Aus­tralian-first study looks to prove get­ting trim be­fore you get preg­nant as im­por­tant as fo­late

The Sunday Telegraph (Sydney) - - THE SNITCH - JANE HANSEN

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

Pic­ture: Sam Rut­tyn

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

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