Skip to main content
Log in

Lifestyle After Bariatric Surgery: a Multicenter, Prospective Cohort Study in Pregnant Women

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

To ensure a good pregnancy outcome after bariatric surgery, a healthy life-style and a multidisciplinary prenatal follow-up is recommended. The aim of this prospective multicenter trial was to compare diet quality and physical activity (PA) of pregnant women with bariatric surgery with current lifestyle recommendations.

Methods

Pregnant women (>18 years, prepregnancy BMI 28 ± 6 kg/m², 39 % nulliparae, 25 % smokers) with a history of bariatric surgery were recruited and allocated to two groups according to surgery type: restrictive (N = 18) and bypass group (N = 31). One 7-day dietary record and one Kaiser questionnaire on PA were collected during the first and second trimester. Dietary quality was assessed using the Healthy Eating Index.

Results

The diet quality did not change during pregnancy (restrictive group p = 0.050; bypass group p = 0.975) and was comparable between groups (first trimester p = 0.426; second trimester p = 0.937). During the first trimester, 15 % of the pregnant women had a healthy diet quality, 82 % had a diet that needed improvement, and 3 % had a poor diet quality. This was independent of surgery type and was comparable in the second trimester (p = 0.525). No difference between groups was observed for the PA level, but the PA level in the bypass group significantly decreased from the first to the second trimester (p = 0.033).

Conclusions

Nutritional advice and lifestyle coaching in this high-risk population seems recommendable since only 15 % of the pregnant women had a healthy diet quality, 25 % was smoking at the beginning of pregnancy, and the reported PA levels were low.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  PubMed  CAS  Google Scholar 

  2. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. 215–357, iii-iv.

    CAS  Google Scholar 

  3. Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond). 2007;31(8):1248–61.

    Article  CAS  Google Scholar 

  4. Poitou Bernert C, Ciangura C, Coupaye M, et al. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab. 2007;33(1):13–24.

    Article  PubMed  CAS  Google Scholar 

  5. Sarwer DB, Wadden TA, Moore RH, et al. Preoperative eating behavior, postoperative dietary adherence, and weight loss after gastric bypass surgery. Surg Obes Relat Dis. 2008;4(5):640–6.

    Article  PubMed  Google Scholar 

  6. Jacobi D, Ciangura C, Couet C, et al. Physical activity and weight loss following bariatric surgery. Obes Rev. 2011;12(5):366–77.

    Article  PubMed  CAS  Google Scholar 

  7. Elkins G, Whitfield P, Marcus J, et al. Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg. 2005;15(4):546–51.

    Article  PubMed  Google Scholar 

  8. Mathus-Vliegen EM. Long-term health and psychosocial outcomes from surgically induced weight loss: results obtained in patients not attending protocolled follow-up visits. Int J Obes (Lond). 2007;31(2):299–307.

    Article  CAS  Google Scholar 

  9. Phelan S. Pregnancy: a "teachable moment" for weight control and obesity prevention. Am J Obstet Gynecol. 2010;202(2):135. e1-8.

    Article  PubMed  Google Scholar 

  10. Institute of Medicine (IOM). Weight gain during pregnancy: reexamining the guidelines. Washington, DC: The National Academies Press; 2009.

    Google Scholar 

  11. Olson CM. Tracking of food choices across the transition to motherhood. J Nutr Educ Behav. 2005;37(3):129–36.

    Article  PubMed  Google Scholar 

  12. Siega-Riz AM, Bodnar LM, Savitz DA. What are pregnant women eating? Nutrient and food group differences by race. Am J Obstet Gynecol. 2002;186(3):480–6.

    Article  PubMed  Google Scholar 

  13. Verbeke W, De Bourdeaudhuij I. Dietary behaviour of pregnant versus non-pregnant women. Appetite. 2007;48(1):78–86.

    Article  PubMed  Google Scholar 

  14. Guelinckx I, Devlieger R, Mullie P, et al. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Am J Clin Nutr. 2010;91(2):373–80.

    Article  PubMed  CAS  Google Scholar 

  15. Ziegler O, Sirveaux MA, Brunaud L, et al. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab. 2009;35(6 Pt 2):544–57.

    Article  PubMed  CAS  Google Scholar 

  16. Burton PR, Brown W, Laurie C, et al. Outcomes, satiety, and adverse upper gastrointestinal symptoms following laparoscopic adjustable gastric banding. Obes Surg. 2011;21(5):574–81.

    Article  PubMed  Google Scholar 

  17. Hoge Gezondheidsraad. Voedingsaanbevelingen voor België, herziening 2009. HGR dossiernummer: 8309.

  18. Hann CS, Rock CL, King I, et al. Validation of the healthy eating index with use of plasma biomarkers in a clinical sample of women. Am J Clin Nutr. 2001;74(4):479–86.

