Offspring of obese women are at increased risk of features of the metabolic syndrome, including obesity and diabetes. Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity. In the Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention (DALI) lifestyle trial, 436 women with a BMI ≥29 kg/m2 were randomly assigned to counselling on healthy eating (HE), physical activity (PA) or HE&PA, or to usual care (UC). In secondary analyses of the lifestyle trial, intervention effects on neonatal outcomes (head, abdominal, arm and leg circumferences and skinfold thicknesses, estimated fat mass, fat percentage, fat-free mass and cord blood leptin) were assessed using multilevel regression analyses. Mediation of intervention effects by lifestyle and gestational weight gain was assessed. Outcomes were available from 334 neonates. A reduction in sum of skinfolds (−1.8 mm; 95% CI −3.5, −0.2; p = 0.03), fat mass (−63 g; 95% CI −124, −2; p = 0.04), fat percentage (−1.2%; 95% CI −2.4%, −0.04%; p = 0.04) and leptin (−3.80 μg/l; 95% CI −7.15, −0.45; p = 0.03) was found in the HE&PA group, and reduced leptin in female neonates in the PA group (−5.79 μg/l; 95% CI −11.43, −0.14; p = 0.05) compared with UC. Reduced sedentary time, but not gestational weight gain, mediated intervention effects on leptin in both the HE&PA and PA groups. The HE&PA intervention resulted in reduced adiposity in neonates. Reduced sedentary time seemed to drive the intervention effect on cord blood leptin. Implications for future adiposity and diabetes risk of the offspring need to be elucidated. ISRCTN70595832.

A better understanding of what drives behaviour change in obese pregnant overweight women is needed to improve the effectiveness of lifestyle interventions in this group at risk for gestational diabetes (GDM). Therefore, we assessed which factors mediated behaviour change in the Vitamin D and Lifestyle Intervention for GDM Prevention (DALI) Lifestyle Study. A total of 436 women, with pre-pregnancy body mass index ≥29 kg/m2, ≤19 + 6 weeks of gestation and without GDM, were randomised for counselling based on motivational interviewing (MI) on healthy eating and physical activity, healthy eating alone, physical activity alone, or to a usual care group. Lifestyle was measured at baseline, and at 24–28 and 35–37 weeks of gestation. Outcome expectancy, risk perception, task self-efficacy and social support were measured at those same time points and considered as possible mediators of intervention effects on lifestyle. All three interventions resulted in increased positive outcome expectancy for GDM reduction, perceived risk to the baby and increased task self-efficacy. The latter mediated intervention effects on physical activity and reduced sugared drink consumption. In conclusion, our MI intervention was successful in increasing task self-efficacy, which was related to improved health behaviours.

Background: Gestational diabetes mellitus (GDM) is associated with perinatal health risks to both mother and offspring, and represents a large economic burden. The DALI study is a multicenter randomized controlled trial, undertaken to add to the knowledge base on the effectiveness of interventions for pregnant women at increased risk for GDM. The purpose of this study was to evaluate the cost-effectiveness of the healthy eating and/or physical activity promotion intervention compared to usual care among pregnant women at increased risk of GDM from a societal perspective. Methods: An economic evaluation was performed alongside a European multicenter-randomized controlled trial. A total of 435 pregnant women at increased risk of GDM in primary and secondary care settings in nine European countries, were recruited and randomly allocated to a healthy eating and physical activity promotion intervention (HE + PA intervention), a healthy eating promotion intervention (HE intervention), or a physical activity promotion intervention (PA intervention). Main outcome measures were gestational weight gain, fasting glucose, insulin resistance (HOMA-IR), quality adjusted life years (QALYs), and societal costs. (Continued on next page) * Correspondence: j.m.van.dongen@vu.nl Department of Health Sciences and EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Health Sciences and EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, The Netherlands Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Broekhuizen et al. International Journal of Behavioral Nutrition and Physical Activity

