Maternal overweight and obesity during pregnancy: strategies to improve outcomes for women, babies, and children

Introduction: Women with overweight and obesity, and their children, are at increased risk of adverse pregnancy, birth, and longer term health outcomes, believed to be compounded by excessive gestational weight gain (GWG). Research to date has focused on interventions to reduce excessive GWG through changes to maternal diet and/or lifestyle. Areas covered: Current clinical recommendations for GWG vary according to a woman's early pregnancy body mass index, based on assumptions that associations between GWG and adverse pregnancy outcomes are causal in nature, and modifiable. While there are small differences in GWG following pregnancy interventions, there is little evidence for clinically relevant effects on pregnancy, birth, and longer term childhood outcomes. This review considers interventional studies targeting women with overweight or obesity to reduce GWG in an effort to improve maternal and infant health, and the current evidence for interventions prior to conception. Expert opinion: GWG is not modifiable via diet and lifestyle change, and continued efforts to find the 'right' intervention for women with overweight and obesity during pregnancy are unjustified. Researchers should focus on gathering evidence for interventions prior to pregnancy to optimize maternal health and weight to improve pregnancy, birth, and longer term health outcomes associated with obesity.

Automated summary

Excessive gestational weight gain (GWG) in overweight and obese women and their children can lead to adverse pregnancy, birth, and long-term health outcomes. Current interventions focused on reducing excessive GWG through changes in maternal diet and lifestyle have shown limited clinically relevant effects. Instead, researchers should focus on interventions prior to pregnancy to optimize maternal health and weight, which can improve the outcomes associated with obesity during pregnancy, birth, and long term.