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“Disabled people could soon re-grow damaged or diseased limb joints,” said the Daily Mirror. The newspaper said that the prospect of a new technique, using people’s own stem cells rather than transplanted ones “offers hope to millions suffering crippling pain”.

The study behind this news attempted to grow new cartilage in rabbits by drawing the rabbits’ own circulating stem cells to a scaffolding of bone-like substances implanted into their shoulder joints. To assess the technique the researchers then observed the rabbits’ movement and took samples from the joint to see if new cartilage had formed. The rabbits regenerated cartilage and were soon able to bear weight.

The real test of this technology will come if it is eventually applied to humans. While the researchers have tried growing cartilage to attach to artificial joints they say that regeneration of other tissues may also be possible with their technique. However, this type of research proceeds in small steps and so it is too soon to say if this could ever be a reliable alternative to a simple artificial hip replacement in humans.

Where did the story come from?

The study was carried out by researchers from Columbia University Medical Center, the University of Missouri and Clemson University in the US. It was funded by the New York State Stem Cell Science programme and the US National Institutes of Health. The study was published in the peer-reviewed medical journal The Lancet.

Several newspapers have accurately reported this research, with some pointing out that experts have said that even if the technique is successful in eventual human trials, a conventional hip replacement might still be the best option. The Daily Mirror goes further, claiming that this early animal research offers “new hope for millions”.

What kind of research was this?

The researchers explain that they wanted to test a new approach to generating new tissues. In this case, they wanted to test whether they could grow new sections of the cartilage naturally found on the surface of joints. Rather than directly transplanting stem cells from an external source, which some experiments have attempted, they instead wanted to provide an artificial surface that could attract the body’s own circulating stem cells and encourage them to deposit and grow on this artificial scaffolding.

The study was well conducted, and the research paper features cautious reminders that this is very preliminary work that still needs much more research to assess the feasibility of applying this technology to humans.

What did the research involve?

The researchers designed a ‘proof of concept’ study to see if it was technically possible to grow new cartilage in rabbits by attracting their circulating stem cells to a new form of scaffolding.

They compared two ‘bioscaffolds’ in an experiment on 23 rabbits. Ten scaffolds were covered in a growth factor called TGFβ3 and implanted into the rabbits, while ten rabbits were implanted with scaffolds lacking the growth factor chemical. Three rabbits also had operations to remove the joint without a bioscaffold replacement (the ‘defect only’ rabbits).

To produce these bioscaffolds, the researchers first used a computer to trace the surface shape and size of a rabbit shoulder joint. They then made a bioscaffold out of a composite of a biodegradable polymer, a polyester and a substance called hydroxyapatite, a mineral that forms a large part of normal bone.

The whole joint surface of the shoulder in the rabbits was then surgically removed and replaced with these bioscaffolds that either lacked or contained the transforming growth factor. The researchers then assessed the movement of the joints and ability of the rabbits’ shoulders to bear weight at 1–2, 3–4 and 5–8 weeks after surgery. At four months they took a sample of bone and cartilage from the live rabbits and checked them for things such as cracks, thickness, density, cell numbers and mechanical properties.

What were the basic results?

All the animals in the group given the scaffolds infused with growth factor fully resumed weight bearing and movement 3–4 weeks after surgery. The rabbits that had received the bioscaffolds infused with growth factor showed more consistent improvement than the rabbits that had received the bioscaffolds lacking the growth factor. Defect-only rabbits limped at all times.

When the sample of scaffolding and cartilage was removed at four months after surgery, joint-facing surfaces of the TGFβ3-infused bioscaffolds were fully covered with hyaline cartilage, a pad of tough but flexible cartilage that naturally lines joints. There was only isolated cartilage formation in the other implant group and no cartilage formation in the defect-only rabbits.

How did the researchers interpret the results?

The researchers say that their findings suggest that the cartilage layer across the entire surface of synovial joints (lubricated, freely moving joints) “can regenerate without cell transplantation”.

They go on to call for further investigation into the technique, saying that the regeneration of complex tissues seems probable when using ‘homing’ (having a surface or environment that attracts the body’s circulating cells) in tissues that need repair.

