Over 50% of Australian women enter pregnancy overweight or obese. Preconception higher BMI independently increases complications including gestational diabetes mellitus, preeclampsia, caesarean section, and large-for-gestational-age infants. Intergenerational epigenetic risks are alarming, with maternal weight at conception a key determinant of childhood obesity and those born to mothers with obesity, in turn, having twice the rate of obesity, higher insulin resistance and metabolic syndrome. In pregnancy, excessive gestational weight gain (GWG) above US Institute of Medicine (IOM) recommendations occurs in over 40% of pregnancies in Australia and in developed countries internationally, with every kilogram above IOM recommendations increasing adverse maternal and foetal and child outcomes by ~10%. Approximately, 57% of Aboriginal and Torres Strait Islander women are overweight or obese at conception16 and CALD women also experience high rates of excessive GWG.
Despite years of research, millions of dollars invested in preconception programs and in RCTs in pregnancy, implementation and translation of evidence is lacking. Crucial knowledge gaps now rest in implementation research, translation, workforce development and collaboration. In 2019 a Centre of Research Excellence was awarded by the Australian National Health and Medical Research Council to support a multidisciplinary international research team to generate the new knowledge needed to improve lifestyle preconception and in pregnancy, and reduce maternal obesity. Our Health in Preconception and Pregnancy (HiPP) initiative is also global, having formed the first Global Alliance for HiPP in September 2018 with representatives from all continents, including consumers. This paper outlines >10 years of research from our Centre and investigators and covers three areas of focus: (1) how to promote active agency in preconception women to prioritise lifestyle health and weight management prior to conception; (2) how to implement multifaceted obesity prevention strategies in pregnancy; (3) co-designing and testing culturally relevant models of preconception and pregnancy lifestyle health care.