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  1. Pam Factor-Litvak, associate professor of epidemiology
  1. 1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
  1. prf1{at}cumc.columbia.edu

Interventions may need to begin before pregnancy

The prevalence of overweight and obesity in women of childbearing age and in pregnant women has steadily increased over the past 20 years.1 2 Maternal obesity is associated with a variety of adverse outcomes for the mother, such as increased mortality, pre-eclampsia, and gestational diabetes. It is also associated with adverse outcomes for the child at birth (such as large for gestational age babies and fetal distress) and in later life (such as increased risk of later obesity, metabolic disorders including insulin resistance and dyslipidemia, hypertension, asthma, and behavioral problems).3 The linked paper by Reynolds and colleagues (doi:10.1136/bmj.f4539) is the first to describe associations between maternal obesity and risk of cardiovascular morbidity and mortality in mid-life.4

What are the possible …

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