<p>Emerging evidence indicates that in utero exposure to vitamin D metabolites may influence fetal and neonatal bone development. Bone accretion in prenatal and early postnatal life may impact peak bone mass achieved in early adolescence; and peak bone mass is a well-established predictor of osteoporosis risk in later life. <strong>Hypothesis</strong>: We hypothesized that offspring of mothers with higher serum vitamin D status during pregnancy will have higher whole body BMC z-score and bone size at 3 years of age, after adjustment for confounders. <strong>Methods</strong>: In a prospective, longitudinal study, 372 mothers with singleton birth were recruited during pregnancy, and maternal blood samples were obtained during the third trimester. Child bone outcome measures at 3 years of age included: whole body BMC, femoral and humeral lengths by DXA. We controlled for other relevant factors such as maternal nutrition, pre-pregnancy BMI, physical activity during pregnancy, maternal BMD, as well as the child’s nutrition at 6 months and 3 years, and the child’s physical activity. <strong>Results & Discussion</strong>: Maternal vitamin D status during pregnancy did not predict whole body BMC z-score of the child at 3 years of age. Over 92% of Canadian women in our sample were vitamin D sufficient with mean intakes of 435 IU/day from food and supplements and mean serum 25OHD of 111.2 nM. Further, data indicate a potential negative effect on offspring bone size at maternal serum 25OHD concentrations that exceed the upper limit suggested by the most recent DRI report (>125 nM), at which adverse health effects may occur. Our findings may differ from previous studies in the United Kingdom, India and Finland that found a positive relationship between maternal vitamin D status and child bone outcomes due to the high frequency of our mothers that had optimal vitamin D status. In addition, we adjusted for most of the key covariates that were not adjusted for in previous studies, which may contribute to the different findings compared to previous investigations.</p> / Master of Science (MSc)

Les problèmes de santé liés à l’alimentation hyperlipidique chez l’humain sont en constante progression. Or, une perturbation de l’environnement fœtal induit chez la descendance une susceptibilité plus grande à développer des maladies à l’âge adulte (DOHad : Developmental Origins of Health and Disease). L’objectif de ce travail de Thèse est d’évaluer, chez le lapin, les conséquences d’une alimentation hypercholestérolémique et hyperlipidique sur le développement embryonnaire, fœtal, et la survenue de troubles métaboliques à long terme.Nous avons nourri des lapines ad libitum avec un régime hypercholéstérolémique (0,2%) et hyperlipidique (8%) (HH) ou un régime témoin (C) à partir de l'âge de 10 (expérience 1) ou de 18 semaines (age de la mise à la reproduction, expérience 2). A la naissance, les portées ont été équilibrées et des croisements effectués pour différencier l'effet de l'alimentation de la mère pendant la gestation et pendant la lactation. Ainsi des lapereaux nés de mères HH ont été allaités par des mères C (groupe HH-C) ou HH (groupe HH-HH) et des lapereaux nés de mère C ont été allaités par des mères C (groupe C-C) ou HH (groupe C-HH). Au cours de l’expérience 1, un retard de croissance intra utérin (RCIU) significatif a été mis en évidence dès 9 jours de gestation par échographie dans le groupe HH (P<0,05). A la naissance, les laperaux étaient significativement plus légers (P<0,05). En raison d’un rattrapage pondéral rapide, il n’existait plus de différence significative au sevrage. Tous les lapins ont alors reçu un aliment témoin distribué ad libitum. A J176, il n’y avait pas de différence de poids entre les groupes HH-HH et HH-C, mais les animaux de ces deux groupes étaient significativement plus lourds que les groupes C-C and C-HH (P<0.05). De plus, la tension artérielle était plus élevée dans le groupe HH-HH par rapport à tous les autres groupes (P<0.05). Au cours de l’expérience 2, de tels effets physiologiques n’ont pas été observés. Les effets physiologiques n'ayant été observés que lorsque le régime avait été commencé avant la gestation, nous avons émis l'hypothèse que l'environnement maternel précoce avait été modifié, entrainant une perturbation du développement embryonnaire à l'origine des conséquences à long terme. l’expression des gènes au moment de la mise en route du génome embryonnaire a été étudié à l’aide d’une puce dédiée. L’analyse transcriptomique a permis de suggérer que certains transcrits étaient présents en quantités différentes. Nous avons montré par qRT-PCR que