title: Maternal adiposity--a determinant of perinatal and offspring outcomes?
abstract: Experimental and animal data suggest that maternal obesity during pregnancy adversely affects offspring health in the short-term and the long-term. Whether these effects occur in humans and influence population health is less clear. This Review explores evidence from intervention studies and observational studies that have used designs (such as family-based comparisons and Mendelian randomization) that might help improve understanding of the causal effects of maternal obesity in humans. Collectively, human studies provide evidence that maternal overweight and obesity is causally related to pregnancy complications, increased offspring weight and adiposity at birth, and the difficulties associated with delivery of large-for-gestational-age infants. The underlying mechanisms for these effects probably involve maternal and fetal dysregulation of glucose, insulin, lipid and amino acid metabolism. Some evidence exists that extreme maternal obesity (BMI ≥40 kg/m(2)) is causally related to a long-term increase in offspring adiposity, but further exploration of this relationship is needed. High gestational weight gain may result in a long-term increase in offspring adiposity if women are already overweight or have obesity at the start of pregnancy. To date, little high-quality human evidence exists that any of these effects are mediated by epigenetic mechanisms, but approaches to appropriately test this possibility are being developed.
authors.affiliation: MRC Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. d.a.lawlor@bristol.ac.uk
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Lawlor
authors.forename: Caroline
authors.initials: C
authors.lastname: Relton
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Scott M
authors.initials: SM
authors.lastname: Nelson
mesh_terms: D050154:Adiposity / Q000502:physiology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008429:Maternal Welfare / Q000639:trends*; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D018743:Perinatal Care / Q000379:methods / Q000639:trends*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000378:metabolism*; D011256:Pregnancy Outcome; D012307:Risk Factors