Maternal metabolism and obesity: modifiable determinants of pregnancy outcome

Abstract

Background: Obesity among pregnant women is highly prevalent worldwide and is associated in a linear manner with markedly increased risk of adverse outcome for mother and infant. Obesity in the mother may also independently confer risk of obesity to her child. The role of maternal metabolism in determining these outcomes and the potential for lifestyle modification are largely unknown.

Methods: Relevant studies were identified by searching PubMed, the metaRegister of clinical trials and Google Scholar without limitations. Sensitive search strategies were combined with relevant medical subject headings and text words.

Results: Maternal obesity and gestational weight gain have a significant impact on maternal metabolism and offspring development. Insulin resistance, glucose homeostasis, fat oxidation and amino acid synthesis are all disrupted by maternal obesity and contribute to adverse outcomes. Modification of lifestyle is an effective intervention strategy for improvement of maternal metabolism and the prevention of type 2 diabetes and, potentially, gestational diabetes.

Conclusions: Maternal obesity requires the development of effective interventions to improve pregnancy outcome. Strategies that incorporate a detailed understanding of the maternal metabolic environment and its consequences for the health of the mother and the growth of the child are likely to identify the best approach.

Figure 1

Components of GWG. Reproduced with permission from nutritional support in obstetrics and gynaecology (Pitkin, 1976).

Figure 2

Longitudinal changes in skin-fold thicknesses throughout pregnancy. Reproduced with permission from changes in skin-folds during pregnancy (Taggart et al., 1967).

Figure 3

Recommended weight gain by week of pregnancy for obese (BMI ≥30 kg/m²) women (dashed lines represent the range of weight gain) (Institute of Medicine, 2009).