Dr. Catalano and his colleagues believe that other than beginning a life - course effort in reducing obesity in adolescence as discussed in the other reviews in this series, the post-partum period may well be the best opportunity to help ensure the move towards a healthy body
weight and lifestyle for a
subsequent pregnancy, which also effects the whole family.
Regarding the child, the importance of the intrauterine and early postnatal environments for metabolic programming and modifications of the epigenome is increasingly recognised, 12 — 14 particularly for metabolic diseases such as obesity and diabetes.15 Thus, GDM is related to macrosomia at birth (> 4 kg), to excess body fat and (central) obesity and to insulin secretion in infants and children, the obesity being in part mediated by maternal body mass index (BMI) or birth
weight.16 — 23 Intrauterine exposure to GDM also doubles the risk for
subsequent type 2 diabetes in offspring compared with offspring of mothers with a high genetic predisposition for type 2 diabetes, but with normal glucose tolerance during the index
pregnancy.24 Maternal prepregnancy overweight and excessive gestational
weight gain also predict high birth
weight and adiposity during infancy.12 25 This is highly relevant, as up to 60 % — 70 % of women with GDM are overweight or obese before
pregnancy.26 Finally, maternal lifestyle behaviour such as a high fat diet or lack of physical activity during
pregnancy can influence offspring adiposity independent of maternal obesity.12 27