bioscience, Faculty of Science, University of Technology, Sydney, New South Wales, Australia
| | - Margaret J. Morris
- Department of Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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128
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Abstract
Suboptimal maternal nutritional status has been implicated in the development of cardiovascular risk in the child. Initially inferred from studies of low-birthweight children, investigations in cohorts of women subjected to famine provide direct evidence for an independent influence of the mother's diet on the cardiovascular health of her child. Animal studies from rodents and sheep have shown associations between maternal undernutrition and raised blood pressure, as well as abnormalities in resistance artery function, particularly in endothelium-dependent responses. Early life exposure to the influences of maternal over nutritional states, e.g. obesity and excessive gestational weight gain, has also been associated with markers of cardiovascular risk in man, and animal models have shown raised blood pressure and endothelial dysfunction in offspring of diet-induced obese dams. Increased sympathetic tone is commonly associated with hypertension in animal models of both under nutritional and over nutritional states. This and several other similarities may indicate commonality of mechanism and could reflect supranormal nutritional status in postnatal life in both conditions.
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Affiliation(s)
- Lucilla Poston
- Division of Women's Health, King's College London and King's Health Partners, London, UK.
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129
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Identifying 'at risk' women and the impact of maternal obesity on National Health Service maternity services. Proc Nutr Soc 2011; 70:439-49. [PMID: 21854697 DOI: 10.1017/s0029665111001625] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Obesity is a public health concern worldwide, arising from multifaceted and complex causes that relate to individual choice and lifestyle, and the influences of wider society. In addition to a long-standing focus on both childhood and adult obesity, there has been more recent concern relating to maternal obesity. This review explores the published evidence relating to maternal obesity incidence and associated inequalities, the impact of obesity on maternity services, and associated guidelines. Epidemiological data comprising three national maternal obesity datasets within the UK have identified a significant increase in maternal obesity in recent years, and reflect broad socio-demographic inequalities particularly deprivation, ethnicity and unemployment. Obese pregnancies present increased risk of complications that require more resource intensive antenatal and perinatal care, such as caesarean deliveries, gestational diabetes, haemorrhage, infections and congenital anomalies. Healthcare professionals also face difficulties when managing the care of women in pregnancy as obesity is an emotive and stigmatising topic. There is a lack of good-quality evidence for effective interventions to tackle maternal obesity. Recently published national guidelines for the clinical management and weight management of maternal obesity offer advice for professionals, but acknowledge the limitations of the evidence base. The consequence of these difficulties is an absence of support services available for women. Further evaluative research is thus required to assess the effectiveness of interventions with women before, during and after pregnancy. Qualitative work with women will also be needed to help inform the development of more sensitive risk communication and women-centred services.
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130
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Monteiro SMDR, Jancey J, Howat P, Burns S, Jones C, Dhaliwal SS, McManus A, P Hills A, Anderson AS. The protocol of a randomized controlled trial for playgroup mothers: Reminder on Food, Relaxation, Exercise, and Support for Health (REFRESH) Program. BMC Public Health 2011; 11:648. [PMID: 21843366 PMCID: PMC3166931 DOI: 10.1186/1471-2458-11-648] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 08/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mother's physical activity levels are relatively low, while their energy consumption is generally high resulting in 58% of Australian women over the age of 18 years being overweight or obese. This study aims to confirm if a low-cost, accessible playgroup based intervention program can improve the dietary and physical activity behaviours of mothers with young children. METHODS/DESIGN The current study is a randomized controlled trial lifestyle (nutrition and physical activity) intervention for mothers with children aged between 0 to 5 years attending playgroups in Perth, Western Australia. Nine-hundred participants will be recruited and randomly assigned to the intervention (n = 450) and control (n = 450) groups. The study is based on the Social Cognitive Theory (SCT) and the Transtheoretical Model (TTM), and the Precede-Proceed Framework incorporating goal setting, motivational interviewing, social support and self-efficacy. The six month intervention will include multiple strategies and resources to ensure the engagement and retention of participants. The main strategy is home based and will include a specially designed booklet with dietary and physical activity information, a muscle strength and flexibility exercise chart, a nutrition label reading shopping list and menu planner. The home based strategy will be supported by face-to-face dietary and physical activity workshops in the playgroup setting, posted and emailed bi-monthly newsletters, and monthly Short Message Service (SMS) reminders via mobile phones. Participants in the control group receive no intervention materials. Outcome measures will be assessed using data that will be collected at baseline, six months and 12 months from participants in the control and intervention groups. DISCUSSION This trial will add to the evidence base on the recruitment, retention and the impact of community based dietary and physical activity interventions for mothers with young children. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12609000735257.