le régime HH induit une augmentation transitoire de la quantité de transcrit de l’adipophiline (présente à J2 mais pas à J5,5). L’analyse immunohistochimique montre une quantité plus importante de gouttelettes lipidiques localisées près du noyau dans les embryons issus de mères nourries par le régime HH à J5,5 comparé aux témoins. Ces résultats illustrent l’importance de la nutrition avant et pendant la gestation pour la determination de la croissance in utero et postnatale, ainsi que pour le développement de maladies métaboliques à long terme. La nutrition maternelle avant la gestation peut engendrer des modifications d’expression de gènes au moment de la transmission materno embryonnaire. / The prevalence of human health problems associated with high-fat diets continues to rise, as does the number of such problems known to be associated with this diet. Disruption of the fetal environment induces in progeny a greater susceptibility to developing diseases in adulthood (DOHad: Developmental Origins of Health and Disease). The objective of the work for this thesis was to assess in rabbits the consequences of a high-cholesterol and high-fat diet on embryonic and fetal development and on the onset of metabolic disorders in the long term.We fed rabbits ad libitum with a high-cholesterol (0.2%) and high-fat (8%) (HH) diet or a control (C) diet, starting at the age of 10 (experiment 1) or 18 weeks (age at which reproduction began, experiment 2).The litters were balanced at birth, and crossings were performed to differentiate the effect of the mother's food during gestation and during lactation. Accordingly, rabbits born to HH mothers were nursed by C (HH-C group) or HH (HH-HH) mothers and those born to C mothers were nursed either by C (C-C) or HH (C-HH) mothers. During experiment 1, ultrasound clearly showed significant intrauterine growth restriction (IUGR) beginning at 9 days of gestation in the HH group (P<0.05). At birth, these rabbits weighed significantly less than their C counterparts (P<0.05). Because of their rapid weight catch-up, the significant difference had disappeared at weaning. All the rabbits thereafter received control food distributed ad libitum. At D176, there was no difference in weight between the HH-HH and HH-C groups but the animals in both these groups were significantly heavier than those in the C-C and C-HH groups (P<0.05). Moreover, blood pressure was higher in the HH-HH group than in any of the other groups (P<0.05). These physiological effects were not observed during experiment 2. Because the physiological effects were observed only when the diet began before gestation, we hypothesized that the early maternal environment been modified, a change that resulted in disruption of embryo development with long-term consequences. We then used a specially designed chip to study gene expression at the maternal to embryonic transition. Transcriptomic analysis suggested that some transcripts were present in different quantities. We showed with qRT-PCR that the HH diet induced a transient augmentation in the quantity of adipophilin transcripts (present at D2 but not at D5.5). The immunohistochemical analysis on D5.5 showed a higher quantity of lipid droplets localized near the nucleus of embryos from mothers fed with the HH diet than in embryos of control mothers. These results illustrate the importance of nutrition before and during pregnancy in the determination of in utero and postnatal growth as well as in the development of metabolic diseases over the long term. Maternal nutrition before conception can engender modifications in gene expression at the moment of the maternal to embryonic transition.

The objective of this thesis was to determine the association of leg length (LL), a marker of early childhood conditions, with metabolic abnormalities underlying type 2 diabetes. Utilizing data from a population at-risk for diabetes, the associations of LL with i) insulin resistance (IR) and beta-cell dysfunction and ii) a continuous metabolic syndrome risk score (MetScore) were analyzed. Results showed that shorter LL was associated with IR and beta-cell dysfunction, and that the combination of short legs and large waist (a marker of adult obesogenic conditions) was associated with the greatest IR. Height, a marker of overall childhood conditions, was found to be inversely associated with the MetScore. Therefore, both adverse childhood conditions and early-late life mismatched conditions may increase the risk for diabetes through differing pathways. Improving childhood conditions (i.e. nutritionally or economically) may be an important strategy to prevent diabetes.

