J Pediatr Genet 2015; 04(02): 071-083
DOI: 10.1055/s-0035-1556739
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Update on Prepregnancy Maternal Obesity: Birth Defects and Childhood Outcomes

Noha Iessa
1   Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
2   Research Center, CHU Sainte-Justine, Montreal, Québec, Canada
,
Anick Bérard
1   Faculty of Pharmacy, University of Montreal, Montreal, Québec, Canada
2   Research Center, CHU Sainte-Justine, Montreal, Québec, Canada
› Author Affiliations
Further Information

Publication History

19 January 2015

25 January 2015

Publication Date:
31 July 2015 (online)

Abstract

Obesity is a growing global health epidemic. It is estimated that more than 20% of pregnancies are complicated by obesity. Prepregnancy obesity has been associated with birth defects such as neural tube defects, macrosomia, fetal death, and long-term effects such as asthma on the offspring. We provide a summary of the most recent studies and meta-analyses on obesity and birth outcome. Possible mechanisms of actions are explored and recommendations for further research are highlighted.

 
  • References

  • 1 Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks JS, Koplan JP. The spread of the obesity epidemic in the United States, 1991–1998. JAMA 1999; 282 (16) 1519-1522
  • 2 Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999; 282 (16) 1523-1529
  • 3 Martorell R, Khan LK, Hughes ML, Grummer-Strawn LM. Obesity in Latin American women and children. J Nutr 1998; 128 (9) 1464-1473
  • 4 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 2012; 307 (5) 483-490
  • 5 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009–2010: Centers for Disease Control and Prevention; 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22617494 . Accessed June 21, 2015
  • 6 Kanagalingam MG, Forouhi NG, Greer IA, Sattar N. Changes in booking body mass index over a decade: retrospective analysis from a Glasgow Maternity Hospital. BJOG 2005; 112 (10) 1431-1433
  • 7 Obesity: Preventing and Managing the Global Epidemic. Report of the WHO Consultation on Obesity; 1997. Available at: http://whqlibdoc.who.int/trs/WHO_TRS_894_(part1).pdf?ua=1&ua=1 . Accessed January 22, 2015
  • 8 Sebire NJ, Jolly M, Harris JP , et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25 (8) 1175-1182
  • 9 O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003; 14 (3) 368-374
  • 10 Chu SY, Callaghan WM, Kim SY , et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007; 30 (8) 2070-2076
  • 11 Poston L, Harthoorn LF, Van Der Beek EM ; Contributors to the ILSI Europe Workshop. Obesity in pregnancy: implications for the mother and lifelong health of the child. A consensus statement. Pediatr Res 2011; 69 (2) 175-180
  • 12 Waller DK, Mills JL, Simpson JL , et al. Are obese women at higher risk for producing malformed offspring?. Am J Obstet Gynecol 1994; 170 (2) 541-548
  • 13 Rasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J. Maternal obesity and risk of neural tube defects: a metaanalysis. Am J Obstet Gynecol 2008; 198 (6) 611-619
  • 14 Smith SA, Hulsey T, Goodnight W. Effects of obesity on pregnancy. J Obstet Gynecol Neonatal Nurs 2008; 37 (2) 176-184
  • 15 Weight Gain During Pregnancy. Weight Gain during Pregnancy: Reexamining the Guidelines; 2009. Available at: http://www.nap.edu/catalog/12584/weight-gain-during-pregnancy-reexamining-the-guidelines . Accessed November 1, 2014
  • 16 Castro LC, Avina RL. Maternal obesity and pregnancy outcomes. Curr Opin Obstet Gynecol 2002; 14 (6) 601-606
