Background: The obesity epidemic has resulted in more overweight/obese women before and during pregnancy. Their offspring tend to have higher birth weights and more body fat, and carry an increased risk of obesity later in life. These effects may partly be related to the heightened risk of gestational diabetes, occurring in at least 16% of all pregnancies irrespective of current body weight. Methods: An ILSI Europe workshop reviewed the key contributors leading to adverse outcomes in pregnancy and childhood, including gestational weight gain and nutrition. New research opportunities from prospective mother-child cohort studies were explored. Results: Simple measures of gestational weight gain provide insufficient detail of the underlying physiological and metabolic adaptations occurring in pregnancy, and should be complemented by measures of body composition, metabolic and endocrine responses. Recordings of maternal dietary intake and nutrient status are often limited and potential correlations with gestational weight gain have been poorly studied. Many pregnancies in overweight/obese women are uncomplicated and result in offspring of normal weight, leaving the main determinants of later adverse outcomes to be clarified. Conclusions: The workshop provided insights of primary measurements for the characterization of sustainable nutritional intervention strategies in the mother, infant and child for preventing obesity in later life.

Keywords:
Pregnancy, Obesity, Insulin resistance
1.
Heslehurst N, Bell R, Rankin J: Tackling maternal obesity: the challenge for public health. Perspect Public Health 2011;131:161–162.
2.
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;69:175–180.
3.
Djelantik A, Kunst A, van der Wal M, Smit H, Vrijkotte T: Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort: population attributive fractions for Amsterdam. BJOG 2012;119:283–290.
4.
Guxens M, Ballester F, Espada M, Fernandez MF, Grimalt JO, Ibarluzea J, Olea N, Rebagliato M, Tardon A, Torrent M, Vioque J, Vrijheid M, Sunyer J: Cohort profile: the INMA – INfancia y Medio Ambiente – (environment and childhood) project. Int J Epidemiol 2012;41:930–940.
5.
Kuzawa CW, Hallal PC, Adair L, Bhargava SK, Fall CH, Lee N, Norris SA, Osmond C, Ramirez-Zea M, Sachdev HS, Stein AD, Victora CG, COHORTS Group: Birth weight, postnatal weight gain, and adult body composition in five low and middle income countries. Am J Hum Biol 2012;24:5–13.
6.
Norris SA, Osmond C, Gigante D, Kuzawa CW, Ramakrishnan L, Lee NR, Ramirez-Zea M, Richter LM, Stein AD, Tandon N, Fall CH, COHORTS Group: Size at birth, weight gain in infancy and childhood, and adult diabetes risk in five low- or middle-income country birth cohorts. Diabetes Care 2012;35:72–79.
7.
Leibowitz KL, Moore RH, Ahima RS, Stunkard AJ, Stallings VA, Berkowitz RI, Chittams JL, Faith MS, Stettler N: Maternal obesity associated with inflammation in their children. World J Pediatr 2012;8:76–79.
8.
King JC: Maternal obesity, metabolism, and pregnancy outcomes. Annu Rev Nutr 2006;26:271–291.
9.
Larsson G, Spjuth J, Ranstam J, Vikbladh I, Saxtrup O, Astedt B: Prognostic significance of birth of large infant for subsequent development of maternal non-insulin-dependent diabetes mellitus: a prospective study over 20–27 years. Diabetes Care 1986;9:359–364.
10.
Kim SY, England JL, Sharma JA, Njoroge T: Gestational diabetes mellitus and risk of childhood overweight and obesity in offspring: a systematic review. Exp Diabetes Res 2011;2011:541308.
11.
Catalano PM, McIntyre HD, Cruickshank JK, McCance DR, Dyer AR, Metzger BE, Lowe LP, Trimble ER, Coustan DR, Hadden DR, Persson B, Hod M, Oats JJ, Group HSCR: The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 2012;35:780–786.
12.
Lawrence JM, Contreras R, Chen W, Sacks DA: Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care 2008;31:899–904.
13.
Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, Brown TJ, Summerbell CD: The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008;9:635–683.
14.
Belogolovkin V, Alio AP, Mbah AK, Clayton HB, Wathington D, Salihu HM: Patterns and success of fetal programming among women with low and extremely low pre-pregnancy BMI. Arch Gynecol Obstet 2009;280:579–584.
15.
McMillen IC, Adam CL, Muhlhausler BS: Early origins of obesity: programming the appetite regulatory system. J Physiol 2005;565:9–17.
16.
Symonds ME, Sebert S, Budge H: The obesity epidemic: from the environment to epigenetics – not simply a response to dietary manipulation in a thermoneutral environment. Front Genet 2011;2:24.
17.
Lagiou P, Tamimi RM, Mucci LA, Adami HO, Hsieh CC, Trichopoulos D: Diet during pregnancy in relation to maternal weight gain and birth size. Eur J Clin Nutr 2004;58:231–237.
