Dietary recommendations for obese pregnant women: current questions and controversies

With the increasing prevalence of obesity, maternal obesity is now one of the most common high-risk obstetric conditions. Obesity and excessive gestational weight gain are important modifiable risk factors for maternal and neonatal morbidity and mortality. Maternal obesity, associated with neonatal adiposity and high birthweight, has been implicated in increased risk of childhood obesity. Considerable effort has been directed towards improving clinical outcomes by lifestyle change in pregnant obese women, but there is at present no evidence-based intervention of adequate efficacy which can be recommended. The focus has been on preventing excessive weight gain, but studies have lacked the power to address effects on clinical outcomes; therefore preventing clinical practice translation. Adequately powered intervention studies devised to reduce neonatal adiposity by improvement of maternal glucose homeostasis, are needed to inform the optimal dietary and/or physical activity regimen.