The obesity and diabetes epidemic is an unintended consequence of economic, social and technological changes.

In non-pregnancy, people identified as high risk to develop type 2 diabetes may delay progression by 30 to 70% with lifestyle interventions and pharmacological agents. In pregnancy, lifestyle interventions has been the primary focus to prevent fetal short and long term complications that may evolve into substantial weight gain and gestational diabetes mellitus (GDM).

The dilemma for obstetricians is whether diabetes and obesity can be prevented and not simply treated after the fact. Interventions after women become pregnant may be too late to see the kinds of meaningful improvements in child and maternal health because there is a short interval from GDM diagnosis to delivery.

Therefore, future efforts need to incorporate quality research, lifestyle interventions that designate time of initiation and duration during pregnancy, the preventative intervention of a pre-pregnant «fourth trimester» coupled with the concept of precision medicine so that there is the potential to make the «impossible dream» a reality.

Oded Langer, MD, PhD
American Journal of Obstetrics and Gynecology, available online 23 March 2018
DOI: 10.1016/j.ajog.2018.03.014