18.
Fernandez ID, Olson CM, De Ver Dye T: Discordance in the assessment of prepregnancy weight status of adolescents: a comparison between the Centers for Disease Control and Prevention sex- and age-specific body mass index classification and the Institute of Medicine-Based classification used for maternal weight gain guidelines. J Am Diet Assoc 2008;108:998–1002.
19.
Schack-Nielsen L, Michaelsen KF, Gamborg M, Mortensen EL, Sorensen TI: Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood. Int J Obes (Lond) 2010;34:67–74.
20.
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;174:1159–1165.
21.
McAllister EJ, Dhurandhar NV, Keith SW, Aronne LJ, Barger J, Baskin M, Benca RM, Biggio J, Boggiano MM, Eisenmann JC, Elobeid M, Fontaine KR, Gluckman P, Hanlon EC, Katzmarzyk P, Pietrobelli A, Redden DT, Ruden DM, Wang C, Waterland RA, Wright SM, Allison DB: Ten putative contributors to the obesity epidemic. Crit Rev Food Sci Nutr 2009;49:868–913.
22.
Levine JA, Lanningham-Foster LM, McCrady SK, Krizan AC, Olson LR, Kane PH, Jensen MD, Clark MM: Interindividual variation in posture allocation: possible role in human obesity. Science 2005;307:584–586.
23.
Simpson SA, Shaw C, McNamara R: What is the most effective way to maintain weight loss in adults? BMJ 2011;343:d8042.
24.
Alwan NA, Greenwood DC, Simpson NA, McArdle HJ, Cade JE: The relationship between dietary supplement use in late pregnancy and birth outcomes: a cohort study in British women. BJOG 2010;117:821–829.
25.
Pepper GV, Craig Roberts S: Rates of nausea and vomiting in pregnancy and dietary characteristics across populations. Proc Biol Sci 2006;273:2675–2679.
26.
Grote V, Theurich M, Koletzko B: Do complementary feeding practices predict the later risk of obesity? Curr Opin Clin Nutr Metab Care 2012;15:293–297.
27.
Rolfo A, Many A, Racano A, Tal R, Tagliaferro A, Ietta F, Wang J, Post M, Caniggia I: Abnormalities in oxygen sensing define early and late onset preeclampsia as distinct pathologies. PLoS One 2010;5:e13288.
28.
van der Merwe JL, Hall DR, Wright C, Schubert P, Grove D: Are early and late preeclampsia distinct subclasses of the disease – what does the placenta reveal? Hypertens Pregnancy 2010;29:457–467.
29.
Blumfield ML, Hure AJ, Macdonald-Wicks L, Smith R, Collins CE: Systematic review and meta-analysis of energy and macronutrient intakes during pregnancy in developed countries. Nutr Rev 2012;70:322–336.
30.
Despres JP, Lemieux I: Abdominal obesity and metabolic syndrome. Nature 2006;444:881–887.
31.
Koletzko B, Brands B, Poston L, Godfrey K, Demmelmair H, Early Nutrition Project: Early nutrition programming of long-term health. Proc Nutr Soc 2012;71:371–378.
32.
Hauner H, Much D, Vollhardt C, Brunner S, Schmid D, Sedlmeier EM, Heimberg E, Schuster T, Zimmermann A, Schneider KT, Bader BL, Amann-Gassner U: Effect of reducing the n-6:n-3 long-chain PUFA ratio during pregnancy and lactation on infant adipose tissue growth within the first year of life: an open-label randomized controlled trial. Am J Clin Nutr 2012;95:383–394.
33.
Muhlhausler BS, Gibson RA, Makrides M: The effect of maternal omega-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) supplementation during pregnancy and/or lactation on body fat mass in the offspring: a systematic review of animal studies. Prostaglandins Leukot Essent Fatty Acids 2011;85:83–88.
34.
Zambrano E, Martinez-Samayoa PM, Rodriguez-Gonzalez GL, Nathanielsz PW: Dietary intervention prior to pregnancy reverses metabolic programming in male offspring of obese rats. J Physiol 2010;588:1791–1799.
35.
Godfrey KM, Sheppard A, Gluckman PD, Lillycrop KA, Burdge GC, McLean C, Rodford J, Slater-Jefferies JL, Garratt E, Crozier SR, Emerald BS, Gale CR, Inskip HM, Cooper C, Hanson MA: Epigenetic gene promoter methylation at birth is associated with child’s later adiposity. Diabetes 2011;60:1528–1534.
36.
Sen S, Simmons RA: Maternal antioxidant supplementation prevents adiposity in the offspring of western diet-fed rats. Diabetes 2010;59:3058–3065.
37.
