Brain responses to food viewing in women during pregnancy and post partum and their relationship with metabolic health: study protocol for the FOODY Brain Study, a prospective observational study

BMJ Open · 10 authors, 10 centres

AI SUMMARY

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POPULATIONPregnant women (24–36 weeks gestation) and at 6 months postpartum, including 20 with GDM and 20 healthy controls (target with valid primary outcome data).

INTERVENTIONViewing of food images of varying fat and carbohydrate content during EEG recording; no experimental intervention.

COMPARISONWomen with GDM vs. healthy controls; pregnancy vs. postpartum state; responses to different food categories (HIGH-FAT/LOW-CARB, HIGH-FAT/HIGH-CARB, LOW-FAT/LOW-CARB, LOW-FAT/HIGH-CARB).

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TL;DR

This protocol describes the FOODY Brain Study, a prospective observational study investigating brain responses to food images (using EEG) in pregnant and postpartum women with and without gestational diabetes mellitus (GDM). The study aims to link these brain responses to eating behaviors, emotional states, and metabolic health outcomes, including weight, body composition, and glycemic control. Findings may inform future interventions to manage excessive gestational weight gain and improve metabolic health in the perinatal period.

Full summary

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**Background:** Food cravings are common in pregnancy and are associated with excessive gestational weight gain (GWG) and adverse metabolic outcomes, including gestational diabetes mellitus (GDM). Cravings and disinhibited eating behaviors are linked to activity in brain reward circuits (e.g., ventral striatum, orbitofrontal cortex, anterior cingulate cortex). However, no studies have investigated brain responses to food cues during pregnancy or the postpartum period using EEG. This study aims to fill that gap by examining spatiotemporal brain dynamics to food images and their relationship with eating behavior and metabolic health in women with and without GDM.

**Methods:** This prospective observational study will recruit at least 35 women with GDM and at least 34 healthy controls to obtain 20 valid datasets per group. Inclusion criteria: gestational age 24–36 weeks, age ≥18 years. GDM diagnosed per IADPSG/ADA criteria at 24–32 weeks. Healthy controls: normal prepregnancy BMI (<25 kg/m²), no prior/current GDM, no significant weight changes. Exclusion criteria: pre-existing diabetes, eating disorders, vegetarian/vegan diet, current insulin treatment, psychiatric medication, active suicidal thoughts. Two visits occur: at 24–36 weeks gestation and at 6 months postpartum. Participants eat a standardized meal at 12:00, arrive at 13:30, and testing ends at 16:00. The primary outcome is EEG responses (128-channel) to food images from the Salzburg food picture database, divided into four categories: HIGH-FAT/LOW-CARB (>5 g fat/100g, <15 g carb/100g), HIGH-FAT/HIGH-CARB, LOW-FAT/LOW-CARB (<5 g fat/100g, <15 g carb/100g), and LOW-FAT/HIGH-CARB. Images are presented in 4 blocks of 240 randomized images (200 food, 40 non-food). Participants indicate food vs. non-food via button press. VEPs are analyzed for amplitude, latency, topography, and intracranial source estimation. Secondary outcomes include: weight, HbA1c (capillary, Afinion), body composition (bioimpedance, BIA 101 and InBody s10), eating rate (Auracle device, accuracy >92%), heart rate and heart rate variability (Actiheart), and glucose sensors (Freestyle Libre 1, 14 days, GDM group only). Questionnaires assess: food cravings (Food Craving Questionnaire-Trait-reduced, Food Craving Questionnaire-State), intuitive eating (Intuitive Eating Scale-2, French version, 14 items from EPR and RHSC subscales), eating behaviors (Three-Factor Eating Questionnaire-R18), depression (Edinburgh Postnatal Depression Scale, EPDS), mood (PANAS), stress (Perceived Stress Scale-10), handedness (Edinburgh Handedness Inventory), and current hunger. A food wanting questionnaire (20 items, 0–10 scale) is completed post-EEG. Eight crunchy snacks (two per food category) are offered; intake weight, kcal, and eating duration are measured.

