Trends in Obesity and Implications for the Fetus

  • Jamie O. Lo
  • Antonio E. Frias
Part of the Nutrition and Health book series (NH)


Obesity is a worldwide pandemic. The high prevalence of obesity and the projected increasing trend have adverse implications for pregnant women including thromboembolic complications, gestational diabetes, hypertension, cesarean section, maternal hemorrhage, and infection. Maternal obesity has a measureable impact on infant and future adult health. Offspring are at increased risk for spontaneous miscarriage, fetal malformations, fetal macrosomia, stillbirth, and preterm delivery. This review focuses on the trends in maternal obesity and its implications for maternal and fetal health as well as evidence suggesting that the pre-pregnancy and the prenatal period provide a window of opportunity to intervene and curtail the intergenerational cycle of obesity.


Obesity epidemic Fetal programming Increased adult disease risk Obesity Trends 



American College of Obstetricians and Gynecologists


Body mass index


Health Survey for England


Institute of Medicine


Pregnancy Risk Assessment Monitoring System


World Health Organization


  1. 1.
    World Health Organization. Jan 2015. Obesity and overweight fact Sheet no. 311. Available:
  2. 2.
    Tjepkema M. Measured obesity: adult obesity in Canada: measured height and weight. Statistics Canada. 2005.Google Scholar
  3. 3.
    Heslehurst N, Simpson H, Ells LJ, et al. The impact of maternal BMI status on pregnancy outcomes with intermediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008;9(6):635–83.CrossRefPubMedGoogle Scholar
  4. 4.
    O’Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology. 2003;14(3):368–74.PubMedGoogle Scholar
  5. 5.
    Johansson S, Villamor E, Altman M, Bonamy AK, Granath F, Cnattingius S. Maternal overweight and obesity in early pregnancy and risk of infant mortality: a population based cohort study in Sweden. BMJ. 2014;349:g6572.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Salihu HM, Weldeselasse HE, Rao K, Marty PJJ, Whiteman VE. The impact of obesity on maternal morbidity and feto-infant outcomes among macrosomic infants. J Matern Fetal Neonatal Med. 2011;24(9):1088–94.CrossRefPubMedGoogle Scholar
  7. 7.
    Flegal KM, Carroll MD, Ogden CL, Curtin JR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Berenson AB, Pohlmeier AM, Laz TH, Rahman M, Saade G. Obesity risk knowledge, weight misperception, and diet and health attitudes among women intending to become pregnant. J Acad Nutr Diet. 2016;116(1):69–75.CrossRefPubMedGoogle Scholar
  9. 9.
    Institute of Medicine Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009.Google Scholar
  10. 10.
    Dalenius K, Brindley P, Smith B, Reinold C, Grummer-Strawn L. Pregnancy nutrition surveillance 2010 report. Atlanta: Centers for Disease Control and Prevention; 2012. ( Scholar
  11. 11.
    Kim SY, Dietz PM, England L, et al. Trends in pre-pregnancy obesity in nine states, 1993–2003. Obestiy. 2007;15(4):986–93.CrossRefGoogle Scholar
  12. 12.
    Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Trend in maternal obesity incidence rates, demographic predictors, and health inequalities in 36,821 women over a 15-year period. BJOG. 2007;114(2):187–94.CrossRefPubMedGoogle Scholar
  13. 13.
    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):1431–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Centre for Maternal and Child Enquiries (CMACE). Maternal obesity in the UK: findings from a national project. London: CMACE; 2010.Google Scholar
  15. 15.
    Public Health Agency of Canada and Canadian Institute for Health Information. Obesity in Canada: a joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information. 2011.Google Scholar
  16. 16.
    Freedman DS. Obesity-United States, 1988–2008. Cent Dis Control Prev Morb Mortal Wkly Rep. 2011;60(1):73–7.Google Scholar
  17. 17.