  • 17 Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301 (6) 636-650
  • 18 Waller DK, Shaw GM, Rasmussen SA , et al; National Birth Defects Prevention Study. Prepregnancy obesity as a risk factor for structural birth defects. Arch Pediatr Adolesc Med 2007; 161 (8) 745-750
  • 19 Fernandez-Twinn DS, Ozanne SE. Early life nutrition and metabolic programming. Ann N Y Acad Sci 2010; 1212: 78-96
  • 20 Correia-Branco A, Keating E, Martel F. Maternal undernutrition and fetal developmental programming of obesity: the glucocorticoid connection. Reprod Sci 2015; 22 (2) 138-145
  • 21 Madan JC, Davis JM, Craig WY , et al. Maternal obesity and markers of inflammation in pregnancy. Cytokine 2009; 47 (1) 61-64
  • 22 Catalano PM. The impact of gestational diabetes and maternal obesity on the mother and her offspring. J Dev Orig Health Dis 2010; 1 (4) 208-215
  • 23 Mehta S, Farmer JA. Obesity and inflammation: a new look at an old problem. Curr Atheroscler Rep 2007; 9 (2) 134-138
  • 24 Greenberg AS, Obin MS. Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr 2006; 83 (2) 461S-465S
  • 25 Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab 2002; 87 (9) 4231-4237
  • 26 Wolf M, Kettyle E, Sandler L, Ecker JL, Roberts J, Thadhani R. Obesity and preeclampsia: the potential role of inflammation. Obstet Gynecol 2001; 98 (5, Pt 1) 757-762
  • 27 Mokdad AH, Ford ES, Bowman BA , et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003; 289 (1) 76-79
  • 28 Yoon BH, Romero R, Kim CJ , et al. High expression of tumor necrosis factor-alpha and interleukin-6 in periventricular leukomalacia. Am J Obstet Gynecol 1997; 177 (2) 406-411
  • 29 McDonald DG, Kelehan P, McMenamin JB , et al. Placental fetal thrombotic vasculopathy is associated with neonatal encephalopathy. Hum Pathol 2004; 35 (7) 875-880
  • 30 Berry SM, Romero R, Gomez R , et al. Premature parturition is characterized by in utero activation of the fetal immune system. Am J Obstet Gynecol 1995; 173 (4) 1315-1320
  • 31 Gomez R, Romero R, Ghezzi F, Yoon BH, Mazor M, Berry SM. The fetal inflammatory response syndrome. Am J Obstet Gynecol 1998; 179 (1) 194-202
  • 32 Romero R, Gomez R, Ghezzi F , et al. A fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition. Am J Obstet Gynecol 1998; 179 (1) 186-193
  • 33 Leviton A, Dammann O. Coagulation, inflammation, and the risk of neonatal white matter damage. Pediatr Res 2004; 55 (4) 541-545
  • 34 Dammann O, Leviton A. Inflammation, brain damage and visual dysfunction in preterm infants. Semin Fetal Neonatal Med 2006; 11 (5) 363-368
  • 35 Pohlmeier WE, Xie F, Kurz SG, Lu N, Wood JR. Progressive obesity alters the steroidogenic response to ovulatory stimulation and increases the abundance of mRNAs stored in the ovulated oocyte. Mol Reprod Dev 2014; 81 (8) 735-747
  • 36 Morrison JL, Duffield JA, Muhlhausler BS, Gentili S, McMillen IC. Fetal growth restriction, catch-up growth and the early origins of insulin resistance and visceral obesity. Pediatr Nephrol 2010; 25 (4) 669-677
  • 37 Gupta A, Srinivasan M, Thamadilok S, Patel MS. Hypothalamic alterations in fetuses of high fat diet-fed obese female rats. J Endocrinol 2009; 200 (3) 293-300
  • 38 Sullivan EL, Smith MS, Grove KL. Perinatal exposure to high-fat diet programs energy balance, metabolism and behavior in adulthood. Neuroendocrinology 2011; 93 (1) 1-8
  • 39 Stachowiak EK, Oommen S, Vasu VT , et al. Maternal obesity affects gene expression and cellular development in fetal brains. Nutr Neurosci 2013; 16 (3) 96-103