The objective of this thesis was to determine the association of leg length (LL), a marker of early childhood conditions, with metabolic abnormalities underlying type 2 diabetes. Utilizing data from a population at-risk for diabetes, the associations of LL with i) insulin resistance (IR) and beta-cell dysfunction and ii) a continuous metabolic syndrome risk score (MetScore) were analyzed. Results showed that shorter LL was associated with IR and beta-cell dysfunction, and that the combination of short legs and large waist (a marker of adult obesogenic conditions) was associated with the greatest IR. Height, a marker of overall childhood conditions, was found to be inversely associated with the MetScore. Therefore, both adverse childhood conditions and early-late life mismatched conditions may increase the risk for diabetes through differing pathways. Improving childhood conditions (i.e. nutritionally or economically) may be an important strategy to prevent diabetes.

Cette thèse explore la Première Guerre mondiale comme modèle historique de stress psychologique subi dans l'enfance. L'Hypothèse d'Origine Développementale des Maladies (DOHaD) prévoit une susceptibilité accrue aux maladies chroniques à l'âge adulte des individus exposés à des événements traumatiques aux premiers stades du développement. Nous avons constitué une cohorte d'orphelins nés en 1914-1916, et ce grâce au statut de "pupilles de la Nation", créé par une loi de 1917 et accordé sur requête à tous les orphelins, quel que soit le statut socioéconomique de la famille. L'attribution du statut de pupille était inscrite en marge de l'acte de naissance. Les registres de naissance ont donc permis un recensement exhaustif de tous les pupilles nés dans les villes incluses ainsi qu'un suivi de la mortalité à l'âge adulte. Les actes de naissance de 7,250 pupilles ont été transcrits à ce jour. L'appel à la Base des Morts pour la France a fourni la date de décès du père, et donc sa position dans le calendrier de développement de l'enfant. Des matched non-orphans (MNOs) ont été sélectionnés dans les mêmes registres. Le critère d'intérêt était la longévité de ceux ayant atteint l'âge de 31 ans. Un écart orphelin - MNO de ~ 2.5 années a été trouvé en cas de perte prénatale du père, mais aucune différence n'a été mise en évidence dans le cas d'une perte postnatale. La conjonction de ces deux résultats suggère qu'un traumatisme in utero a un effet de programmation de la susceptibilité biologique à l'âge adulte assez fort pour altérer la longévité. / This thesis explores the First World War as a historical model in early life psychological stress. The Developmental Origins of Health and Disease (DOHaD) hypothesis predicts increased susceptibility to chronic diseases in adulthood for those exposed to an extreme psychological trauma in very early life. We collected vital information on French orphans born 1914-1916 thanks to the “pupille de la Nation” distinction, a legal status created in 1917 and granted upon request to all orphans. Notification of “adoption by the Nation” was by law inscribed on the birth certificate of a newly adopted child. Birth registers thus provided a census of all pupilles born in the included cities during the inclusion period as well as long-term mortality follow-up. The birth certificates of 7,250 pupilles have been digitized. Call to the Died for France Database enabled us to retrieve the paternal date of death. Matched non-orphans (MNOs) were drawn from the same birth registers. For each orphan, his MNO was therefore chosen born in the same district at the same time. The outcome of interest was longevity of those who survived to 31 y. An orphan-MNO difference in adult longevity of ~2.5 years was found for orphans who had lost their father before) birth (prenatal orphans), but no difference in adult longevity could be measured between postnatal orphans and their MNOs. These two results suggest early trauma in utero has programming effects on biological susceptibility in adulthood strong enough to alter longevity. The fact that no loss of lifespan was found in the case of a postnatal loss of father further suggests efficient buffers to early postnatal stress existed in French society.

