Pregnancy offers a window of opportunity to program the future health of both mothers and offspring. During gestation, women experience a series of physical and metabolic modifications and adaptations, which aim to protect the fetus development and are closely related to both pre-gestational nutritional status and gestational weight gain. Moreover, pre-gestational obesity represents a challenge of treatment, and nowadays there are new evidence as regard its management, especially the adequate weight gain. Recent evidence has highlighted the determinant role of nutritional status and maternal diet on both pregnancy outcomes and long-term risk of chronic diseases, through a transgenerational flow, conceptualized by the Development Origin of Health and Diseases (Dohad) theory. In this review we will analyse the physiological and endocrine adaptation in pregnancy, and the metabolic complications, thus the focal points for nutritional and therapeutic strategies that we must early implement, virtually before conception, to safeguard the health of both mother and progeny. We will summarize the current nutritional recommendations and the use of nutraceuticals in pregnancy, with a focus on the management of pregnancy complicated by obesity and hyperglycemia, assessing the most recent evidence about the effects of ante-natal nutrition on the long-term, on either maternal health or metabolic risk of the offspring.

: Obesity represents one of the most important health problems worldwide with increasing morbidity and mortality. Widespread prevalence of this disease justifies its actual definition of a “global epidemic”. Adipose tissue is nowadays considered a complex organ with lots of endocrine and metabolic functions. In addition to fulfilling its task for energy storage and thermal regulation, by virtue of its constituent white and brown cells, adipose tissue represents, considering its size, the biggest endocrine gland in the body. Both adipocytes and surrounding resident cells (macrophages, endothelial cells and others) produce a huge number of molecules, or adipokines, with endocrine or paracrine functions, that regulate various aspects of metabolism whose clinical relevance is emerging. By balancing proinflammatory and anti-inflammatory effects, the adipokines control insulin sensitivity and related glucose metabolism changes, lipid accumulation in the liver and other organs, and finally gonadal function. Collectively, literature data remains cloudy because of still conflicting results of pre-clinical and clinical studies. The aim of this review was to summarize scientific evidence about adipokines’ effects on human metabolism, by focusing on their role on either Metabolic Syndrome and NAFLD, or insulin-resistance in pregnancy, or finally, reproductive function disorders.

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The regulation of glucose and adipose tissue metabolism by GLP1-receptor agonist is a possible treatment of T2D and obesity. These new pharmacologic agents target insulin resistance and metabolic disorders. Methods: Eighteen patients, 7 males and 11 females, were studied with T2D, divided into two groups: the first (I) was poorly controlled by metformin and sulfonylureas; the second (II) was treated only with metformin. Exenatide was administered at an initial dose of 5 μg twice a day for one month, and then the dose was adjusted to 10 μg twice a day throughout 24-26 weeks. From the beginning of therapy, each group was analyzed at time 0 and at 1 month (T1) and then 6 months (T2). At every time, anthropometric data, body composition by DXA and biochemical parameters were recorded. Results: At baseline, all patients enrolled showed metabolic disorders and obesity. The comparison of both groups between baseline and T2 showed a significant decrease of body weight, total Fat Mass (FM) and HbA1c (%), only in group (I) a statical reduction of Glycaemia and Total Cholesterol was observed. The Free Fat Mass (FFM) was never seen significantly different. The patients with HbA1c levels >75 mmol/mol (9%) at baseline showed a greater decline of HbA1c when compared to the patients with HbA1c <75 mmol/mol. Conclusion: Exenatide improves glucose metabolism and total cholesterol levels. Moreover, Exenatide reduced total FM and did not affect FFM. Exenatide could be used to treat obesity in diabetic but also non-diabetic patients. Summary: Exenatide, a GLP1-receptor agonist, is a pharmacological agent against obesity and type 2 diabetes mellitus. Exenatide decreases insulin resistance and lipids metabolism, and could be able to reduce fat mass and cardiovascular risk.