title: From fatalism to mitigation: A conceptual framework for mitigating fetal programming of chronic disease by maternal obesity.
abstract: Prenatal development is recognized as a critical period in the etiology of obesity and cardiometabolic disease. Potential strategies to reduce maternal obesity-induced risk later in life have been largely overlooked. In this paper, we first propose a conceptual framework for the role of public health and preventive medicine in mitigating the effects of fetal programming. Second, we review a small but growing body of research (through August 2015) that examines interactive effects of maternal obesity and two public health foci - diet and physical activity - in the offspring. Results of the review support the hypothesis that diet and physical activity after early life can attenuate disease susceptibility induced by maternal obesity, but human evidence is scant. Based on the review, we identify major gaps relevant for prevention research, such as characterizing the type and dose response of dietary and physical activity exposures that modify the adverse effects of maternal obesity in the offspring. Third, we discuss potential implications of interactions between maternal obesity and postnatal dietary and physical activity exposures for interventions to mitigate maternal obesity-induced risk among children. Our conceptual framework, evidence review, and future research directions offer a platform to develop, test, and implement fetal programming mitigation strategies for the current and future generations of children.
authors.affiliation: School of Public Health, Oregon Health & Science University, Portland, OR, USA. Electronic address: boonej@ohsu.edu.
authors.forename: Janne
authors.initials: J
authors.lastname: Boone-Heinonen
authors.affiliation: School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA.
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Messer
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, OR, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fortmann
authors.affiliation: School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wallack
authors.affiliation: Bob and Charlee Moore Institute for Nutrition and Wellness, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Kent L
authors.initials: KL
authors.lastname: Thornburg
mesh_terms: D000818:Animals; D002648:Child; D002908:Chronic Disease / Q000517:prevention & control*; D004032:Diet; D004195:Disease Models, Animal; D015444:Exercise; D005260:Female; D047109:Fetal Development; D006801:Humans; D008954:Models, Biological; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D011297:Prenatal Exposure Delayed Effects
keywords: Nutrition; Obesity; Physical activity; Prenatal exposure delayed effects; Prevention; Second hit