    Brawarsky P, Stotland NE, Jackson RA, et al. Pre-pregnancy and pregnancy-related factors and the risk of excessive or inadequate gestational weight gain. Int J Gynaecol Obstet. 2005;91(2):125–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States 1988–1994 and 2005–2008. NCHS data brief no 50. Hyattsville: National Center for Health Statistics; 2010.Google Scholar
  19. 19.
    Scantlebury R, Moody A. Adult obesity and overweight. Chapter 9. In: Craig R, Mindell J, editors. Health survey for England 2014: health, social care and lifestyles. Leeds: Health and Social Care Information Center; 2014.Google Scholar
  20. 20.
    Dietl J. Maternal obesity and complications during pregnancy. J Perinat Med. 2005;33(2):100–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Singh J, Huang CC, Driggers RW, et al. The impact of pre-pregnancy body mass index on the risk of gestational diabetes. J Matern Fetal Neonatal Med. 2012;25(1):5–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9688):1773–9.CrossRefPubMedGoogle Scholar
  23. 23.
    ACOG Committee opinion no. 650: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015:126(6):135–42.Google Scholar
  24. 24.
    Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity. 2008;16(3):643–53.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Shekelle PG, Newberry S, Maglione M, et al. Bariatric surgery in women of reproductive age: special concerns for pregnancy. Evid Rep Technol Assess (Full Rep). 2008;169:1–51.Google Scholar
  26. 26.
    Maggard MA, Yermilov I, Li Z, et al. Pregnancy and fertility following bariatric surgery: a systematic review. JAMA. 2008;300(19):2286–96.CrossRefPubMedGoogle Scholar
  27. 27.
    Galazis N, Docheva N, Simillis C, Nicolaides KH. Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014;181:45–53.CrossRefPubMedGoogle Scholar
  28. 28.
    Johansson K, Cnattingius S, Naslund I, et al. Outcomes of pregnancy after bariatric surgery. NEJM. 2014;372(9):814–24.CrossRefGoogle Scholar
  29. 29.
    Kjaer MM, Nilas L. Pregnancy after bariatric surgery – a review of benefits and risks. Acta Obstet Gynecol Scand. 2013;92(3):264–71.CrossRefPubMedGoogle Scholar
  30. 30.
    Kjaer MM, Lauenborg J, Breum BM, Nilas L. The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol. 2013;208(6):464.e1-5.CrossRefPubMedGoogle Scholar
  31. 31.
    Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011;29(6):507–13.CrossRefPubMedGoogle Scholar
  32. 32.
    Werler MM, Louik C, Shapiro S, Mitchell AA. Prepregnant weight in relation to risk of neural tube defects. JAMA. 1996;275(14):1089–92.CrossRefPubMedGoogle Scholar
  33. 33.
    Davies GA, Maxwell C, McLeod L, et al. SOGC clinical practice guidelines: obesity in pregnancy. No 239, February 2010. Int J Gynaecol Obstet. 2010;110(2):167–73.CrossRefPubMedGoogle Scholar
  34. 34.
    Robinson HE, O’Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol. 2005;106(6):1357–64.CrossRefPubMedGoogle Scholar
  35. 35.
    Siega-Riz AM, Siega-Riz AM, Laraia B. The implications of maternal overweight and obesity on the course of pregnancy and birth outcomes. Matern Child Health J. 2006;10(Suppl 1):153–6.CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH. Pregnancy complications and birth outcomes in obese and normal-weight women: effects of gestational weight change. Obstet Gynecol. 1996;87(3):389–94.CrossRefPubMedGoogle Scholar
  37. 37.
    Larsen TB, Sørensen HT, Gislum M, Johnsen SP. Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res. 2007;120(4):505–9.CrossRefPubMedGoogle Scholar
  38. 38.
    RCOG 2015. Reducing the risk of venous thromboembolism during pregnancy and the puerperium (Green-top 37a). Available at: Accessed 14 Apr 2016.
  39. 39.
    Chu SY, Kim SY, Schmid CH, Dietz PM, Callaghan WM, Lau J, Curtis KM. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev. 2007;8(5):385–94.CrossRefPubMedGoogle Scholar
  40. 40.
