Association between gestational weight gain according to prepregnancy body mass index and short postpartum weight retention in postpartum women

Effect of mode of delivery on postpartum weight retention: A systematic review and meta-analysis

OBJECTIVE

Retention of weight gained over pregnancy increases the risk of long-term obesity and related health concerns. While many risk factors for this postpartum weight retention have been examined, the role of mode of delivery in this relationship remains controversial. We carried out a systematic review and meta-analysis to determine the effect of mode of delivery on postpartum weight retention.

METHODS

Ten electronic databases including PubMed, Cochrane Library, EMBASE, Web of Science, MEDLINE, CINAHL, China National Knowledge Infrastructure (CNKI), Wan-Fang database, the VIP database and China Biology Medicine Database (CBM) were searched from inception through November 2022. Review Manager 5.4 was used to pool the study data and calculate effect sizes. For dichotomous data, the odds ratio and 95 % confidence interval were used to report the results. For continuous data, the mean difference (MD) and 95 % confidence interval were used to report the results. The outcomes were the amount of postpartum weight retention and the number or proportion of women who experienced postpartum weight retention. The Newcastle- Ottawa Scale (NOS) and GRADE Guidelines were used to assess the methodological quality of the included studies.

FINDINGS

A total of 16 articles were included in the systematic review and 13 articles were included in the meta-analysis. The results showed that the mode of delivery had a significant effect on postpartum weight retention, women who delivered by caesarean section were more likely to experience postpartum weight retention compared to those who delivered vaginally. Sensitivity analysis showed that the results were stable and credible.

CONCLUSION

Due to the limitations of this study, the findings need to be treated with caution. And, to better prevent the postpartum weight retention, future practice and research need to further focus on upstream modifiable factors.

How does gestational weight gain influence short- and long-term postpartum weight retention? An updated systematic review and meta-analysis

This systematic review and meta-analysis provide an update of an earlier meta-analysis examining the impact of gestational weight gain (GWG) on postpartum weight retention (PPWR). Thirty-four observational studies were included, and results from 18 studies were combined in meta-analyses. We found that women with excessive GWG retained an additional 2.98 kg (95% CI: 0.59, 5.37 kg, I2  = 91%) at 0.5 years, 1.89 kg (95% CI: 0.90, 2.88 kg, I2  = 61%) at > 0.5-1 year and 2.89 kg (95% CI: 1.74, 4.04 kg, I 2  = 0%) at 2-4 years, compared to women who met the National Academy of Medicine GWG recommendations. Moreover, synthesis of confounder-adjusted regression coefficients showed that each 1 kg increase of GWG corresponded to 0.62 kg (95% CI: 0.22, 1.02 kg, I2  = 96%) additional PPWR at 6-9 months, 0.48 kg (95% CI: 0.14, 0.81 kg, I2  = 93%) at 1-3 years, and 0.31 kg (95% CI: -0.24, 0.86 kg, I2  = 89%) at 5-7 years postpartum. Findings suggest that higher GWG contributes to increased maternal body weight in the short- and long-term after childbirth, independent of prepregnancy body mass index. The heterogeneity of reported data and methodological differences across studies complicate the ability to synthesize data and interpret findings.

Does the postpartum body image of primiparous women giving vaginal delivery affect their sexual functions and depression and fatigue levels?

The body image-related problems can negatively affect women's lives in many ways. The study was aimed at investigating the effects of postpartum body image on sexual functions, and fatigue and depression levels of primiparous women who gave birth vaginally. This cross-sectional study was conducted with 133 women who presented to the obstetrics and gynecology clinics of a state hospital in Turkey between June 2021 and December 2021. At the end of the study, a moderate relationship was determined between the women's body image and their depression (r = 0.500; p < 0.001) and fatigue (r = 0.666; p < 0.001) levels, and a weak relationship between their body image and sexual functions (r = -0.372; p < 0.001). According to the backward regression model used in the study, the women's fatigue and education levels accounted for their body image by 45.7%.

The relationship between social determinants of health and postpartum weight retention based on the World Health Organization model: path analysis

BACKGROUND

Postpartum weight retention (PPWR) causes obesity, chronic diseases, and occurring adverse maternal-fetal and neonatal outcomes. Given the social factors' effect on health and disease and considering the lack of information on social determinants of health (SDH) effects on PPWR, this study was conducted to survey the relationship between SDH and PPWR based on the World Health Organization (WHO) model.

