Perinatal Research Laboratories, Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles, Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA.
Curr Diab Rep. 2013 Feb;13(1):27-33. doi: 10.1007/s11892-012-0344-x.
The metabolic syndrome epidemic, including a marked increase in the prevalence of obesity and gestational diabetes mellitus (GDM) among pregnant women, represents a significant public health problem. There is increasing recognition that the risk of adult obesity is clearly influenced by prenatal and infant environmental exposures, particularly nutrition. This tenet is the fundamental basis of developmental programming. Low birth weight, together with infant catch-up growth, is associated with a significant risk of adult obesity. Exposure to maternal obesity, with or without GDM, or having a high birth weight also represents an increased risk for childhood and adult obesity. Animal models have replicated human epidemiologic findings and elucidated potential programming mechanisms that include altered organ development, cellular signaling responses, and epigenetic modifications. Prenatal care has made great strides in optimizing maternal, fetal, and neonatal health, and now has the opportunity to begin interventions which prevent or reduce childhood/adult obesity. Guidelines that integrate optimal pregnancy nutrition and weight gain, management of GDM, and newborn feeding strategies with long-term consequences on adult obesity, remain to be elucidated.
代谢综合征流行，包括孕妇肥胖和妊娠糖尿病（GDM）发病率显著增加，是一个重大的公共卫生问题。越来越多的人认识到，成人肥胖的风险显然受到产前和婴儿环境暴露的影响，尤其是营养。这一原则是发育编程的基础。低出生体重，加上婴儿追赶性生长，与成人肥胖的显著风险相关。暴露于母体肥胖，无论是否存在 GDM，或具有高出生体重，也代表了儿童和成人肥胖的风险增加。动物模型复制了人类的流行病学发现，并阐明了潜在的编程机制，包括改变器官发育、细胞信号反应和表观遗传修饰。产前保健在优化母婴和新生儿健康方面取得了重大进展，现在有机会开始进行干预，以预防或减少儿童/成人肥胖。阐明了将最佳妊娠营养和体重增加、GDM 管理以及新生儿喂养策略与成人肥胖的长期后果相结合的指南。
