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An examination of maternal contributors and potential modifiers of
fetal growth in pregnancy
Zachary M. Ferraro
Abstract: A greater understanding of critical periods of body weight regulation, including pregnancy, may aid in efforts to
optimize weight management strategies for the mother and her baby. The gestational period has been implicated to play, in the
child, a vital role in the developmental origins of obesity and other cardiometabolic diseases later in life. Therefore, we initially
examined existing literature on the role of maternal obesity and its link to pediatric obesity and documented the known
improve maternal–fetal outcomes. In a second paper, we aimed to quantify maternal predictors of large for gestational-age
neonates in the Ottawa and Kingston birth cohort with specific hypotheses verifying the independent contribution of maternal
prepregnancy body mass index (BMI) and excessive gestational weight gain (GWG) to fetal overgrowth. This paper also high-
lighted the clinical utility of the revised 2009 Institute of Medicine GWG guidelines and discussed the potential role of physio-
logical factors underlying the observed associations. As follow-ups to our population-level analysis, papers 3 and 4 highlighted
with attenuated expression of IGF binding protein-4 (IGFBP-4) in umbilical cord blood and discussed how this may preferentially
promote fetal adipogenesis. The effects of excessive GWG on IGF axis protein expression were addressed in paper 4, where we
showed that independent of prepregnancy BMI, excessive weight gain during pregnancy is associated with increased expression
of IGFBP-3 in maternal circulation in normoglycemic term pregnancies. In that paper we discussed the potential inhibitory role
of IGFBP-3 on adipogenesis and how it relates to glucose intolerance during pregnancy. Recognizing that both obesity and
excessive GWG can alter physiological processes in a mother and her baby, we concluded that appropriate evidence-based
interventions are warranted to best optimize outcomes. In paper 5, we discussed the results of a study that sought to assess
patient information channels and knowledge of nutrition and physical activity during pregnancy. The intent was that these
findings be applied to best-design efficacious strategies that cater to the needs of our target group of pregnant women. In our
analysis we showed that the majority of pregnant women studied would be willing to participate in a lifestyle intervention for
their own personal health and that of their child. Of great interest was the observation that most women were not informed of
the importance of pregnancy-specific energy intake, or made aware of their own healthy GWG targets. Additionally, many of the
respondents reported that they did not receive information that pertained to appropriate physical activity recommendations,
even though the vast majority of participants considered this lifestyle modality to be safe during their pregnancy. Finally, in
paper 6 we built on the results of our previous work and evaluated the risks and benefits of physical activity during pregnancy
on maternal–fetal outcomes through a review of the literature and noted that engaging in nonsedentary pursuits during
gestation may aid in maternal weight regulation, protect against metabolic disorders, and optimize neonatal birth weight and
body composition. Overall, the collective nature of the papers presented in this dissertation provides qualitative and quantita-
tive evidence to support not only the complexity of body weight regulation in the mother and her baby, but also highlights
potential avenues for intervention that may improve maternal–fetal outcomes during this critical period.
Received 5 November 2012. Accepted 9 November 2012.
Z.M. Ferraro.*,†HALO Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
E-mail for correspondence: firstname.lastname@example.org.
Research Institute; Dr. Denis Prud'homme, MD, MSc (co-advisor), Full Professor, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa.
†Dr. Ferraro is currently working as a part-time clinical research associate in the Adamo lab at the HALO research group. He is a Certified Exercise Physiologist (CSEP-CEP) and
factors and how these influence placenta nutrient transport and fetal growth.
Appl. Physiol. Nutr. Metab. 38: 360 (2013) dx.doi.org/10.1139/apnm-2012-0426
Published at www.nrcresearchpress.com/apnm on 19 November 2012.
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