Widdowson EM: Chemical composition of newly born animals. Nature 1950;116:626–628.
38.
Cannon B, Nedergaard J: Brown adipose tissue: function and physiological significance. Physiol Rev 2004;84:277–359.
39.
Symonds ME, Henderson K, Elvidge L, Bosman C, Sharkey D, Perkins AC, Budge H: Thermal imaging to assess age-related changes of skin temperature within the supraclavicular region co-locating with brown adipose tissue in healthy children. J Pediatr 2012;161:892–898.
40.
Nedergaard J, Bengtsson T, Cannon B: Unexpected evidence for active brown adipose tissue in adult humans. Am J Physiol Endocrinol Metab 2007;293:E444–E452.
41.
Vijgen GH, Bouvy ND, Teule GJ, Brans B, Schrauwen P, van Marken Lichtenbelt WD: Brown adipose tissue in morbidly obese subjects. PLoS One 2011;6:e17247.
42.
Kirk SL, Samuelsson AM, Argenton M, Dhonye H, Kalamatianos T, Poston L, Taylor PD, Coen CW: Maternal obesity induced by diet in rats permanently influences central processes regulating food intake in offspring. PLoS One 2009;4:e5870.
43.
Symonds ME, Pope M, Sharkey D, Budge H: Adipose tissue and fetal programming. Diabetologia 2012;55:1597–606.
44.
Diouf I, Charles MA, Thiebaugeorges O, Forhan A, Kaminski M, Heude B, Group EM-CCS: Maternal weight change before pregnancy in relation to birthweight and risks of adverse pregnancy outcomes. Eur J Epidemiol 2011;26:789–796.
45.
Hull HR, Thornton JC, Ji Y, Paley C, Rosenn B, Mathews P, Navder K, Yu A, Dorsey K, Gallagher D: Higher infant body fat with excessive gestational weight gain in overweight women. Am J Obstet Gynecol 2011;205:211.e1–7.
46.
Gale C, Logan KM, Santhakumaran S, Parkinson JR, Hyde MJ, Modi N: Effect of breastfeeding compared with formula feeding on infant body composition: a systematic review and meta-analysis. Am J Clin Nutr 2012;95:656–669.
47.
Andres A, Shankar K, Badger TM: Body fat mass of exclusively breastfed infants born to overweight mothers. J Acad Nutr Diet 2012;112:991–995.
48.
Beltrand J, Soboleva TK, Shorten PR, Derraik JG, Hofman P, Albertsson-Wikland K, Hochberg Z, Cutfield WS: Post-term birth is associated with greater risk of obesity in adolescent males. J Pediatr 2012;160:769–773.
49.
Wiklund P, Xu L, Lyytikainen A, Saltevo J, Wang Q, Volgyi E, Munukka E, Cheng S, Alen M, Keinanen-Kiukaanniemi S: Prolonged breast-feeding protects mothers from later-life obesity and related cardio-metabolic disorders. Public Health Nutr 2012;15:67–74.
50.
Disantis KI, Collins BN, Fisher JO, Davey A: Do infants fed directly from the breast have improved appetite regulation and slower growth during early childhood compared with infants fed from a bottle? Int J Behav Nutr Phys Act 2011;8:89.
51.
Cnattingius S, Villamor E, Lagerros YT, Wikstrom AK, Granath F: High birth weight and obesity-a vicious circle across generations. Int J Obes (Lond) 2012;36:1320–1324.
52.
Koletzko B, von Kries R, Closa R, Escribano J, Scaglioni S, Giovannini M, Beyer J, Demmelmair H, Gruszfeld D, Dobrzanska A, Sengier A, Langhendries JP, Rolland Cachera MF, Grote V, European Childhood Obesity Trial Study Group: Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr 2009;89:1836–1845.
53.
Hawkes CP, Hourihane JO, Kenny LC, Irvine AD, Kiely M, Murray DM: Gender- and gestational age-specific body fat percentage at birth. Pediatrics 2011;128:e645–e651.
54.
Wang Y, Beydoun MA, Li J, Liu Y, Moreno LA: Do children and their parents eat a similar diet? Resemblance in child and parental dietary intake: systematic review and meta-analysis. J Epidemiol Community Health 2011;65:177–189.
55.
Coad J, Al-Rasasi B, Morgan J: Nutrient insult in early pregnancy. Proc Nutr Soc 2002;61:51–59.
56.
Thornburg KL, O’Tierney PF, Louey S: Review: the placenta is a programming agent for cardiovascular disease. Placenta 2010;31:S54–S59.
57.
Amusquivar E, Laws J, Clarke L, Herrera E: Fatty acid composition of the maternal diet during the first or the second half of gestation influences the fatty acid composition of sows’ milk and plasma, and plasma of their piglets. Lipids 2010;45:409–418.
58.
