Abstract
The aim is to decrease the prevalence of pregnancy and birth-related complications (pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), caesarean section (CS), and large-for-gestational-age babies (LGA)). These complications occur in 26% of pregnancies with normal start BMI and adequate weight gain, in 34% in normal start BMI but excessive gestational weight gain and in up to 66% in obese class III (BMI≥40kg/m²) combined with excessive gestational weight gain (table 1, B1). Moreover, as the prevalence of maternal obesity continues to rise, increasing numbers of children are exposed to an 'obesogenic intrauterine environment'. Obesity in pregnancy has therefore the potential to result in an 'intergenerational cycle' of obesity through in utero programming.
We focus on women with excessive weight gain during their 1st pregnancy as currently, half of them do not return to their pre-pregnancy weight before the next pregnancy. This results in a complication rate as high as 42% (PIH, GDM, CS, LGA). We target a healthy BMI at start of pregnancy by intervening during the pre-conception period- and an adequate weight gain during pregnancy by intervening during pregnancy in these women. The intervention will be evaluated in a randomized controlled trial including 1,100 women.
Our proposed intervention combines face-to-face coaching with the use of a mobile App connected to medical devices (scale and pedometer). The app monitors women's weight, eating behaviour, physical activity, mental wellbeing, and provides continuously coaching through positive behavioral change techniques. The 'inter-Act' App (during pre-conception, will be developed in the course of this project) covers breast-feeding support, while 'ZWApp' (during pregnancy, prototype available) includes the gestational weight gain guidelines of the Institute of Medicine (IOM).
Drop out of less motivated women is avoided as the time points of the six pre-conception coaching sessions coincide with the existing postnatal follow-up visits for neonates (Governmental vaccination scheme through the organisation " Kind & Gezin"), and the three pregnancy coaching sessions coincide with the three routine ultrasound scans during normal pregnancy (KCE Guidelines).
Each year, there are 8,900 singleton pregnancies in whom the mother had excessive gestational weight gain in the prior pregnancy. The current rate of at least one of the four major pregnancy and birth-related complications (PIH, GDM, CS, LGA) in the 8,900 pregnancies is 42%. If we can reduce this with 1/4, we prevent complications in more than 900 pregnancies, and reduce the costs of related caesarean sections, gestational diabetes, obesity in mother & child.
Utilisation of study results into Flanders is facilitated as the advisory committee covers all important Flemish health care organisations: RIZIV, Kind & Gezin (huizen van het kind), Academic Centre for General Practice, organizations of midwives, dieticians, 'Wit-Gele Kruis', knowledge center Eetexpert.
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