Obesity Begins in the Womb

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If you were asked “how much weight should a woman gain during pregnancy?” you might posit a guess around 15 or 20 pounds. In reality, it’s not that simple. The amount depends on her pre-pregnancy body mass index (BMI). As such, in 2009, The Institute of Medicine (IOM) released gestational weight gain recommendations for each BMI category (Table 1). These recommendations were published to promote adequate foetal growth and reduce the risk of adverse pregnancy outcomes (Rasmussen & Yaktine, 2013). Total recommended weight gain during pregnancy ranges from 28-40 pounds for underweight women and 11-20 pounds for obese women (Rasmussen & Yaktine, 2013). However, many women are not meeting these guidelines and 58% of Canadian women are surpassing them (Ferraro et al., 2012). Currently, obesity is recognized as a global public health concern with no signs of slowing down (NCD Risk Factor Collaboration, 2016). Is gestational weight gain a contributing factor?

Table 1: The Institute of Medicine’s 2009 Gestational Weight Gain Recommendations According to Pre-Pregnancy BMI

Copyright National Academy Press
Copyright National Academy Press (Adapted from Rasmussen & Yaktine, 2013)

The Lancet published a colossal study of roughly 19 million individuals in early April 2016 that examined global trends in adult BMI from 1975 to 2014 (NCD Risk Factor Collaboration, 2016). The authors concluded that, globally, there are more people who are overweight than underweight (NCD Risk Factor Collaboration, 2016). The stark rise in obesity may be due, in part, to women entering pregnancy overweight or obese, gaining too much weight during pregnancy and then giving birth to large infants who grow up to be overweight children and eventually, overweight adults. In fact, maternal overweight, obesity, high birth weight (≥4,000g) and gestational weight gain (≥20.4kg) are independently associated with childhood overweight and obesity, even after adjusting for numerous confounders (Li, Goran, Kaur, Nollen, & Ahluwalia, 2007).

We know that overweight and obese Canadian women are most likely to exceed the gestational weight gain recommendations. For instance, of the 4,321 participants studied in an Ontario pregnancy cohort, 78% of obese women and 72% of overweight women exceeded the IOM’s recommendations for gestational weight gain, compared to just 47% and 25% of normal weight and underweight women (Ferraro et al., 2012). Obese women, closely followed by overweight women gave birth to the highest amount of large for gestational age infants (Ferraro et al., 2012). These infants are at a greater risk for obesity, diabetes and even cancer (Curhan et al., 1996; Fall, 2013). In addition, women who were born large for gestational age are twice as likely to give birth to a large for gestational age infant (Ahlsson, Gustafsson, Tuvemo, & Lundgren, 2007).

Unfortunately, being overweight or obese during pregnancy poses significant risks to the developing child. Whether obese women gain the recommended weight during pregnancy or exceed it, they put their infant at risk of being born large for gestational age. Moreover, if an obese woman loses weight or gains less than the recommended amount during pregnancy, she increases her risk of having an infant born small for gestational age, a condition accompanied by a plurality of health consequences in adulthood, including obesity and type II diabetes (Blomberg, 2011; Karlberg, Albertsson-Wikland, Baber, Low, & Yeung, 1996; Oza-Frank & Keim, 2013; Reinehr, Kleber, & Toschke, 2009; Xu, Wen, Zhou, Li, & Luo, 2016).

In sum, obesity begins early in life and thus far there seems to be no imminent end to the vicious intergenerational cycle. Consequently, there is a strong need to implement promising interventions and policies to combat rising BMIs and widening waistlines around the world.

References

Ahlsson, F., Gustafsson, J., Tuvemo, T., & Lundgren, M. (2007). Females born large for gestational age have a doubled risk of giving birth to large for gestational age infants. Acta Paediatrica, 96(3), 358–362. doi:10.1111/j.1651-2227.2006.00141.x

Blomberg, M. (2011). Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Obstet Gynecol, 117(5), 1065–1070. doi:10.1097/AOG.0b013e318214f1d1

Curhan, G. C., Willett, W. C., Rimm, E. B., Spiegelman, D., Ascherio, a L., & Stampfer, M. J. (1996). Birth weight and adult hypertension, diabetes mellitus, and obesity in US men. Circulation, 94(12), 3246–3250. doi:10.1161/01.CIR.94.12.3246

Fall, C. H. D. (2013). Fetal malnutrition and long-term outcomes. Nestlé Nutrition Institute Workshop Series, 74, 11–25. doi:10.1159/000348384

Ferraro, Z. M., Barrowman, N., Prud’homme, D., Walker, M., Wen, S. W., Rodger, M., & Adamo, K. B. (2012). Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index. Journal of Maternal-Fetal and Neonatal Medicine, 25(5), 538–542. doi:10.3109/14767058.2011.638953

Karlberg, J., Albertsson-Wikland, K., Baber, F. M., Low, L. C., & Yeung, C. Y. (1996). Born small for gestational age: consequences for growth. Acta Paediatrica (Oslo, Norway : 1992). Supplement, 417, 8–13; discussion 14. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10808251

Li, C., Goran, M. I., Kaur, H., Nollen, N., & Ahluwalia, J. S. (2007). Developmental trajectories of overweight during childhood: role of early life factors. Obesity (Silver Spring, Md.), 15(3), 760–71. doi:10.1038/oby.2007.585

NCD Risk Factor Collaboration. (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet, 387(10026), 1377–1396. doi:10.1016/S0140-6736(16)30054-X

Osterweil, N.  (2014). Gestational Weight Gain in Obese Women Better With Program. Medscape Multispecialty. Retrieved from: http://www.medscape.com/viewarticle/830644

Oza-Frank, R., & Keim, S. A. (2013). Should obese women gain less weight in pregnancy than recommended? Birth, 40(2), 107–114. doi:10.1111/birt.12037

Rasmussen, K. M., & Yaktine, A. (2013). Weight Gain During Pregnancy. Women’s Health Care Physicians (Vol. 548). Washington. doi:10.17226/12584

Reinehr, T., Kleber, M., & Toschke, A. M. (2009). Small for gestational age status is associated with metabolic syndrome in overweight children. European Journal of Endocrinology, 160, 579–84. doi:10.1530/EJE-08-0914

Xu, Z., Wen, Z., Zhou, Y., Li, D., & Luo, Z. (2016). Inadequate weight gain in obese women and the risk of small for gestational age (SGA): A Systematic Review and Meta-Analysis. The Journal of Maternal-Fetal & Neonatal Medicine, 1–34. doi:10.3109/14767058.2016.1173029

 

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