Conclusion

This interesting study has demonstrated the potential of a new technique. The researchers point out the areas that need further investigation:

• They do not yet know where the stem cells (or progenitor early cartilage cells) came from. Although they think that some of these cells are derived from stem or progenitor cells of synovium, bone marrow, fat cells and perhaps blood vessels, more research will be needed to find out exactly where they came from.
• They suspect that if TGFβ3 can attract multiple cell types then more research will be needed to find out how to target the specific cell populations needed for the regeneration of more complex tissues.
• They say that it is good news that the regenerated cartilage is strong enough for weight bearing in rabbits.

The real test of this technology will come if it is eventually applied to humans. The researchers were not just thinking of growing cartilage to attach to artificial joints, and explain that regeneration of other tissues may also be possible with their technique. However, this type of research proceeds in small steps and so it is too soon to say if this could ever be a reliable alternative to a simple artificial hip replacement in humans.

Links To The Headlines

Hip hope from stem cell technique. BBC News, July 29 2010

The 'grow your own' hip and knee replacements with full range of movement. Daily Mail, July 29 2010

Regrowing limb joints. Daily Mirror, July 29 2010

Links To Science

Lee CH, Cook JL, Mendelson A et al. Regeneration of the articular surface of the rabbit synovial joint by cell homing: a proof of concept study. The Lancet, Early Online Publication, July 29 2010

“Kicking and lashing out while asleep could mean you’re more likely to develop dementia or Parkinson’s disease,” reported the Daily Mail. It said a study has found a link between a sleep disorder and a higher risk of certain types of dementia up to 50 years later.

The study looked at people diagnosed with one of several related neurological conditions and analysed their history of a severe form of REM sleep behaviour disorder (RBD), a condition in which people can act out recurrent dreams and move excessively while asleep.

The study was not designed to look at the strength of the link between RBD and dementias, as patients in the study were selected because they were known to have had both of these conditions. Therefore, it is not possible to say from this study whether restless sleep is a predictor of future dementia as is implied in the newspaper headline. More research into whether RBD could be an early sign of the brain changes that lead to dementia later on would be useful.

Where did the story come from?

The study was carried out by researchers from the Department of Neurology at the Mayo Clinic in the US. The researchers received several individual grants and awards. The study was published in the peer-reviewed medical journal Neurology.

The Daily Mail has concentrated on the theoretical link between a group of neurological conditions and this sleep disorder. Previous research has indicated that there is some association between the two, but the strength of this relationship is unclear and, at this stage, RBD cannot be used to predict later disease.

What kind of research was this?

The stage of sleep in which your brain activity increases and when dreaming may occur is known as rapid eye movement (REM) sleep because, during this phase, your eyes start to move quickly and flicker.

This research looked at the association between a sleep disorder called REM sleep behaviour disorder (RBD) and a group of neurological conditions including Parkinson’s disease, multiple system atrophy (MSA) and dementia with Lewy bodies (DLB). RBD is a sleep disorder where people act out recurrent dreams and move excessively while asleep, and in this study injured themselves or their partners as a result.

To investigate this, the researchers used the records from a specialist neurological clinic of 27 patients who had been diagnosed with RBD and then went on to develop degenerative neurological symptoms at least 15 years later.

The researchers confirmed the diagnoses of RBD and analysed the records to define the types and timing of diseases and symptoms the patient developed. They used these data to calculate the length of time between the first sign of restless sleep and the diagnosis of a range of dementias.

This was a case series analysis in which all the participants were selected because they had both conditions. As such, it cannot demonstrate a link between the conditions as there was no comparison group. However, the researchers refer to previous research that they say has demonstrated this link. They say that the first study to document this relationship reported that nearly 40% of patients with isolated, idiopathic RBD developed a parkinsonian disorder an average of 12.7 years later. This current study was mainly interested in the question of whether the length of time between RBD and dementia could be even longer than 12.7 years.

What did the research involve?

Some patients with these neurological disorders have reported that their first experience of restless sleep happened many years previously. The aim of this study was to explore a theory based on this anecdotal evidence that RBD symptoms can predate Parkinson’s disease by several decades.

