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Obesity before pregnancy: new evidence and future strategies

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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

While pregnancy may be an opportune time to intervene, as women are often more motivated to change their behaviour during this period,5