Be Healthy in Pregnancy (BHIP) With Nutrition and Exercise
Be Healthy in Pregnancy (BHIP) With Nutrition and Exercise
Excess weight gain in pregnancy is a major problem affecting 55-75% of Canadian women who
 enter pregnancy overweight or obese and about 40% of women who are normal weight. Excess
 weight gain puts mothers at risk for health problems such as diabetes and developing or
 sustaining obesity after pregnancy, and puts their babies at risk of being born too large or
 developing related health problems. Mothers will be randomized to a structured high dairy
 protein diet and walking program or the usual care by their care provider. The investigators
 research questions are: Will a structured nutrition and exercise program in pregnancy
 compared to usual prenatal care increase the chance that mothers will achieve pregnancy
 weight gain within the current recommendations; improve health measures, in mother and infant
 at six months post-partum; to evaluate the benefits of a high dairy intake in pregnancy on
 maintenance of bone status in the mother and bone health outcomes in the child in early life
 (6 months); and to investigate the interactions between genes associated with bone health and
 high dairy diet supplementation on bone status in mothers during pregnancy, and bone health
 in mothers post-delivery and children to 6 months of age. Mothers' weight, physical activity
 and adherence to the nutrition plan will be assessed until birth and at follow-up with their
 infants at 6 months after birth. The research team will ensure new information is quickly
 transferred to programs to assist women to have healthier pregnancies.
This will be a 2-arm randomized 3-site trial. Recruitment will be within the community care
 clinics by poster and flyer advertisements. Pregnant women will be stratified by BMI
 categories and study site and randomized within strata to Group A (Nutrition+Exercise
 intervention program) or Group B (Usual Prenatal Care + Health Canada materials about healthy
 pregnancy + two focus group sessions exploring women's experiences with exercise, nutrition
 and weight gain in pregnancy).

 Primary research question: Among pregnant women, does introducing a structured and monitored
 nutrition and exercise program (treatment) in early pregnancy compared with Usual Prenatal
 Care (control) increase the likelihood of attaining gestational weight gain within the
 Institute of Medicine (IOM) guidelines over the pregnancy period? Secondary research
 questions: Among pregnant women (population), does introducing a structured and monitored
 nutrition and exercise program in early pregnancy (intervention) compared with Standard
 Prenatal Care (control) lead to 1) better maternal outcomes (outcome) at 6 months post-
 partum; and ii) better infant outcomes (outcome) at 6 months post partum?; and 2) i) to
 evaluate the benefits of a high dairy intake in pregnancy on maintenance of bone status in
 the mother and bone health outcomes in the child in early life (6 months); and ii) to
 investigate the interactions between genes associated with bone health and high dairy diet
 supplementation on bone status in mothers during pregnancy, and bone health in mothers
 post-delivery and children to 6 months of age.

 Experimental and Control groups: Both groups of mothers and their health care providers will
 be given the Health Canada materials on "Healthy Weight Gain during Pregnancy", "Eating Well
 with Canada's Food Guide" and the "Pregnancy Weight Gain Calculator". Baseline information
 will be recorded for eligible and consenting women after which they will be randomized to
 Experimental or Control group. Nutrition intake, physical measures and physical activity will
 be recorded at baseline, 26-28 weeks, 36-38 weeks of gestation, and 6 months postpartum in
 the same manner for both groups. All mothers will receive the study promotional materials and
 small incentives. Also, all mothers will be followed by their primary care provider and have
 usual access to public health.
Inclusion Criteria:

 -  Healthy pregnant females > 18 years of age with singleton pregnancies (either
 nulliparous or multiparous);

 -  less than 17 weeks gestation;

 -  a pre pregnancy BMI < 40 kg/m2 (owing to the fact that severe obesity with BMI> 40 may
 have limitations with respect to physical activity);

 -  plans to deliver at a Hamilton or London regional hospital or by home birth and
 willing to attend research visits at the community site where they were recruited;

 -  able to tolerate dairy foods;

 -  approval of primary care provider;

 -  able to provide signed informed consent.

 Exclusion Criteria:

 -  unable to understand some English;

 -  type 1 or type 2 diabetes;

 -  known contraindications to exercise as recommended by the Canadian clinical practice
 guidelines for pregnancy;

 -  severe gastrointestinal diseases or conditions;

 -  any significant heart, kidney, liver or pancreatic diseases;

 -  pre-existing diabetes;

 -  currently smoking;

 -  a depression score 12 or above on the validated Edinburgh depression questionnaire.