The researchers were interested in a range of conditions thought to be caused by abnormal deposition of a protein called alpha-synuclein in the brain. These diseases included Parkinson's disease, dementia with Lewy bodies and multiple system atrophy, which are all neurodegenerative diseases that appear later in life.

The researchers used the Mayo Clinic’s records to identify all patients who had been evaluated for these diseases between 2002 and 2006. They then selected all those who had a history of RBD and for whom there was at least 15 years between onset of RBD and their neurodegenerative symptoms. To be eligible, patients also had to have been assessed by a specialist in a sleep lab and by at least one other neurological specialist in the Mayo Clinic’s behavioural neurology or movement disorders sections.

RBD was diagnosed if abnormal flailing movements occurred during sleep, with sleep-related injuries or movements that were potentially injurious or disruptive. Symptoms of physical activity during sleep were provided by the patient and bed partner. Patients were then divided into probable and definite RBD. The numbers of patients with the different disorders were counted, and the interval between RBD and symptom onset for the neurological disorder recorded.

What were the basic results?

The researchers identified 550 patients with RBD and one of the three neurodegenerative disorders of interest.

Of the 550 patients, 27 (4.9%) had first started experiencing RBD more than 15 years before the onset of neurodegenerative disease symptoms. Of these, 13 had developed Parkinson’s disease, Parkinson’s with mild cognitive impairment or Parkinson disease dementia. Another 13 had developed probable dementia with Lewy bodies and one had developed parkinsonism-predominant MSA.

Most of the patients were male (24 [89%]). The average (median) interval between RBD symptoms and neurodegenerative syndrome symptom onset was 25 years (range 15–50 years), and the median age at onset of restless sleep was 49 years.

How did the researchers interpret the results?

The researchers say that their cases add a new time dimension to theories on the evolution of neurodegenerative syndromes characterised by alpha-synuclein deposition. They say that, until now, the estimated interval between changes in the brain and disease onset had been about 5-6 years, but this study suggests that it may be longer.

Conclusion

These findings suggest that the brain changes associated with certain neurodegenerative diseases could begin many years before the symptoms start to show.

There are a few points to note about this study:

• This study was not set up to evaluate the strength of the association between RBD and neurodegenerative disease, and it does not shed any light on how many people with restless sleep go on to develop neurological conditions.
• The study only looked at a few specific types of dementia and not the more common Alzheimer’s or vascular type of dementia. As such, these findings are even less applicable to people concerned about the more common dementias.
• These participants had a very specific form of severe sleep disturbance, involving lashing out and characteristic brain wave patterns during their sleep. Many people will have the occasional restless night of sleep, but most are unlikely to have RBD. The results of this study are unlikely to apply to them.

In general, this study provides some insight into these rare conditions and will be of interest to doctors, scientists and the public. The results should not be interpreted to mean that restless sleep can be used to predict future dementias or neurological diseases.

Links To The Headlines

Kicking and lashing during sleep 'could signal dementia or Parkinson's disease'. Daily Mail, July 29 2010

Links To Science

Claassen DO, Josephs KA, Ahlskog JE, et al. REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology 2010, [Published online before print] July 28, 2010

“Loneliness is a killer” and is “as bad for your health as alcoholism, smoking and overeating”, reported the Daily Mail.

The research behind this story looked at studies on the effects of social relationships on health and disease. It found that having stronger social relationships generally increased a person’s likelihood of survival over an eight-year period by 50% compared to people with fewer social relationships.

The researchers point out that the 148 studies they included in their analysis measured the strength of social relationships in very different ways, and that they did not all take into account other factors that could influence the risk of death.

Although this study found that people generally lived longer if they had larger networks of family and friends, it does not spell doom for those with smaller or less intimate social networks. The study could not show why there was a relationship between social networks and health. The researchers put forward two theories: that social networks may provide a cushion against stress or that they may encourage healthier lifestyles.

Where did the story come from?

