Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes.
Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes.
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DOI：
10.1038/ijo.2015.15
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发表时间：
2015-04
期刊：
影响因子：
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通讯作者：
deMouzon SH
中科院分区：
文献类型：
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作者：
Catalano P;deMouzon SH
怀孕期间肥胖与母亲及其后代短期和长期代谢功能障碍的风险增加有关。较高的孕妇孕前体重指数（kg m−2）和妊娠体重增加过多（GWG）与妊娠不良结局相关，如妊娠糖尿病、先兆子痫和胎儿肥胖。多种生活方式干预试验包括使用各种饮食、增加身体活动和行为改变技术进行体重管理，以避免过多的GWG并改善围产期结局。这些随机对照试验（RCTs）在减少过量GWG方面取得了一定的成功，尽管GWG的减少通常不在当前医学研究所指南的范围内。随机对照试验在降低母体妊娠期糖尿病（GDM）、先兆子痫或胎儿过度生长（通常称为巨大儿）的风险方面通常没有取得任何成功。虽然这些试验缺乏成功归因于缺乏统计能力和对研究方案的依从性差，但我们自己的研究表明，母体妊娠前和妊娠早期的代谢状况会影响早期胎盘功能和基因表达。这些母体/胎盘功能的改变发生在大多数干预试验开始之前的妊娠前三个月。例如，母体脂肪组织的增加依赖于妊娠早期控制脂肪生成和低度炎症的基因的预先激活。这些代谢改变发生在母体表型的任何改变之前。因此，需要在怀孕前进行生活方式干预试验，以证明对母亲及其后代的安全性和有效性。
Obesity during pregnancy is associated with an increased risk of short- and long-term metabolic dysfunction in the mother and her offspring. Both higher maternal pregravid body mass index (kg m−2) and excessive gestational weight gain (GWG) have been associated with adverse pregnancy outcomes such as gestational diabetes, preeclampsia and fetal adiposity. Multiple lifestyle intervention trials consisting of weight management using various diets, increased physical activity and behavioral modification techniques have been employed to avoid excessive GWG and improve perinatal outcomes. These randomized controlled trials (RCTs) have achieved modest success in decreasing excessive GWG, although the decrease in GWG was often not within the current Institute of Medicine guidelines. RCTs have generally not had any success with decreasing the risk of maternal gestational diabetes (GDM), preeclampsia or excessive fetal growth often referred to as macrosomia. Although the lack of success for these trials has been attributed to lack of statistical power and poor compliance with study protocols, our own research suggests that maternal pregravid and early pregnancy metabolic condition programs early placenta function and gene expression. These alterations in maternal/placental function occur in the first trimester of pregnancy prior to when most intervention trials are initiated. For example, maternal accrural of adipose tissue relies on prior activation of genes controlling lipogenesis and low-grade inflammation in early pregnancy. These metabolic alterations occur prior to any changes in maternal phenotype. Therefore, trials of lifestyle interventions before pregnancy are needed to demonstrate the safety and efficacy for both the mother and her offspring.