Obesity and the health of future generations

The prevalence of obesity in women of reproductive age around the world is increasing in both low-to-middle-income and high-income populations, and is a concern for the health of at least two generations. It not only affects the woman's health, by increasing her risk of gestational diabetes and, longer-term, type two diabetes and cardiovascular disease, but also places her offspring at risk, particularly of developing childhood obesity and its later consequences, and so the cycle repeats. The alarming rise in the prevalence of childhood obesity led WHO's Director-General to establish a Commission on Ending Childhood Obesity, which reported to the World Health Assembly in May, 2016. The Commission's report 1 Commission on Ending Childhood ObesityEnding childhood obesity. www.who.int/entity/end-childhood-obesity/final-report/en/ Google Scholar stressed the need for concerted and sustained action, not only in childhood but also earlier in the life course—ie, in the mother (and father) both before and during pregnancy. The Series on preconception and maternal obesity in The Lancet Diabetes & Endocrinology suggests new directions that such an initiative could take. Preconceptional and maternal obesity: epidemiology and health consequencesObesity in women of reproductive age is increasing in prevelance worldwide. Obesity reduces fertility and increases time taken to conceive, and obesity-related comorbidities (such as type 2 diabetes and chronic hypertension) heighten the risk of adverse outcomes for mother and child if the woman becomes pregnant. Pregnant women who are obese are more likely to have early pregnancy loss, and have increased risk of congenital fetal malformations, delivery of large for gestational age infants, shoulder dystocia, spontaneous and medically indicated premature birth, and stillbirth. Full-Text PDF Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partumThe global epidemic of obesity has led to an increasing number of obese women of reproductive age. Obesity is associated with reduced fertility, and pregnancies complicated by maternal obesity are associated with adverse outcomes, including increased risk of gestational diabetes, pre-eclampsia, preterm birth, instrumental and caesarean births, infections, and post-partum haemorrhage. The medical and obstetric management of obese women is focused on identifying, addressing, and preventing some of these associated complications, and is a daunting challenge given the high percentage of patients with obesity and few therapeutic options proven to improve outcomes in this population. Full-Text PDF Influence of maternal obesity on the long-term health of offspringIn addition to immediate implications for pregnancy complications, increasing evidence implicates maternal obesity as a major determinant of offspring health during childhood and later adult life. Observational studies provide evidence for effects of maternal obesity on her offspring's risks of obesity, coronary heart disease, stroke, type 2 diabetes, and asthma. Maternal obesity could also lead to poorer cognitive performance and increased risk of neurodevelopmental disorders, including cerebral palsy. Full-Text PDF Interventions to prevent maternal obesity before conception, during pregnancy, and post partumPrevention of obesity in women of reproductive age is widely recognised to be important both for their health and for that of their offspring. Weight-control interventions, including drug treatment, in pregnant women who are obese or overweight have not had sufficient impact on pregnancy and birth outcomes, which suggests that the focus for intervention should include preconception or post-partum periods. Further research is needed into the long-term effects of nutritional and lifestyle interventions before conception. Full-Text PDF