  • 40 Wells JC. The thrifty phenotype as an adaptive maternal effect. Biol Rev Camb Philos Soc 2007; 82 (1) 143-172
  • 41 Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R. Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 2002; 75 (4) 683-688
  • 42 Després JP. Is visceral obesity the cause of the metabolic syndrome?. Ann Med 2006; 38 (1) 52-63
  • 43 Ross R, Freeman J, Hudson R, Janssen I. Abdominal obesity, muscle composition, and insulin resistance in premenopausal women. J Clin Endocrinol Metab 2002; 87 (11) 5044-5051
  • 44 Després JP, Moorjani S, Ferland M , et al. Adipose tissue distribution and plasma lipoprotein levels in obese women. Importance of intra-abdominal fat. Arteriosclerosis 1989; 9 (2) 203-210
  • 45 Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet 1993; 341 (8850) 938-941
  • 46 Ravelli GP, Stein ZA, Susser MW. Obesity in young men after famine exposure in utero and early infancy. N Engl J Med 1976; 295 (7) 349-353
  • 47 Pomeroy J, Renström F, Gradmark AM , et al. Maternal physical activity and insulin action in pregnancy and their relationships with infant body composition. Diabetes Care 2013; 36 (2) 267-269
  • 48 Committee on Obstetric Practice; American College of Obstetricians and Gynecologists. ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. Int J Gynaecol Obstet 2002; 77 (1) 79-81
  • 49 Hendricks KA, Nuno OM, Suarez L, Larsen R. Effects of hyperinsulinemia and obesity on risk of neural tube defects among Mexican Americans. Epidemiology 2001; 12 (6) 630-635
  • 50 Carmichael SL, Shaw GM, Selvin S, Schaffer DM. Diet quality and risk of neural tube defects. Med Hypotheses 2003; 60 (3) 351-355
  • 51 Carmichael SL, Shaw GM, Schaffer DM, Laurent C, Selvin S. Dieting behaviors and risk of neural tube defects. Am J Epidemiol 2003; 158 (12) 1127-1131
  • 52 Lupo PJ, Mitchell LE, Canfield MA , et al; National Birth Defects Prevention Study. Maternal-fetal metabolic gene-gene interactions and risk of neural tube defects. Mol Genet Metab 2014; 111 (1) 46-51
  • 53 Mojtabai R. Body mass index and serum folate in childbearing age women. Eur J Epidemiol 2004; 19 (11) 1029-1036
  • 54 Parker SE, Yazdy MM, Tinker SC, Mitchell AA, Werler MM. The impact of folic acid intake on the association among diabetes mellitus, obesity, and spina bifida. Am J Obstet Gynecol 2013; 209 (3) 239.e1-239.e8
  • 55 Wang M, Wang ZP, Gao LJ, Gong R, Sun XH, Zhao ZT. Maternal body mass index and the association between folic acid supplements and neural tube defects. Acta Paediatr 2013; 102 (9) 908-913
  • 56 Centre for Maternal and Child Enquiries and Royal College of Obstetricians and Gynaecologists. Management of Women with Obesity in Pregnancy 2012. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/cmacercogjointguidelinemanagementwomenobesitypregnancya.pdf . Accessed June 21, 2015
  • 57 Cai GJ, Sun XX, Zhang L, Hong Q. Association between maternal body mass index and congenital heart defects in offspring: a systematic review. Am J Obstet Gynecol 2014; 211 (2) 91-117
  • 58 Gilboa SM, Correa A, Botto LD , et al; National Birth Defects Prevention Study. Association between prepregnancy body mass index and congenital heart defects. Am J Obstet Gynecol 2010; 202 (1) 51.e1-51.e10
  • 59 Mills JL, Troendle J, Conley MR, Carter T, Druschel CM. Maternal obesity and congenital heart defects: a population-based study. Am J Clin Nutr 2010; 91 (6) 1543-1549