    PubMed  CAS  Google Scholar 

  19. Kennedy ET, Ohls J, Carlson S, et al. The healthy eating index: design and applications. J Am Diet Assoc. 1995;95(10):1103–8.

    Article  PubMed  CAS  Google Scholar 

  20. Kourlaba G, Panagiotakos DB. Dietary quality indices and human health: a review. Maturitas. 2009;62(1):1–8.

    Article  PubMed  Google Scholar 

  21. Guelinckx I, Devlieger R, Vansant G. Alcohol during pregnancy and lactation: recommendations versus real intake. Arch Public Health. 2010;68:134–42.

    Google Scholar 

  22. Schmidt MD, Freedson PS, Pekow P, et al. Validation of the kaiser physical activity survey in pregnant women. Med Sci Sports Exerc. 2006;38(1):42–50.

    Article  PubMed  Google Scholar 

  23. Ainsworth BE, Sternfeld B, Richardson MT, et al. Evaluation of the kaiser physical activity survey in women. Med Sci Sports Exerc. 2000;32(7):1327–38.

    Article  PubMed  CAS  Google Scholar 

  24. Guelinckx I, Vansant G, Devlieger R. A prospective study analysing nutritional status during pregnancy and pregnancy outcome of women with bariatric surgery. 2011;submitted.

  25. Carpenter M, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obest Gynecol. 1982;144:768–73.

    CAS  Google Scholar 

  26. Guelinckx I, Devlieger R, Bel S, et al. Lifestyle of pregnant women with bariatric surgery. Submitted.

  27. Devriese S, Huybrechts I, Moreau M, et al. De Belgische Voedselconsumptiepeiling 1–2004. Wetenschappelijk Instituut Volksgezondheid, Afdeling Epidemiologie, 2006.

  28. Poudevigne MS, O'Connor PJ. A review of physical activity patterns in pregnant women and their relationship to psychological health. Sports Med. 2006;36(1):19–38.

    Article  PubMed  Google Scholar 

  29. Zhang C, Solomon CG, Manson JE, et al. A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Intern Med. 2006;166(5):543–8.

    Article  PubMed  Google Scholar 

  30. Van der Heyden J, Gisle L, Demarest S, et al. Gezondheidsenquête België, 2008. Rapport I - Gezondheidstoestand. Brussel: Operationele Directie Volksgezondheid en surveillance 2010, Wetenschappelijk Instituut Volksgezondheid.

  31. Guelinckx I, Devlieger R, Vansant G. Reproductive outcome after bariatric surgery: a critical review. Hum Reprod Update. 2009;15(2):189–201.

    Article  PubMed  Google Scholar 

  32. Pauly JR, Slotkin TA. Maternal tobacco smoking, nicotine replacement, and neurobehavioural development. Acta Paediatr. 2008;97(10):1331–7.

    Article  PubMed  Google Scholar 

  33. Prochaska JO, DiClemente CC. In: Miller WR, Heather N, editors. Toward a comprehensive model of change. Addictive behaviors: process of change. New York: Plenum; 1986.

    Google Scholar 

  34. Rubak S, Sandbaek A, Lauritzen T, et al. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305–12.

    PubMed  Google Scholar 

  35. Kulick D, Hark L, Deen D. The bariatric surgery patient: a growing role for registered dietitians. J Am Diet Assoc. 2010;110(4):593–9.

    Article  PubMed  Google Scholar 

  36. Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obes Surg. 2008;18(8):1023–7.

    Article  PubMed  Google Scholar 

  37. Kaiser L, Allen LH. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc. 2008;108(3):553–61.

    Article  PubMed  CAS  Google Scholar 

  38. Harbottle L. Audit of nutritional and dietary outcomes of bariatric surgery patients. Obes Rev. 2011;12(3):198–204.

    Article  PubMed  CAS  Google Scholar 

  39. Stevens-Simon C, Roghmann KJ, McAnarney ER. Relationship of self-reported prepregnant weight and weight gain during pregnancy to maternal body habitus and age. J Am Diet Assoc. 1992;92(1):85–7.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

IG was funded by a postdoctoral grant from the K.U.Leuven (2010–2011). RD is a recipient of a postdoctoral research grant from the FWO Flanders (2010–2015).

Conflict of Interest

All authors state to have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Devlieger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guelinckx, I., Devlieger, R., Donceel, P. et al. Lifestyle After Bariatric Surgery: a Multicenter, Prospective Cohort Study in Pregnant Women. OBES SURG 22, 1456–1464 (2012). https://doi.org/10.1007/s11695-012-0675-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-012-0675-3

Keywords

Navigation