Problématique : Durant la période fœtale, le métabolisme global du fœtus fonctionne en hypoxie, ce qui limite la phosphorylation oxydative dans la mitochondrie, et par conséquent la production d’adénosine triphosphate (ATP). Ces conditions sont nécessaires pour le développement intra-utérin. Lors de la naissance, l’augmentation des concentrations d’oxygène et un stress oxydatif permettent une transition métabolique. Une charge oxydative supplémentaire en période néonatale pourrait perturber cette transition métabolique et causer des complications. La nutrition parentérale (NP) administrée aux nouveau-nés prématurés apporte un triple fardeau oxydatif : une exposition à des peroxydes oxydants autogénérés par l’interaction des composants de la NP, une carence en vitamine C (instable en solution), et une déficience en glutathion, vu la charge oxydative élevée. Cette charge oxydative excessive affecte l’homéostasie redox au foie et aux poumons, ainsi que le métabolisme énergétique hépatique, et ce, par des effets immédiats et à long-terme. La méthylation de l’ADN est un possible mécanisme qui explique les effets à long terme. Le but de ce travail était de caractériser l’impact à court- et long-terme de la NP néonatale sur l’homéostasie redox, la méthylation de l’ADN, et le métabolisme des glucides et lipides, en isolant chacun des facteurs nutritionnels. Méthodes : Des cochons d’Inde ont été divisés dans les groupes suivants 1) NP : nutrition intraveineuse complète ; 2) NP+ glutathion disulfure (GSSG) (6 ou 12µM- substrat pour la synthèse intra-cellulaire de glutathion); 3) Diète complète : nutrition orale complète 4) Diète déficiente en Vitamine C; 5) Diète déficiente en Cystéine; 6) Diète double déficiente; ou. À 1 semaine de vie, la moitié des animaux était sacrifié et l’autre moitié a commencé à manger une diète complète jusqu’à l’âge adulte. Résultats et discussion : Les animaux ayant reçu une NP néonatale ont un métabolisme énergétique permettant la synthèse de nicotinamide adénine dinucléotide phosphate (NADPH) par l’augmentation de l’activité de la glucokinase (captation de glucose), et diminution de celles de la phosphofructokinase-1 (PFK-1) (glycolyse) et acétyl-CoA-carboxylase-1 (ACC)(lipogenèse). À l’âge adulte, les animaux ont une diminution des niveaux de GSSG, indiquant un débalancement de l’homéostasie redox vers le côté réducteur programmé par la NP néonatale. L’activité augmentée de l’ACC suggère une tendance à accumuler les lipides au foie à la suite d’une diète riche en glucides. L’ajout de glutathion à la NP ne prévient pas ces perturbations, car les déficiences en glutathion et vitamine C jouent un rôle sur la modulation des niveaux protéiques de l’ACC. Les diètes néonatales déficientes en vitamine C et cystéine augmentent l’activité de la PFK-1. Cette augmentation se maintient jusqu’à l’âge adulte chez les mâles, mais pas chez les femelles. Les niveaux protéiques de la glucokinase et ACC sont diminués à 1 semaine, et ceux de l’ACC sont élevés à 3 mois dans les groupes ayant reçu une des diètes déficientes. Ces effets sont similaires à ceux trouvés dans les animaux nourris avec la NP, suggérant que la déficience de la NP en ces nutriments et non les peroxydes cause ces effets. Dans tous les groupes, un stress oxydatif a été démontré à 1 semaine de vie, soit par l’augmentation des niveaux de GSSG, ou la diminution du GSH. Cet effet est vrai pour le foie et le poumon. Une réponse de Nrf2 est observée aussi au foie, ce qui caractérise un niveau bas de stress oxydatif. La baisse de GSH pulmonaire chez les animaux déficients est secondaire à l’inhibition oxydative de la voie de transméthylation au foie. Une diminution des niveaux d’ARNm de glutathion réductase et glutarédoxine sont observées, ce qui favorise encore le stress oxydatif pulmonaire. À long terme, les effets sont les opposés, soit débalancement de l’homéostasie redox vers le côté réducteur au foie et poumon. La méthylation de l’ADN était diminuée au foie des animaux nouveau-nés recevant les diètes déficientes, mais aucun changement n’a été observé aux poumons. Cette diminution est en accord avec les hauts niveaux d’ARNm des gènes de la protéine régulatrice de la glucokinase, et AMPK. À long-terme, l’effet inverse est observé pour la méthylation de l’ADN Conclusion : La NP modifie le flot d’énergie au foie à 1 semaine visant favoriser le métabolisme redox en détriment du métabolisme énergétique. Cet effet semble créer une déficience énergétique fonctionnelle, qui se développe en une lipogenèse accrue en âge adulte. Cela peut représenter un exemple de la plasticité développementale. Bien qu’un stress oxydatif en âge néonatal ne soit pas létal, il affecte le métabolisme énergétique et redox à long-terme, probablement