WEBVTT 00:00:00.240 --> 00:00:02.240 We identified that women who lost 00:00:02.240 --> 00:00:06.160 two to three kilograms of weight in that third trimester of pregnancy 00:00:06.160 --> 00:00:08.880 improve their glucose levels quite quickly 00:00:08.880 --> 00:00:11.920 and also had babies who were a healthier size. 00:00:11.920 --> 00:00:14.480 We know that this is safe and beneficial 00:00:14.480 --> 00:00:17.760 for mothers with gestational diabetes and their babies 00:00:17.760 --> 00:00:20.000 and is likely to have long-term benefits. 00:00:27.360 --> 00:00:29.440 Hello, my name is Professor Claire Meek. 00:00:29.440 --> 00:00:30.800 I work at the Leicester Diabetes Centre 00:00:30.800 --> 00:00:34.840 as professor of Chemical Pathology and Diabetes in Pregnancy. 00:00:34.840 --> 00:00:38.320 My research group aims to focus on healthy moms, healthy babies, 00:00:38.320 --> 00:00:41.640 and healthy families in the context of diabetes and pregnancy. 00:00:41.640 --> 00:00:43.520 And my special interest is in helping women 00:00:43.520 --> 00:00:46.320 maintain healthy weight gain during pregnancy. 00:00:46.320 --> 00:00:48.000 In the past, there's been lots of concern 00:00:48.000 --> 00:00:51.320 about undernutrition in women approaching pregnancy 00:00:51.320 --> 00:00:53.280 and because of that, common mantras 00:00:53.280 --> 00:00:55.640 such as the need to eat for two 00:00:55.640 --> 00:00:57.240 has resulted in a situation 00:00:57.240 --> 00:00:58.960 where many women are encouraged to gain 00:00:58.960 --> 00:01:01.560 excessive amounts of weight during pregnancy. 00:01:01.560 --> 00:01:06.920 This is no longer healthy in a population with rising rates of obesity. 00:01:06.920 --> 00:01:10.080 And therefore, the role of our work is to help understand 00:01:10.080 --> 00:01:12.080 how much weight is the right amount of weight 00:01:12.080 --> 00:01:13.520 to gain during pregnancy? 00:01:13.520 --> 00:01:15.040 And how can we help women 00:01:15.040 --> 00:01:18.600 maintain a healthy weight before, during, and after pregnancy? 00:01:23.560 --> 00:01:27.000 Most authorities internationally use the guidance 00:01:27.000 --> 00:01:28.680 prescribed by the Institute of Medicine, 00:01:28.680 --> 00:01:31.880 which was identified around three decades ago in the US. 00:01:32.480 --> 00:01:35.440 This suggests that women with overweight and obesity 00:01:35.440 --> 00:01:37.800 should gain a smaller amount of weight during pregnancy, 00:01:37.800 --> 00:01:39.800 compared to women entering pregnancy 00:01:39.800 --> 00:01:41.800 with a BMI in the lean range. 00:01:41.800 --> 00:01:44.400 So, for example, women with obesity are recommended 00:01:44.400 --> 00:01:48.000 to gain five to nine kilos of weight during pregnancy. 00:01:48.200 --> 00:01:50.000 However, there are increasing concerns 00:01:50.000 --> 00:01:53.120 that actually nine kilograms of weight gain might be too much 00:01:53.160 --> 00:01:54.800 for many women with obesity, 00:01:54.800 --> 00:01:57.960 particularly those women entering with a higher BMI. 00:02:03.000 --> 00:02:05.760 So, we recently ran a DiGest trial, 00:02:05.760 --> 00:02:08.960 that's a Dietary Intervention in Gestational Diabetes. 00:02:08.960 --> 00:02:10.640 It's a randomised controlled trial 00:02:10.640 --> 00:02:14.240 of a reduced calorie diet in women with gestational diabetes. 00:02:14.680 --> 00:02:16.440 And women were randomised to receive 00:02:16.440 --> 00:02:19.840 either 1,200 calories or 2,000 calories per day 00:02:19.840 --> 00:02:23.160 from diagnosis to the end of pregnancy at delivery. 00:02:23.840 --> 00:02:27.600 We identified that women who lost two to three kilograms of weight 00:02:27.600 --> 00:02:29.920 in that third trimester of pregnancy 00:02:29.920 --> 00:02:32.440 improved their glucose levels quite quickly 00:02:32.440 --> 00:02:35.160 and also had babies who were a healthier size. 00:02:35.840 --> 00:02:37.280 Importantly, we also found 00:02:37.280 --> 00:02:40.600 there were benefits to women's postnatal HbA1C, 00:02:40.600 --> 00:02:43.440 which was lower in the group who had lost weight. 00:02:43.440 --> 00:02:45.440 So, following the results of the DiGest trial, 00:02:45.440 --> 00:02:47.240 we know that a small amount of weight loss 00:02:47.240 --> 00:02:49.160 in the third trimester of pregnancy 00:02:49.160 --> 00:02:52.120 is safe and beneficial for mothers and babies 00:02:52.120 --> 00:02:54.960 in the context of gestational diabetes. 00:02:54.960 --> 00:02:57.880 However, there are still many unanswered questions 00:02:57.880 --> 00:03:00.200 about what is a healthy level of weight gain 00:03:00.200 --> 00:03:01.760 throughout the whole pregnancy 00:03:01.760 --> 00:03:05.000 and even if weight loss overall could be beneficial. 00:03:05.000 --> 00:03:07.200 We have some data from our DiGest trial 00:03:07.200 --> 00:03:09.760 suggesting that modest amounts of weight loss 00:03:09.760 --> 00:03:13.400 throughout the whole pregnancy could also be beneficial. 00:03:13.400 --> 00:03:14.640 However, it's really key 00:03:14.640 --> 00:03:16.840 that avoiding excessive gestational weight gain 00:03:16.840 --> 00:03:19.040 is one of the most important ways 00:03:19.040 --> 00:03:21.000 we can improve pregnancy outcomes 00:03:21.000 --> 00:03:23.120 for women with diabetes or obesity. 00:03:28.440 --> 00:03:30.480 My take home messages would be that 00:03:30.480 --> 00:03:34.480 avoiding excessive gestational weight gain is absolutely crucial 00:03:34.480 --> 00:03:37.280 if we want to improve outcomes for mothers and babies 00:03:37.280 --> 00:03:40.680 in the context of diabetes or obesity in pregnancy. 00:03:40.680 --> 00:03:44.360 However, increasingly we can actually benefit 00:03:44.360 --> 00:03:47.520 from small amounts of weight loss in the third trimester 00:03:47.520 --> 00:03:49.720 for women with gestational diabetes. 00:03:49.720 --> 00:03:52.880 We know that this is safe and beneficial for mothers 00:03:52.880 --> 00:03:55.400 with gestational diabetes and their babies 00:03:55.400 --> 00:03:57.480 and is likely to have long-term benefits.