Molecular mechanisms: Comprehensive experimental research is required into the epigenetic and other mechanisms linking maternal obesity to long term outcomes in the offspring. This will enable development of novel biomarkers and assist design of new intervention studies. Lifestyle, nutritional and metabolic drivers: Detailed information is needed on the specific maternal lifestyle (e.g. physical activity, smoking, other environmental stressors), nutritional and metabolic exposures that underpin effects of maternal obesity on offspring outcomes. This needs to be combined with information on whether there are critical periods during development when such exposures have their effects and whether any outcomes are sex-specific. Causality: Alongside mechanistic research, sophisticated observational studies are needed to obtain further insight into the (multiple) causalities of the observed associations. Such study designs include parent-offspring longitudinal cohorts, sib-pair analyses and the use of genetic variants and haplotypes as instrumental variables. The need for new intervention studies: There is a paucity of intervention studies focused on remediation of maternal obesity before and during pregnancy, or on moderation of the effects of maternal obesity on the offspring. With a deeper understanding of the underlying mechanisms, new interventions need to be designed and tested, with long-term follow-up of the offspring.
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