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Affiliation(s)
- Sarojini MDR Monteiro
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Jonine Jancey
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Peter Howat
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Sharyn Burns
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
| | - Carlie Jones
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Satvinder S Dhaliwal
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Western Australia, Australia
- Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia, Australia
| | - Alexandra McManus
- Curtin Health Innovation Research Institute, Curtin University, Western Australia, Australia
| | - Andrew P Hills
- Griffith University and Mater Medical Research Institute, Queensland, Australia
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, UK
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131
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Misra VK, Trudeau S, Perni U. Maternal serum lipids during pregnancy and infant birth weight: the influence of prepregnancy BMI. Obesity (Silver Spring) 2011; 19:1476-81. [PMID: 21394096 DOI: 10.1038/oby.2011.43] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Maternal obesity may be associated with metabolic factors that affect the intrauterine environment, fetal growth, and the offspring's long-term risk for chronic disease. Among these factors, maternal serum lipids play a particularly important role. Our objective was to estimate the influence of variation in maternal serum lipid levels on variation in infant birth weight (BW) in overweight/obese and normal weight women. In a prospective cohort of 143 gravidas, we measured maternal serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) at 6-10, 10-14, 16-20, 22-26, and 32-36 weeks gestation. Effects of maternal serum lipid levels on infant BW adjusted for gestational age at delivery (aBW) were analyzed using linear regression models. In analyses stratified by maternal prepregnancy BMI categorized as normal (≤25.0 kg/m(2)) and overweight/obese (>25.0 kg/m(2)), we found a significant (P < 0.05) inverse association between aBW and HDL-C at all time points starting at 10 weeks gestation in overweight/obese women. No significant effect was found in normal weight women. In contrast, increased maternal serum TG was significantly associated with increased aBW only for normal weight women at 10-14 and 22-26 weeks gestation. Variation in aBW is not associated with variation in maternal serum TC or LDL-C for either stratum at any time point. We postulate that such differences may be involved in the "physiological programming" that influences later risk of chronic disease in the infants of overweight/obese mothers.
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Affiliation(s)
- Vinod K Misra
- Department of Pediatrics, Division of Genetic and Metabolic Disorders, Wayne State University School of Medicine, Detroit, Michigan, USA.
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132
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Abstract
AIM Research in animals has shown that altering foetal nutrition by under-nourishing or over-nourishing the mother or rendering her diabetic or foetal exposure to glucocorticoids and toxins can programme obesity in later life. The increased adiposity is mediated by permanent changes in appetite, food choices, physical activity and energy metabolism. In humans, increased adiposity has been shown in people who experienced foetal under-nutrition due to maternal famine or over-nutrition due to maternal diabetes. Lower birth weight (a proxy for foetal under-nutrition) is associated with a reduced adult lean mass and increased intra-abdominal fat. Higher birth-weight caused by maternal diabetes is associated with increased total fat mass and obesity in later life. There is growing evidence that maternal obesity, without diabetes, is also a risk factor for obesity in the child, due to foetal over-nutrition effects. Maternal smoking is associated with an increased risk of obesity in the children, although a causal link has not been proven. Other foetal exposures associated with increased adiposity in animals include glucocorticoids and endocrine disruptors. CONCLUSIONS Reversing the current obesity epidemic will require greater attention to, and better understanding of, these inter-generational (mother-offspring) factors that programme body composition during early development.