**Key Results:** This is a study protocol; no results are reported. The study started in March 2022 and is scheduled to end in June 2024. The sample size (n=40 with valid primary outcome data) is based on previous EEG studies of similar design. Analyses are exploratory. Statistical methods include ANOVA, t-tests, χ² tests, and regression analyses, with adjustment for covariates (maternal age, gestational age, prepregnancy BMI) as appropriate.

**Clinical Implications:** This study is the first to investigate brain responses to food cues during pregnancy and the postpartum period using EEG. By linking implicit neural responses to explicit eating behaviors and metabolic outcomes, it may identify mechanistic pathways underlying excessive GWG and postpartum weight retention. Findings could inform future interventions targeting neural responses to energy-dense foods to reduce cravings and improve metabolic health in women with and without GDM, potentially benefiting both maternal and offspring health.

PICO

PPOPULATION

Pregnant women (24–36 weeks gestation) and at 6 months postpartum, including 20 with GDM and 20 healthy controls (target with valid primary outcome data).

IINTERVENTION

Viewing of food images of varying fat and carbohydrate content during EEG recording; no experimental intervention.

OOUTCOME

Primary: EEG visual evoked potentials (amplitude, latency, topography) to food images. Secondary: weight, HbA1c, body composition, eating rate (Auracle), food cravings, intuitive eating, emotional eating, depression (EPDS), mood (PANAS), stress (PSS-10, heart rate variability).

STUDY TYPE

other

SPECIALTY

obstetrics

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10124253

Brain responses to food viewing in women during pregnancy and post partum and their relationship with metabolic health: study protocol for the FOODY Brain Study, a prospective observational study

BMJ Open

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ABSTRACT

Abstract Introduction Food cravings are common in pregnancy and along with emotional eating and eating in the absence of hunger, they are associated with excessive weight gain and adverse effects on metabolic health including gestational diabetes mellitus (GDM). Women with GDM also show poorer mental health, which further can contribute to dysregulated eating behaviour. Food cravings can lead to greater activity in brain centres known to be involved in food ‘wanting’ and reward valuation as well as emotional eating. They are also related to gestational weight gain. Thus, there is a great need to link implicit brain responses to food with explicit measures of food intake behaviour, especially in the perinatal period. The aim of this study is to investigate the spatiotemporal brain dynamics to visual presentations of food in women during pregnancy and in the post partum, and link these brain responses to the eating behaviour and metabolic health outcomes in women with and without GDM. Methods and analysis This prospective observational study will include 20 women with and 20 without GDM, that have valid data for the primary outcomes. Data will be assessed at 24–36 weeks gestational age and at 6 months post partum. The primary outcomes are brain responses to food pictures of varying carbohydrate and fat content during pregnancy and in the post partum using electroencephalography. Secondary outcomes including depressive symptoms, current mood and eating behaviours will be assessed with questionnaires, objective eating behaviours will be measured using Auracle and stress will be measured with heart rate and heart rate variability (Actiheart). Other secondary outcome measures include body composition and glycaemic control parameters. Ethics and dissemination The Human Research Ethics Committee of the Canton de Vaud approved the study protocol (2021-01976). Study results will be presented at public and scientific conferences and in peer-reviewed journals. Keywords: Diabetes in pregnancy, Neurobiology, NUTRITION & DIETETICS, Eating disorders

CITATION EXPORT

Anna Lesniara-Stachon, Dan Yedu Quansah, Sybille Schenk et al.. Brain responses to food viewing in women during pregnancy and post partum and their relationship with metabolic health: study protocol for the FOODY Brain Study, a prospective observational study. BMJ Open. (2023). https://doi.org/10.1136/bmjopen-2022-067013

AUTHORS

10 · 10 CENTRES

Anna Lesniara-Stachon, Dan Yedu Quansah, Sybille Schenk, Chrysa Retsa, Ryan J Halter, Micah M Murray, Alain Lacroix, Antje Horsch, Ulrike Toepel, Jardena J Puder

1Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
2Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
3Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
4Laboratory for Investigative Neurophysiology (the LINE), Radiology Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
5The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
6CIBM Center for Biomedical Imaging, Lausanne, Switzerland
7Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
8Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
9Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
10Neonatology service, Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland