College of Health and Medicine

Maternal obesity and gestational diabetes mellitus (GDM) has increased rapidly in recent decades corresponding with population increases in overweight and obesity. During this same period, the physical activity levels of many women and adolescent girls have declined precipitously, commonly commencing in the transition from primary to secondary school is some, but progressively across the high school years for others. Inappropriate levels of physical activity, and an increase in sedentary or inactive behaviours are commonplace despite an increasing community awareness of the many benefits of physical activity to health, including contribution to healthy weight and body composition.

Risk of an unhealthy body composition, dominated by increases in body fat and typically due to a clustering of poor dietary habits and reduced physical activity levels, is magnified at certain life stages. Such critical life stages include adolescence, pre-pregnancy and pregnancy.

An increasing body of research confirms that maternal obesity and excessive gestational weight gain are associated with poor health outcomes for both mothers and infants. Given that many adult women are overweight or obese, and carrying excess weight pre-pregnancy, one might hypothesise that poor adolescent health, including obesity, is a precursor and significant contributor to excessive gestational weight gain. In turn, unhealthy gestational weight gain is an independent risk factor for obesity in childhood with high- and low-birth weights linked to maternal obesity associated with greater maternal and infant complications. A natural extension is the association between rapid infant weight gain and significant increase in the risk of later obesity.

An ideal foil to the snowballing effect of increasing body fat is engagement in healthy eating and activity behaviours in pre-pregnancy and a continuation or refinement during pregnancy.

In short, an appropriate engagement in physical activity may be pivotal to the attenuation of excess weight gain and improvement in maternal health plus optimisation of fetal and infant growth and development.
An overarching contributor to obesity risk and poor body composition in young children is maternal health status, which is impacted by the lifestyle practices of adolescent girls.

There is an urgent need to invest in strategies to improve eating and activity behaviours of adolescent girls to maximise both personal health and the health of offspring. The merits of a healthy and active lifestyle during the sequential phases of adolescence, pre-pregnancy and pregnancy should not be underestimated as a precursor to healthy infancy and childhood.

The attainment of a healthy pre-pregnancy weight and composition during adolescence ahead of the childbearing years is of paramount importance. Similarly important is minimisation of unhealthy gestational weight gain and a return to a healthy postpartum weight, if possible encompassing breastfeeding. For the infant and young child, monitoring growth and development and the promotion of healthy feeding and activity practices are essential. This includes limiting screen time and other sedentary activities. Every effort must be made to ensure that unrestricted active play is not engineered out but factored into normal activity for all youngsters.

– Andrew Hills