[Frontiers in Bioscience E3, 442-452, January 1, 2011]

Obesity in pregnancy: problems and potential solutions

Jason R. McKnight1, M. Carey Satterfield1, Xilong Li1, Haijun Gao2, Junjun Wang1,3, Defa Li3, and Guoyao Wu1,3

1Faculty of Nutrition and Department of Animal Science, Texas A&M University, College Station, TX 77843; 2Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555, 3State Key Laboratory of Animal Nutrition, China Agricultural University, Beijing, China 100193


1. Abstract
2. Introduction
3. Weight gain during pregnancy
4. Maternal complications of gestational obesity and/or excess weight gain
4.1. Insulin resistance and gestation diabetes mellitus
4.2. Hypertension and pre-eclampsia
4.3. Deep vein thrombosis, coagulopathies and respiratory complications
4.4. Delivery complications
4.5. Post-partum complications
5. Fetal and Neonatal Complications
6. Obesity management during pregnancy
6.1. Calorie restriction
6.2. Exercise
6.3. Pharmacological intervention
6.4. Supplementation with functional amino acids
7. Concluding remarks
8. Acknowledgments
9. References


Recent years have witnessed an increase in the prevalence of maternal obesity during pregnancy in the United States and worldwide. Obese women have increased risks for gestational problems, such as diabetes, hypertension, and pre-eclampsia. Further, gestational obesity can adversely impact fetal growth and result in macrosomia, congenital abnormalities, and even fetal death. Measures must be taken to reduce maternal adiposity, as even a modest weight loss during pregnancy is beneficial for the health of mothers and fetus. Calorie restriction and moderate exercise are proven safe methods of stopping weight gain and/or inducing white-fat loss in these subjects. Additionally, therapeutic drugs that activate the AMP-activated protein kinase signaling pathway may be effective in ameliorating pathological conditions in obese patients. Finally, dietary supplementation with L-arginine or its effective precursor (L-citrulline) may be beneficial for managing overweight or obese gestating women by reducing white-fat accretion. Because of ethical concerns over human studies, animal models (e.g., sheep, pigs, baboons, rats, and mice) are warranted to test novel hypotheses with enormous biological significance and clinical applications.