par la méthylation de l’ADN. Les résultats de ce travail démontrent que ces animaux adultes ont une capacité accrue d’entreposer de l’énergie, soit par une lipogenèse plus élevée, soit par une accumulation d’énergie redox (glutathion). Aucune maladie métabolique n’était observée chez les animaux, mais il est attendu à ce que ces animaux développent ces maladies plus facilement suite à l’exposition à des insultes (habitudes de vie malsaines, tabagisme, etc.). / Problematic: During the fetal period, the general metabolism works under hypoxia, limiting oxidative phosphorylation in mitochondria and adenine triphosphate (ATP) synthesis. These conditions are necessary for intrauterine development. After birth, the increasing oxygen concentrations and the associated oxidative stress induce a metabolic transition. An excessive oxidative load during the neonatal period could perturb this transition. Parenteral nutrition (PN) administered to premature newborns comes with a triple oxidative burden: contaminating peroxides generated in solution, vitamin C deficiency (unstable in solution), and glutathione deficiency (caused by the high oxidative load). This oxidative load affects redox homoeostasis in the liver and lungs, as well as energy metabolism in the liver. These effects are not only immediate, but they are also delayed. DNA methylation is a candidate mechanism explaining the long-term effects. The objective of this work was to characterize the short- and long-term impacts of neonatal PN over redox homoeostasis, DNA methylation and carbohydrate and lipid metabolism by isolating each of these factors. Methods: Six groups of three-day-old guinea pigs received for 4 days either: 1) Total PN; 2) PN+glutathione disulfide (GSSG) (6 or 12µM-anti-peroxide);3) Vitamin C deficient; 4) Cysteine deficient; 5) Double deficient; or 6) Complete diets. At 1 week of life, half of the animals were sacrificed, and the other half started eating nutritionally complete diets until adulthood. Results and discussion: NP animals had energy metabolism shifted favouring nicotinamide adenine dinucleotide phosphate (NADPH) synthesis, as evidenced by the increase in glucokinase activity (glucose trapping in hepatocytes) and decrease in phosphfuctokinase-1 (PFK-1) (glycolysis) and acetyl-CoA-carboxyalase-1 (ACC) (lipogenesis) activities. Adding GSSG to parenteral nutrition prevents these changes. During adulthood, ACC activity is increased, suggesting a tendency to accumulate lipids after a diet rich in carbohydrates. Adding GSSG to PN does not prevent these changes as they seem to be caused by the nutritional deficiencies in vitamin C and cysteine. Neonatal diets deficient in vitamin C and cysteine increase PFK-1 activity. This increase is maintained until adulthood in males but not in females. Protein levels of glucokinase and ACC are decreased at 1 week of life and ACC levels are increased at adulthood in deficient groups. These effects are like the ones observed in PN animals. In all groups, oxidative stress is demonstrated in 1-week-old animals, either by an increase in GSSG levels, or a decrease in GSH. This is true for the liver and lungs. An Nrf2 response is also observed in the liver, suggesting a low level of oxidative stress. The decrease in lung GSH is secondary to the oxidative inhibition of the transmethylation pathway in the liver. Decreased levels of glutathione reductase and glutaredoxin mRNA levels are observed in lungs, favouring pulmonary oxidative stress. At adulthood, an imbalance in redox homeostasis towards a reducing state is observed in lungs and liver. DNA methylation was decreased in the liver of deficient animals at 1-week, but no changes were observed in lungs. This decrease is in accordance with the decrease in mRNA levels of glucokinase regulatory protein and AMPK. At adulthood, the opposite effect was observed for DNA methylation. Conclusion: Parenteral nutrition alters the energy flow in the liver of 1-week-old animals, favouring redox metabolism over energy metabolism. This effect seems to create a phenotype of functional energy deficiency which translates into an increased lipogenesis at adult age. This may be an example of developmental plasticity. Although neonatal oxidative stress is not lethal, it affects energy and redox metabolism at adulthood, probably through DNA methylation. The presented results demonstrate these animals have an increased capacity of storing energy, either through increased lipogenesis, or by an increase in redox energy accumulation (glutathione). No metabolic disease was observed. Although it would be expected that these animals would develop these diseases more easily after exposure to insults, such as unhealthy lifestyle habits, smoking, and others.

