ENDOCRINOLOGY IN PREGNANCY: Targeting metabolic health promotion to optimise maternal and offspring health

Abstract

There is an increase in maternal metabolic burden due to the rise in pregnancies complicated by obesity, gestational diabetes, type 2 diabetes and polycystic ovary syndrome. Metabolic dysfunction during pregnancy is associated with increased risks of long-term morbidity and mortality for women and their offspring. Lifestyle interventions in pregnancy in women at risk of metabolic dysfunction, have demonstrated short term improvements such as reduced gestational weight gain and lowered risk of gestational diabetes. It is not known if these interventions lead to sustained improvements in the metabolic health of the mother and baby. Pharmacological interventions have also shown benefits for the mother and baby in pregnancy, including improvements in glycaemic control, reduced gestational weight gain and reduction in large for gestational age infants however, there remains uncertainty over long term outcomes for mother and child. Existing studies on interventions targeting metabolic health is limited to selected populations in the preconception and postpartum periods and lack follow-up beyond delivery of the intervention. The COVID-19 pandemic has refocused our attention on the effects maternal metabolic ill health plays in contributing to premature morbidity and mortality. There is an urgent need for strategies to accurately identify the growing number of women and offspring at risk of long-term adverse metabolic health. Strategies which focus on early identification and risk stratification using individualised risk scores in the pre and inter-conception periods must take priority if we are to target and improve the metabolic health of women and their offspring who are at highest risk.

Understanding risk and causal mechanisms for developing obesity in infants and young children: A National Institutes of Health workshop

“…Substantial evidence demonstrates that maternal metabolic factors, before and during pregnancy, adversely affect offspring growth or adiposity in utero and after birth, leading to increased risk for metabolic dysfunction and cardiovascular disease into adulthood 71,72 . A recent systematic review and evidence synthesis examined the associations between maternal metabolic exposures and offspring weight and/or adiposity using data from 76 published human ( n = 38) and animal ( n = 38) studies 73 .…”

“…Substantial evidence demonstrates that maternal metabolic factors, before and during pregnancy, adversely affect offspring growth or adiposity in utero and after birth, leading to increased risk for metabolic dysfunction and cardiovascular disease into adulthood. 71,72 A recent systematic review and evidence synthesis examined the associations between maternal metabolic exposures and offspring weight and/or adiposity using data from 76 published human (n = 38) and animal (n = 38) studies. 73 Maternal obesity, diabetes, and poor dietary quality (high fat, high sugar, or high calorie diets) were found to be associated with greater risk of high birth weight or higher BMI during childhood in humans, as well as greater risk of excess adipose tissue accumulation in both human and animal offspring.…”

Impact of COVID‐19 on gestational diabetes pregnancy outcomes in the UK: A multicentre retrospective cohort study

“…28,29 One explanation for an increase in GDM diagnosis during COVID-19 may relate to lockdown behaviours, such as increased consumption of snacks and carbohydrates 30,31 and reduced exercise, 32 leading to weight gain, 33 an independent risk factor for GDM. 34…”

Impact of Obesity and Diabetes in Pregnant Women on Their Immunity and Vaccination

“…Both conditions are associated with in utero complications, including stillbirth, fetal macrosomia, being large for gestational age (LGA), preterm birth, and post-delivery complications such as perinatal death, neonatal death, or infant mortality. These conditions are correlated with an increased risk of postpartum depression, stroke, the development of cardiometabolic diseases, or T2DM in the future [ 26 , 33 ]. According to Egan et al, the risk of developing T2DM within 15 years of delivery was found to be 30% for women with GDM at an optimal weight, compared to 70% for obese women with GDM [ 28 ].…”