Early life programming of health and disease: The long‐term consequences of obesity in pregnancy

Abstract

The prevalence of overweight and obesity is rising in all parts of the world and, among young women, it presents a very clear danger during pregnancy. Women who are overweight or who gain excessive weight during pregnancy are at greater risk of complications in pregnancy and labour, and are more likely to lose their child to stillbirth or die themselves during pregnancy. This narrative review considers the evidence that, in addition to increasing risk of poor pregnancy outcomes, obesity has the capacity to programme foetuses to be at greater risk of cardiometabolic disorders later in life. An extensive body of evidence from prospective and retrospective cohorts, as well as record linkage studies, demonstrates associations of maternal obesity and/or gestational diabetes with cardiovascular disease, as well as type 1 and type 2 diabetes. Studies in animals suggest that these associations are underpinned by adaptations that occur in foetal life, which remodel the structures of major organs, including the brain, kidney and pancreas.

Optimising nutritional status for healthy pregnancy

“…GWG outside these ranges, along with obesity, is associated with greater risk of maternal and fetal death, pregnancy complications and interventions during labour 12 . Moreover, a growing body of evidence indicates that fetal exposure to maternal obesity and excessive GWG can programme lifelong risk of cardiometablic disorders 18 …”

“…12 Moreover, a growing body of evidence indicates that fetal exposure to maternal obesity and excessive GWG can programme lifelong risk of cardiometablic disorders. 18 Maternal obesity is associated with greater risk of first trimester miscarriage and is also a risk factor for stillbirth. The systematic review by Aune et al 19 estimated that, for every 5 kg/m 2 pre-pregnancy BMI, the risk of stillbirth increased by 24%.…”

Metabolic abnormalities in the bone marrow cells of young offspring born to obese mothers

“…Epidemiological studies have revealed a strong association between obesity in pregnancy and adverse long-term consequences for offspring health and well-being (6); in particular, greater maternal pre-pregnancy body mass index (BMI) is linked to pregnancy complications (7) and progression of cardiovascular and metabolic diseases during the offspring's adult life, including obesity, hyperinsulinemia, lipotoxicity, and increased metabolic inflammation (8)(9)(10)(11). This intergenerational transmission may partly explain the present exacerbated epidemic of obesity and metabolic diseases (12).…”

Adipositasprävention in den ersten 1000 Tagen

“…The challenge for the coming years will be to develop, evaluate and implement suitable approaches to support a healthy lifestyle around pregnancy and thus more effectively protect the long-term health of mother and child. [11,12]. So können mütterliche Faktoren wie Adipositas das intrauterine Milieu beeinflussen und zu permanenten, epigenetisch bedingten Veränderungen im Phänotyp des Kindes führen, welche wiederum das spätere Risiko für Adipositas und kardiometabolische Erkrankungen prägen.…”

“…1 ) 9 10 . Die lebenslange Prägung des kindlichen Stoffwechsels und die damit einhergehende Prädisposition für die Entwicklung nicht-übertragbarer Erkrankungen durch Umwelteinflüsse in den frühen Entwicklungsstadien umfasst das Prinzip der fetalen Programmierung oder auch das Developmental Origins Of Health and Disease (DOHaD) Konzept 11 12 . So können mütterliche Faktoren wie Adipositas das intrauterine Milieu beeinflussen und zu permanenten, epigenetisch bedingten Veränderungen im Phänotyp des Kindes führen, welche wiederum das spätere Risiko für Adipositas und kardiometabolische Erkrankungen prägen.…”