Maternal metabolism and obesity: modifiable determinants of pregnancy outcome.
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.
Nelson
Scott M
SM
Division of Developmental Medicine, Reproductive and Maternal Medicine, Faculty of Medicine, University of Glasgow, Glasgow, UK. s.nelson@clinmed.gla.ac.uk
Matthews
Phillippa
P
Poston
Lucilla
L
D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D016640:Diabetes, Gestational / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D008019:Life Style; D009765:Obesity / Q000150:complications / Q000378:metabolism* / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism* / Q000628:therapy*; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects / Q000517:prevention & control; D012307:Risk Factors; D015430:Weight Gain