Short- and Long-Term Effects of Maternal Obesity and Dysglycaemia for Women and Their Children

More than half of women of reproductive age are overweight or obese. Such women enter pregnancy at an increased risk of adverse pregnancy, birth and longer-term maternal and child outcomes. Maternal dysglycaemias including impaired glucose tolerance, gestational diabetes and type 2 diabetes confer additional risk for women and their infants. Risks for women include increasing dysglycaemia, pre-eclampsia, caesarean birth and longer-term risks of diabetes and cardiovascular disease; risks for infants include unexplained fetal death, macrosomia and traumatic birth. Longer-term risks for infants include childhood obesity and sequelae. There is growing interest in epigenetic modifications as potential causal mechanisms linking in utero exposures to childhood obesity though findings are inconclusive. Interventions designed to improve diet and physical activity in pregnancy to reduce the risks of obesity and dysglycaemia have been ineffective. Maternal pre-pregnancy BMI is potentially modifiable, and strongly associated with short- and long-term adverse outcomes for women and their infants; lowering pre-pregnancy BMI warrants further investigation through robust randomized trials.