Isabelle Guelinckx

Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial

BACKGROUND Maternal obesity and excessive gestational weight gain (GWG) are major short- and long-term risk factors for maternal and fetal complications. OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits, increase physical activity (PA), and reduce GWG in obese pregnant women. DESIGN In this randomized controlled trial, 195 white, obese pregnant women [age: 29 + or - 4 y; body mass index (in kg/m(2)); 33.6 + or - 4.2] were randomly assigned into 3 groups: a group that received nutritional advice from a brochure, a group that received the brochure and lifestyle education by a nutritionist, and a control group. Nutritional habits were evaluated every trimester through 7-d food records. PA was evaluated with the Baecke questionnaire. RESULTS Energy intake did not change during pregnancy and was comparable in all groups. Fat intake, specifically saturated fat intake, decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group. Calcium intake and vegetable consumption increased during pregnancy in all groups. PA decreased in all groups, especially in the third trimester. No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups. CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy. Neither PA nor GWG was affected.

Reproductive outcome after bariatric surgery: a critical review

BACKGROUND After many cycles of weight loss and weight gain, more and more morbidly obese patients undergo bariatric surgery, like gastric banding or gastric bypass, as the ultimate treatment for their obesity-problem. Since women of reproductive age are candidates for bariatric surgery, concerns arise regarding the potential impact on future pregnancy. METHODS English-language articles were identified in a PUBMED search from 1982 to January 2008 using the keywords for pregnancy and bariatric surgery or gastric bypass or gastric banding. RESULTS The few reported case-control and cohort studies clearly show improved fertility and a reduced risk in obstetrical complications, including gestational diabetes, macrosomia and hypertensive disorders of pregnancy, in women after operatively induced weight loss when compared with morbidly obesity women. The incidence of intrauterine growth restriction (IUGR) appears to be increased, however. No conclusions can be drawn concerning the risk for preterm labour and miscarriage, although these risks are probably increased compared with controls matched for body mass index. Operative complications are not uncommon with bariatric surgery and several cases have pointed to the increased risk for intestinal hernias and nutritional deficiencies in subsequent pregnancy. Deficiencies in iron, vitamin A, vitamin B(12), vitamin K, folate and calcium can result in both maternal complications, such as severe anaemia, and fetal complications, such as congenital abnormalities, IUGR and failure to thrive. CONCLUSIONS Close supervision before, during and after pregnancy following bariatric surgery and nutrient supplementation adapted to the patients individual requirements can help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population.

The effect of pre-pregnancy BMI on intention, initiation and duration of breast-feeding

OBJECTIVE To determine whether pre-pregnancy BMI influences breast-feeding practice. DESIGN Retrospective epidemiological study. SETTING University Hospital Leuven, Catholic University Leuven, Belgium. SUBJECTS Two hundred women (median age 29 years, interquartile range (IQR) 4; 52 % nulliparae) were grouped into four categories according to pre-pregnancy BMI using WHO cut-offs. RESULTS The incidence of intention and initiation of breast-feeding was significantly lower in underweight (64 %) and obese women (68 %) compared with normal weight (92 %) and overweight women (80 %). Initiation was also related to parity (OR = 0.582; 95 % CI 0.400, 0.846), but not to gestational weight gain, method of delivery or hypertensive disorders. Fifty-two per cent of underweight, 70 % of normal weight and 56 % of overweight women were exclusively breast-feeding their infant during the first month of life. This incidence was significantly lower in the obese group (34 %; P = 0.030). Only 40 % of all infants were exclusively breast-fed at 3 months of age, with the lowest prevalence among women with obesity (P = 0.0 0 1). The median duration of any breast-feeding in the obese group (1.8 months, IQR 3.4) was significantly shorter than in the underweight (3.0 months, IQR 3.1), normal weight (3.0 months, IQR 2.4) and overweight group (3.0 months, IQR 3.5; P = 0.024). Reasons given for ceasing breast-feeding in the obese group were maternal complications (29 %), insufficient milk supply (23 %), sucking problems (21 %) and work resumption (21 %). CONCLUSIONS Breast-feeding practice in the total population, but especially among women with obesity, fell short of global WHO recommended standards. Policy initiatives and local interventions should continue to support breast-feeding, but also prevent maternal obesity.

Anxiety and depressed mood in obese pregnant women : A prospective controlled cohort study

Background: The psychological health in obese women during pregnancy has been poorly studied. Objective: To compare levels of anxiety and depressed mood during pregnancy in obese versus normal-weight women. Methods: 63 obese pregnant women and 156 normal-weight controls were included prospectively before 15 weeks of gestation. Levels of state and trait anxiety and depressed mood were measured during the first, second and third trimester of pregnancy. A linear mixed-effect model with repeated measures was used to evaluate group differences. Results: The levels of state anxiety significantly increased from trimester 1 to trimester 3 in obese pregnant women (beta = 3.70; p = 0.007), while this parameter remained constant throughout pregnancy in normal-weight women. Levels of trait anxiety and depressed mood significantly decreased from trimester 1 to trimester 2 in controls, but not in obese pregnant women. Variables such as maternal education, ethnicity, marital state, psychological history and miscarriages, parity and smoking behaviour had significant effects on anxiety and/or depressed moods during pregnancy. Obese pregnant women show higher levels of anxiety and depressive symptomatology compared to normal-weight pregnant women. Conclusion: Interventional programmes aiming at preventing the deleterious influence of maternal obesity on perinatal outcomes should include a psycho-educational program specifically tailored to this high-risk group.

