Obesity & Fetal Programming

Many parents and doctors need better information on how to prevent obesity. What can help today’s children — and tomorrow’s adults — avoid obesity-related problems such as diabetes, heart disease and cancer? What can a mom do before and during pregnancy to help her child enjoy lifelong health? Research in our Division of Endocrinology is focused on finding answers in this important, emerging field.

Our specialists are looking at fetal origins of disease. We want to know more about how metabolism is programmed, especially by abnormal conditions in the mother’s body. Creating a healthier environment for the short time in the womb may be easier than applying weight loss and exercise strategies throughout life.

A Mother’s Body May Influence Her Child’s

Our physician researchers want to tackle the burden of obesity from very early on for a child. Jami Josefson, MD, an attending physician in our Division of Endocrinology and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine has begun several related studies. In a pilot study on maternal body size and vitamin D levels, Dr. Josefson gathered information about the body fat of newborns, relating it to the amount of a nutritional element (vitamin D) in the blood of mothers and the umbilical cord of their newborns. Collaborating on this study was Craig Langman, MD, head of our Division of Kidney Diseases and the Isaac A Abt, MD, Professor of Kidney Diseases and Professor of Pediatrics at the Feinberg School.

In the MANNA Study (Maternal Nutrition and Newborn Adiposity) , Dr. Josefson is collecting information from mothers on their diet during pregnancy and measuring the body fat of newborns using the Pea Pod® Infant Body Composition System. The goal is to identify factors in the womb that influence development of body fat at birth.

At the Lurie Children’s Clinical Research Unit, Josefson is looking forward to meeting children and mothers in the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Follow Up Study. This study is looking at glucose metabolism and body fat in both moms and their children. Wendy Brickman, MD, attending physician, Endocrinology, and Associate Professor of Pediatrics at the Feinberg School is the Principal Investigator for the study at Lurie Children’s. Eight to 12 years ago, data was collected both nationwide and internationally on thousands of mothers and their newborn children. “It’s exciting for us to be part of this long-term, follow-up study. We’re expecting to bring back about 300 moms and kids,” said Dr. Josefson.

For Northwestern University’s MOMFIT study (Maternal-Offspring Metabolics: Family Intervention Trial), Dr. Josefson is working with a collaborative team of investigators on a randomized/control diet and lifestyle intervention trial for overweight and obese pregnant women. Dr. Josefson will gather information on the body fat of infants and toddlers of mothers enrolled in this study.

Dr. Josefson likes being able to help families break the cycle of obesity and insulin resistance. As a pediatric endocrinologist at Lurie Children’s, she counsels our team and families in her care. This subject is especially important today because so many women of childbearing age are overweight or obese. Their children face greater health risks as a result.

An Epidemic Fueled in the Womb

Finding ways to prevent obesity requires big thinking. What is really fueling the obesity epidemic?

Lifestyle: Of course, what children eat (or are fed) and how active they are matters. But making these improvements may only be part of the solution to the problem.
Genes: Inherited genes can be a factor. But the problem isn’t always an old defect in a family’s genes. The child’s genes might have adapted to conditions in the uterus.
Fetal origins: A child’s metabolism may be wrongly programmed by poor conditions in the mother’s body during the pregnancy.

We’re studying how conditions in the womb may program a child’s body toward obesity. Three conditions of concern are getting lots of attention, says Josefson:

Diabetic effects during pregnancy: Does the mom have diabetes while she is pregnant? Does she have more glucose in her blood than is healthy for the developing fetus?
Pregnancy when overweight or obese: What happens when the mom starts the pregnancy at an unhealthy weight? What transfers to or changes in the fetus as a result?
Gaining too much weight when pregnant: What happens when the mother gains extra weight during the pregnancy? For example, how is the child’s metabolism changed or how is an organ, like the kidneys or liver, affected while it forms?

Some diseases that we see in childhood and adulthood may have started not in the home, but in the womb. Conducting further research about these conditions gives us new avenues to protect children from obesity and its complications.