The study was carried out by researchers from Brigham Young University, which also funded the research along with TP Industrial Inc. The study was published in the open access peer-reviewed journal PLoS Medicine.

The newspapers reflected the content of the research accurately.

What kind of research was this?

This was a systematic review and meta-analysis that investigated the extent to which social relationships influence the risk of death and which aspects of these relationships contributed to the risk.

The researchers said that there are two possible ways that social relationships may influence health. The first is that friends and family may help people deal with stress and prevent it from building up. The second reason is that they encourage people to have healthy behaviours, as people with these social networks are more likely to conform to social norms of health and self-care.

A systematic review is the best way to find all the information available in a research area. However, the researchers reported that there was a large variation in how social relationships were measured, making it more difficult to directly compare different studies. The researchers focussed on three major components of social relationships that were consistently evaluated to see how each of these components contributed to health:

• the degree of integration in social networks
• the social interactions that are intended to be supportive (received social support)
• the beliefs and perceptions of support availability held by the individual (perceived support)

What did the research involve?

The researchers searched for studies published between 1990 and 2007 using medical and scientific journal databases. They used the search terms “mortality”, “death”, “decease(d)”, “died”, “dead” and “remain(ed) alive” in addition to search words linked to social isolation, including “social”, “interpersonal”, “support”, “network”, “integration”, “participation”, “cohesion”, “relationship”, “capital” and “isolation”. If they found a review article using this search strategy, they looked at the references included in its reference list to make sure they had not omitted any relevant studies.

The researchers included studies that provided quantitative data on the association between death and an individual’s social relationships. As they were interested in the effect of social relationships on disease, they excluded studies where people had died as a result of suicide or injury. They also excluded studies where the measurement of social support was a treatment (for example, a support group for bereavement counselling) and studies that looked at the effects of having a pet or having faith in a god. Studies where individuals gave support (such as caregivers) rather than received support were also excluded.

Each paper was assessed and rated by four researchers. Data within the studies were often reported as odds ratios or hazard ratios, which show the risk of an outcome in people with a particular risk factor relative to those without the risk factor. The researchers used various statistical techniques to combine results between studies to give overall odds ratios for the risk of disease or death.

What were the basic results?

The researchers identified 148 studies that met their inclusion criteria and had data that could be pooled. The studies included data from over 300,000 individuals from North America (51%), Europe (37%), Asia (11%) and Australia (1%). The average age of the participants was 64 years. The participants were followed for an average of seven-and-a-half-years, and an average of 29% died during follow-up.

The researchers found that when they combined data from studies that had taken any type of measure of social interaction (for example, the number of people in a social network, amount of received support and amount of perceived support), the odds of survival was increased by 50% in those with stronger social interactions compared to weaker social interactions (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.42 to 1.59).

In the 63 studies that only looked at the structural measures of social relationships (for example, how many people are in a social network), the odds of survival increased by 57% for individuals with stronger social networks compared to weaker ones (OR 1.57, 95% CI 1.46 to 1.70).

Twenty-four studies looked at functional measures of social relationships only, such as received or perceived social support. They found that stronger functional social relationships were associated with a 46% increase in odds of survival (OR 1.46, 95% CI 1.28 to 1.66).

How did the researchers interpret the results?

The researchers say that individuals with adequate social relationships have a 50% greater likelihood of survival (over 7.5 years) than those with poor or insufficient social relationships. They report that the size of this effect is similar to or larger than that seen with smoking, obesity and physical activity.

They suggest that their meta-analysis should promote further research into treatments that explicitly account for social relationship factors across levels of healthcare such as prevention, evaluation, treatment, compliance and rehabilitation. They also suggest that hospitals and clinics could involve patient support networks in implementing and monitoring treatment regimes.

