Pre-Gestational Obesity and Gestational Weight Gain as Predictors of Childhood Obesity.

OBJECTIVE: To evaluate the associations of pre-gestational body mass index (BMI) and gestational weight gain (GWG) with the risks of overweight, obesity, and adiposity in the first seven years of life in the offspring of a cohort of pregnant women. METHODS: Analysis of 751 mothers and their children participating in the PROGRESS cohort. These women were recruited in Mexico City between 2007 and 2010. Pre-gestational BMI was classified as normal, overweight, and obesity according to the WHO. GWG was calculated as the difference between the last reported pre-pregnancy weight and the pre-gestational weight and categorized as inadequate, adequate, or excessive, according to US IOM recommendations. Children's anthropometry was evaluated at 4-5 and 6-7 years of age. Adiposity was classified into three groups: normal (BMI z-score and waist circumference), overweight (BMI z-score>1), and overweight plus abdominal obesity (OW+AO). A generalized structural equation model (GSEM) was constructed to account for the temporal relationship between variables and to assess direct and indirect effects. RESULTS: A total of 49.3% of the women had excessive (13.8 ± 4.2 kg) and 19.8% inadequate (3.15 ± 3.4 kg) GWG. Women with pre-gestational overweight or obesity were more likely to have excessive GWG (OR 1.9 [95% CI: 1.32, 2.74] and 3.50 [95% CI: 1.83, 6.69], respectively). In the GSEM, excessive GWG was directly associated with OW+AO at 4-5 years. At 6-7 years, pre-gestational obesity was associated with OW+AO. CONCLUSION: Pre-gestational obesity and excessive GWG were independent predictors of childhood obesity.

SOCS3 deficiency in leptin receptor-expressing cells mitigates the development of pregnancy-induced metabolic changes.

OBJECTIVE: During pregnancy, women normally increase their food intake and body fat mass, and exhibit insulin resistance. However, an increasing number of women are developing metabolic imbalances during pregnancy, including excessive gestational weight gain and gestational diabetes mellitus. Despite the negative health impacts of pregnancy-induced metabolic imbalances, their molecular causes remain unclear. Therefore, the present study investigated the molecular mechanisms responsible for orchestrating the metabolic changes observed during pregnancy. METHODS: Initially, we investigated the hypothalamic expression of key genes that could influence the energy balance and glucose homeostasis during pregnancy. Based on these results, we generated a conditional knockout mouse that lacks the suppressor of cytokine signaling-3 (SOCS3) only in leptin receptor-expressing cells and studied these animals during pregnancy. RESULTS: Among several genes involved in leptin resistance, only SOCS3 was increased in the hypothalamus of pregnant mice. Remarkably, SOCS3 deletion from leptin receptor-expressing cells prevented pregnancy-induced hyperphagia, body fat accumulation as well as leptin and insulin resistance without affecting the ability of the females to carry their gestation to term. Additionally, we found that SOCS3 conditional deletion protected females against long-term postpartum fat retention and streptozotocin-induced gestational diabetes. CONCLUSIONS: Our study identified the increased hypothalamic expression of SOCS3 as a key mechanism responsible for triggering pregnancy-induced leptin resistance and metabolic adaptations. These findings not only help to explain a common phenomenon of the mammalian physiology, but it may also aid in the development of approaches to prevent and treat gestational metabolic imbalances.

Ejercicio y prevención de obesidad y diabetes mellitus gestacional / Exercise in the prevention of excessive gestational weight gain and gestational diabetes

La obesidad y la diabetes tipo 2 están aumentando a nivel mundial y generan gran morbilidad y mortalidad, y afectan al paciente, la familia y al sistema de salud. Los niveles bajos de actividad física están contribuyendo con la epidemia de obesidad y diabetes tipo 2 en mujeres en edad fértil. La mayoría de las mujeres siguen el sedentarismo o suspende el ejercicio cuando se dan cuenta del embarazo, lo cual predispone al desarrollo de diabetes gestacional y a ganancia excesiva de peso durante el embarazo. Está demostrado que el ejercicio durante el embarazo es seguro para la madre y el feto, y brinda beneficios fisiológicos, psicológicos, metabólicos y mejora la capacidad física de una manera similar al periodo preconcepcional. Aunque no está definida la prescripción de ejercicio exacta durante el embarazo, actualmente se recomienda lograr un nivel de actividad física de mínimo 16 MET Hora por semana, o preferiblemente 28 MET Hora por semana, e incrementar la intensidad del ejercicio a más del 60 por ciento de la frecuencia cardiaca de reserva, para disminuir el riesgo de obesidad o ganancia excesiva de peso en el embarazo, diabetes gestacional y quizás trastornos hipertensivos asociados al embarazo. Por lo tanto, el ejercicio puede ser una estrategia adecuada para prevenir estas patologías que generan morbilidad y mortalidad materna y fetal.

Obesity and type 2 diabetes are increasing worldwide and generate high morbidity and mortality and affect the patient, family and the health system. Low levels of physical activity are contributing to the epidemic of obesity and type 2 diabetes in women of childbearing age. Most women are sedentary or stop exercising when they realize the pregnancy, which predisposes to the development of gestational diabetes and excessive weight gain during pregnancy. There is ample evidence that exercise during pregnancy is safe for mother and fetus and provides physiological, psychological, metabolic benefits, and improving physical capacity in a manner similar to the preconception period. Although not defined the exact exercise prescription during pregnancy, achieve currently recommended level of physical activity at least 16 MET H per week, or preferably 28 MET H per week, and increase the intensity of exercise over 60 percent of heart rate reserve to reduce the risk of obesity or gain excessive weight during pregnancy, gestational diabetes and perhaps hypertensive disorders of pregnancy. Therefore, exercise may be an appropriate strategy to prevent these pathologies leading to morbidity and mortality maternal and fetal.