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    Maternal obesity and the fetal brain

     

    Limitations of existing epidemiologic data

    The aforementioned studies defined maternal pre-pregnancy obesity as a reported pre-pregnancy or measured early pregnancy BMI ≥30 kg/m2 or absolute pregnancy weight >90 kg. These definitions do not identify percent of weight due to body fat and/or the distribution of body fat, both of which may have bearing on maternal and fetal health.27,30

    Epidemiological studies are also limited by their inability to demonstrate causation or to elucidate mechanism; the fact that some of these data are from large US or European population-level studies in the 1970s–1990s, when obesity was less prevalent; and the fact that many of these studies suffer from attrition, sampling biases for control groups, reliance on parental report to evaluate past exposure and offspring diagnosis, lack of statistical power, and inability to adjust for confounders.31

    Physiology of obese pregnancy

    The primary mechanisms that have been proposed to underlie the risk of neurodevelopmental morbidity in offspring of obese women include:

    1) Inflammation-induced malpro­gramming

    2) Relative excess and/or deficiencies of circulating nutrients

    3) Metabolic hormone-induced malprogramming, and

    4) Impaired development of serotonergic and dopaminergic signaling

    These mechanisms are not necessarily distinct from one another, and feature several interconnections (Figure). A brief summary of the evidence in these areas follows.

    Andrea G Edlow, MD, MSc
    Dr Edlow is an attending physician in the Division of Maternal-Fetal Medicine, Department of Ob-Gyn, Tufts Medical Center, Boston, ...
    Larissa H Mattei, BA
    Ms Mattei is a fourth-year medical student at Tufts University School of Medicine, Boston, Massachusetts.

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