Bridging Obstetrics and Pediatrics to Close the Life Span Gap in Child Obesity Research Megan H. Pesch, MD, MS,a Katharine Asta, MD, MS,b Julie C. Lumeng, MDa

Childhood obesity prevention efforts effective. Should efforts be focused on are increasingly focused on the prenatal helping women achieve a healthy period, but the effects of these weight even before conception, if interventions on birth weight have metabolic programming occurs even in been mixed.1 In this issue of Pediatrics, the first trimester? Should obstetrical Moore et al2 present evidence providers recommend earlier delivery suggesting the importance of neonatal or intensify supports to ensure optimal adiposity, as opposed to birth weight nutrition and physical activity among alone, as a predictor of overweight in pregnant women? If the link between early childhood. The effects were neonatal adiposity and later obesity is robust: at age 5 years, the difference in more modifiable than fat accretion in the prevalence of overweight among utero, should pediatric providers focus aDivision of Developmental Behavioral Pediatrics, children born 1 SD above versus below on modifying infant sleep, diet, physical bDepartment of Pediatrics, University of Michigan, Ann the mean for neonatal adiposity was activity, and caregiving behavior? Arbor, Michigan 23% vs 3%. Contributors to neonatal Ultimately, large, multisite, longitudinal Opinions expressed in these commentaries are adiposity may include shared genetics studies will be needed to determine the those of the authors and not necessarily those of the as well as epigenetic changes or relative effects of intervention during American Academy of Pediatrics or its Committees. metabolic priming caused by the preconception, pregnancy, or DOI: https://doi.org/10.1542/peds.2020-001990 intrauterine exposure to a myriad of postnatal periods as well as whether Accepted for publication May 13, 2020 known (eg, diet and smoking) and interventions during each of these Address correspondence to Megan H. Pesch, MD, MS, unknown factors in the maternal developmental periods have additive or University of Michigan, 300 N Ingalls St, 1111 SE, Ann environment. For the pediatric multiplicative effects. Disentangling Arbor, MI 48109-5456. E-mail: [email protected] provider, the results raise the these relationships will be important PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, possibility that our postnatal for health care providers, both 1098-4275). interventions in infancy and early obstetrical and pediatric, to develop Copyright © 2020 by the American Academy of childhood are too little, too late. clinically actionable recommendations Pediatrics that take into consideration prenatal FINANCIAL DISCLOSURE: The authors have indicated Although neonatal adiposity is an end and postnatal environments. they have no financial relationships relevant to this point for prenatal obstetrical article to disclose. interventions, it is a starting point for The results of this study illuminate the FUNDING: No external funding. pediatric interventions. If neonatal connection between pediatrics and POTENTIAL CONFLICT OF INTEREST: The authors have adiposity is nearly entirely explained by obstetrics. Specialization in medicine indicated they have no potential conflicts of interest shared genetics between the mother has contributed to dramatic reductions to disclose. and child, efforts to modify the in maternal, infant, and child mortality COMPANION PAPER: A companion to this article can environment will have limited effect. If over the last century3 but has be found online at www.pediatrics.org/cgi/doi/10. the link between mother and child simultaneously created silos of 1542/peds.2020-0737. adiposity is explained by modifiable expertise.4 Pediatrics and obstetrics factors in the environment, the next share a common goal of supporting the To cite: Pesch MH, Asta K, Lumeng JC. Bridging most pressing question is to determine interdependent health of the mother Obstetrics and Pediatrics to Close the Life Span when interventions to disrupt the and child, but our individual training Gap in Child Obesity Research. Pediatrics. 2020; 146(3):e2020001990 pathways of association can be most paths have fragmented our focus on

