Effect of Personalized Nutrition Counseling in Pregnant Women After Bariatric Surgery on Nutritional Status and Habits
Condition: Pregnancy
Study type: Interventional

Summary: 
      Background: Nutrition challenges follow bariatric surgery can intensify during pregnancy and
      may have a crucial effect on fetus. To the best of the investigators knowledge, the effect of
      nutritional counseling on improvement of maternal diet quality and eating habits among post-
      bariatric pregnant women has not been evaluated.

      Objective: study aims to expand the existing limited knowledge in respect to post bariatric
      pregnant women's eating habits and quality of food intake, and to investigate the impact of
      nutrition counseling on these factors.

      Design: This is a controlled clinical trial comparing post Laparoscopic sleeve gastrectomy
      (LSG) pregnant women who received nutritional counseling with age-matched control healthy
      pregnant women. Counseling will focus on improving quality of food consumption, eating habits
      and behavioral changes in order to improve the mother and the fetus' nutritional status
      Nutritional data and eating behavior will be obtained using 24 hours recall dietary records
      and the Family Eating and Activity Habit Questionnaire (FEAHQ).
    

Detailed description: 
      Introduction Pregnancy is a critical period that can determine health for years to come.
      Appropriate nutrition during pregnancy is key to improved survival and health status of
      offspring, and can prevent numerous disease states from infancy to adult life. In recent
      year, as obesity has become a rising problem, bariatric surgery is the only way for many
      women to increase the chances of fertility.

      A possible adverse effect of this approach is high frequency of nutritional deficiencies
      reported among this population, which may be critical in cases of pregnancy.

      The risk for sub-optimal nutritional status and consequently a potential risk of developing
      micro and macronutrients deficiencies in post bariatric pregnancies, are higher compared to
      non-surgical pregnant women, given the nutrition challenges brought about by the surgery such
      as food aversions, nausea, and vomiting beyond the increased nutritional requirements exist
      in healthy pregnancy. Furthermore, even without the existence of nutritional deficiencies,
      maternal diet quality has a critical effect on fetus. "Western" diet, high in fats and
      sugars, increased sympathetic nervous system activity and hyperactivity in rodent offspring
      that persisted into adulthood. However Investigation of diet quality during pregnancy among
      women with bariatric surgery has shown that 82% of women's diet quality needs improvement.
      Moreover, dietary modifications are mainly directed towards increased pollution safety rather
      than improving diet quality in order to improve the mother and the fetus' nutritional status.

      To the best of the investigators knowledge, the effect of dietary counseling in post
      bariatric pregnant women has not been evaluated despite the findings about its importance and
      efficacy in studies on non-pregnant bariatric patient.

      The aims of this study is to expand the existing limited knowledge in respect to post
      bariatric pregnant women's' eating habits and quality of food intake, and to investigate the
      impact of nutrition counseling on these factors, which to best of the investigators knowledge
      had never been published.

      Intervention Patients from the intervention group will receive nutritional counseling from a
      specialist bariatric dietitian trained in pregnancy nutrition as well. The main goals are a
      healthy balanced diet including adequate daily servings from all food groups (dairy and egg,
      meat, vegetables, fruit, whole grain starches, and healthy fats), intake of essential
      nutrient during pregnancy such as iron and folic acid and limitation of high-sugar and fatty
      foods. In addition, the patients were advised concerning eating at scheduled times (e.g., 4-6
      times daily), taking supplements, preference of water. Advice concerning healthy cooking
      methods will also be provided. Participants will be advised to avoid soft drinks, drinking
      during meals, grazing and emotional eating, as well as fast foods. Also the subject of
      lifestyle in general will be addressed, and participants will be encouraged to incorporate
      suitable physical activity on most days, refraining from alcohol, and smoking. As currently,
      no guidelines exist in the literature for nutrition or behavioral modifications for pregnancy
      after LSG, counseling is based on previously published literature for bariatric and healthy
      pregnancy nutrition separately.

      Each participant will received 8 follow-up sessions for dietary counseling.
    

Intervention name(s): nutrition counseling
Intervention type(s): Behavioral
Intervention description(s): nutrition counseling and guidance.
Other intervention name(s): follow-up
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: sleeve gastrectomy