  • 60 Balaha MH, Ali WH, Al Aswad LH, Al Moghannum MS, Hashim I. Maternal obesity predict isolated birth defects in live births in Eastern Province of Saudi Arabia. J Matern Fetal Neonatal Med 2012; 25 (7) 924-929
  • 61 Oddy WH, De Klerk NH, Miller M, Payne J, Bower C. Association of maternal pre-pregnancy weight with birth defects: evidence from a case-control study in Western Australia. Aust N Z J Obstet Gynaecol 2009; 49 (1) 11-15
  • 62 Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311 (15) 1536-1546
  • 63 Flenady V, Koopmans L, Middleton P , et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377 (9774) 1331-1340
  • 64 Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998; 91 (1) 97-102
  • 65 Kumari AS. Pregnancy outcome in women with morbid obesity. Int J Gynaecol Obstet 2001; 73 (2) 101-107
  • 66 Lu GC, Rouse DJ, DuBard M, Cliver S, Kimberlin D, Hauth JC. The effect of the increasing prevalence of maternal obesity on perinatal morbidity. Am J Obstet Gynecol 2001; 185 (4) 845-849
  • 67 Lederman SA. Pregnancy weight gain and postpartum loss: avoiding obesity while optimizing the growth and development of the fetus. J Am Med Womens Assoc 2001; 56 (2) 53-58
  • 68 Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB ; Diabetes Endocrine Pregnancy Outcome Study in Toronto. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. QJM 2001; 94 (7) 347-356
  • 69 Alberico S, Montico M, Barresi V , et al; Multicentre Study Group on Mode of Delivery in Friuli Venezia Giulia. The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. BMC Pregnancy Childbirth 2014; 14: 23
  • 70 Salihu HM, Weldeselasse HE, Rao K, Marty PJ, Whiteman VE. The impact of obesity on maternal morbidity and feto-infant outcomes among macrosomic infants. J Matern Fetal Neonatal Med 2011; 24 (9) 1088-1094
  • 71 Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115 (3) e290-e296
  • 72 Crespo PS, Prieto Perera JA, Lodeiro FA, Azuara LA. Metabolic syndrome in childhood. Public Health Nutr 2007; 10 (10A): 1121-1125
  • 73 Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS ONE 2013; 8 (4) e61627
  • 74 Tie HT, Xia YY, Zeng YS , et al. Risk of childhood overweight or obesity associated with excessive weight gain during pregnancy: a meta-analysis. Arch Gynecol Obstet 2014; 289 (2) 247-257
  • 75 Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med 2008; 359 (1) 61-73
  • 76 Armitage JA, Poston L, Taylor PD. Developmental origins of obesity and the metabolic syndrome: the role of maternal obesity. Front Horm Res 2008; 36: 73-84
  • 77 Lawlor DA, Smith GD, O'Callaghan M , et al. Epidemiologic evidence for the fetal overnutrition hypothesis: findings from the mater-university study of pregnancy and its outcomes. Am J Epidemiol 2007; 165 (4) 418-424
  • 78 Breier BH, Vickers MH, Ikenasio BA, Chan KY, Wong WP. Fetal programming of appetite and obesity. Mol Cell Endocrinol 2001; 185 (1-2) 73-79
  • 79 Godfrey KM, Barker DJ. Fetal nutrition and adult disease. Am J Clin Nutr 2000; 71 (5, Suppl): 1344S-1352S
  • 80 Li M, Sloboda DM, Vickers MH. Maternal obesity and developmental programming of metabolic disorders in offspring: evidence from animal models. Exp Diabetes Res 2011; 2011: 592408
  • 81 Van Lieshout RJ, Taylor VH, Boyle MH. Pre-pregnancy and pregnancy obesity and neurodevelopmental outcomes in offspring: a systematic review. Obes Rev 2011; 12 (5) e548-e559
  • 82 Basatemur E, Gardiner J, Williams C, Melhuish E, Barnes J, Sutcliffe A. Maternal prepregnancy BMI and child cognition: a longitudinal cohort study. Pediatrics 2013; 131 (1) 56-63
