0:27
Many countries around the world have published specific guidelines
addressing obesity during pregnancy.
The main messages to take from these recommendations are,
moderate gestational weight gain, offer dietary counseling on healthy eating,
encourage physical activity and increase micronutrient intakes.
1:05
However, currently there is some discussion
about the adequacy of guidance on gestational weight gain.
The Institute of Medicine in the US, has provided specific numbers for
desirable weight gain based on different BMI at the outset of pregnancy.
But these are based on observational studies and
testing by interventional studies is not yet available.
And, therefore, a number of recommendations in the world
have questioned whether the IOM guidelines should and
can be translated directly to clinical practice.
We hope that further information will become available from ongoing
intervention studies.
2:20
Foods that contain large amounts of sugar, saturated fats, and
cholesterol should be avoided.
Ideally, all obese pregnant women should be encouraged to consult with
a nutritionist already early in pregnancy, so that an individualized diet and
exercise plan can be developed for the whole pregnancy.
3:19
Evidence has shown that the risk of neural tube defects among obese
pregnant women is double that of women with normal BMI.
And, therefore, these obese women who wish to become pregnant
should be advised to take a higher dosage of folic acid supplementation daily,
starting at least one month before conception and
continuing throughout at least the first trimester of pregnancy.
4:23
Obese women are at a markedly increased risk of vitamin D deficiency
compared to women with BMI in the normal range.
And the offspring of obese women,
also have lower levels of vitamin D in their cord blood.
4:37
The prevalence of vitamin D deficiency in pregnant women can be quite high in some
populations, reaching, for example, one third in the USA, 35% in
the UK and 77% in Germany.
Vitamin D is believed to be sequestered in the adipose tissue,
making it less available in obese people.
5:39
The need to intervene, even before conception, and
to reduce the effects of an obesogenic environment on the pregnant woman and
on the unborn child, is highly important.
Lifestyle changes, which include modification of diet and
enhancement of physical activity, are the most prevalent type of interventions
attempted to manage excessive body mass index before pregnancy and
excessive gestational weight gain during the course of pregnancy.
[MUSIC]
So I've been involved in a very large study of obese pregnant women,
which is called the UPBEAT Trial.
And we studied one and
a half thousand obese pregnant women from across the United Kingdom.
I was encouraged to do that because
of a number of issues which hadn't been sorted out.
Essentially, one was,
how to we get the message across healthy nutrition to obese pregnant women?
The second was, if we actually do get the message across,
can we really help those adverse pregnancy outcomes?
We didn't know that.
The only studies which had been done up to that point were in small numbers of women
and, therefore, really weren't conclusive one way or another.
So we decided to undertake a very large study.
We started off for over a year planning how we were going to do it.
So we looked into the psychology of how we were going to ask women to
change their nutritional behavior.
Also, their physical activity.
7:08
We went to good experts in the field,
people who really understood psychology, understood obesity.
And we developed an intervention that was based on theory.
Now, a lot of interventions in obese pregnant women have not
been actually focused on established theory of how you change behavior.
So we went to the experts, and we developed this intervention.
And we decided it should be quite long, that's eight weeks, and that it should be
delivered by health trainers, so people who actually coach women, who have some
experience in health training behavior but not a lot, and not expensive to employ.
And that was important,
that we actually translated over to health care in the clinic.
So we invited these women to join in.
Half of the women were randomized to their standard antenatal care with
no intervention, nothing happening.
And the other half were randomized intervention with health trainers.
So what we hoped we'd be able to do is reduce the amount of gestational diabetes
that developed in the women.
So they all had a test for gestational diabetes, which was between 26 and
28 weeks of pregnancy.
8:16
But we also wanted to see if we could change their nutrition.
So we had nutritionists working with us, so
we're carefully estimating what the women were eating in quite a complicated way,
but one which was actually validated, so
we knew what the answer was going to be, if it was going to be right.
So at the end of the study,
we were delighted to see that the women had changed their diet, and that
really hadn't been shown before to the degree that we'd been able to achieve it.
A very substantial improvement in diet.
8:44
And I think the success of that was due to, one,
that it was an established theory that we were using to try to change behavior, but
also that it was the long term duration of the intervention is very important.
Seeing somebody every week for eight weeks, and
there is some evidence to suggest that the more often that
the women have that advice, that they're more likely, obviously, to adopt it.
9:08
Another good thing was that the women didn't put on quite so
much weight during pregnancy, so
there was a significant reduction in their gestational weight gain.
Unfortunately, it wasn't enough to stop all of the gestation diabetes and
there was a lot of it.
So 25% of the women had gestation diabetes because we measured it in everybody, and
we actually knew what the rate was.
The interesting thing is, that we've been following up the children.
And as we'd hoped, this is much in relation to the early nutrition project that,
what you eat in pregnancy can determine the obesity of your child.
We have found that at six months after the intervention,
after delivery, that the children are thinner.
So they're not very much thinner, but they are a bit thinner,
and we know that small amounts of weight reduction or
fat reduction in children can actually be exaggerated when they grow up.
So we're very interested to see over the next year or so, when we're looking
now at three to four year olds, whether they are actually considerably thinner,
those that their mothers received the intervention.
[MUSIC]
>> Many women, in particularly, those who entered pregnancy with a body
mass index of 25 kilogram per meter square or more,
have great difficulties losing weight gained during pregnancy.
10:54
Lifestyle interventions that reduce excessive gestational weight gain and
increase physical activity in obese pregnant women,
may have beneficial effects also on postpartum weight retention and
they can improve health and outcomes also in subsequent pregnancies.
Taking steps to manage obesity in pregnancy is essential in order to
minimize the increased risk of adverse outcomes for mother and
child both in the short and the long term.
[MUSIC]