There has been a significant increase over the past few decades in the number of reproductive age women who are either overweight or
obese. Overweight and obese women are at increased risk for having decreased insulin sensitivity as compared with lean or average
weight women. The combination of obesity and decreased insulin sensitivity increases the long-term risk of these individuals developing
the metabolic syndrome and associated problems of diabetes, hypertension, hyperlipidemia, and cardiovascular disorders. Because of the
metabolic alterations during normal pregnancy, particularly the 60% decrease in insulin sensitivity, overweight and obese women are at
increased risk of metabolic dysregulation in pregnancy, i.e. gestational diabetes, preeclampsia, and fetal overgrowth. Hence, pregnancy
can be considered as a metabolic stress test for the future risk of the metabolic syndrome. In this review, we will review the underlying
pathophysiology related to these disorders. Most importantly, an understanding of these risks provides an opportunity for prevention.
For example, a planned pregnancy offers an opportunity to address weight control prior to conception. At the very least, by avoiding
excessive weight gain during pregnancy, this may prevent excessive weight retention post partum. Finally, based on the concept of in utero