Inter-pregnAncy Coaching for a Healthy fuTure
Inter-pregnAncy Coaching for a Healthy fuTure
The project focuses on prevention of major pregnancy and birth related complications :
 pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), caesarean section
 (CS), and large-for-gestational-age (LGA), i.e. the birth weight of the baby exceeds the 90%
 percentile of birth weights for the specific pregnancy duration.

 The investigators focus on the pre-conception period, i.e. the pre-conception period of the
 2nd pregnancy in women with an excessive weight gain during their 1st pregnancy, aiming to
 decrease the complications rate in their 2nd pregnancy.

 Women with an excessive gestational weight gain have obtained the extra weight during a
 rather short period of time, e.g. 20 kilos in the last 4 or 5 months of their pregnancy. This
 characteristic distinguishes the target group from the general population with
 overweight/obesity, in whom the extra weight was acquired during many years and independent
 from a pregnancy, making a behaviour change more complex.

 The coaching intervention combines face-to-face counselling with the use of a mobile App
 connected to medical devices (scale and pedometer). The app monitors important indicators
 (weight, eating behaviour, physical activity, mental wellbeing), provides coaching through
 established behavioral change techniques, and is specifically tailored for women with
 excessive weight gain during the previous pregnancy.

 The goal is to decrease the rate of pregnancy and birth-related adverse outcomes in the next
 pregnancy by a healthy life style, starting shortly after their 1st delivery and sustained
 during the next pregnancy.
The aim is to decrease the prevalence of pregnancy and birth-related complications
 (pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), caesarean section
 (CS), and large-for-gestational-age babies (LGA)). These complications occur in 26% of
 pregnancies with normal start BMI and adequate weight gain, in 34% in normal start BMI but
 excessive gestational weight gain and in up to 66% in obese class III (BMI≥40kg/m²) combined
 with excessive gestational weight gain. Moreover, as the prevalence of maternal obesity
 continues to rise, increasing numbers of children are exposed to an 'obesogenic intrauterine
 environment'. Obesity in pregnancy has therefore the potential to result in an
 'intergenerational cycle' of obesity through in utero programming.

 The investigators focus on women with excessive weight gain during their 1st pregnancy as
 currently, half of them do not return to their pre-pregnancy weight before the next
 pregnancy. This results in a complication rate as high as 42% (PIH, GDM, CS, LGA). The
 investigators target a healthy BMI at start of pregnancy by intervening during the
 pre-conception period- and an adequate weight gain during pregnancy by intervening during
 pregnancy in these women. The intervention will be evaluated in a randomized controlled trial
 including 1,100 women.

 The proposed intervention combines face-to-face coaching with the use of a mobile App
 (so-called 'inter-act' app) connected to medical devices (scale and pedometer). The app
 monitors women's weight, eating behaviour, physical activity, mental wellbeing, and provides
 continuously coaching through positive behavioral change techniques. The 'inter-act' App
 covers after the 1st delivery breast-feeding support, while during pregnancy, the gestational
 weight gain guidelines of the Institute of Medicine (IOM) are included.

 Drop out of less motivated women is avoided as the time points of the four pre-conception
 coaching sessions coincide with the existing postnatal follow-up visits for neonates
 (Governmental vaccination scheme through the organisation " Kind & Gezin"), and the three
 pregnancy coaching sessions coincide with the three routine ultrasound scans during normal
 pregnancy (KCE Guidelines).

 Each year, there are 8,900 singleton pregnancies in Flanders in whom the mother had excessive
 gestational weight gain in the prior pregnancy. The current rate of at least one of the four
 major pregnancy and birth-related complications (PIH, GDM, CS, LGA) in the 8,900 pregnancies
 is 42%. If the complications rate reduces with 1/4, this involves more than 900 pregnancies,
 and reduces costs related to caesarean sections, gestational diabetes, obesity in mother &
 child.
Inclusion Criteria:

 -  Excessive weight gain during their previous pregnancy (above the IOM recommendations)

 -  Child wish for having a next pregnancy

 -  Women aged 18 years or more

 -  Sufficient fluent in Dutch language

 -  Able to give written informed consent

 -  Able to use a smartphone. If the women do not have a smartphone because of
 socio-economic reasons, a smartphone is at her disposal for the whole duration of the
 intervention, in order to be able to use Apps connected with a Bluetooth pedometer and
 balance scale.

 Exclusion Criteria:

 -  Requirement for (complex) diets

 -  History of or a plan for bariatric surgery

 -  Underlying or chronic disorders (e.g. diabetes, thyroid disease, renal diseases)

 -  Significant psychiatric disorder

 -  Previous still birth