<p><strong>Aim:  </strong>To describe health professional's treatment of pregnant overweight or obese women at an antenatal clinic in Nairobi, Kenya. <strong>Method: </strong>A descriptive qualitative method was used including interviews with 11 health professionals at an antenatal clinic in Nairobi, Kenya. The interviews were semi-structured and consisted of five open-ended question. The result was then analysed through a systematic content analyse. <strong>Result: </strong>Four categories were identified. The methods used to state gestational overweight or obesity were weighting and assessing from the previous weight. BMI was also measured. The most common intervention is counselling on diet and lifestyle. Some respondents mentioned referral to nutritionist and also multidisciplinary involvement. Many of the respondents stated however that gestational overweight and obesity is very rare and that they don't have any specific routines or interventions. <strong>Conclusion:</strong> The basic measures used to survey  pregnant women´s weight are  pre- pregnant weight, continuously weighting and measuring BMI are used. There are also basic interventions such as counselling on diet and exercise. However, gestational overweight or obesity is not a prioritised issue at Kenyatta National Hospital and few routines and interventions exist. This study demonstrates the necessity for training and educating the staff to raise awareness about the risks gestational overweight or obesity implies. It also highlights the need of clear guidelines on how manage gestational overweight and obesity.  </p> / <p><strong>Syfte:</strong> Att beskriva hälso- och sjukvårdspersonals behandling av överviktiga eller feta gravida kvinnor. <strong>Metod:</strong> Beskrivande kvalitativ metod där intervjuer med 11 vårdpersonal utfördes på en mödravårdscentral i Nairobi, Kenya. Intervjuerna var semi- strukturerade och bestod av fem öppna frågor. Resultatet analyseras sedan genom en systematisk innehållsanalys. <strong>Resultat: </strong>Fyra kategorier identifierades. De metoder som användes för att fastställa övervikt eller fetma under graviditet var vägning, jämförelse med tidigare vikt samt BMI. Den vanligaste insatsen var rådgivning om kost och livsstil. Några respondenter nämnde att de vid behov remitterar patienter till en dietist och att de arbetar tvärvetenskapligt. Många av respondenterna uppgav dock att övervikt och fetma under graviditet är mycket ovanligt och att inga särskilda rutiner eller interventioner finns. <strong>Slutsats:</strong> Den vanligaste åtgärden för att förebygga graviditetsdiabetes övervikt och fetma är rådgivning om kost och motion. Kvinnornas vikt, kontinuerligt vägning och mätning av BMI är de grundläggande redskapen för att hålla en god kontroll på gravida kvinnors vikt. Övervikt och fetma hos gravida kvinnor är dock inte en prioriterad fråga på Kenyatta National Hospital och mycket få rutiner och åtgärder finns. Studien belyser behovet av att utbilda personal för att öka medvetenheten om vilka risker övervikt och fetma hos gravida kvinnor kan medföra. Det finns även ett behov av tydliga riktlinjer för hur man identifierar, behandlar och följer upp överviktiga eller feta gravida kvinnor.</p>

Aim:  To describe health professional's treatment of pregnant overweight or obese women at an antenatal clinic in Nairobi, Kenya. Method: A descriptive qualitative method was used including interviews with 11 health professionals at an antenatal clinic in Nairobi, Kenya. The interviews were semi-structured and consisted of five open-ended question. The result was then analysed through a systematic content analyse. Result: Four categories were identified. The methods used to state gestational overweight or obesity were weighting and assessing from the previous weight. BMI was also measured. The most common intervention is counselling on diet and lifestyle. Some respondents mentioned referral to nutritionist and also multidisciplinary involvement. Many of the respondents stated however that gestational overweight and obesity is very rare and that they don't have any specific routines or interventions. Conclusion: The basic measures used to survey  pregnant women´s weight are  pre- pregnant weight, continuously weighting and measuring BMI are used. There are also basic interventions such as counselling on diet and exercise. However, gestational overweight or obesity is not a prioritised issue at Kenyatta National Hospital and few routines and interventions exist. This study demonstrates the necessity for training and educating the staff to raise awareness about the risks gestational overweight or obesity implies. It also highlights the need of clear guidelines on how manage gestational overweight and obesity. / Syfte: Att beskriva hälso- och sjukvårdspersonals behandling av överviktiga eller feta gravida kvinnor. Metod: Beskrivande kvalitativ metod där intervjuer med 11 vårdpersonal utfördes på en mödravårdscentral i Nairobi, Kenya. Intervjuerna var semi- strukturerade och bestod av fem öppna frågor. Resultatet analyseras sedan genom en systematisk innehållsanalys. Resultat: Fyra kategorier identifierades. De metoder som användes för att fastställa övervikt eller fetma under graviditet var vägning, jämförelse med tidigare vikt samt BMI. Den vanligaste insatsen var rådgivning om kost och livsstil. Några respondenter nämnde att de vid behov remitterar patienter till en dietist och att de arbetar tvärvetenskapligt. Många av respondenterna uppgav dock att övervikt och fetma under graviditet är mycket ovanligt och att inga särskilda rutiner eller interventioner finns. Slutsats: Den vanligaste åtgärden för att förebygga graviditetsdiabetes övervikt och fetma är rådgivning om kost och motion. Kvinnornas vikt, kontinuerligt vägning och mätning av BMI är de grundläggande redskapen för att hålla en god kontroll på gravida kvinnors vikt. Övervikt och fetma hos gravida kvinnor är dock inte en prioriterad fråga på Kenyatta National Hospital och mycket få rutiner och åtgärder finns. Studien belyser behovet av att utbilda personal för att öka medvetenheten om vilka risker övervikt och fetma hos gravida kvinnor kan medföra. Det finns även ett behov av tydliga riktlinjer för hur man identifierar, behandlar och följer upp överviktiga eller feta gravida kvinnor.

