Obese pregnancies and offspring health: dietary intake and nutritional status

Abstract

Obesity has been recognized as a serious global health concern due to its increasing prevalence worldwide. Obesity is more pronounced in young women with increased frequency of obesity in women of reproductive age. Maternal obesity, defined as obesity among pregnant women during their pregnancy, is a risk factor for both maternal and fetal morbidity as well as mortality and has future implications for both mother and child. The underlying onset of this global health concern is an unhealthy dietary and physical lifestyle (e.g. high fat and/or high carbohydrate intake, (micro)nutrient deficiencies and physical inactivity) over a prolonged period. Poor maternal nutrition is known to be a key contributor to poor fetal growth and short-long term infant morbidity and mortality (e.g. gestational diabetes, macrosomia, large/small infants, low/high birth weights and pre-term delivery). The aim of this thesis is to investigate the nutritional status of obese pregnant women compared to lean counterparts and to assess whether this influences the adverse pregnancy outcomes associated with overweight/obesity during pregnancy. Maternal obesity is the outcome of a complex set of interactions, with a set of genetic and environmental factors that may induce a pathogenic psychological cascade (e.g. impaired glucose homeostasis, lipid metabolism and anti-oxidant status). These alterations are exacerbated by dietary factors and nutritional disturbances during pregnancy (particularly excessive intake of saturated fats, omega-6 fatty acids and micronutrient deficiencies). Deficiency of key maternal nutrients combined with impaired anti-oxidant defenses, altered glucose and lipid metabolism, may contribute to the adverse fetal and maternal outcomes associated with maternal obesity. Maternal dietary intervention may be a potential strategy to improve pregnancy outcomes in obese mothers and their offspring, including maternal low-fat diet (omega-3 fatty acids), low glycemic index diet, protein supplementations and micronutrient supplementations of particularly iron and folate. However, clinical intervention studies are very limited and most of the available studies produced conflicting results. There is the need for more well-designed large-scale prospective cohort and intervention studies in each high-risk region of the world, which examines maternal dietary interventions and their long-term effects on the health outcomes of the offspring, specifically in overweight and obese pregnant women. Therefore, it remains to be determined whether maternal dietary interventions will produce persistent health benefits to the offspring.