Conclusion

The study showed an association between the strength of social relationships and lower mortality rates. However, as the researchers highlighted, many different measures of the strength of social interactions are used, and this study does not classify what constitutes a healthy social life. Owing to the high variability of the studies included in this meta-analysis, the researchers looked at social relationships in very broad terms. There are some limitations to this research, some of which the authors highlight:

• Behavioural risk factors for disease, such as smoking and drinking alcohol, were adjusted for in some but not all of the studies included in this meta-analysis. Some of the effect on mortality may, therefore, be due to these and other factors that were not adjusted for in the analyses, rather than social factors.
• The participants included in the individual studies varied greatly. For example, some studies included people who had diseases at the start of the study and looked at how their social relationships affected the outcome of their disease, while other studies looked at people who were healthy at the start of their follow-up.
• Most measures of social relationships did not take into account the quality of the relationship and assumed that all relationships were positive.
• The researchers used various standard methods to try to assess whether publication bias could have contributed to their results. Publication bias means that scientific research that has negative results (finds no association) is less likely to be published than studies that have positive results. Although the researchers say that, based on their calculations, this is unlikely to have had an effect, publication bias is an important factor in this type of meta-analysis and may still have affected the results.
• It is difficult to directly compare the effects of loneliness seen in this meta-analysis with results seen in other studies of smoking, physical inactivity or other unhealthy behaviours, as the people participating in the studies may not be comparable.

The link between social relationships and disease is likely to be complex, as people who are seriously ill may have reduced capacity for social interaction and this could affect their social networks. It may also represent something that happens naturally with aging: that as people get older, their social networks get smaller. This study highlights that social relationships may play a role in health and disease, but further work is needed to assess what type of social interactions are helpful and the biology underlying this.

Links To The Headlines

Can your friendships save your life? The Guardian, July 28 2010

Popular people live longer. The Daily Telegraph, July 28 2010

Having pals 'helps you live longer'. Daily Mirror, July 28 2010

Loneliness is a killer: It's as bad for your health as alcoholism, smoking and over-eating, say scientists. Daily Mail, July 28 2010

Links To Science

Holt-Lunstad J, Smith TB, Bradley Layton J. Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Medicine 7(7)

“Maternal love helps you deal better with stress and anxiety later in life,” according to the Daily Mail. The newspaper said that a study has found that children whose mothers showed them high levels of affection at eight months of age experienced lower levels of distress as adults.

The study followed 482 individuals from birth until their mid thirties, and this unusually long follow-up time is one of the study’s strengths. The main limitation of this study is that many unmeasured factors may influence a person’s adult wellbeing, for example paternal affection as a child, or health or work status as an adult. It is also important to note that the adults in this study were, on average, in the normal range of emotional functioning.

It is likely that a complex mix of factors influences our adult wellbeing, and it seems plausible that our childhood experiences could be among them. However, the interactions between these numerous factors mean that teasing out the effects of individual factors is likely to be difficult and that maternal affection may not necessarily be the principal factor behind mental resilience.

Where did the story come from?

The study was carried out by researchers from Duke University, Harvard School of Public Health and Brown University in the US. One of its authors received partial funding from the US National Institutes of Mental Health. The study was published in the peer-reviewed Journal of Epidemiology and Community Health.

The Daily Mail and BBC News have reported on this research. The Daily Mail points out a strength of the study, saying that “most previous studies have relied on people's recollections - whereas this research tracked participants from early childhood to adult life”. The BBC also makes the important point that “the influence of other factors, such as personality, upbringing and schooling, could not be ruled out”.

What kind of research was this?

This was a prospective cohort study that looked at the association between maternal affection early in a child’s life and their emotional functioning as an adult.

The researchers looked at children who had originally been part of the National Collaborative Perinatal Project (NCPP), which had enrolled their mothers during pregnancy from 1959 to 1966. At the age of eight months, the interaction of mothers with their children was observed and rated according to how affectionate it was. The emotional functioning of the offspring was assessed when they became adults. The researchers then looked to see whether there were relationships between a mother’s level of affection at eight months and adult emotional functioning.

What did the research involve?

An evaluation of maternal affection was made by a psychologist while the mother and baby attended cognitive and developmental testing as part of the NCPP study. Levels of affection were rated as: “negative” or “occasionally negative” (both indicating a low level of affection), “warm” (indicating normal affection), and “caressing” or “extravagant” (both indicating a high level of affection). For the current analyses the “negative”, “occasionally negative” and “warm” groups were pooled, while “caressing” and “extravagant” were pooled into a high affection group.

