Table 1. Maternal metabolic phenotypes and potential risks to offspring.

Metabolic phenotypes	Association with obesity	Exposure window	Metabolic changes and intrauterine environment	Potential risks to offspring	Possible mechanism
Maternal undernutrition	This can occur in obesity due to poor dietary habits	First and second trimesters	Lack of essential nutrients, imbalance of vitamin B12 and folate levels, reduced folate levels	Overeating, obesity, and diabetes in offspring, restricted fetal growth, risk of structural defects, development of neural tube defects	Hypothalamic appetite “programmed” to adapt, influences cellular growth and synthesis of amino acids, underdevelopment of neural tube
Gestational diabetes			Overnutrition, increase in transfer of nutrients, hyperglycemia, stimulates fetal islets hyperinsulinemia	Macrosomia at birth, fetal adiposity, increased risk of childhood obesity and diabetes	Growth promoted in Insulin sensitive organs, alters structure and function of the pancreas, increases fat deposition
Pregestational diabetes in mother	Associated with obesity as a risk factor.	First trimester	Extratransfer of glucose	Increased risk of obesity in offspring and increased risk of diabetes	Hampers fetal β-cell formation, alters structure and function of the pancreas, stimulates fetal islets, and causes hyperinsulinemia
Visceral adiposity	Associated with obesity	First trimester	Increase in insulin glucose levels and leptin; insulin resistance and procoagulant proteins cause impaired fibrinolysis and increased susceptibility to thrombosis, proinflammatory cytokines (tumor necrosis factor-α, interleukin-6), monocyte chemoattractant protein-1	Risk of; macrosomic baby, neurodevelopmental disorders, type 2 diabetes, fetal death, birth defects, childhood asthma	Elevate progesterone concentrations (induce changes in brain development), fetal programming, increase risk of maternal diseases (e.g., preeclampsia), chronic inflammatory state