Mulchand S. Patel

Perinatal Nutrition and Programming of the Hypothalamic Regulation of Feeding Behavior and Energy Homeostasis

Obesity is a major public health problem in both Western and non-Western countries (WHO 1999). In recent decades, the prevalence of obesity has nearly doubled worldwide. In 2014, the World Health Organization estimated that 11% of men and 15% of women of the world’s adult population were obese (WHO 1999). The strong increase in obesity prevalence has also affected women of reproductive age. A study among 66,221 births in 9 U.S. states showed that from 1993 to 2003, the rate of maternal obesity at the start of pregnancy increased from 13% in 1993/1994 to 22% around 2002/2003 (Kim et al. 2007). Similarly, a study from 1990 to 2004 among 36,821 women in the United Kingdom showed a significant increase in the proportion of maternal obesity at the start of pregnancy from approximately 10% to 16% (Heslehurst et al. 2007). To date, the obesity prevalence rate in pregnant women is estimated to be as high as 30% in Western countries (Huda et al. 2010; Flegal et al. 2012; Bahadoer et al. 2015; Devlieger et al. 2016). In addition, in these countries, even higher percentages of women gain an excessive amount of weight during pregnancy based on the U.S. Institute of Medicine (IOM) guidelines 238(Fraser et al. 2010; Restall et al. 2014; Bahadoer et al. 2015). In the IOM guidelines, optimal ranges of maternal weight gain during pregnancy are defined according to a mother’s prepregnancy body mass index (BMI; Rasmussen et al. 2009) (Table 13.1). These guidelines have been established based on evidence from observational studies that relate gestational weight gain to various maternal and offspring outcomes (Rasmussen et al. 2009). As described previously, an accumulating body of evidence suggests that maternal obesity and excessive weight gain during pregnancy also have a long-term adverse influence on common health outcomes in the offspring (Gaillard et al. 2014a, 2016; Gaillard 2015).