  • 83 Bilbo SD, Tsang V. Enduring consequences of maternal obesity for brain inflammation and behavior of offspring. FASEB J 2010; 24 (6) 2104-2115
  • 84 Tanda R, Salsberry PJ, Reagan PB, Fang MZ. The impact of prepregnancy obesity on children's cognitive test scores. Matern Child Health J 2013; 17 (2) 222-229
  • 85 Heikura U, Taanila A, Hartikainen AL , et al. Variations in prenatal sociodemographic factors associated with intellectual disability: a study of the 20-year interval between two birth cohorts in northern Finland. Am J Epidemiol 2008; 167 (2) 169-177
  • 86 Neggers YH, Goldenberg RL, Ramey SL, Cliver SP. Maternal prepregnancy body mass index and psychomotor development in children. Acta Obstet Gynecol Scand 2003; 82 (3) 235-240
  • 87 Krakowiak P, Walker CK, Bremer AA , et al. Maternal metabolic conditions and risk for autism and other neurodevelopmental disorders. Pediatrics 2012; 129 (5) e1121-e1128
  • 88 Hertz-Picciotto I, Delwiche L. The rise in autism and the role of age at diagnosis. Epidemiology 2009; 20 (1) 84-90
  • 89 Reynolds LC, Inder TE, Neil JJ, Pineda RG, Rogers CE. Maternal obesity and increased risk for autism and developmental delay among very preterm infants. J Perinatol 2014; 34 (9) 688-692
  • 90 Hinkle SN, Schieve LA, Stein AD, Swan DW, Ramakrishnan U, Sharma AJ. Associations between maternal prepregnancy body mass index and child neurodevelopment at 2 years of age. Int J Obes 2012; 36 (10) 1312-1319
  • 91 Rodriguez A, Miettunen J, Henriksen TB , et al. Maternal adiposity prior to pregnancy is associated with ADHD symptoms in offspring: evidence from three prospective pregnancy cohorts. Int J Obes 2008; 32 (3) 550-557
  • 92 Baumeister H, Härter M. Mental disorders in patients with obesity in comparison with healthy probands. Int J Obes 2007; 31 (7) 1155-1164
  • 93 Holtkamp K, Konrad K, Müller B , et al. Overweight and obesity in children with attention-deficit/hyperactivity disorder. Int J Obes Relat Metab Disord 2004; 28 (5) 685-689
  • 94 Lam LT, Yang L. Overweight/obesity and attention deficit and hyperactivity disorder tendency among adolescents in China. Int J Obes 2007; 31 (4) 584-590
  • 95 Brookes K, Xu X, Chen W , et al. The analysis of 51 genes in DSM-IV combined type attention deficit hyperactivity disorder: association signals in DRD4, DAT1 and 16 other genes. Mol Psychiatry 2006; 11 (10) 934-953
  • 96 Levitan RD, Masellis M, Lam RW , et al. Childhood inattention and dysphoria and adult obesity associated with the dopamine D4 receptor gene in overeating women with seasonal affective disorder. Neuropsychopharmacology 2004; 29 (1) 179-186
  • 97 Camarena B, Ruvinskis E, Santiago H , et al. Serotonin transporter gene and obese females with impulsivity. Mol Psychiatry 2002; 7 (8) 829-830
  • 98 Dallman MF, Pecoraro N, Akana SF , et al. Chronic stress and obesity: a new view of “comfort food.”. Proc Natl Acad Sci U S A 2003; 100 (20) 11696-11701
  • 99 Van den Bergh BR, Mulder EJ, Mennes M, Glover V. Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci Biobehav Rev 2005; 29 (2) 237-258
  • 100 Lee DH, Jacobs DR, Porta M. Association of serum concentrations of persistent organic pollutants with the prevalence of learning disability and attention deficit disorder. J Epidemiol Community Health 2007; 61 (7) 591-596
  • 101 Hendler I, Blackwell SC, Mehta SH , et al. The levels of leptin, adiponectin, and resistin in normal weight, overweight, and obese pregnant women with and without preeclampsia. Am J Obstet Gynecol 2005; 193 (3, Pt 2) 979-983
