Obesity in pregnancy: implications for fetal and postnatal growth
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Obesity in pregnancy is increasing in line with the excessive weight gains of the general population. Obese women are less likely to get pregnant, either naturally or with assisted conception, more likely to miscarry and more likely to have significant medical problems such as preeclampsia and gestational diabetes. Both mother and baby may be affected by increased risk of thromboses or bleeding and increased problems in labour. Despite existing guidelines, weight gain during pregnancy is often excessive. While such guidelines aim to protect against fetal undernutrition, they are also associated with an increased risk of large for gestational age babies and increased weight retention in mothers post-pregnancy. Such effects are most common in women with the highest pre-pregnancy body mass index. Most studies use the fixed time point of birth to describe in utero growth, but this may misrepresent the fetal growth trajectory. Recent work, including from our group, has produced data on in utero growth and adiposity. Multinational studies, including those from India, have shown that fetal adiposity and birth weight may not be closely related across racial groups. Adiposity at birth, along with subsequent growth rates, may predict propensity for adult disease and as such further studies of perinatal nutrition are important targets for preventative interventions in population health.