Die Entwicklung eines Embryos und Fetus beeinflusst die Anfälligkeit für kardiovaskuläre Erkrankungen im weiteren Verlauf des Lebens entscheidend. Zugrundeliegende Mechanismen sind jedoch weitestgehend unbekannt. Unter Zuhilfenahme eines neuen Mausmodells für intrauterine kardiale Wachstumsretardierung zielt die vorliegende Dissertation auf die Identifikation adaptiver Wachstumsmechanismen ab, welche die Anpassung der Organgröße und die Aufrechterhaltung einer normalen Herzfunktion ermöglichen. Vielzählige Gene des Aminosäure (AS)-Metabolismus und der Proteinhomeostase zeigten eine vermehrte Expression in neugeborenen Mausherzen nach gestörter Embryonalentwicklung. Es wurde angenommen, dass sowohl die AS-Verfügbarkeit als auch die Aktivität der mechanistic target of rapamycin (mTOR) Signalkaskade entscheidend für eine normale Herzentwicklung und postnatales kompensatorisches Wachstum sind. Der mTOR Komplex 1 (mTORC1) wurde in prä- und perinatalen Mäusen mittels Rapamycin-Behandlung trächtiger Weibchen inhibiert. Die Auswirkungen einer prä- und postnatalen AS-Restriktion wurden anhand einer Niedrigproteindiät untersucht. Rapamycin-behandelte Neugeborene zeichneten sich durch vermindertes Gesamtwachstum sowie Entwicklungsverzögerung aus. Dabei war die kardiale Entwicklung besonders betroffen. Kardiale Proliferationsraten waren nicht verändert, die verminderte Herzgröße wurde jedoch auf eine verringerte Kardiomyozytengröße sowie eine erhöhte Apoptoserate zurückgeführt. Die intrauterine AS-Restriktion wurde überraschend gut von den Mausherzen toleriert. Zusammenfassend konnte gezeigt werden, dass die mTOR Signalkaskade essentiell für eine normale Herzentwicklung sowie kompensatorisches kardiales Wachstum ist. Darüber hinaus stellt die pränatale Rapamycin-Behandlung möglicherweise ein neues Modell der intrauterinen Wachstumsretardierung dar, welches Untersuchungen von Programmierungs-Mechanismen vor allem während der fötalen und perinatalen Herzentwicklung ermöglicht. / Intrauterine development influences the susceptibility to cardiovascular disease in adulthood, although the underlying molecular mechanisms are vastly unknown. Utilizing a new mouse model of impaired heart development, this thesis aims at identifying pre- and postnatal adaptive growth mechanisms to restore organ size and allow normal cardiac function. Unbiased functional annotation of genes differentially expressed in neonatal hearts after impaired intrauterine development revealed numerous gene clusters involved in amino acid (AA) metabolism and protein homeostasis. It was hypothesized that both AA availability and mechanistic target of rapamycin (mTOR) pathway activation are crucial for normal heart development and compensatory cardiac growth. mTOR complex 1 (mTORC1) was inhibited in fetal and neonatal mice by rapamycin treatment of pregnant dams. The effects of pre- and postnatal AA restriction were studied by feeding dams a low protein diet (LPD) throughout pregnancy and keeping the offspring on LPD postnatally. Rapamycin treated neonates were characterized by overall growth restriction and developmental delay, where cardiac development was especially affected (reduction of heart size, weight and heart weight to body weight ratio, severe thinning and noncompaction of the ventricular myocardium as well as immature myocardial morphology). While proliferation rates were unaffected, the reduced neonatal heart size was attributed to decreased cardiomyocyte size and increased apoptosis. Strikingly, the murine heart appeared to be surprisingly resistant to intrauterine AA restriction. In conclusion, the data revealed mTOR being essential for normal as well as compensatory cardiac development and growth. Moreover, prenatal rapamycin treatment might represent a new model of intrauterine growth restriction, which potentially allows the investigation of developmental programming mechanisms within the heart particularly in the fetal and neonatal phase of development.