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Affiliation(s)
- Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
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133
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Exercise Training in Pregnancy for obese women (ETIP): study protocol for a randomised controlled trial. Trials 2011; 12:154. [PMID: 21682869 PMCID: PMC3148988 DOI: 10.1186/1745-6215-12-154] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 06/17/2011] [Indexed: 01/13/2023] Open
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Abel T, Blázovics A, Kemény M, Lengyel G. [Hyperlipoproteinemia in pregnancy]. Orv Hetil 2011; 152:753-7. [PMID: 21498165 DOI: 10.1556/oh.2011.29108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Physiological changes in lipoprotein levels occur in normal pregnancy. Women with hyperlipoproteinemia are advised to discontinue statins, fibrates already when they consider pregnancy up to and including breast-feeding the newborn, because of the fear for teratogenic effects. Hypertriglyceridemia in pregnancy can rarely lead to acute pancreatitis. Management of acute pancreatitis in pregnant women is similar to that used in non-pregnant patients. Further large cohort studies are needed to estimate the consequence of supraphysiologic hyperlipoproteinemia or extreme hyperlipoproteinemia in pregnancy on the risk for cardiovascular disease later in life.
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Affiliation(s)
- Tatjána Abel
- Állami Egészségügyi Központ Szakrendelő Intézet Budapest Róbert Károly krt. 44. 1134.
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135
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The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: the EPOCH study. J Pediatr 2011; 158:941-6. [PMID: 21238981 PMCID: PMC3090715 DOI: 10.1016/j.jpeds.2010.12.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/21/2010] [Accepted: 12/02/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine associations between exposure to maternal diabetes in utero and body mass index (BMI) growth trajectories from birth through 13 years of age among a diverse cohort of youth. STUDY DESIGN Mixed linear effects models were constructed to assess differences in BMI and BMI growth velocity from birth through 13 years of age for 95 subjects exposed to diabetes in utero and 409 unexposed subjects enrolled in a retrospective cohort study. RESULTS The overall BMI growth trajectory (adjusted for sex and race/ethnicity) was not significantly different for exposed and unexposed subjects from birth through 26 months of age (P = .48). However, the overall growth trajectory from 27 months of age through 13 years differed by exposure status (P = .008), adjusted for sex and race/ethnicity. The difference was primarily due to a significantly higher BMI growth velocity among exposed youth between 10 and 13 years, increasing by 4.56 kg/m² compared with 3.51 kg/m² in the unexposed (P = .005). Control for demographic variables, socioeconomic factors, and maternal prepregnancy BMI did not alter the observed associations. CONCLUSIONS Exposure to maternal diabetes in utero accelerates BMI growth in late childhood, thus increasing long-term obesity risk.
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137
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Ferraro Z, Rutherford J, Keely EJ, Dubois L, Adamo KB. An assessment of patient information channels and knowledge of physical activity and nutrition during pregnancy. Obstet Med 2011; 4:59-65. [PMID: 27582855 DOI: 10.1258/om.2011.110006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Excessive weight gain during pregnancy increases the risk for obesity in mother and child. Healthy eating and physical activity may help prevent excessive gestational weight gain and minimize offspring risk of developing obesity, diabetes and cardiovascular disease. Our goal was to determine the information channels used by pregnant women to obtain information on nutrition and exercise. METHODS We collected information about their knowledge of physical activity and nutrition during pregnancy and assessed their satisfaction with this information to identify factors that may be improved upon when designing a behavioural intervention. An anonymous, voluntary questionnaire was completed by 147 pregnant women to identify the proportion who are currently receiving information about exercise from their care provider. RESULTS The primarily Caucasian sample (age: 30.9 ± 4.2, weeks gestation: 21.4 ± 9.4) completed the survey. A total of 86% are willing to participate in a lifestyle intervention trial. Personal health and the health of their child were cited as top reasons for participation. Most women were not informed as to the importance of appropriate pregnancy-specific energy intake or made aware of their own personal healthy gestational weight gain targets. A total of 63% report receiving some form of information on physical activity during pregnancy. Of those who do not, almost all (93%) would like to receive this information from a care provider. Overall, 88% of women consider it safe to exercise when pregnant. DISCUSSION Given their responses, nutrition and exercise information offered through a lifestyle intervention during pregnancy may increase healthy behaviours and warrants clinical investigation.