A sample of 1,062 NCPP offspring were contacted in 1996, when they were on average 34 years old. Of these individuals, 482 agreed to participate and had complete data available for analyses. Emotional functioning was assessed using a standard symptom checklist (Symptom Checklist-90, SCL-90). This checklist includes an assessment of four common types of distress, including distress due to:

• somatisation: psychological distress manifesting itself through physical symptoms
• interpersonal sensitivity: the extent to which an individual can recognise or understand another’s emotions or feelings
• anxiety
• hostility/anger

An overall distress score was calculated based on these four types of distress. These scores were calculated in such a way that they ranged from 0 to 100, where the average score in a normal population would be 50, and a normal range considered to be 40 to 60.

The researchers took into account factors that could influence the analysis, including parental socio-economic status and maternal history of mental illness (based on self-report), which were assessed as part of the NCPP. They also took into account age, race, high-school completion and marital status of the adult offspring.

What were the basic results?

Approximately 10% of mothers displayed a low level of affection for their child at the age of eight months, 85% showed a normal level of affection and 6% showed a high level of affection.

Participants whose mothers showed a high level of affection to them at the age of eight months showed lower levels of overall distress as adults than those whose mothers showed normal or low levels of affection. The high-affection group had an overall average distress score of 50.39 and the low/normal affection group an overall average distress score of 55.38. When looking at the specific areas of distress, the relationship was strongest in the area of anxiety, where the high and low/normal groups differed by 7.15 points, and least strong in the area of hostility, where the high and low/normal groups differed by 3.29 points.

How did the researchers interpret the results?

The researchers concluded that “early nurturing and warmth have long-lasting positive effects on mental health well into adulthood”.

Conclusion

This study’s findings suggest that maternal affection early in life may influence adult distress levels. Strengths of this research include assessment of maternal affection by an independent observer and the following-up of participants from childhood into adulthood. However, there are some limitations:

• Only a subset of children from the original study was followed up. Inclusion of all of the children might have influenced the results if the children who did not participate differed from those who did.
• There may be factors other than maternal affection that are influencing results. Although the researchers took some of these into account, there are many others that may be having an effect, including paternal affection or general family affection as a child, or health and work conditions as an adult.
• Although maternal affection was rated by independent observers, the ratings of affection are likely still to be subjective to some extent (for example, what one observer considered negative might be normal to another observer). The researchers attempted to counteract this by providing extensive training for the assessors and carrying out quality control across the study sites.
• Maternal affection was only assessed on one occasion (at the age of eight months), and may not be representative of overall maternal affection throughout childhood.
• It is also important to note that both groups of adults (those receiving low/normal and those receiving high levels of affection as babies) had distress scores within the normal range.

There are likely to be many factors influencing our adult wellbeing, and it seems plausible that this could include our childhood experiences. However, the number of factors and the possible interactions between these factors means that teasing out the effects of individual factors is likely to be difficult.

Links To The Headlines

Maternal love helps you deal better with stress and anxiety later in life. Daily Mail, July 27 2010

Motherly love 'does breed confidence'. BBC News, July 27 2010

Links To Science

Maselko J, Kubzansky L, Lipsitt L,  Buka SL. Mother's affection at 8 months predicts emotional distress in adulthood. Journal of Epidemiology and Community Health 2010; Published Online First July 26 2010

Many newspapers have reported on new official guidelines for how women can manage their weight before, during and after pregnancy. The advice comes from the National Institute for Health and Clinical Excellence (NICE).

The importance of the guidelines is borne out by figures suggesting that more pregnant women than ever are overweight or obese. The Guardian suggests that, “15-20% of women getting pregnant are overweight or obese”. The Daily Mail puts the number higher, saying that “almost half of expectant mothers are overweight or obese”. It goes on to spell out the dangers of being obese or overweight during pregnancy, which include “fatal health conditions such as blood clots, pre-eclampsia, miscarriages and stillbirths”.

