Commentary to Accompany
The notion that factors occurring in early life could impact the predisposition to chronic diseases later in life originated in the 1980s after David Barker and Clive Osmond observed a correlation between low birth weight and increased risk of adult cardiovascular disease in a historical cohort (2,4). Since then, this observation has grown into a field known as developmental origins of health and disease (DOHaD), bringing together clinical, experimental, and now epigenetic studies to examine how early life (preconception, pregnancy, and infancy/early childhood) exposures affect susceptibility to later chronic diseases such as diabetes, metabolic syndrome, and cardiovascular disease. The majority of DOHaD studies have investigated the role of maternal nutrition, stress and environmental elements, and the interaction between those factors and genetics. More recently, how maternal physical activity and exercise may affect offspring health, and potentially alter offspring phenotype, has received consideration. Initial studies on maternal exercise focused on maternal outcomes (insulin sensitivity and glucose metabolism, placental development, etc.) and neonatal and early life offspring outcomes (birth weight, small or large for gestational age size, infant body composition, etc.). In the current issue of Exercise and Sport Sciences Reviews, Blaize et al. (3) discuss novel data from research examining how maternal exercise affects long-term offspring outcomes and how offspring physiological changes induced by maternal exercise may mediate later chronic disease risk.
Blaize et al. (3) hypothesize that maternal exercise during pregnancy will improve offspring cardiovascular health while reducing offspring risk for type 2 diabetes and cardiovascular disease later in life. Data from the authors’ recent studies in animal models, as well as those of others, support this hypothesis. Offspring from mothers exposed to a variety of aerobic exercise protocols ranging from voluntary wheel running in mice to treadmill running in rodent and swine models, in combination with various nutritional paradigms, show improved insulin sensitivity, decreased body fat with increased lean mass, augmented autonomic nervous system development, and improved vascular endothelial and smooth muscle function. Furthermore, a single study examining maternal exercise and offspring breast cancer found a profound decrease in the incidence of tumor development in offspring whose mothers had access to running wheels. The mechanism behind the observation is unknown. Importantly, the authors note that there are potential negative consequences of maternal exercise and that there is a complexity in understanding the optimal volume and type of maternal exercise in conjunction with maternal health status at the time of pregnancy that has not yet been fully examined or elucidated.
The area of public health concern where understanding the long-term effects of maternal exercise on offspring chronic disease risk could have profound impact is overweight and obese pregnancy. With 50% of pregnant women classified as overweight or obese (1), the negative effect of obese pregnancy on offspring health and later disease risk is a pressing issue. Despite evidence demonstrating that offspring from overweight/obese mothers are at increased risk of birth defects, increased fetal and neonatal fat mass, higher rates of childhood and adult obesity, and increased risk of cardiovascular and metabolic disease later in life, there are little data guiding current weight gain recommendations in obese pregnancy or indicating how physical activity may help manage the excess maternal weight gain that often accompanies obese pregnancy. The American College of Obstetricians and Gynecologists recommends 30 min of moderate-intensity physical activity most days of the week for pregnant women without complications but simply states that obese pregnant women should “be encouraged to follow an exercise program” (1). In addition, the effect of physical activity during obese pregnancy on offspring phenotype and later disease risk, independent of effects on maternal health or weight gain, is largely unknown. The necessary studies are challenging and multifactorial, but the data presented by Blaize et al. (3) suggest that there are significant and long-term benefits to the offspring when a pregnant mother exercises. If future studies continue to show that maternal exercise, particularly in obese pregnancy, is not only safe for the mother and her developing offspring but also can reduce offspring susceptibility to later chronic disease, getting mothers moving should become a priority in pregnancy management.
Elise L. Donovan
Aging and Metabolism Research Program
Oklahoma Medical Research Foundation
Oklahoma City, OK
1. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet. Gynecol.
2013; 121(1): 213–7.
2. Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet
. 1989; 2(8663): 577–80.
3. Blaize AN, Pearson KJ, Newcomer S. Impact of maternal exercise during pregnancy on offspring chronic disease susceptibility. Exerc. Sport Sci. Rev.
2015; 43(4): 200–5.
4. Osmond C, Barker DJ, Winter PD, Fall CH, Simmonds SJ. Early growth and death from cardiovascular disease in women. BMJ
. 1993; 307(6918): 1519–24.