Pregnancy as a window to future health: Excessive gestational weight gain and obesity

Abstract

Metabolic and behavioral changes that occur during pregnancy have well-known effects on maternal and fetal health during the immediate pregnancy and now are thought to be a catalyst for future health throughout later life. Recommendations for appropriate gestational weight gain (GWG) and lifestyle modifications during pregnancy have changed throughout history as more is known about this crucial time. Herein we discuss the current GWG recommendations and the impact of pregnancy and excess GWG gain on the current and future health of women and children including risk of obesity, gestational diabetes, type 2 diabetes, cardiovascular disease, and metabolic syndrome.

Keywords: Adiposity; Diabetes; Food intake; Pregnancy; Visceral fat.

Figure 1

Preconception BMI has increased steadily since 1988 resulting in more and more women entering pregnancy as overweight or obese (A). With the steady rise in preconception BMI, a larger percent of pregnant women are exceeding the IOM gestational weight gain (GWG) recommendations (B). Light gray squares = % of women entering pregnancy as overweight; Dark gray diamonds = % of women entering pregnancy as underweight (A). Dark gray bar = % of women who gain below the IOM recommendations; Light gray bar = % women who gain within the IOM recommendation; Gray bar = % of women who gain above or exceed the IOM recommendations (B).

Figure 2

Average weight gain in kilograms (kg) at different time points postpartum for women gaining below, within, and above IOM guidelines. Data is adapted from Nehring et al . Postpartum weight retention (PPWR) from six studies is averaged for the six month time point, PPWR from two studies is averaged for the one year time point, PPWR from two studies is averaged for the three year time point, and PPWR from one study was conducted for both 15 and 21 years postpartum. Weight retention was greatest for women gaining above IOM guidelines at every time point postpartum. Dark gray bars = women gaining below IOM recommendations; Gray bars = women gaining above IOM recommendations; Light gray = women gaining within IOM recommendations.

Figure 3

Long- and short-term metabolic consequences of (excess) GWG and postpartum weight retention in reproductive age women. Excess GWG and postpartum weight retention, especially over the course of multiple pregnancies, results in harmful metabolic consequences due to greater increases in BMI, FM, and visceral fat. BMI = body mass index; GDM = gestational diabetes mellitus; LDL = low-density lipoprotein; HDL = high-density lipoprotein; TG = triglycerides.