The far-reaching implications of weight gain in pregnancy

It is not surprising that a pregnant woman’s actions heavily influence her developing baby. Ob.gyns. advise patients to stop smoking or to stop using illicit drugs, and limit their alcohol consumption during pregnancy because we know that these substances can cause serious, even fatal, consequences for the fetus. Although we routinely provide nutrition information and guidelines on healthy weight gain in pregnancy, we may not stress the importance of healthy eating to the same degree as we may emphasize the need to eliminate tobacco use. But should we?

In 2011, a study by researchers at Yale University, the University of Texas, and Arizona State University suggested that food can have effects on the brain similar to those of addictive substances ( Arch Gen Psychiatry. 2011 Aug;68[8]:808-16 ). Using MRI, the investigators examined which areas of the brain became active in response to the consumption of a chocolate milkshake, and compared these results to brain scans of people addicted to opioids. The study enrolled 48 women who were lean to obese, based on body mass index. The researchers found that people who were obese had brain activity patterns in response to food that were similar to patterns that people with drug addiction had in response to opioids. Although the sample size was small, the investigators showed, in essence, that food is a “drug.”

Dr. E. Albert Reece

Ob.gyns. working with patients who are overweight or obese typically encourage weight loss prior to pregnancy, or suggest limited weight gain during gestation, because obesity increases complications for both the pregnant mother and her unborn baby. If, as the 2011 study suggests, we were to think of food addiction as we do any other drug addiction – tobacco, opioids, alcohol – that should be curbed out of concern for the developing baby, ob.gyns. might tell our patients to reduce or completely eliminate their “trans-fat food habit” before and during pregnancy.

Importantly, a mother’s nutrition, or lack thereof, may exert harmful effects on her child’s long-term health. This idea was intimated decades ago when Dr. David Barker proposed that a person’s future risk for disease began during pregnancy. Exactly how this type of early programming may occur remains to be determined. Therefore, this month we examine the fetal origins of obesity, and have invited Dr. Michael G. Ross, professor of obstetrics and gynecology, and Mina Desai, Ph.D., assistant professor of obstetrics and gynecology, at the University of California, Los Angeles, to discuss this important topic.

Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at obnews@frontlinemedcom.com.