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Affiliation(s)
- Zach Ferraro
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa
| | - Jane Rutherford
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute
| | - Erin J Keely
- Departments of Medicine and Obstetrics/Gynecology, University of Ottawa, Ottawa Hospital
| | - Lise Dubois
- Department of Epidemiology and Community Medicine
| | - Kristi B Adamo
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa ON, CanadaK1H 8L1
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Voigt M, Zels K, Guthmann F, Hesse V, Görlich Y, Straube S. Somatic classification of neonates based on birth weight, length, and head circumference: quantification of the effects of maternal BMI and smoking. J Perinat Med 2011; 39:291-7. [PMID: 21526885 DOI: 10.1515/jpm.2011.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We defined neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) based on birth weight, length, and head circumference. We analyzed the effects on the somatic classification of maternal body mass index (BMI) (<18.5, 18.5-24.99, 25.0-29.99, ≥ 30) and smoking during pregnancy (0, 1-7, 8-14, ≥ 15 cigarettes daily). Data were from the German Perinatal Survey (1998-2000; 433,669 cases). The following refers to the classification by birth weight. In the normal maternal weight population SGA rates increased with cigarette consumption: 9.8%, 17.8%, 21.6%, and 25.4% for non-smokers, and smokers of 1-7, 8-14, and ≥ 15 cigarettes daily, respectively. In non-smoking underweight women the SGA rate was 17.4%. In underweight smokers of ≥ 15 cigarettes daily the SGA rate was 38.5% [odds ratio 5.77, 95% confidence interval 5.10-6.53, compared with normal weight non-smokers]. In the normal maternal weight population, LGA rates were 9.9%, 5.3%, 4.6%, and 3.5% for non-smokers, and smokers of 1-7, 8-14, and ≥ 15 cigarettes daily, respectively. In the obese, LGA rates were 20.9% (non-smokers) and 11.4% (≥ 15 cigarettes). Similar findings were obtained for the somatic classifications based on birth length and head circumference. Results for the various combinations of maternal BMI and smoking status in the three classification systems are described. Our findings may assist in individualized risk assessment for SGA and LGA births.
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Affiliation(s)
- Manfred Voigt
- German Center for Growth, Development, and Health Encouragement during Childhood and Youth, Berlin, Germany
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139
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Dunn GA, Morgan CP, Bale TL. Sex-specificity in transgenerational epigenetic programming. Horm Behav 2011; 59:290-5. [PMID: 20483359 DOI: 10.1016/j.yhbeh.2010.05.004] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 04/23/2010] [Accepted: 05/06/2010] [Indexed: 12/21/2022]
Abstract
Prenatal programming of the epigenome is a critical determinant in offspring outcome and stands at the interface between environment and genetics. Maternal experiences such as stress and obesity are associated with a host of neurodevelopmental and metabolic diseases, some of which have been characterized into the second and third generations. The mechanism through which determinants such as maternal diet or stress contribute to disease development likely involves a complex interaction between the maternal environment, placental changes, and epigenetic programming of the embryo. While we have begun to more fully appreciate and explore the epigenome in determination of disease risk, we know little as to the contribution embryo sex makes in epigenetic regulation. This review discusses the importance of sex differences in the transmission and inheritance of traits that are generated in the prenatal environment using models of maternal stress and diet.
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Affiliation(s)
- Gregory A Dunn
- Department of Animal Biology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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140
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Poston L, Harthoorn LF, Van Der Beek EM. Obesity in pregnancy: implications for the mother and lifelong health of the child. A consensus statement. Pediatr Res 2011; 69:175-80. [PMID: 21076366 DOI: 10.1203/pdr.0b013e3182055ede] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Obesity among pregnant women is becoming one of the most important women's health issues. Obesity is associated with increased risk of almost all pregnancy complications: gestational hypertension, preeclampsia, gestational diabetes mellitus, delivery of large-for-GA infants, and higher incidence of congenital defects all occur more frequently than in women with a normal BMI. Evidence shows that a child of an obese mother may suffer from exposure to a suboptimal in utero environment and that early life adversities may extend into adulthood. In September 2009, ILSI Europe convened a workshop with multidisciplinary expertise to review practices and science base of health and nutrition of obese pregnant women, with focus on the long-term health of the child. The consensus viewpoint of the workshop identified gaps and gave recommendations for future research on gestational weight gain, gestational diabetes, and research methodologies. The evidence available on short- and long-term health impact for mother and child currently favors actions directed at controlling prepregnancy weight and preventing obesity in women of reproductive ages. More randomized controlled trials are needed to evaluate the effects of nutritional and behavioral interventions in pregnancy outcomes. Moreover, suggestions that maternal obesity may transfer obesity risk to child through non-Mendelian (e.g. epigenetic) mechanisms require more long-term investigation.