  • 102 Rodriguez A. Maternal pre-pregnancy obesity and risk for inattention and negative emotionality in children. J Child Psychol Psychiatry 2010; 51 (2) 134-143
  • 103 Chen Q, Sjölander A, Långström N , et al. Maternal pre-pregnancy body mass index and offspring attention deficit hyperactivity disorder: a population-based cohort study using a sibling-comparison design. Int J Epidemiol 2014; 43 (1) 83-90
  • 104 Thomsen SF, van der Sluis S, Kyvik KO, Skytthe A, Skadhauge LR, Backer V. Increase in the heritability of asthma from 1994 to 2003 among adolescent twins. Respir Med 2011; 105 (8) 1147-1152
  • 105 Cohen RT, Raby BA, Van Steen K , et al; Childhood Asthma Management Program Research Group. In utero smoke exposure and impaired response to inhaled corticosteroids in children with asthma. J Allergy Clin Immunol 2010; 126 (3) 491-497
  • 106 Caudri D, Savenije OE, Smit HA , et al. Perinatal risk factors for wheezing phenotypes in the first 8 years of life. Clin Exp Allergy 2013; 43 (12) 1395-1405
  • 107 Guerra S, Sartini C, Mendez M , et al. Maternal prepregnancy obesity is an independent risk factor for frequent wheezing in infants by age 14 months. Paediatr Perinat Epidemiol 2013; 27 (1) 100-108
  • 108 Forno E, Young OM, Kumar R, Simhan H, Celedón JC. Maternal obesity in pregnancy, gestational weight gain, and risk of childhood asthma. Pediatrics 2014; 134 (2) e535-e546
  • 109 Bogaerts A, Devlieger R, Van den Bergh BR, Witters I. Obesity and pregnancy, an epidemiological and intervention study from a psychosocial perspective. Facts Views Vis Obgyn 2014; 6 (2) 81-95
  • 110 Scott C, Andersen CT, Valdez N , et al. No global consensus: a cross-sectional survey of maternal weight policies. BMC Pregnancy Childbirth 2014; 14: 167
  • 111 Yajnik CS. Transmission of obesity-adiposity and related disorders from the mother to the baby. Ann Nutr Metab 2014; 64 (Suppl. 01) 8-17
  • 112 Vesco KK, Karanja N, King JC , et al. Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale. Contemp Clin Trials 2012; 33 (4) 777-785
  • 113 Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes 2008; 32 (3) 495-501
  • 114 Thornton YS, Smarkola C, Kopacz SM, Ishoof SB. Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. J Natl Med Assoc 2009; 101 (6) 569-577
  • 115 Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jørgensen JS. The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care 2011; 34 (12) 2502-2507
  • 116 Barakat R, Cordero Y, Coteron J, Luaces M, Montejo R. Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial. Br J Sports Med 2012; 46 (9) 656-661
  • 117 Gillies CL, Abrams KR, Lambert PC , et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 2007; 334 (7588) 299
  • 118 Ross R, Janssen I, Dawson J , et al. Exercise-induced reduction in obesity and insulin resistance in women: a randomized controlled trial. Obes Res 2004; 12 (5) 789-798
  • 119 Tobias DK, Zhang C, van Dam RM, Bowers K, Hu FB. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care 2011; 34 (1) 223-229
  • 120 Hayes L, Bell R, Robson S, Poston L ; UPBEAT Consortium. Association between physical activity in obese pregnant women and pregnancy outcomes: the UPBEAT pilot study. Ann Nutr Metab 2014; 64 (3-4) 239-246
  • 121 Stafne SN, Salvesen KA, Romundstad PR, Eggebø TM, Carlsen SM, Mørkved S. Regular exercise during pregnancy to prevent gestational diabetes: a randomized controlled trial. Obstet Gynecol 2012; 119 (1) 29-36