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Although her investigation did not specifically look at women with more than one child and thus could have been colored by other genetic and environmental factors, Kitsantas says that the results from her work and The Lancet report are complementary. "Both studies pointed to one direction: mothers' body weight affected their offspring's weight."" G/ {" i& n& z8 T
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0 Z1 z4 p1 W4 l3 ^5 v+ h Extra birth weight might not be the only change many of these infants face. Excessive maternal weight during pregnancy is also likely changing the metabolic and hormonal environment of the developing fetus, Ludwig says.; ]6 E1 _6 H* G5 Z9 k8 `
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Even if an infant has a few extra ounces due to a mother's excessive gestational weight gain, "the infant developed in a metabolically abnormal intrauterine environment," Ludwig explains.& S7 M2 l+ Y% d% b, i3 `( ~+ U
1 u8 F, X7 N# H" @6 k Excessive caloric intake by a pregnant woman can stimulate the overgrowth of fetal tissues, change hormonal balances, alter metabolic pathways, "and perhaps even structures in the brain that regulate appetite and metabolism," he says. And those changes might stay with an individual for life.
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Many adults have a difficult time losing weight and keeping it off, and if the body is predisposed to putting on the pounds, fighting obesity on both individual and societal levels will be even more challenging.
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Researchers are still working to understand just how some of these pathways and hormones can influence disease risk, primarily through animal studies in the lab. And until more chemical links are found, a direct cause-and-effect relationship cannot be established, Kitsantas notes.
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! \' |2 d- b o% q. m; H" O She applauds the new work, noting that Ludwig and colleagues used apt statistical models to try to avoid confounding effects and excluded subjects with other risk factors such as gestational diabetes or extremely high birth weight. Kitsantas is not entirely convinced, however, that genetics can be erased from the picture, and asserts that more lab work remains to be done to parse out nature, nurture and nutrition.
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Not every baby born on the heavy side will battle obesity or related chronic diseases. But, Ludwig points out, "on a population basis, [increased birth weight] is shifting risk upward."& @0 ]4 q7 M* K4 Q2 k# z
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The amount of weight pregnant women are putting on has been growing—as has their prepregnancy weight in the past few decades, Ludwig notes. Alongside that trend are signs that average birth weight is also headed upward.
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" y0 F! R( w3 T: {; p8 L "If we don't stop the vicious cycle at some point, we'll just keep going and going," Kitsantas says. If female babies are born more prone to obesity, the likelihood of their gaining too much weight before or during pregnancy increases, thus putting their offspring at greater risk.
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Even though the specific mechanisms at work remain poorly understood and there is still not enough evidence to draw a cause-and-effect conclusion between maternal weight and a child's risk for obesity, Kitsantas says that is not reason enough to delay action. "We really have to jump in based on the findings we have to create specific interventions to fix the problem."
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6 P3 C3 H& ^, a6 L: p* a Ludwig acknowledges that the challenge of getting Americans to stay fit is great but says that changing the habits of mothers-to-be might be a little easier. "Women tend to be especially motivated during pregnancy because it's not just their health [that is] at stake—it's their children's," he notes. "Almost every mother instinctively wants to give their children a healthy start in life."
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% M+ a! `+ M! @! Y1 o9 N2 Y2 R, C6 ? And, along with physical activity, food quality is just as important as quantity, he says. "The higher quality of diet consumed, the easier it is to maintain a health body weight," says Ludwig, who has been working on a new study comparing the effects of two different diets on maternal and infant health. "The best time to begin obesity prevention efforts for the next generation is actually prior to birth," he says. |