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NELIP) for Obese Pregnant Women Into Clinical Practice Western University Scholarship@Western Electronic Thesis and Dissertation Repository 10-8-2015 12:00 AM Bringing an Evidence-Based Nutrition and Exercise Lifestyle Intervention Program (NELIP) for Obese Pregnant Women into Clinical Practice Samantha Langstaff University of Western Ontario Supervisor Dr. Michelle Mottola The University of Western Ontario Graduate Program in Kinesiology A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Science © Samantha Langstaff 2015 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Obstetrics and Gynecology Commons Recommended Citation Langstaff, Samantha, "Bringing an Evidence-Based Nutrition and Exercise Lifestyle Intervention Program (NELIP) for Obese Pregnant Women into Clinical Practice" (2015). Electronic Thesis and Dissertation Repository. 3290. https://ir.lib.uwo.ca/etd/3290 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. BRINGING AN EVIDENCE-BASED NUTRITION AND EXERCISE LIFESTYLE INTERVENTION PROGRAM (NELIP) FOR OBESE PREGNANT WOMEN INTO CLINICAL PRACTICE by Samantha Langstaff Graduate Program in Kinesiology A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science The School of Graduate and Postdoctoral Studies The University of Western Ontario London, Ontario, Canada © Samantha Langstaff 2015 Abstract One purpose was to identify the need for specialized care (My Clinic) for women with a pre- pregnancy body mass index (BMI) of ≥ 35 kg/m2. Women receiving My Clinic care were compared to a matched cohort control group (perinatal database, N=47). My Clinic care significantly reduced rates of macrosomia (5% vs 28%, p=0.02) and small birth weight babies (0% vs 6%, p=0.00) compared to perinatal database. The second purpose was to test the efficacy of a Nutrition and Exercise Lifestyle Intervention Program (NELIP) in this clinical setting to prevent excessive weight gain, macrosmia, small birth weight babies and pregnancy complications. Twelve women with a BMI ≥ 35 kg/m2 were randomized between 12-20 weeks of pregnancy to Nutrition-only, Exercise-only, or full NELIP. Exercise-only intervention reduced rate of weight gain (0.15 ± 0.13 kg/week vs 0.61 ± 0.12 kg/week, p=0.01) compared to Nutrition-only. Combining a nutrition and exercise intervention appeared difficult for this population, as 100% of the women randomized to full NELIP did not complete the program. Keywords “Obesity, gestational weight gain, exercise and pregnancy, nutrition and pregnancy, gestational diabetes mellitus, macrosomia, small birth weight” ii Co-Authorship Statement (for future publication) Dr. Michelle Mottola - R. Samuel McLaughlin Foundation - Exercise & Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, ON; Department of Anatomy & Cell Biology, The University of Western Ontario, London, ON Dr. Barbra de Vrijer – Obstetrician/Gynaecologist, Associate Scientist, Division of Maternal, Fetal & Newborn Health, Children's Health Research Institute Associate Professor, Maternal- Fetal Medicine Subspecialist, Department of Obstetrics & Gynaecology, The University of Western Ontario, London, ON Dr. Debbie Penava – Obstetrician/Gynaecologist, Associate Scientist, Division of Maternal, Fetal & Newborn Health, Children's Health Research Institute Associate Professor, Department of Obstetrics & Gynaecology, The University of Western Ontario, London, ON Dr. Maggie Sopper - R. Samuel McLaughlin Foundation - Exercise & Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, ON iii Acknowledgments I would like to express my sincere gratitude to all those that helped me throughout the stages of this thesis process. In particular, I am appreciative and thankful for: • Dr. Mottola, for not only her wealth of knowledge, but also her undying patience, constant enthusiasm and encouragement that has helped guide and support me throughout this process. • Dr. de Vrijer and Dr. Penava, for providing the opportunity for this project and allowing me to gain invaluable clinical experience. Special thanks to them for their never-ending patient recruitment. • Melissa, Jen, Amanda and the nursing staff, for their assistance in patient recruitment, nutrition analysis, patient counseling, blood work, and simply the Monday morning chats. • Maggie, for her assistance in data collection and blood draw analysis. • My fellow kinesiology graduate students, for making this experience a great one. • My family, for their unconditional love and support. iv Table of Contents Abstract ..................................................................................................................................... ii Co-Authorship Statement (for future publication) ................................................................... iii Acknowledgments .................................................................................................................... iv Table of Contents ...................................................................................................................... v List of Tables .......................................................................................................................... vii List of Figures ........................................................................................................................ viii List of Appendices .................................................................................................................. ix Chapter 1 ................................................................................................................................... 1 1 Obesity ................................................................................................................................ 1 1.1 Prevalence of Obesity .................................................................................................. 1 1.1.1 Obesity Management ............................................................................................. 2 1.1.2 Psychosocial Issues of Obesity ............................................................................. 3 1.1.3 Physical Activity and Obesity ............................................................................... 4 1.1.4 Barriers to Physical Activity in Obese Individuals ............................................... 4 1.1.5 Challenges and Barriers of Obesity ....................................................................... 5 1.1.6 Obesity and Health Care Practitioners .................................................................. 6 1.2 Maternal Obesity in Pregnancy ................................................................................... 7 1.2.1 Maternal Obesity Increases Pregnancy Complications ......................................... 8 1.2.2 Maternal Obesity Increases Childhood Obesity Risk ........................................... 9 1.2.3 Maternal Obesity and Gestational Diabetes Mellitus (GDM) Risk .................... 10 1.2.4 Physical Activity During Pregnancy in Non-Obese Women .............................. 12 1.2.5 Assessing Physical Activity Readiness During Pregnancy ................................. 13 1.2.6 Pregnancy Weight Gain Guidelines .................................................................... 13 1.2.7 New Literature in Pregnancy Weight Gain Guidelines ....................................... 15 1.2.8 Excessive Gestational Weight Gain and Weight Retention ................................ 17 1.2.9 Maternal Obesity Management ........................................................................... 17 1.2.10 Difficulty of Behaviour Change and Obesity .................................................... 18 v Chapter 2 ................................................................................................................................. 24 2 Purpose ............................................................................................................................. 24 2.1 Hypotheses ................................................................................................................. 25 Chapter 3 ................................................................................................................................. 26 3 Methodology ..................................................................................................................... 26 3.1 Perinatal Database ..................................................................................................... 26 3.2 Standard Care Procedure at My Clinic ....................................................................... 26 3.3 My Clinic Randomized Controlled Trial ................................................................... 27 3.3.1 Participants .......................................................................................................... 27 3.3.2 Randomization .................................................................................................... 27 3.3.3 Intervention Procedure at My Clinic ................................................................... 28 3.4 Outcome Measurements ...........................................................................................
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