Problem: Gestational obesity and insulin resistance pose a significant threat to the future health of our population. Mothers and children of these metabolically maladaptive pregnancies experience extensive morbidity and mortality. This study characterized postprandial insulin sensitivity in female Sprague Dawley rats at 5-days and 15-days gestation. Based on these findings, a model of gestational obesity was developed using 35% sucrose supplementation (SS). The efficacy of a preventative and a therapeutic intervention at modulating sucrose-induced gestational insulin resistance in Sprague Dawley rats was elucidated. Methods: Insulin sensitivity in the post-prandial state includes insulin-dependent and Hepatic Insulin Sensitizing Substance (HISS)-dependent components, and can be characterized with the Rapid Insulin Sensitivity Test (RIST). HISS is a putative hepatic factor released in the fed-state that selectively increases glucose uptake in skeletal muscle, kidney and heart. In the first phase of this study, the effects of insulin were assessed in pregnant animals (5 and 15-days gestation) and their virgin controls. Groups of 15-day gestation and virgin animals had SS for 8-weeks (with a 2-week recovery), 10-weeks or 22-weeks. Half of all of the 10-week SS animals were treated with either SAMEC (given chronically, containing S-adenosyl-methionine, vitamin C and vitamin E) or BENAC (given once the night before the acute study, containing bethanechol chloride and n-acetyl-l-cysteine). Body weight, weight gained over the gestational period, fat pad mass, post-prandial glycemia, plasma insulin and triglyceride concentrations were measured in all groups. Results: 5-days gestation was associated with preserved direct insulin action and increased HISS-dependent insulin action. 15-days gestation was associated with a mixed insulin resistance: both direct and HISS-dependent insulin action were reduced. SS in these pregnant and virgin rats eliminated HISS-dependent insulin action, associated with hyperinsulinemia, hypertriglyceridemia and obesity. In the SS group given 8-weeks of sucrose (then a 2-week recovery), virgins spontaneously partially recovered HISSdependent insulin action. At 15-days gestation, recovery was complete with reductions in plasma insulin and triglyceride concentrations, and normalization of body weight and fat pad mass. 10-week SS resulted in complete absence of HISS-dependent insulin action, and produced a model of gestational obesity. Prolonged (22-week) SS did not result in hyperglycemia or elevation of plasma insulin concentration above 10-week SS. SAMEC in 10-week SS 15-day pregnant and virgin rats prevented the loss of HISS-dependent insulin action, and normalized plasma insulin and triglyceride concentrations. BENAC given to 10-week SS virgin and 15-day pregnant rats normalized overall insulin responses secondary to restoration of HISS-dependent insulin action. This was accompanied by a reduction (for virgins) and normalization (at 15-days gestation) of plasma insulin and triglyceride concentrations. In 15-day pregnant controls (no sucrose), BENAC increased the HISS-dependent insulin action significantly above baseline and reduced plasma triglycerides and insulin below control levels. Conclusions: These results suggest an explanation for the insulin resistance occurring in pregnancy, whereby HISS may facilitate metabolic adaptation. HISS may represent a pathophysiological missing link in the insulin resistant disorders of pregnancy. These findings substantiate a series of unexplored treatments (including BENAC and SAMEC) for the epidemic of gestational obesity and diabetes in mothers-to-be and the deleterious metabolic programming occurring in the next generation.