Obesity before pregnancy: new evidence and future strategies

Kirsten I Black and Adrienne Gordon
Med J Aust 2016; 205 (4): . || doi: 10.5694/mja16.00469
Published online: 15 August 2016

Pre-conception weight control is important for both mother and child — and for Australia

The world is getting fatter. Between 1975 and 2014 we transitioned from a planet with a higher prevalence of malnourished individuals to one in which there are more obese than underweight people.1 The mean body mass index (BMI) of Australian women rose during this period from 23.4 kg/m2 to 26.8 kg/m2, so that 50% are now overweight or obese at the start of a pregnancy. This has several adverse consequences for the mother, including gestational diabetes, hypertension during pregnancy, pre-eclampsia, an increased likelihood of a caesarean delivery, and an elevated risk of cardiovascular disease in future years,2,3 all of which are potentially avoidable. Perhaps more important, however, are the increasingly recognised intergenerational effects of maternal obesity that may be manifested during pregnancy (prematurity, stillbirth, congenital anomalies, macrosomia), during childhood (obesity) or later in adult life (increased risk of metabolic disease).3,4

  • 1 University of Sydney, Sydney, NSW
  • 2 Royal Prince Alfred Hospital, Sydney, NSW
  • 3 Charles Perkins Centre, University of Sydney, Sydney, NSW


Competing interests:

No relevant disclosures.

  • 1. NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 2016; 387: 1377-1396.
  • 2. Thrift AP, Callaway LK. The effect of obesity on pregnancy outcomes among Australian Indigenous and non-Indigenous women. Med J Aust 2014; 201: 592-595. <MJA full text>
  • 3. Zaballa K, Liu A, Peek M, et al. Association between World Health Organization categories of body mass index and relative risks for weight-related pregnancy outcomes: a retrospective cohort study. Obstet Med 2012; 5: 112-118.
  • 4. Drake AJ, Reynolds, RM. Impact of maternal obesity on offspring obesity and cardiometabolic disease risk. Reproduction 2010; 140: 387-398.
  • 5. Phelan S. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol 2010; 202: 135.e1-135.e8.
  • 6. Dodd JM, Turnbull D, McPhee AJ, et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 2014; 348: g1285.
  • 7. Poston L, Bell R, Croker H, et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3: 767-777.
  • 8. World Health Organization. Report of the commission on ending childhood obesity. Geneva: WHO, 2016. (accessed June 2016).
  • 9. Schummers L, Hutcheon JA, Bodnar LM, et al. Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregancy weight loss counseling. Obstet Gynecol 2015; 125: 133-143.
  • 10. Cnattingius S, Villamor E. Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study. Lancet 2016; 387: 558-565.
  • 11. Opray N, Grivell RM, Deussen AR, Dodd JM. Directed preconception health programs and interventions for improving pregnancy outcomes for women who are overweight or obese. Cochrane Database Syst Rev 2015; (7): CD010932.
  • 12. Huypens P, Sass S, Wu M, et al. Epigenetic germline inheritance of diet-induced obesity and insulin resistance. Nat Genet 2016; 48: 497-499.
  • 13. Peterson C, Grosse S, Li R, et al. Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States. Am J Obstet Gynecol 2015; 212: 74.e1-74.e9.
  • 14. Watson M, Howell S, Johnston T, et al. Pre-pregnancy BMI: costs associated with maternal underweight and obesity in Queensland. Aust N Z J Obstet Gynaecol 2013; 53: 243-249.
  • 15. Johnson KPS, Biermann J, Cordero J, et al. Recommendations to improve preconception health and health care – United States. A report of the CDC/ATSDR Preconception Care Workgroup and the Select Panel on Preconception Care. MMWR Recomm Rep 2006; 55: 1-23.
  • 16. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Management of obesity in pregnancy (College Statement C-Obs 49). Sept 2013. (accessed June 2016).
  • 17. Royal Australian College of General Practitioners. Preventive activities prior to pregnancy. In: Guidelines for preventive activities in general practice. 8th edition. Melbourne: RACGP, 2012 [internet]. (accessed June 2016).
  • 18. Rassi A, Wattimena J, Black K. Pregnancy intention in an urban Australian antenatal population. Aust N Z J Public Health 2013; 37: 568-573.
  • 19. Oza-Frank R, Kachoria R, Keim SA, et al. Provision of specific preconception care messages and associated maternal health behaviors before and during pregnancy. Am J Obstet Gynecol 2015; 212: 372.e1-372.e8.
  • 20. Mutsaerts M, van Oers A, Groen H, et al. Randomized trial of a lifestyle program in obese infertile women. N Engl J Med 2016; 374: 1942-1953.
  • 21. Strang J, Huffman LG. Position of the Academy of Nutrition and Dietetics: obesity, reproduction and, pregnancy outcomes. J Acad Nutr Diet 2016; 116: 677-691.
  • 22. Nitert MD, Foxcroft KF, Lust K, et al. Overweight and obesity knowledge prior to pregnancy: a survey study. BMC Pregnancy Childbirth 2011; 11: 1-8.
  • 23. Thow AM, Downs S, Jan S. A systematic review of the effectiveness of food taxes and subsidies to improve diets: understanding the recent evidence. Nutr Rev 2014; 72: 551-565.
  • 24. van der Pligt P, Willcox J, Hesketh KD, et al. Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth. Obes Rev 2013; 14: 792-805.
  • 25. Obesity Australia. No time to weight. Obesity: a national epidemic and its impact on Australia. Obesity Australia, 2014. (accessed June 2016).


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