Fields DA, Demerath EW: Relationship of insulin, glucose, leptin, IL-6 and TNF-alpha in human breast milk with infant growth and body composition. Pediatr Obes 2012;7:304–312.
59.
Socha P, Grote V, Gruszfeld D, Janas R, Demmelmair H, Closa-Monasterolo R, Subias JE, Scaglioni S, Verduci E, Dain E, Langhendries JP, Perrin E, Koletzko B: Milk protein intake, the metabolic-endocrine response, and growth in infancy: data from a randomized clinical trial. Am J Clin Nutr 2011;94:S1776–S1784.
60.
McMillen IC, Robinson JS: Developmental origins of the metabolic syndrome: prediction, plasticity, and programming. Physiol Rev 2005;85:571–633.
61.
Vrijheid M, Casas M, Bergstrom A, Carmichael A, Cordier S, Eggesbo M, Eller E, Fantini MP, Fernandez MF, Fernandez-Somoano A, Gehring U, Grazuleviciene R, Hohmann C, Karvonen AM, Keil T, Kogevinas M, Koppen G, Kramer U, Kuehni CE, Magnus P, Majewska R, Andersen AM, Patelarou E, Petersen MS, Pierik FH, Polanska K, Porta D, Richiardi L, Santos AC, Slama R, Sram RJ, Thijs C, Tischer C, Toft G, Trnovec T, Vandentorren S, Vrijkotte TG, Wilhelm M, Wright J, Nieuwenhuijsen M: European birth cohorts for environmental health research. Environ Health Perspect 2012;120:29–37.
62.
Mendez MA, Kogevinas M: Alternative methods of accounting for underreporting and overreporting when measuring dietary intake-obesity relations. Am J Clin Nutr 2011;94:1993–1999.
63.
Padmanabhan V, Veiga-Lopez A, Abbott DH, Recabarren SE, Herkimer C: Developmental programming: impact of prenatal testosterone excess and postnatal weight gain on insulin sensitivity index and transfer of traits to offspring of overweight females. Endocrinology 2010;151:595–605.
64.
Freedman LS, Schatzkin A, Midthune D, Kipnis V: Dealing with dietary measurement error in nutritional cohort studies. J Natl Cancer Inst 2011;103:1086–1092.
65.
Arab L, Tseng CH, Ang A, Jardack P: Validity of a multipass, web-based, 24 h self-administered recall for assessment of total energy intake in blacks and whites. Am J Epidemiol 2011;174:1256–1265.
66.
Forner F, Kumar C, Luber CA, Fromme T, Klingenspor M, Mann M: Proteome differences between brown and white fat mitochondria reveal specialized metabolic functions. Cell Metab 2009;10:324–335.
67.
Druet C, Stettler N, Sharp S, Simmons RK, Cooper C, Smith GD, Ekelund U, Levy-Marchal C, Jarvelin MR, Kuh D, Ong KK: Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol 2012;26:19–26.
68.
Mendez MA, Popkin BM, Buckland G, Schroder H, Amiano P, Barricarte A, Huerta JM, Quiros JR, Sanchez MJ, Gonzalez CA: Alternative methods of accounting for underreporting and overreporting when measuring dietary intake-obesity relations. Am J Epidemiol 2011;173:448–458.
69.
Thompson FE, Subar AF, Loria CM, Reedy JL, Baranowski T: Need for technological innovation in dietary assessment. J Am Diet Assoc 2010;110:48–51.
70.
Painter RC, Roseboom TJ, Bleker OP: Prenatal exposure to the Dutch famine and disease in later life: an overview. Reprod Toxicol 2005;20:345–352.
71.
Phelan S, Hart C, Phipps M, Abrams B, Schaffner A, Adams A, Wing R: Maternal behaviors during pregnancy impact offspring obesity risk. Exp Diabetes Res 2011;2011:985139.
72.
Frayling TM, Timpson NJ, Weedon MN, Zeggini E, Freathy RM, Lindgren CM, Perry JR, Elliott KS, Lango H, Rayner NW, Shields B, Harries LW, Barrett JC, Ellard S, Groves CJ, Knight B, Patch AM, Ness AR, Ebrahim S, Lawlor DA, Ring SM, Ben-Shlomo Y, Jarvelin MR, Sovio U, Bennett AJ, Melzer D, Ferrucci L, Loos RJ, Barroso I, Wareham NJ, Karpe F, Owen KR, Cardon LR, Walker M, Hitman GA, Palmer CN, Doney AS, Morris AD, Smith GD, Hattersley AT, McCarthy MI: A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Science 2007;316:889–894.
73.
Godfrey KM, Gluckman PD, Hanson MA: Developmental origins of metabolic disease: life course and intergenerational perspectives. Trends Endocrin Met 2010;21:199–205.
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