    Sarvanakumar K, Rao SG, Cooper GM. Obesity and obstetric anesthesia. Anesthesia. 2006;61(1):36–48.CrossRefGoogle Scholar
  41. 41.
    Catalano PM, Ehrenberg HM. The short- and long-term implications of maternal obesity on the mother and her offspring. BJOG. 2006;113(10):1126–33.CrossRefPubMedGoogle Scholar
  42. 42.
    Torloni MR, Betran AP, Horta BL, et al. Pre-pregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev. 2009;10(2):194–203.CrossRefPubMedGoogle Scholar
  43. 43.
    Hedderson MM, Williams MA, Holt VL, et al. Body mass index and weight gain prior to pregnancy and risk of gestational diabetes mellitus. Am J Obstet Gynecol. 2008;198(4):409.e1-7.CrossRefPubMedGoogle Scholar
  44. 44.
    Kim C, Berger DK, Chamany S. Recurrence of gestational diabetes mellitus: a systematic review. Diabetes Care. 2007;30(5):1314–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Nohr EA, Vaeth M, Baker JL, Sorensen TI, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008;87(6):1750–9.PubMedGoogle Scholar
  47. 47.
    Ovesen P, Rasmussen S, Kesmodel U. Effect of pre-pregnancy maternal overweight and obesity on pregnancy outcome. Obstet Gynecol. 2011;118(2):305–12.CrossRefPubMedGoogle Scholar
  48. 48.
    Artal R, Lockwood CJ, Brown HL. Weight gain recommendations in pregnancy and the obesity epidemic. Obstet Gynecol. 2010;115(1):152–5.CrossRefPubMedGoogle Scholar
  49. 49.
    ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013;121(1):210–12.Google Scholar
  50. 50.
    Bechtel-Blackwell DA. Computer-assisted self-interview and nutrition education in pregnant teens. Clin Nurs Res. 2002;11(4):450–62.CrossRefPubMedGoogle Scholar
  51. 51.
    Wolff S, Legarth J, Vansgaard 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 Obses (Lond). 2008;32(3):495–501.CrossRefGoogle Scholar
  52. 52.
    Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial. Obstet Gynecol. 2009;113(2 Pt 1):305–12.CrossRefPubMedGoogle Scholar
  53. 53.
    Quinlivan JA, Lam LT, Fisher J. A randomised trial of four-step multidisciplinary approach to the antenatal care of obese pregnant women. Aust N Z J Obstet Gynaecol. 2011;51(2):141–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Grivell RM, Yelland LN, Deussen A, Crowther CA, Dodd JM. Antenatal dietary and lifestyle advice for women who are overweight or obese and the effect on fetal growth and adiposity: the LIMIT randomized trial. BJOG. 2016;123(2):233–43.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Chiswick C, Reynolds RM, Denison F, et al. Effect of metformin on maternal and fetal outcomes in obese pregnant women (EMPOWaR): a randomized, double-blind, placebo-controlled trial. Lancet. 2015;3(10):778–86.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Syngelaki A, Nicolaides KH, Balani J, et al. Metformin versus placebo in obese pregnant women without diabetes mellitus. NEJM. 2016;374(5):434–43.CrossRefPubMedGoogle Scholar
  57. 57.
    Sattar N, Greer IA. Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening? BMJ. 2002;325(7356):157–60.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Keppel KG, Taffel SM. Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine guidelines. Am J Public Health. 1993;83(8):1100–3.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. AJOG. 2007;196(4):322.31–8.CrossRefGoogle Scholar
  60. 60.
    Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet. 2006;368(9542):1164–70.CrossRefPubMedGoogle Scholar
  61. 61.
    Oken E, Taveras EM, Popoola FA, Rich-Edwards JW, Gillman MW. Television, walking, and diet associations with postpartum weight retention. Am J Prev Med. 2007;32(4):305–11.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Choi J, Fukuoka Y, Lee JH. The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and met-analysis of randomized controlled trials. Prev Med. 2013;56(6):351–64.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012;8:CD003517.Google Scholar
  64. 64.
