Can obesity prevention begin before birth?

David LudwigDavid Ludwig’s research was featured in Time, The Boston Globe, USA Today and CNN.

If you believe that gaining a little weight above what’s recommended while pregnant doesn’t matter, it may be time to re-think that notion. Janet Currie, PhD, of Columbia University and I collaborated to examine this question, and found that excess pregnancy weight gain is a strong predictor of high birth weight in infants. What’s the big deal if a baby is a bit too heavy? Research suggests high birth weight increases risk for numerous health problems, including obesity later in life.

Nearly one-third of children in America are now overweight or obese. Without marked decreases in prevalence, this generation of children may lead shorter, less healthful lives than their parents due to weight related diseases. Because conventional methods to combat the obesity epidemic have had limited success, novel approaches aiming to decrease lifetime risk are greatly needed.

In our study, published online today in The Lancet, we examined all known births in the states of Michigan and New Jersey from 1989 to 2003, focusing on the 513,501 women with multiple births. On average, the women gained about 30 pounds. However, in 12 percent of the pregnancies, women gained more than 44 pounds. Recently updated guidelines from the Institute of Medicine suggest that women gain 25 to 35 pounds if they are normal weight at the beginning of pregnancy, 15 to 25 pounds if overweight, and 11 to 20 pounds if obese.

We found that women who gain excessive weight during pregnancy tend to give birth to heavier infants.  For example, women gaining 44 to 49 pounds were 1.7 times more likely to have a high birth weight baby than those gaining just 18 to 22 pounds. Women who gained more than 53 pounds were 2.3 times more likely to do so. Because our study involved comparisons of infants born to the same mother, we can be confident that this effect is not due to genetics.

These findings suggest that the ideal time to begin obesity prevention efforts is before birth, and that the type and amount of food a woman eats during pregnancy may have lasting consequences for her offspring.  While much remains to be learned about optimal nutrition during pregnancy, we recommend a low glycemic load diet: abundant quantities of vegetables, fruits and beans; reduced consumption of concentrated sugar and refined starchy foods; moderate amounts of healthy fats (like olive oil, nuts and avocado); and adequate amounts of protein.

  • Jesy Payne

    How about women, such as myself who are eating right, exercising 5 days a week and still gain ridiculous amounts of weight? I will be seeing a nutritionist soon, but I don’t understand why I have gained almost 40 pounds by 20 weeks. I was 185 going into pregnancy #2 and it boggles my mind that I have gained so much weight. I worked so hard to lose the 60 pounds with my first child and I lost an additional 30. It kills me that I can work so hard but feel like I failed.

  • Dr. Anders Cohen, brooklyn, NY

    I firmly believe that there are certain disease and medical conditions that can be controlled before birth. One of which is being obese because it’s in the mother who they are taking nutrition at.

  • Nik_pula

    Just a couple questions. Is the large baby cause or effect? Women who give birth to larger babies do gain more weight during their pregnancies, however, is it the babies causing the extra weight or poor eating habits? Were these women obese at onset of pregnancy? Also, did you find that more weight was gained with successive pregnancies or was there no correlation? Thanks for the info. It’s a very interesting subject.

  • Linda

    That’s very sound advice – women should be careful with their weight during pregnancy and not use the ‘eating for two’ excuse as a chance to over eat.

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  • Anonymous

    I am a nutritionist and I am curious if 1) are you eating any white flour or white sugar and 2) do you have any suspected food or otherwise allergies? I have seen allergies sabotage the best of diets!

  • Jesy Payne

    Nope. I only eat whole wheat bread and pasta (though the first few weeks of this pregnancy I was eating a lot of rice and crackers. Not any more though). I am trying to stay away from white sugar as much as possible, but I do have the occasional ice cream now and again. I have some frozen fruit bars and my grandmother suggested sorbet, if I have an ice cream craving. I do have an allergy to chocolate, but I can tolerate small amounts rarely. I eat a lot of fruits and veggies and I have been trying to get a lot of lean healthy proteins in my diet (fat free Greek Yogurt, almonds, lean white meat, eggs). When I am not pregnant Weight Watchers does wonders for me and I can’t wait to go back once I can, after this pregnancy.