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In this video, we will expand on the material covered in obesity and pregnancy.

As previously discussed,

maternal obesity can cause an increased risk of many pregnancy complications.

If a woman starts her pregnancy already obese,

it is important to take measures to manage this risk.

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.

Most guidelines recommend routine weight check during prenatal visits and

discussion with the patient, about ideal weight gain during pregnancy

to improve maternal and neonatal outcomes.

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.

Healthy eating should be advised already at the beginning of the pregnancy and

reaffirmed again throughout the pregnancy.

Overweight and obese pregnant women have a documented decrease in diet quality, and

this makes dietary counseling in this population even more essential.

Nutritional recommendations include a diet that should be high in fiber with

fresh fruits, vegetables, lean protein, and complex carbohydrates.

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.

The healthcare provider should reaffirm that any physical activity is better

than no physical activity.

And walking and

being active can be appropriate for any woman during pregnancy.

Water exercise is particularly well suited for

obese women since the water buoyancy helps support the weight.

For further information, please see our video on practical tips for

physical activity during pregnancy.

Women who enter into pregnancy obese are also at increased risk of nutrient

deficiencies, in particular, deficiencies of folic acid and vitamin D.

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.

The Center for Maternal and

Child Enquiry jointly with the Royal College of Obstetrics and

Gynecology, recommend that women with a body mass index higher than 29.9 should

take a supplement on top of their diet, with 5 milligram folic acid daily.

In contrast, the recommended folic acid dosage for women with a healthy BMI,

of course, is only 400 micrograms daily.

Also in pregnant women,

BMI is inversely associated with the serum concentrations of vitamin D.

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.

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.

Hence, obese women have an even higher prevalence of vitamin D

deficiency during pregnancy.

Recently, the Royal College of Obstetrics and

Gynecology recommended that obese pregnant women should be taking

at least 1,000 units a day of vitamin D supplementation.

Pregnant women generally have an increase motivation to change their lifestyle

habits in order to improve their own health and

the health of their unborn child.

Hence, lifestyle interventions are prevalent during pregnancy and

may have a real potential to minimize maternal and neonatal complications.

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.

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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.

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.

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.

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.

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.

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>> 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.

Weight retention after birth, or postpartum weight retention,

is an important risk factor for lasting obesity and overweight.

Risk factors for postpartum weight retention include a high

body mass index before pregnancy, the lack of breast feeding,

the lack of postpartum exercise and excessive gestational weight gain.

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.

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Obesity: Management During Pregnancy

Nutrition and Lifestyle in Pregnancy

Meet the Instructors