    Mehta UJ, Siega-Riz AM, Herring AH, Adair LS, Bentley ME. Maternal obesity, psychological factors and breastfeeding initiation. Breastfeed Med. 2011;6(6):369–76.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    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):66–650.CrossRefGoogle Scholar
  66. 66.
    Harder T, Dudenhausen JW, Plagemann A. Maternal diabesity and developmental programming in the offspring. In: Ovesen PG, Jensen DM, editors. Maternal obesity and pregnancy. Springer. 2012; p. 133–54.Google Scholar
  67. 67.
    Anath CV, Wen SW. Trends in fetal growth among singleton gestations in the United States and Canada, 1985 through 1998. Semin Perinatol. Berlin Heidelberg. 2002;26(4):260–7.Google Scholar
  68. 68.
    Orskou J, Kesmodel U, Henriksen TB, Secher NJ. An increasing proportion of infants weigh more than 4000 grams at birth. Acta Obstet Gynaecol Scand. 2001;80(10):931–6.CrossRefGoogle Scholar
  69. 69.
    Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780–6.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Graversen L, Sorensen TI, Gerds TA, et al. Prediction of adolescent and adult adiposity outcomes from early life anthropometrics. Obesity. 2014;23(1):162–9.CrossRefPubMedGoogle Scholar
  71. 71.
    Reynolds RM, Allan RM, Raja EA, et al. Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1,323,275 person years. BMJ. 2013;347:f4539.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Barker DJ. The fetal and infant origins of adult disease. BMJ. 1990;301(6761):1111.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Lawlor DA, Smith GD, O’Callaghan M, et al. Epidemiologic evidence for fetal overnutrition hypothesis: findings from the mater-university study of pregnancy and its outcomes. Am J Epidemiol. 2007;165(4):418–24.CrossRefPubMedGoogle Scholar
  74. 74.
    Whitaker RC. Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics. 2004;114(1):e29–36.CrossRefPubMedGoogle Scholar
  75. 75.
    Turdi S, Ge W, Hu N, Gradley KM, Wang X, Ren J. Interaction between maternal and postnatal high fat diet leads to a greater risk of myocardial dysfunction in offspring via enhanced lipotoxicity, irs-1 serine phosphorylation and mitochondrial defects. J Mol Cell Cardiol. 2013;55:117–29.CrossRefPubMedGoogle Scholar
  76. 76.
    McCurdy C, Bishop JM, Williams S, et al. Maternal high-fat diet triggers lipotoxicity in the fetal livers of nonhuman primates. J Clin Invest. 2009;119(2):323–35.PubMedPubMedCentralGoogle Scholar
  77. 77.
    Frias A, Morgan T, Evans A, et al. Maternal high-fat diet disturbs uteroplacental hemodynamics and increases the frequency of stillbirth in a nonhuman primate model of excess nutrition. Endocrinology. 2011;152(6):2456–64.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Frias A, Grove K. Obesity: a transgenerational problem linked to nutrition during pregnancy. Semin Reprod Med. 2012;30(6):472–8.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Grayson B, Levasseur P, Williams S, Smith M, Marks D, Grove K. Changes in melanocortin expression and inflammatory pathways in fetal offspring of nonhuman primates fed a high-fat diet. Endocrinology. 2010;151(4):1622–32.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Sullivan E, Grayson B, Takahashi D, et al. Chronic consumption of a high-fat diet during pregnancy cause perturbations in the serotonergic system and increased anxiety-like behavior in nonhuman primate offspring. J Neurosci. 2010;30(10):3826–30.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    de Boo HA, Harding JE. The developmental origins of adult disease (Barker) hypothesis. Aust N Z J Obstet Gynecol. 2006;45(1):4–14.CrossRefGoogle Scholar
  82. 82.
    Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities. 2006. Contraception. 2011;84(5):478–85.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyOregon Health & Science UniversityPortlandUSA

Personalised recommendations