Eating Behaviours in Severely Obese Pregnant Women Compared with Lean Pregnant Controls.

Abstract

Context: The vast perpetuation of the modern obesity epidemic has been identified as a major constituent in the development of antenatal complications in today's society. Abnormal eating behaviours are common in obese individuals; disordered eating prior to pregnancy has a profound impact on gestational weight gain (GWG). Due to a lack of dietary advice for obese women during pregnancy, there has been an increase in demand for specialist healthcare in an attempt to reduce obesity-related obstetric complications and prevent life-long health implications for both mother and child. Aim: To describe eating behaviours in severely obese pregnant women compared with lean controls and determine if such eating behaviours correlate with nutritional intake and thus influence GWG. Methods: 72 lean (BMI≤25 kg/m2) and 81 severely obese (BMI>40 kg/m2) pregnant subjects, with a mean age of 33.3 (± 4.4) years completed the Dutch Eating Behaviour Questionnaire (DEBQ) to assess eating behaviours. A subgroup of obese (n=42) and lean (n=36) women completed a food frequency questionnaire to assess dietary intake during 0-28 weeks gestation and 28-36 weeks gestation. GWG data was available for 40% of the total population, measured from 16-36 weeks gestation. The DEBQs were coded, and differences in scores between lean and obese were compared and associations between eating behaviour scores, parity, age, GWG and macronutrient intake were tested. Exploratory analysis assessed the influence of eating behaviours on micronutrient intake. Results: Obese women had lower GWG and a higher BMI than the lean women. Obese women scored a significantly higher restrained, emotional and total eating behaviour score than lean controls (p=<0.05) although external eating behaviour scores were significantly higher in lean women (p=<0.05). There were no significant associations with protein, fat carbohydrate or total energy intake and restrained eating in obese women (p=>0.05). However, a positive correlation was noted with GWG and restrained eating score in obese women (r=0.3, p=<0.05). Increased dietary protein (r=0.42, p=0.002), fat intake (r=0.57, p=<0.001), carbohydrate (r=0.31, p=0.05) and total energy intake (r=0.50, p=0.002) were all significantly correlated with higher reported external eating behaviours in obese women in early pregnancy. Most correlations observed between eating behaviour patterns and macronutrient intake were very similar in late pregnancy however a greater association between fat intake and emotional eating in obese women was observed (r=0.34, p=0.05 versus r=0.25, p=0.11 respectively) along with a greater fat intake and external eating association in lean women (r=0.51, p=0.01 versus r=0.34, p=0.04 respectively). Conclusions: The complex psychology of obesity implements difficulty in understanding disparities in eating behaviours in lean and obese women without considering the independent psychological impact of pregnancy. The complexities of psychology during pregnancy implement difficulty in understanding disparities in eating behaviours in lean and obese women without considering the psychological aspect of obesity Understanding the experience of obesity during pregnancy will allow for a more tailored approach toward nutrition advice and psychological needs of severely obese women, and thus allow better guidance for GWG. Key Words: Maternal obesity, eating behaviours, Dutch Eating Behaviour Questionnaire, psychology of eating, Food Frequency Questionnaire, dietary intake, gestational weight gain.