A greater understanding of critical periods of body weight regulation, including pregnancy, may aid in efforts to optimize weight management strategies for the mother and her baby. The gestational period has been implicated to play, in the child, a vital role in the developmental origins of obesity and other cardiometabolic diseases later in life. Therefore, we initially examined existing literature on the role of maternal obesity and its link to pediatric obesity and documented the known underlying physiological mechanisms responsible for this relationship while suggesting potential intervention targets that may improve maternal-fetal outcomes. In a second paper, we aimed to quantify maternal predictors of large for gestational age (LGA) neonates in the Ottawa and Kingston (OaK) birth cohort with specific hypotheses verifying the independent contribution of maternal prepregnancy body mass index (BMI) and excessive gestational weight gain (GWG) to fetal overgrowth. This paper also highlights the clinical utility of the revised 2009 Institute of Medicine GWG guidelines and discusses the potential role of physiological factors underlying the observed associations between BMI, excessive GWG and LGA neonates. As a follow-up to our population-level analysis (i.e., OAK cohort), papers three and four highlight how the insulin-like growth factor (IGF) axis, a vital regulator of growth and development, may be compromised at the molecular level in cases of maternal obesity (paper 3) and excessive GWG (paper 4). In paper 3 we show that maternal obesity is associated with attenuated expression of IGF binding protein-4 (IGFBP4) in umbilical cord blood and discuss how this may preferentially promote fetal adipogenesis. The effects of excessive GWG on IGF axis protein expression are addressed in paper four where we show that excessive weight gain during pregnancy is associated with increased expression of IGFBP3 in maternal circulation in normoglycemic term pregnancies. In this paper we discuss the potential inhibitory role of IGFBP3 on adipogenesis and how it relates to glucose intolerance during pregnancy. Recognizing that both obesity and excessive GWG can alter physiological processes in mother and her baby, appropriate evidence-based interventions are warranted to best optimize outcomes. In paper five, we discuss the results of a study which sought to assess patient information channels and knowledge of nutrition and physical activity during pregnancy with the intent that these findings be applied to best design efficacious strategies that cater to the needs of our target group of pregnant women. In our analysis we show that the majority of pregnant women studied would be willing to participate in a lifestyle intervention for their own personal health and that of their child. Of great interest was the observation that most women were not informed of the importance of pregnancy-specific energy intake, or made aware of their own healthy GWG targets. Additionally, many of the respondents reported receiving no information pertaining to appropriate physical activity recommendations; despite the fact that the vast majority of participants consider this lifestyle modality to be safe during their pregnancy. Finally in paper six, we build on the results of our previous work and evaluate the risks and benefits of physical activity during pregnancy on maternal-fetal outcomes through a review of the literature and note that engaging in non-sedentary pursuits during gestation may aid in maternal weight regulation, protect against metabolic disorders and optimize neonatal birth weight and body composition. Overall, the collective nature of the papers presented in this dissertation provides qualitative and quantitative evidence to support not only the complexity of body weight regulation in the mother and her baby, but also highlights potential avenues for intervention that may improve maternal-fetal outcomes during this critical period.