BJOG: An International Journal of Obstetrics & GynaecologyVolume 125, Issue 10 p. 1338-1339 BJOG Exchange Re: Vitamin D and gestational diabetes mellitus: a systematic review based on data free of Hawthorne effect Rosa Corcoy, Rosa Corcoy CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca de l′Hospital de la Santa Creu i Sant Pau, Barcelona, SpainSearch for more papers by this authorLilian C Mendoza, Lilian C Mendoza Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, SpainSearch for more papers by this authorDavid Simmons, David Simmons Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UKSearch for more papers by this authorGernot Desoye, Gernot Desoye Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, AustriaSearch for more papers by this authorElisabeth R Mathiesen, Elisabeth R Mathiesen Departments of Endocrinology and Obstetrics, Centre for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, DenmarkSearch for more papers by this authorAlexandra Kautzky-Willer, Alexandra Kautzky-Willer Division of Endocrinology, Department of Medicine III, Gender Medicine Unit, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorPeter Damm, Peter Damm Departments of Endocrinology and Obstetrics, Centre for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, DenmarkSearch for more papers by this authorFidelma P Dunne, Fidelma P Dunne National University of Ireland, Galway, IrelandSearch for more papers by this authorEwa Wender-Ozegowska, Ewa Wender-Ozegowska Division of Reproduction, Medical Faculty I, Poznan University of Medical Sciences, Poznan, PolandSearch for more papers by this authorAnnunziata Lapolla, Annunziata Lapolla Universita Degli Studi di Padova, Padua, ItalySearch for more papers by this authorAndre van Assche, Andre van Assche KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, BelgiumSearch for more papers by this authorRoland Devlieger, Roland Devlieger KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, BelgiumSearch for more papers by this authorDavid Hill, David Hill Recherche en Santé Lawson SA, St Gallen, SwitzerlandSearch for more papers by this authorDorte M Jensen, Dorte M Jensen Department of Endocrinology and Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorJuan M Adelantado, Juan M Adelantado Institut de Recerca de l′Hospital de la Santa Creu i Sant Pau, Barcelona, SpainSearch for more papers by this authorAgnieszka Zawiejska, Agnieszka Zawiejska Division of Reproduction, Medical Faculty I, Poznan University of Medical Sciences, Poznan, PolandSearch for more papers by this authorAlessandra Bertolotto, Alessandra Bertolotto Azienda Ospedaliero-Universitaria Pisana, Pisa, ItalySearch for more papers by this authorMaria G Dalfra, Maria G Dalfra Universita Degli Studi di Padova, Padua, ItalySearch for more papers by this authorJürgen Harreiter, Jürgen Harreiter Division of Endocrinology, Department of Medicine III, Gender Medicine Unit, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorSander Galjaard, Sander Galjaard KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, BelgiumSearch for more papers by this authorLise Lotte T Andersen, Lise Lotte T Andersen Department of Endocrinology and Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorMette Tanvig, Mette Tanvig Department of Endocrinology and Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorJudith G Jelsma, Judith G Jelsma Department of Public and Occupational Health, Amsterdam Public Health Research institute, VU University Medical Centre, Amsterdam, the NetherlandsSearch for more papers by this authorGoele Jans, Goele Jans KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, BelgiumSearch for more papers by this authorFrank J Snoek, Frank J Snoek Department of Medical Psychology, VU University Medical Centre and Academic Medical Centre, Amsterdam, the NetherlandsSearch for more papers by this authorMireille N M van Poppel, Mireille N M van Poppel Department of Public and Occupational Health, Amsterdam Public Health Research institute, VU University Medical Centre, Amsterdam, the Netherlands Department of Medical Psychology, VU University Medical Centre and Academic Medical Centre, Amsterdam, the NetherlandsSearch for more papers by this authoron behalf of the DALI Core Investigator group, the DALI Core Investigator group CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, SpainSearch for more papers by this author Rosa Corcoy, Rosa Corcoy CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain Institut de Recerca de l′Hospital de la Santa Creu i Sant Pau, Barcelona, SpainSearch for more papers by this authorLilian C Mendoza, Lilian C Mendoza Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, SpainSearch for more papers by this authorDavid Simmons, David Simmons Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UKSearch for more papers by this authorGernot Desoye, Gernot Desoye Department of Obstetrics and Gynecology, Medizinische Universitaet Graz, Graz, AustriaSearch for more papers by this authorElisabeth R Mathiesen, Elisabeth R Mathiesen Departments of Endocrinology and Obstetrics, Centre for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, DenmarkSearch for more papers by this authorAlexandra Kautzky-Willer, Alexandra Kautzky-Willer Division of Endocrinology, Department of Medicine III, Gender Medicine Unit, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorPeter Damm, Peter Damm Departments of Endocrinology and Obstetrics, Centre for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, DenmarkSearch for more papers by this authorFidelma P Dunne, Fidelma P Dunne National University of Ireland, Galway, IrelandSearch for more papers by this authorEwa Wender-Ozegowska, Ewa Wender-Ozegowska Division of Reproduction, Medical Faculty I, Poznan University of Medical Sciences, Poznan, PolandSearch for more papers by this authorAnnunziata Lapolla, Annunziata Lapolla Universita Degli Studi di Padova, Padua, ItalySearch for more papers by this authorAndre van Assche, Andre van Assche KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, BelgiumSearch for more papers by this authorRoland Devlieger, Roland Devlieger KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, BelgiumSearch for more papers by this authorDavid Hill, David Hill Recherche en Santé Lawson SA, St Gallen, SwitzerlandSearch for more papers by this authorDorte M Jensen, Dorte M Jensen Department of Endocrinology and Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorJuan M Adelantado, Juan M Adelantado Institut de Recerca de l′Hospital de la Santa Creu i Sant Pau, Barcelona, SpainSearch for more papers by this authorAgnieszka Zawiejska, Agnieszka Zawiejska Division of Reproduction, Medical Faculty I, Poznan University of Medical Sciences, Poznan, PolandSearch for more papers by this authorAlessandra Bertolotto, Alessandra Bertolotto Azienda Ospedaliero-Universitaria Pisana, Pisa, ItalySearch for more papers by this authorMaria G Dalfra, Maria G Dalfra Universita Degli Studi di Padova, Padua, ItalySearch for more papers by this authorJürgen Harreiter, Jürgen Harreiter Division of Endocrinology, Department of Medicine III, Gender Medicine Unit, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorSander Galjaard, Sander Galjaard KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, BelgiumSearch for more papers by this authorLise Lotte T Andersen, Lise Lotte T Andersen Department of Endocrinology and Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorMette Tanvig, Mette Tanvig Department of Endocrinology and Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, DenmarkSearch for more papers by this authorJudith G Jelsma, Judith G Jelsma Department of Public and Occupational Health, Amsterdam Public Health Research institute, VU University Medical Centre, Amsterdam, the NetherlandsSearch for more papers by this authorGoele Jans, Goele Jans KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Leuven, BelgiumSearch for more papers by this authorFrank J Snoek, Frank J Snoek Department of Medical Psychology, VU University Medical Centre and Academic Medical Centre, Amsterdam, the NetherlandsSearch for more papers by this authorMireille N M van Poppel, Mireille N M van Poppel Department of Public and Occupational Health, Amsterdam Public Health Research institute, VU University Medical Centre, Amsterdam, the Netherlands Department of Medical Psychology, VU University Medical Centre and Academic Medical Centre, Amsterdam, the NetherlandsSearch for more papers by this authoron behalf of the DALI Core Investigator group, the DALI Core Investigator group CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Zaragoza, SpainSearch for more papers by this author First published: 05 June 2018 https://doi.org/10.1111/1471-0528.15278Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume125, Issue10Special Issue: Latin America Special IssueSeptember 2018Pages 1338-1339 RelatedInformation