Trends in the evolution of BMI in Belgian army men

OBJECTIVES The first aim was to evaluate BMI cross-sectionally over a period of 14 years (1992 to 2005) in 43,343 army men and the second was to compare BMI using the paired data of 1497 army men. The data were analysed as a function of the military ranking system, used as an indicator for socio-economic position. DESIGN Multiple cross-sectional and longitudinal design. RESULTS A significant increase of BMI between age categories was detected over the 14-year period; BMI remained stable in each age category. In the paired cohort, median BMI increased during the same period from 23.9 (interquartile range 3.3) kg/m2 to 24.7 (interquartile range 3.5) kg/m2 (P < 0.0001). This age-dependent evolution was present in all military rankings. From age 40 years or more, BMI indicated a significant increase in the prevalence of overweight and obesity. CONCLUSION For the total cohort, BMI remained stable in each age category. For the paired cohort, BMI increased over time. The military leadership should emphasize prevention in order to reduce the health-care costs and disease burden in this cohort. This emphasis on prevention should target those aged less than 40 years.

Construction of weight gain charts in a low-risk obstetric Belgian population.

Aim: To generate reference charts for weight gain during pregnancy for the different BMI categories (underweight, normal weight, overweight, obesity), based on recent data in a homogeneous, Caucasian, low-risk obstetric population. Methods: Weight gain and prepregnancy BMI were retrospectively gathered from 605 pregnant Belgian women with accurately dateable, uncomplicated singleton pregnancies. Percentile curves for the different BMI categories were constructed using the linear mixed model, based on absolute weight gain. The effect of parity on weight gain was examined. Results: Overall mean weight gain was 14.8 kg (±4.7). Weight gain differed significantly between underweight (15.4 ± 4.1 kg) and obese patients (12.0 ± 5.9 kg), between patients with normal weight (15.1 ± 4.5 kg) and overweight patients (13.7 ± 5.3 kg), and between normal-weight and obese patients. Parity had a statistical, but no clinically significant, influence on amount and evolution of weight gain. Conclusion: By using strict inclusion criteria, BMI-category-specific reference charts were generated representing, in terms of outcome, the optimal weight gain during pregnancy rather than the mean observed weight gain. This enables the weight charts to be used as a clinical tool during the counseling of pregnant women.

Pregnancy Following Bariatric Surgery

Bariatric surgery such as the laparoscopic adjustable gastric-banding or Roux-en-Y gastric bypass is an effective treatment for morbid obesity. Parallel to the increasing prevalence of obesity, the number of performed bariatric operations is increasing. The predominant part of the patients for this type of surgery are women of reproductive age. Health-care providers will therefore increasingly be confronted with pregnant women with a history of gastric surgery. The impact of this surgery on fertility, pregnancy and neonatal outcome is discussed in the book chapter, as well as the potential mechanic complications and nutritional deficiencies due to the surgery. This high-risk subpopulation of pregnant women should be guided by a multidisciplinary team. The recommendations made at the end of the chapter can assist the team in the clinical guidance during the preconceptional, prenatal, and postpartum period.

Alcohol during pregnancy and lactation: recommendations versus real intake

IntroductionEven though total abstinence of alcohol for pregnant and lactating women is recommended, consumption prevalences ranging from 12% up to 30% have been reported. No Belgian data on alcohol consumption in pregnant women were recently published.MethodsFirst, a literature search on the effects of alcohol consumption during pregnancy and lactation was performed in the MEDLINE database using Pubmed. Secondly, in a prospective study the alcohol consumption of 215 Belgian women was evaluated every trimester through 7-day food records. The international standard unit for alcohol or 1 standard glass equals 13.5 g pure ethanol. Binge drinking was defined as drinking more than 50 g on one occasion.ResultsPrenatal exposure of the foetus to alcohol can lead to a broad range of anomalies, including pre- and postnatal growth retardation, preterm delivery, central or craniofacial dysmorphia, neurological and behavioural disorders and disorders of cognitive function, which can persist throughout adulthood. In the Belgian study population, total abstinence of alcohol was seen in 76% of the women. Of the 24% of women who consumed alcohol, 13.9% consumed alcohol during 1 of the 3 weeks. These women were considered to be low consumers. Five women (2.5%) reported drinking during all 3 weeks of recording. This could suggest that these women drink more regularly. No binge drinking was recorded. The maximum amount was 5 consumptions per week.ConclusionEven though total abstinence of alcohol for pregnant and lactating women is recommended, at least 25% of pregnant women still consumes alcohol. Health care providers have to be aware of the underreporting of alcohol use by pregnant women, especially if they drink heavily since they fear of being stigmatised.

Establishing a Belgian Nutrition Society (BNS): Filling The Void

Cani Patrice, Clarys Peter, Clinquart Antoine, De Henauw Stefaan, Delzenne Nathalie, Deriemaeker Peter, Douny Caroline, Guelinckx Isabelle, Huybrechts Inge, Huybregts Lieven, Kolsteren Patrick, Lachat Carl, Laquiere Isabelle, Larondelle Yvan, Leroy Jef, Manghuin-Rogister Guy, Matthys Christophe, Mullie Patrick, Neve Jean, Scippo Marie-Louise, Sioen Isabelle, Remaut Anne-Marie, Van Camp John, Vandevijvere Stefanie, Vansant Margareta