THE NEW BABY-MAKING DIET
Australian-first study looks to prove getting trim before you get pregnant as important as folate
LOSING weight before getting pregnant may be as important for your baby’s health as stopping smoking and taking folate.
An Australian-first study is hoping to show this simple change could massively reduce the rates of stillbirth, hypertension, diabetes, miscarriage, preterm birth and caesarean delivery.
These are medical complications that not only harm mothers but can even kill their unborn children.
One in two pregnant women is classed as overweight, which has led to issues such as the rate of gestational diabetes almost doubling since 2013, going from 7 per cent to 13 per cent and affecting 12,375 women.
Sydney University researchers are recruiting over- weight women with a body mass index over 25 to participate in a trial that will test two weight loss programs before conception.
If this pilot study is a success, a much wider study will take place.
Royal Prince Alfred neonatologist Dr Adrienne Gordon said losing weight before getting pregnant can boost fertility, increasing a woman’s ability to fall pregnant naturally.
Compared with women with a healthy BMI, overweight women have more fertility problems. A study in fertility conducted by Royal Prince Alfred Hospital found weight loss was associated with a three-fold increase in live births. Conversely, being overweight during pregnancy can have a major impact on both the mother and child.
“One in two pregnant women are overweight, that is the new normal,” Dr Gordon said. “The downstream effects include a higher rate of miscarriage, stillbirth, preterm birth, gestational diabetes, high blood pressure and a higher rate of caesarean sections.
“Babies born to overweight mothers are generally larger and a larger birth weight is a risk factor for childhood obesity.
“Losing weight could be like normal preparation for pregnancy — like taking folate and stopping smoking.
“The big picture in the short term is to improve outcomes for both mother and baby, reduce preterm birth, stillbirth and the like. In the long term, it is to reduce metabolic disease in the next generation.
“If you have gestational diabetes, you are five to seven times more likely to develop type two diabetes. So we want to reduce mothers’ risk of these things in pregnancy because it reduces the risk of developing these things later in life.”
Maternal obesity is now considered one of the most commonly occurring risk factors seen in obstetrics — and the associated statistics are stark.
A Swedish study of 805,275 pregnancies found that women with a BMI over 29 were twice as like-
ly to develop the potentially deadly pre-eclampsia. And another Australian study showed the rate of pregnancy-induced hypertension/pre-eclampsia was much higher in overweight women — 9.1 per cent compared to 2.4 per cent in normal-weight women. The condition can kill both mother and child.
Studies have also found that emergency caesarean section rates were higher for obese women compared with women with a healthy BMI (27 per cent compared to 19 per cent).
A meta-analysis of nine studies found a doubling in the risk of stillbirth among obese women. Women with a BMI over 30 had a stillbirth rate of 6.9 per 1000 births compared with 4 per 1000 in women with a healthy BMI.
“Under and over-nutrition affects metabolically how babies will respond in life,” Dr Gordon said.
And, while weight-loss studies have been conducted in women with fertility problems, this pilot study is the first of its kind to target the general population of women before conception.
The trial will randomly place 60 women on one of two weightloss programs over 10 weeks.
One will be an online supported weight-loss program called Flexi. The diet consists of two meal replacement shakes with a high-protein dinner for six days and one day of eating normally.
The control group will be put on the Get Healthy NSW program, which provides online resources, coaching and a healthy eating plan.
“We want to look at which one will work well in the pilot before we conduct a larger study,” Dr Gordon said.
Aedin Treloar, 39, signed up for the trial two weeks ago. She has been on the Flexi diet, as well as exercising most days (“toddler and work dependent”) and has already lost four kilograms.
“I just felt like I needed to be in the best health I could before I got pregnant and I thought well, this will help me lose the baby weight,” she said.
She was always in good shape and even went to boot camp during her first pregnancy but after her first child 19 months ago, bad eating habits led to weight gain. At 87kg, her BMI is around 31.
“I gained 9kg after I had my baby when I was breastfeeding because you’re tired and you make bad choices. I just overate,” she said.
The Earlwood midwife has seen the downside of carrying too much weight during pregnancy among her patients.
“Absolutely, you see people eating for two and it’s not a good place to be, you need to be as fit as you can be,” she said. WOMEN WITH A BMI ABOVE OR EQUAL TO 25 AND PLANNING A PREGNANCY IN THE NEXT 6 TO 12 MONTHS CAN CONTACT CPC. [email protected]NEY.EDU. AU
Aedin Treloar is taking part in the study and has been placed in the Flexi control group.
Lead researcher Dr Adrienne Gordon hopes her study will help her tiny patients such as Isabella Warner. Picture: Sam Ruttyn