Anxiety and depression levels are higher in obese compared to those in normal weight pregnant women. The aims of this study are to examine anxiety and depression in pregnancy following bariatric surgery and to compare with obese pregnant controls considering the dietary intake of polyunsaturated fatty acids (PUFA), folate, and vitamin B12.

Background: The breast-milk composition in the first 6 wk postpartum of women who have undergone bariatric surgery (BS) is unknown. Objective: The aim of this study was to examine 1) the breast-milk macronutrient and vitamin A composition in women who had and who had not undergone BS and 2) the impact of maternal diet on the breast-milk composition. We hypothesized that the milk of women who had undergone BS would be less energy dense and have a lower vitamin A concentration than that of other women. Methods: A multicenter prospective substudy was conducted at 2 university hospitals. Breast-milk samples were collected from 24 normal-weight [NW; mean +/- SD body mass index (BMI; kg/m(2)): 21.5 +/- 1.7; mean +/- SD age: 29 +/- 6 y], 39 overweight (OW; BMI: 26.9 +/- 1.5; aged 29 +/- 5 y), and 12 obese women (BMI: 35.0 +/- 5.7; aged 29 +/- 5 y) as well as from 11 women who had undergone BS (BMI: 28.0 +/- 4.4; aged 30 +/- 4 y) from day 3 until week 6 of lactation. Milk energy and macronutrients (Human Milk Analyzer; Miris) and vitamin A concentrations (iCheck Fluoro; BioAnalyt) were determined at the end of each week. Maternal diet (food-frequency questionnaire) and physical activity (Kaiser Physical Activity Survey) were measured during the third trimester of pregnancy and on day 3 or 4 and during week 6 of lactation. Statistical analyses include 1-factor ANOVA, Spearman and Pearson correlations, and multiple linear regression. Results: In all women, a weekly increase in milk energy, total fat, and total carbohydrates was seen, whereas a weekly decrease in proteins and vitamin A was found during the first 2 wk of lactation, followed by a stable concentration of all nutrients. At week 4, milk protein concentrations were higher in women who had undergone BS (14 g/L) compared with NW (8 g/L; P = 0.005) and OW (9 g/L; P = 0.019) women. At week 5, milk carbohydrate concentrations were higher in women who had undergone BS (74 g/L) compared with NW women (68 g/L; P = 0.042). Conclusions: Breast milk of women who have undergone BS appears to be adequate in energy, macronutrients, and vitamin A during the first 6 wk of lactation. This supports the conclusion that breast feeding should not be discouraged in this group of women.

Judith G.M. Jelsma, Goele Jans, Christophe Matthys, Jennifer Wessel, Michiel de Boer, Kinga Blumska, Sander Galjaard, David Simmons, Gernot Desoye, Rosa Corcoy, Alexandra KautzkyWiller, Jürgen Harreiter, Andre van Assche, Dirk Timmerman, David Hill, Peter Damm, Elisabeth R. Mathiesen, Ewa Wender-Ozegowska, Agnieszka Zawiejska, Annunziata Lapolla, Maria G. Dalfrà, Stefano del Prato, Alessandra Bertolotto, Fidelma Dunne, Dorte M. Jensen, Liselotte Andersen, Frank J. Snoek, Roland Devlieger and Mireille N.M. van Poppel

Depression during pregnancy is associated with higher maternal morbidity and mortality, and subsequent possible adverse effects on the cognitive, emotional and behavioral development of the child. The aim of the study was to identify maternal characteristics associated with poor mental health, in a group of overweight/obese pregnant women in nine European countries, and thus, to contribute to better recognition and intervention for maternal depression.

The spelling of author name Jill Shawe was incorrect in the original article. It is correct here.

Process evaluation is an essential part of designing and assessing complex interventions. The vitamin D and lifestyle intervention study (DALI) study is testing different strategies to prevent development of gestational diabetes mellitus among European obese pregnant women with a body mass index ≥29 kg/m2. The intervention includes guidance on physical activity and/or healthy eating by a lifestyle coach trained in motivational interviewing (MI). The aim of this study was to assess the process elements: reach, dose delivered, fidelity and satisfaction and to investigate whether these process elements were associated with changes in gestational weight gain (GWG).

CONTEXT:Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results.OBJECTIVE:The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk.DESIGN:The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study].SETTING:The study occurred at antenatal clinics across 11 centers in 9 European countries.PATIENTS:Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language.MAIN OUTCOME MEASURES:The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks.RESULTS:We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (-2.02; 95% confidence interval, -3.58 to -0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar.CONCLUSIONS:The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.

OBJECTIVE: To assess maternal and fetal outcomes of pregnancies complicated by internal herniation after Roux-en-Y gastric bypass. DATA SOURCES: Articles were identified through searches in online databases (ClinicalTrials.gov, MEDLINE, EMBASE, PubMed, and Google Scholar) from January 1980 to March 2015 for the following terms: [gastric bypass OR bariatric surgery] AND [pregnancy] AND [complication OR herniation OR obstruction]. Reference lists of relevant articles were hand-searched. Additionally, we searched our own hospital's obstetric database for cases of internal herniation after Roux-en-Y gastric bypass. METHODS OF STUDY SELECTION: Only articles in English and studies in humans were selected. Cases of internal herniation outside of pregnancy or internal herniation without a history of Roux-en-Y gastric bypass were excluded. Of 384 articles identified by the initial search, 22 were retained for further analysis. TABULATION, INTEGRATION, AND RESULTS: All retrieved articles were case reports or case series. There were no interventional studies. We retrieved 47 cases from the literature and five cases from our own database. The mean gestational age at diagnosis was 28.4±7.3 weeks. All women presented with abdominal pain. Nausea and vomiting were present in only 65%. Ultrasonography and laboratory results are usually noninformative, and computed tomography or magnetic resonance imaging confirmed the diagnosis in only 75% of cases. Nine of 52 women (17.3%) required bowel resections. There were two maternal deaths and three perinatal deaths, all in women treated later than 48 hours after onset of the symptoms. CONCLUSION: Internal herniation complicating pregnancy after Roux-en-Y gastric bypass typically presents with subtle signs in the third trimester of pregnancy. Timely recognition and early surgical intervention are associated with a reduced risk of bowel ischemia and maternal and fetal adverse outcomes.