Downloaded from www.aappublications.org/news by guest on September 24, 2021 PEDIATRICS Volume 146, number 3, September 2020:e2020001990 COMMENTARY either the prenatal or neonatal biologically falls to the mother. This 3. Stevens R. American Medicine and the period. Within this siloed framework, responsibility to prevent neonatal fat Public Interest: A History of it is difficult to approach maternal- mass accretion, on top of the many Specialization. Berkeley, CA: : University infant care and research with other societal expectations placed on of California Press; 1998 a continuous life span perspective. women during pregnancy, is a lot for 4. Hodgson J, Moore K, Acri T, Treisman 10 The moment of birth marks the a woman to carry. Childhood GJ. Integrative Medicine for Vulnerable Populations: A Clinical Guide to Working child’s abrupt transition of care from obesity cannot be viewed as the product of a failure of maternal self- with Chronic and Comorbid Medical obstetrics to pediatrics, and the Disease, Mental Illness, and Addiction. scientific literature corresponds with control during pregnancy. It is heavily fl Cham, Switzerland: Springer; 2020 this divide. Interprofessional in uenced by societal factors, yet collaboration could bridge this gap. there are few societal supports for 5. Jennings J, Nielsen P, Buck ML, et al. Both the American Academy of pregnant women and mothers in the Executive summary: collaboration in practice: implementing team-based Pediatrics and American College of United States and many other nations around the world. Life span care: report of the American College of Obstetricians and Gynecologists Obstetricians and Gynecologists’ Task support patient-centered, team-based intervention and prevention clinical care programs and research should Force on Collaborative Practice. Obstet care by engaging team members from Gynecol. 2016;127(3):612–617 a variety of medical specialties and also include other family members support systems.5,6 This strategy (ie, fathers, grandparents). 6. Katkin JP, Kressly SJ, Edwards AR, et al; Task Force on Pediatric Practice could be applied to maternal-infant As Helen Keller once said, “Alone we Change. Guiding principles for team- care and research to connect can do so little; together we can do so based pediatric care. Pediatrics. 2017; pediatrics with obstetrics, especially much.” Childhood obesity prevention 140(2):e20171489 considering the time frame from requires a collaborative conception to age 2 years is a major 7. Black RE, Victora CG, Walker SP, et al; transdisciplinary approach in both determinant of later health status.7 Maternal and Child Nutrition Study risk factor research and intervention Group. Maternal and child An improved care-continuum design. Such interventions may only undernutrition and overweight in low- between pediatrics and obstetrics be effective in coordination with income and middle-income countries. provides the opportunity to bridge robust supports for families and [published correction appears in the discontinuity in our fields and children across the life course, from Lancet. 2013;382(9890):396]. Lancet. address the public health crisis of – preconception through adolescence. 2013;382(9890):427 451 obesity.8 Few previous studies have 8. Moscetti CW, Pronk NP. Invisible seams: tested childhood obesity preventing childhood obesity through interventions spanning from the REFERENCES 9 an improved obstetrics-pediatrics care second trimester into early infancy. continuum. Prev Med Rep. 2016;5:1–3 A collaborative perspective spanning 1. Thangaratinam S, Rogozinska E, Jolly K, preconception to adolescence will be et al. Interventions to Reduce or 9. Thomson JL, Goodman MH, Tussing- Prevent Obesity in Pregnant Women: A Humphreys LM, Landry AS. Infant needed to understand the nuanced Systematic Review. In: NIHR Health growth outcomes from birth to relationship between neonatal fat Technology Assessment Programme: 12 months of age: findings from the accretion and risk of overweight or Executive Summaries. Southampton, Delta Healthy Sprouts randomized obesity in later childhood. United Kingdom: National Institute for comparative impact trial. Obes Sci While pursuing this life span Health Research; 2012 Pract. 2018;4(4):299–307 approach, it is critical to consider the 2. Moore BF, Harrall KK, Sauder KA, Gluek 10. Lauridsen DS. Between blame and care: burden of responsibility being placed DH, Dabelea D. Neonatal adiposity and women’s ‘needs talk’ about obesity on the woman. The “management” of childhood obesity. Pediatrics. 2020; interventions in prenatal care. Sociol the intrauterine environment 146(3):e20200737 Health Illn. 2020;42(4):758–771

Downloaded from www.aappublications.org/news by guest on September 24, 2021 2 PESCH et al Bridging Obstetrics and Pediatrics to Close the Life Span Gap in Child Obesity Research Megan H. Pesch, Katharine Asta and Julie C. Lumeng Pediatrics originally published online August 13, 2020;

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Downloaded from www.aappublications.org/news by guest on September 24, 2021 Bridging Obstetrics and Pediatrics to Close the Life Span Gap in Child Obesity Research Megan H. Pesch, Katharine Asta and Julie C. Lumeng Pediatrics originally published online August 13, 2020;

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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2020 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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