Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum

Abstract

OBJECTIVES: (1) To describe the relative importance of gestational weight gain, postpartum exercise, food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum; and (2) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing. Design: A prospective cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York. Subjects: A total of 540 healthy adult women who gave birth to full-term singleton infants. MEASUREMENTS: Sociodemographic characteristics, exercise, food-related behaviors and breastfeeding were assessed using the medical record and a mailed questionnaire. Body weight was measured at prenatal visits and 1 y postpartum. Weight retained and major weight gain (4.55 kg) at 1 y postpartum were the main outcomes. ANALYSIS: Linear and logistic regression analyses were conducted. RESULTS: Women were on average 1.51 AE 5.95 kg heavier at 1 y postpartum than they were in early pregnancy. Nearly 25% of women experienced a major weight gain of 4.55 kg or more at 1 y postpartum. Gestational weight gain, exercise frequency, change in food intake and breastfeeding were each significantly related to postpartum weight retention. With the exception of breastfeeding, all of these factors were also associated with major weight gain. Women under 20 y or over 40 y at delivery, and single women retained significantly more weight. Lower income women with gestational weight gains above the Institute of Medicine (IOM) range retained 3.73 kg more than lower income women who gained within the range. They were also 4.7 times more likely to experience major weight gain with childbearing. The impact of exceeding the IOM gestational weight gain guidelines was three times greater in lower income women than it was in higher income women. CONCLUSION: Gestational weight gain, postpartum exercise frequency, and food intake are significantly associated with weight change from early pregnancy to 1 y postpartum and major weight gain with childbearing. Lower income women who gain more weight in pregnancy than the IOM recommends are at high risk for major weight gain with childbearing.

The association of pregnancy and the development of obesity – results of a systematic review and meta-analysis on the natural history of postpartum weight retention

“…Most studies included primarily adult women. 23,[27][28][29][31][32][33]35,36,38,43,46 Four studies reported a mean age above 30 years, 23,27,28,36,46 one study below 20 years. 42 Two studies did not provide any information on their population's age 24,44 (Table 1).…”

“…Tables 1-3 summarize the results of the qualitative analysis. Fifteen prospective studies, 23,24,[29][30][31][32][33][34][35][36]38,[40][41][42][43][44][45] five retrospective studies, 22,[25][26][27][28]37,46 and the control group from a randomized controlled trial 39 were included in the final analysis. Studies in which women were recruited around the time of delivery and then followed prospectively for postpartum body weight (ambivalent design, as baseline weight was assessed retrospectively) 24,29,30,[34][35][36][44][45][46] were considered as prospective in design, as we wanted to focus on the development of postpartum weight change.…”

“…The majority of studies were conducted in North America [22][23][24]29,35,[37][38][39][40]42,45,46 and Europe, [25][26][27][28]34,36,41,43 where the magnitude of weight retention among women appears to be similar. 39 In developing countries, women retain less weight after pregnancy compared with women in developed countries.…”

“…[22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40][41][42][43][44][45][46] The study populations were mainly recruited from inpatients in departments of obstetrics. [24][25][26][31][32][33]35,36,[38][39][40][41][42][43][44][45][46] There was a higher percentage of low-income women in the studies conducted in North America, but socio-economic status was thought to be homogeneous across studies. 35,37,39,42,45,46 The sample size varied between 47 and 1423 women.…”

“…23,27,28,35,39,41,46 Four studies had sample sizes of over 500 women. 24,36,38,40 Studies were judged homogeneous regarding participants' age. Most studies included primarily adult women.…”