The expansion of the obesity epidemic is accompanied with an increase in bariatric procedures, in particular in women of reproductive age. The weight loss induced by the surgery is believed to reverse the negative impact of overweight and obesity on female reproduction, however, research is limited to in particular retrospective cohort studies and a growing number of small case-series and case-(control) studies.

Pregnant and postpartum women with a history of bariatric surgery are at risk of micronutrient deficiencies as a result of the combination of physiologic changes related to pregnancy and iatrogenic postoperative alterations in the absorption and metabolism of crucial nutrients. This systematic review investigates micronutrient deficiencies and related adverse clinical outcomes in pregnant and postpartum women after bariatric surgery. A systematic approach involving critical appraisal was conducted independently by 2 researchers to examine deficiencies of phylloquinone, folate, iron, calcium, zinc, magnesium, iodide, copper, and vitamins A, D, and B-12 in pregnant and postpartum women after bariatric surgery, together with subsequent outcomes in the neonates. The search identified 29 relevant cases and 8 cohort studies. The quality of reporting among the case reports was weak according to the criteria based on the CARE (CAse REporting) guidelines as was that for the cohort studies based on the criteria from the Cohort Study Quality Assessment list of the Dutch Cochrane Center. The most common adverse neonatal outcomes related to maternal micronutrient deficiencies include visual complications (vitamin A), intracranial hemorrhage (phylloquinone), neurological and developmental impairment (vitamin B-12), and neural tube defects (folate). On the basis of the systematically collected information, we conclude that the evidence on micronutrient deficiencies in pregnant and postpartum women after bariatric surgery and subsequent adverse neonatal outcomes remains weak and inconclusive.

Breast milk samples from 12 lactating women with bariatric surgery were investigated by comparing the macronutrient and energy content with samples from 36 non-surgical controls. Samples were analyzed with the Human Milk Analyzer and the maternal diet 24 h prior to sampling with a food record. A higher fat, energy, and a slightly higher carbohydrate milk content was found in the surgical group compared to the non-surgical group (3.0 ± 0.7 versus 2.2 ± 0.9 g/100 ml, P = 0.008; 61.0 ± 7.2 versus 51.7 ± 9 kcal/100 ml, P = 0.002; and 6.6 ± 0.6 versus 6.3 ± 0.4 g/100 ml, P = 0.045, respectively). No correlations and no strong explanatory variance were found between milk macronutrient composition and corresponding maternal dietary intake. The nutritional value of breast milk after bariatric surgery appears to be at least as high as in non-surgical controls.

ObjectiveTo compare breast milk macronutrient composition between women with a history of bariatric surgery and non-surgical controls.Study DesignA cross-sectional study was conducted at the maternity units of the University Hospital of Leuven, Belgium. Postpartum women who delivered a term (≥37 weeks of gestation), did not smoke, were normoglycaemic and who were not on predefined medication, were invited to participate. Participants completed a 24 hour dietary recall prior to sampling. A milk sample of 1.5-2cl was collected at day 4 post-delivery during the first feeding in the morning. Each sample was analyzed for macronutrients (carbohydrate, protein, fat) and energy with the MIRIS® Human Milk Analyzer. The pre-pregnancy weight and length were assessed from the online medical patient file to calculate the pre-pregnancy BMI. Further baseline characteristics included maternal age, ethnicity and parity. Pregnancy outcomes included delivery mode, the use of combined spinal epidural, gestational age, birth weight and gender of the baby.ResultsThe macronutrient (fat, protein and carbohydrate) and energy content of breast milk samples from 12 women with a history pf bariatric surgery was compared with breast milk samples from 36 non-surgical controls (12 obese, 12 overweight and 12 normal weight women) (N=48). A higher fat and energy content and a slightly higher carbohydrate content was found in the surgical group compared to the non-surgical control group (3.0±0.7 versus 2.2±0.9 g/100ml, P = 0.008; 61.0±7.2 versus 51.7±9 kcal/100ml, P = 0.002 and 6.6±0.6 versus 6.3±0.4 g/100ml, P = 0.045 respectively). No correlations were found between human milk macronutrient composition and the maternal dietary intake of macronutrients.ConclusionThe nutritional value of breast milk in women with a history of bariatric surgery appears to be at least as high as in non-surgical controls. Despite these encouraging findings, further studies on specific micronutrients are required before breastfeeding can safely be advised in postsurgical women. ObjectiveTo compare breast milk macronutrient composition between women with a history of bariatric surgery and non-surgical controls. To compare breast milk macronutrient composition between women with a history of bariatric surgery and non-surgical controls. Study DesignA cross-sectional study was conducted at the maternity units of the University Hospital of Leuven, Belgium. Postpartum women who delivered a term (≥37 weeks of gestation), did not smoke, were normoglycaemic and who were not on predefined medication, were invited to participate. Participants completed a 24 hour dietary recall prior to sampling. A milk sample of 1.5-2cl was collected at day 4 post-delivery during the first feeding in the morning. Each sample was analyzed for macronutrients (carbohydrate, protein, fat) and energy with the MIRIS® Human Milk Analyzer. The pre-pregnancy weight and length were assessed from the online medical patient file to calculate the pre-pregnancy BMI. Further baseline characteristics included maternal age, ethnicity and parity. Pregnancy outcomes included delivery mode, the use of combined spinal epidural, gestational age, birth weight and gender of the baby. A cross-sectional study was conducted at the maternity units of the University Hospital of Leuven, Belgium. Postpartum women who delivered a term (≥37 weeks of gestation), did not smoke, were normoglycaemic and who were not on predefined medication, were invited to participate. Participants completed a 24 hour dietary recall prior to sampling. A milk sample of 1.5-2cl was collected at day 4 post-delivery during the first feeding in the morning. Each sample was analyzed for macronutrients (carbohydrate, protein, fat) and energy with the MIRIS® Human Milk Analyzer. The pre-pregnancy weight and length were assessed from the online medical patient file to calculate the pre-pregnancy BMI. Further baseline characteristics included maternal age, ethnicity and parity. Pregnancy outcomes included delivery mode, the use of combined spinal epidural, gestational age, birth weight and gender of the baby. ResultsThe macronutrient (fat, protein and carbohydrate) and energy content of breast milk samples from 12 women with a history pf bariatric surgery was compared with breast milk samples from 36 non-surgical controls (12 obese, 12 overweight and 12 normal weight women) (N=48). A higher fat and energy content and a slightly higher carbohydrate content was found in the surgical group compared to the non-surgical control group (3.0±0.7 versus 2.2±0.9 g/100ml, P = 0.008; 61.0±7.2 versus 51.7±9 kcal/100ml, P = 0.002 and 6.6±0.6 versus 6.3±0.4 g/100ml, P = 0.045 respectively). No correlations were found between human milk macronutrient composition and the maternal dietary intake of macronutrients. The macronutrient (fat, protein and carbohydrate) and energy content of breast milk samples from 12 women with a history pf bariatric surgery was compared with breast milk samples from 36 non-surgical controls (12 obese, 12 overweight and 12 normal weight women) (N=48). A higher fat and energy content and a slightly higher carbohydrate content was found in the surgical group compared to the non-surgical control group (3.0±0.7 versus 2.2±0.9 g/100ml, P = 0.008; 61.0±7.2 versus 51.7±9 kcal/100ml, P = 0.002 and 6.6±0.6 versus 6.3±0.4 g/100ml, P = 0.045 respectively). No correlations were found between human milk macronutrient composition and the maternal dietary intake of macronutrients. ConclusionThe nutritional value of breast milk in women with a history of bariatric surgery appears to be at least as high as in non-surgical controls. Despite these encouraging findings, further studies on specific micronutrients are required before breastfeeding can safely be advised in postsurgical women. The nutritional value of breast milk in women with a history of bariatric surgery appears to be at least as high as in non-surgical controls. Despite these encouraging findings, further studies on specific micronutrients are required before breastfeeding can safely be advised in postsurgical women.