Long-term consequences of obesity on female fertility and the health of the offspring

Abstract

Purpose of review Obesity has reached near epidemic levels among reproductive age women with a myriad of consequences. Obesity adversely affects the maternal milieu by creating conditions that decrease fertility and increase the risk of gestational diabetes, hypertensive disease in pregnancy, fetal growth abnormalities and congenital anomalies. The effects of obesity are not limited to pregnancy. Indeed, beyond the immediate postpartum period, obese women maintain a higher prevalence of insulin resistance and cardiovascular disease. In this article, we will review the pathophysiology underlying the effects of obesity on fertility, pregnancy outcome and health status of offspring. The purpose of this review is to outline proposed models responsible for the short-term and long-term consequences of obesity on fertility and offspring development, and identify knowledge gaps where additional research is needed. Recent findings Maternal over or under nutrition adversely affect maternal reproductive capacity and pregnancy success. Separate from effects on maternal reproductive function, maternal over or under nutrition may also ‘program’ fetal pathophysiology through inheritance mechanisms that suggest epigenetic modification of DNA, differential RNA translation and protein expression, or modification of the fetal hypothalamic–pituitary axis function through programmed adverse effects on the developing hypothalamic circuitry. The concept of maternal health modifying the risk of developing noncommunicable diseases in the offspring is based on Developmental Origins of Health and Disease hypothesis. Summary Of importance, the long-term effects of obesity are not limited to maternal health, but also programs pathophysiology in their offspring. Children of obese gravida are at increased risk for the development of cardiometabolic disease in childhood and throughout adulthood. Future studies directly interrogating mechanisms underlying the risks associated with obesity will allow us to develop interventions and therapies to decrease short-term and long-term morbidities associated with maternal obesity.

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“…[3][4][5][6]8,27 Excess adiposity among women could lead to an increase in obesity during pregnancy, lower the reproductive success, increase infant mortality and the frequency of fetal growth abnormalities and non-communicable diseases (e.g., gestational diabetes, hypertension and cardiovascular diseases). [28][29][30] Studies reported that the prevalence of gender specific overweight and obesity was observed to be higher among women than men in India. 11,13,14,16,20 The general population trend has shown that the prevalence of overweight and obesity increased slightly over the past decade in the country, but the prevalence rate has increased in urban and in high-socio-economic groups.…”

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“…Based on the aforementioned considerations, one of the potential windows of vulnerability linking OSA and epigenetic susceptibility determinants of later onset of disease would be the occurrence of OSA during pregnancy. To this effect, we should be aware that two-thirds of women in the United States are currently overweight or obese at the time of conception, and that pre-conception obesity is fraught with higher risk for the gestation itself and for the foetal outcomes [48][49][50][51][52] . Furthermore, paternal obesity is not without risk either 53 .…”