A greater understanding of critical periods of body weight regulation, including pregnancy, may aid in efforts to optimize weight management strategies for the mother and her baby. The gestational period has been implicated to play, in the child, a vital role in the developmental origins of obesity and other cardiometabolic diseases later in life. Therefore, we initially examined existing literature on the role of maternal obesity and its link to pediatric obesity and documented the known underlying physiological mechanisms responsible for this relationship while suggesting potential intervention targets that may improve maternal-fetal outcomes. In a second paper, we aimed to quantify maternal predictors of large for gestational age (LGA) neonates in the Ottawa and Kingston (OaK) birth cohort with specific hypotheses verifying the independent contribution of maternal prepregnancy body mass index (BMI) and excessive gestational weight gain (GWG) to fetal overgrowth. This paper also highlights the clinical utility of the revised 2009 Institute of Medicine GWG guidelines and discusses the potential role of physiological factors underlying the observed associations between BMI, excessive GWG and LGA neonates. As a follow-up to our population-level analysis (i.e., OAK cohort), papers three and four highlight how the insulin-like growth factor (IGF) axis, a vital regulator of growth and development, may be compromised at the molecular level in cases of maternal obesity (paper 3) and excessive GWG (paper 4). In paper 3 we show that maternal obesity is associated with attenuated expression of IGF binding protein-4 (IGFBP4) in umbilical cord blood and discuss how this may preferentially promote fetal adipogenesis. The effects of excessive GWG on IGF axis protein expression are addressed in paper four where we show that excessive weight gain during pregnancy is associated with increased expression of IGFBP3 in maternal circulation in normoglycemic term pregnancies. In this paper we discuss the potential inhibitory role of IGFBP3 on adipogenesis and how it relates to glucose intolerance during pregnancy. Recognizing that both obesity and excessive GWG can alter physiological processes in mother and her baby, appropriate evidence-based interventions are warranted to best optimize outcomes. In paper five, we discuss the results of a study which sought to assess patient information channels and knowledge of nutrition and physical activity during pregnancy with the intent that these findings be applied to best design efficacious strategies that cater to the needs of our target group of pregnant women. In our analysis we show that the majority of pregnant women studied would be willing to participate in a lifestyle intervention for their own personal health and that of their child. Of great interest was the observation that most women were not informed of the importance of pregnancy-specific energy intake, or made aware of their own healthy GWG targets. Additionally, many of the respondents reported receiving no information pertaining to appropriate physical activity recommendations; despite the fact that the vast majority of participants consider this lifestyle modality to be safe during their pregnancy. Finally in paper six, we build on the results of our previous work and evaluate the risks and benefits of physical activity during pregnancy on maternal-fetal outcomes through a review of the literature and note that engaging in non-sedentary pursuits during gestation may aid in maternal weight regulation, protect against metabolic disorders and optimize neonatal birth weight and body composition. Overall, the collective nature of the papers presented in this dissertation provides qualitative and quantitative evidence to support not only the complexity of body weight regulation in the mother and her baby, but also highlights potential avenues for intervention that may improve maternal-fetal outcomes during this critical period.

Events around conception such as maternal undernutrition and twinning may have effects on offspring physiology and disease risk in adulthood. Periconceptional undernutrition alters offspring physiology and adult pathology without affecting birth size, while twinning affects birth size and physiology but with inconsistent effects on adult pathology. We investigated the effects of these two periconceptional events and their interaction on maternal cardiovascular adaptation to pregnancy and fetal growth, physiology and endocrinology in late gestation in sheep. Pre and/or postconception undernutrition resulted in increased uterine blood flow in late gestation, but no change in maternal blood volume. Preconception undernutrition alone resulted in a relatively large placenta with a small, slow-growing fetus in late gestation. In contrast, postconception undernutrition alone resulted in a fetus with rapid late-gestation growth that was maintained through a maternal fast. Fetuses of ewes undernourished throughout both periods were similar in growth rate and size to controls. Maternal fasting also demonstrated that plasma levels of C-type natriuretic peptide are acutely and independently regulated by nutrient supply in mother and fetus. Fetuses of ewes undernourished both pre- and postconception had increased glucose disposal following a glucose challenge. Hypothalamic-pituitary-adrenal axis tests in these fetuses showed decreased pituitary adrenocorticotropin hormone response to direct stimulation but increased adrenal response to decreased cortisol negative feedback. Twin fetuses grew more slowly in late gestation than singletons. Twins also had a smaller insulin response to arginine and a greater insulin response to glucose, but periconceptional undernutrition abolished this difference. Twins had suppressed baseline hypothalamic-pituitary-adrenal axis function and decreased adrenal sensitivity compared to singletons, but increased fetal pituitary adrenocorticotropin hormone response to direct stimulation and decreased cortisol negative feedback. These studies suggest that firstly, fetal size is a poor reflection of fetal growth trajectory, physiology and endocrinology. Secondly, pre- and postconception undernutrition affect late-gestation fetal growth in different ways, while undernutrition in both periods alters fetal endocrine status in late gestation. Thirdly, the biology of twin fetal development is fundamentally different from that of singletons, which may explain the inconsistency of the relationship between birth weight and adult disease risk in twins. / Auckland Medical Research Foundation, Health Research Council of New Zealand