The newspapers also dispel the myth that women should eat for two during pregnancy. Further advice reported in the press includes taking at least 30 minutes of moderate exercise per day during pregnancy, and that pregnant women should avoid dieting and only need to have an extra 200 calories a day in the last three months of their pregnancy.

These guidelines are published by NICE, and are evidence-based. They are designed so that doctors can give women up-to-date reliable advice to follow to maintain a healthy weight before, during and after their pregnancy.

Where did the advice come from?

The advice has just been published by the National Institute for Health and Clinical Excellence (NICE) as part of its public health programme. NICE produces guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector.

What are the health risks of being obese during pregnancy?

Women who are obese (with a BMI over 30) when they become pregnant face an increased risk of complications such as diabetes, miscarriage, pre-eclampsia, blood clots and death. Obese women are also more likely to have an induced or longer labour, post-delivery bleeding and slower wound healing after delivery. They also tend to be less mobile, which can result in a need for more pain-relieving drugs during labour. These can be difficult to administer in obese women, resulting in a greater need for general anaesthesia with its associated risks.

For women who have gained weight between pregnancies, even a relatively small gain of 1-2 BMI units can increase the risk of high blood pressure or diabetes during their next pregnancy and may also increase the chance of giving birth to a large baby.

What sort of diet does NICE recommend?

NICE offers the following dietary advice to help women to achieve and maintain a healthy weight:

• Base meals on starchy foods (such as potatoes, bread, rice and pasta), choosing wholegrain where possible.
• Eat foods rich in fibre.
• Eat at least five portions of fruit and vegetables per day in place of foods higher in fat or calories.
• Eat as little as possible of fried foods, and drinks and confectionery high in sugars and fats.
• Eat breakfast.
• Watch portion size of meals and how often they are eaten.

What should women aim to weigh before getting pregnant?

Women with a BMI of 30 or more can achieve significant health benefits if they lose between 5-10% of their weight. Further weight loss to achieve a BMI within the healthy range of 18.5 and 24.9 is encouraged.

What about weight during pregnancy?

The amount of weight a woman may gain in pregnancy varies a great deal, and only some of it is due to increased body fat. The unborn child, placenta, amniotic fluid and increases in maternal blood and fluid volume all contribute to weight gain during pregnancy.

• Dieting during pregnancy is not recommended as it may harm the health of the child.
• There is no need to ‘eat for two’ or drink full-fat milk (as opposed to lower-fat milk). Energy needs do not change in the first six months of pregnancy. Only in the last three months do a woman’s energy needs increase by around 200 calories per day.
• Moderate-intensity physical activity will not harm the mother or baby. At least 30 minutes per day of moderate intensity activity is recommended. This can include activities such as swimming or brisk walking. If women have not exercised routinely up to that point, they should begin with no more than three 15-minute sessions a week, increasing gradually to daily 30-minute sessions.
• There are no formal evidence-based guidelines from the UK Government or professional bodies on what constitutes appropriate weight gain during pregnancy.

How do I safely lose weight after giving birth?

Women are encouraged to breastfeed, but are advised against dieting while breastfeeding. Women who feed their babies with breastmilk only for the first six months may require an additional 330 calories a day, but this may differ between individuals, and some of these additional calories will be derived from fat stores built up during pregnancy.

If the pregnancy and delivery are uncomplicated, mothers may start a mild exercise programme consisting of walking, pelvic floor exercises and stretching immediately after giving birth, but women should not resume high-impact activity too soon. Women who have had complicated deliveries or caesareans should not resume pre-pregnancy levels of physical activity before consulting their medical caregiver.

Health professionals should be able to provide details of appropriate community-based services for women who want support to lose weight.

Where can I get more information?

Women should consult their GP or midwife about maintaining a healthy lifestyle before, after and during their pregnancy.

Links To The Headlines

Mothers must lose baby weight before getting pregnant again, NICE says. The Daily Telegraph, July 28 2010

Weight, exercise and pregnancy confusion. BBC News, July 28 2010

Mothers who lose weight before further pregnancy 'reduce risks'. The Guardian, July 28 2010

Don't eat for two, pregnant mothers are told amid obesity fears. Daily Mail, July 28 2010