Ann Arbor — Women with obesity before and during pregnancy are at risk of more complications than leaner women, including hypertension, gestational diabetes and increased need for Caesarian delivery. Their children also have an increased risk of obesity and other metabolic problems.
Some of the risk in children may be due to programming of the fetus by exposure to an altered environment due to obesity during gestation causing ‘epigenetic’ changes in their DNA.
Michigan Medicine researchers led by Taubman Institute Director Charles F. Burant, MD, PhD, have received a $3.3 million grant to study what happens to a woman and her child if the woman participates in a weight-loss program prior to becoming pregnant. The team, which includes Amy Rothberg, MD; Dana Dolinoy PhD, and Vasantha Pabmanabhan, PhD, is recruiting subjects for the study via UMHealthResearch.org.
The funds were awarded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, the nation’s medical research agency.
Studies in animals suggest that certain conditions during pregnancy can program the offspring for long-term weight variations, said Burant, Michigan Medicine’s Robert C. and Veronica Atkins Professor of Metabolism endowed chair, and Professor of Internal Medicine in the department of Metabolism, Endocrinology, and Diabetes.
And in humans, maternal obesity is associated with increased fat tissue in children at birth and at age three, he said.
“One theory is that small changes to the intrauterine environment can cause changes to gene expression that may contribute to future risk of obesity and, potentially, other diseases,” said Burant. Gene expression occurs when the instructions coded in our DNA are relayed to regulate cell functions, such as the production of protein.
The goal of the project is two-fold. First, to determine if the pre-pregnancy intervention will optimize the environment for the fetus and second, to the blood factors that change the intergenerational risk of obesity and attendant risks, such as type 2 diabetes and cardiovascular disease.
The formal title of the project is “Maternal metabolic and molecular changes induced by preconception weight loss and their effects on birth outcome.”
Several studies which sought to reduce weight gain in women with obesity after they become pregnant have been disappointing, showing minimal changes in pregnancy complications and birth outcomes, the researchers say.
“Yet despite evidence that obesity negatively impacts reproductive outcomes, few studies have been conducted to estimate the impact of medical weight loss that occurs ahead of conception,” said Rothberg, Director of the University of Michigan Weight Management Program.
Women age 18-40 who don’t have diabetes and who plan to become pregnant within the next year are eligible to apply for inclusion in the study.
Investigators will follow women with obesity as well as a group of lean women for two years. Women with obesity will randomly be assigned to one of two medical weight loss interventions. Some will receive current best practice of nutritional counseling, education and advice to manage their diet and lose weight, while others will be enrolled in an aggressive 16-week weight-management program targeting the loss of at least 15 percent of body weight before pregnancy.
Following the four-month weight-management program, the participants will be prescribed a healthy maintenance diet until they conceive.
Metabolic status, pregnancy outcomes, and measures of infant growth are just some of the measures that are being evaluated by investigators.
The Taubman Institute supported the development and initial testing of the study’s approach.
For additional details and information for participants, visit https://umhealthresearch.org/#studies/HUM00124673