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Affiliation(s)
- Lucilla Poston
- Division of Women's Health, King's College London, London SE1 7EH, United Kingdom
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141
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Josefson J. The impact of pregnancy nutrition on offspring obesity. ACTA ACUST UNITED AC 2011; 111:50-2. [PMID: 21185964 DOI: 10.1016/j.jada.2010.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Jami Josefson
- Feinberg School of Medicine, Northwestern University, Department of Pediatrics, Division of Endocrinology, Children's Memorial Hospital, Chicago, IL, USA.
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142
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Prepregnancy Body Mass Index and Gestational Age-Dependent Changes in Lipid Levels During Pregnancy. Obstet Gynecol 2010; 116:107-113. [PMID: 20567175 DOI: 10.1097/aog.0b013e3181e45d23] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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143
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Lee CYW, Koren G. Maternal obesity: Effects on pregnancy and the role of pre-conception counselling. J OBSTET GYNAECOL 2010; 30:101-6. [DOI: 10.3109/01443610903474355] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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144
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Samuelsson AM, Morris A, Igosheva N, Kirk SL, Pombo JM, Coen CW, Poston L, Taylor PD. Evidence for Sympathetic Origins of Hypertension in Juvenile Offspring of Obese Rats. Hypertension 2010; 55:76-82. [DOI: 10.1161/hypertensionaha.109.139402] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Anne-Maj Samuelsson
- From the Division of Reproduction and Endocrinology, King’s College London, London, United Kingdom
| | - Abigail Morris
- From the Division of Reproduction and Endocrinology, King’s College London, London, United Kingdom
| | - Natalia Igosheva
- From the Division of Reproduction and Endocrinology, King’s College London, London, United Kingdom
| | - Shona L. Kirk
- From the Division of Reproduction and Endocrinology, King’s College London, London, United Kingdom
| | - Joaquim M.C. Pombo
- From the Division of Reproduction and Endocrinology, King’s College London, London, United Kingdom
| | - Clive W. Coen
- From the Division of Reproduction and Endocrinology, King’s College London, London, United Kingdom
| | - Lucilla Poston
- From the Division of Reproduction and Endocrinology, King’s College London, London, United Kingdom
| | - Paul D. Taylor
- From the Division of Reproduction and Endocrinology, King’s College London, London, United Kingdom
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145
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Case A, Menendez A. Sex differences in obesity rates in poor countries: evidence from South Africa. ECONOMICS AND HUMAN BIOLOGY 2009; 7:271-282. [PMID: 19664973 PMCID: PMC2767444 DOI: 10.1016/j.ehb.2009.07.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 07/08/2009] [Accepted: 07/09/2009] [Indexed: 05/26/2023]
Abstract
Globally, men and women face markedly different risks of obesity. In all but of handful of (primarily Western European) countries, obesity is much more prevalent among women than men. We examine several potential explanations for this phenomenon. We analyze differences between men and women in reports and effects of potential underlying causes of obesity-childhood and adult poverty, depression, and attitudes about obesity. We evaluate the evidence for each explanation using data collected in an urban African township in the Cape Town metropolitan area. Three factors explain the greater obesity rates we find among women. Women who were nutritionally deprived as children are significantly more likely to be obese as adults, while men who were deprived as children face no greater risk. In addition, women of higher adult socioeconomic status are significantly more likely to be obese, which is not true for men. These two factors - childhood circumstances and adult SES - can fully explain the difference in obesity rates between men and women that we find in our sample. More speculatively, in South Africa, women's perceptions of an 'ideal' female body are larger than men's perceptions of the 'ideal' male body, and individuals with larger 'ideal' body images are significantly more likely to be obese.
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Affiliation(s)
- Anne Case
- Research Program in Development Studies, Princeton University, United States.
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