Abstract
Factors operating in the preconception and prenatal periods, such as maternal obesity, excessive gestational weight gain and gestational diabetes, predict a substantial fraction of childhood obesity as well as lifelong adverse health consequences in the mother. These periods may lend themselves to successful intervention to reduce such risk factors because parents may be especially willing to change behavior if it confers health advantages to their children. If effective interventions started before or during pregnancy can be maintained after birth, they have the potential to lower the risk of both maternal obesity in the next pregnancy and obesity in the growing child, thus helping to interrupt maternal and child intergenerational vicious cycles of obesity, diabetes and related cardiometabolic health consequences. While this paradigm is appealing, challenges include determining the magnitude, causality and modifiability of these risk factors, and quantifying any adverse consequences of intervention.