Optimizing weight for maternal and infant health: tenable, or too late?

Obesity in pregnancy is the leading cause of maternal and fetal morbidity. Furthermore, gestational weight gain is one modifiable risk factor that improves pregnancy outcomes. Most pregnant women experience a weight increase that is higher than the 2009 Institute of Medicine recommendations, particularly with already overweight and obese women. Gestational weight gain less than the 2009 Institute of Medicine guidelines in obese women may improve pregnancy outcomes and reduce large-for-gestational-age infants, an independent risk factor for childhood obesity, without increasing small-for-gestational-age infants. Unfortunately, despite the fact that over 50 interventional trials designed to decrease excess gestational weight gain have been conducted, these interventions have only been modestly effective, and interventions designed to facilitate postpartum weight loss have also been disappointing. Successful interventions are of paramount importance not only to improve pregnancy outcomes but also for the future metabolic health of the mother and her infant, and may be key in attenuating the trans-generational risk on childhood obesity.