METHODS

A cross-sectional study was performed on 400 women six months after delivery in 2020. Twelve health centers were randomly selected from the three universities of Medical Sciences in the city of Tehran, Iran. Participants were selected by convenience method and based on eligibility. Questionnaires used included: Lifestyle Profile Health Promoting II, Short Form Postpartum Quality of Life Questionnaire, Multidimensional Scale of Perceived Social Support, Postpartum Social Support, Depression Anxiety Stress Scales, and questionnaires designed by reviewing the literature about breastfeeding, sleep, contraceptive, child health, unhealthy behaviors, postpartum nutritional awareness/beliefs, body satisfaction, access to postpartum care, socioeconomic status, demographic, and obstetric questionnaire. Data analysis was performed in SPSS-23, and the relationship model was examined using the path analysis method in LISREL-8.8.

RESULTS

Path analysis indicated the direct effect of six intermediate factors on PPWR including: gestational weight gain (β = 0.42), access to postpartum care (β = 0.11), postpartum nutritional awareness/beliefs (β=-0.17), anxiety (β = 0.09), sleep duration (β=-0.09), pre-pregnancy body mass index (β = 0.09). Among the structural factors, woman's education and socioeconomic status had an indirect negative effect on PPWR. The model fit indices showed good fit (RMSE = 0/05, GFI = 0.92, CFI = 0.92, χ2/df = 2.17).

CONCLUSION

The results indicate the effect of structural and intermediate determinants of health on PPWR. It is recommended to use the proposed model as an appropriate framework in the research, design, and implementation of programs to prevent and control PPWR.

Gestational weight gain and postpartum weight retention in Tasmanian women: The Baby-bod Study

Many factors can negatively impact perinatal outcomes, including inappropriate gestational weight gain (GWG). Despite having the greatest potential to influence maternal and infant health, there is a lack of consensus regarding the GWG consistent with a healthy pregnancy. To date, GWG in Northern Tasmania remains understudied. We investigated how maternal pre-pregnancy body mass index (BMI) is related to weight gain during pregnancy and weight retention post-partum, and how maternal pre-pregnancy BMI is related to the mode of delivery. Approximately 300 Tasmanian mothers (n = 291 for mode of delivery and n = 282 for GWG) were included in this study. Analysis of variance and chi square tests were conducted to assess differences in BW of mothers across BMI categories and differences between categorical variables; respectively. Based on pre-pregnancy BMI, mothers were assigned to one of three groups, with healthy weight (<25 kg m-2), with overweight (25–29.9 kg m-2), or with obesity (>30 kg m-2). Pre-pregnancy BMI and body weight (BW) were significantly associated (p<0.001) with post-partum BW at 3 and 6 months. Only 25% of mothers with a normal weight BMI, 34% with overweight and 13% with obesity, achieved the Institute of Medicine (IOM) recommendation for GWG. Interestingly, a number of women in our cohort lost weight during gestation (1.5, 9 and 37% in <25, 25–29.9 and >30 kg m-2 groups, respectively). Further, women with obesity showed the lowest level of BW fluctuation and retained less weight post-partum. The highest number of caesarean sections were observed in mothers who exceeded GWG recommendations. Most mothers either exceeded or failed to achieve IOM recommendations for GWG. To improve the generalisability of these findings, this study should be replicated in a larger representative sample of the Tasmanian maternal population.

Weight Change Pattern Among Breastfeeding Mothers: One-Year Follow-Up

Objective: Excessive gestational weight gain (GWG) and postpartum weight retention are risk factors for female obesity. The aim of the study was to assess postpartum weight change patterns among 64 Turkish, exclusively breastfed to 6 months and continued to 1 year and beyond, mothers during 1-year follow-up. Materials and Methods: Postpartum women's sociodemographic characteristics and breastfeeding patterns were obtained and anthropometric measurements were determined at five time points (1st, 3rd, 6th, 9th, and 12th months). Results: Mean GWG was 12.2 ± 5.8 kg and mean postpartum weight retention was 4.2 ± 4.9, 4.6 ± 4.8, 3.7 ± 5.4, 2.8 ± 5.0, and 3.3 ± 5.5 kg at 1st, 3rd, 6th, 9th, and 12th months, respectively. According to the results of repeated measure analysis of variance (ANOVA), there was significant time effect in body weight (F = 6.509; p = 0.001), body mass index (BMI) (F = 6.743; p = 0.001), and weight retention (F = 6.509; p = 0.001) measured over 1 year. Bonferroni multiple post hoc tests results showed similar significant changes between 1st-9th months (p < 0.05), 3rd-6th months (p < 0.05), 3rd-9th months (p < 0.05), 3rd-9th months (p < 0.001), and 3rd-12th months (p < 0.05) for body weight, BMI, and weight retention. Two-way repeated measures ANOVA of body weight, BMI, and weight retention by time showed significant interactions for employment status (p < 0.05) and prepregnancy BMI (p < 0.05). Conclusion: These findings highlight the importance of weight management starting from pregnancy to postpartum 1 year.

The effect of a low carbohydrate ketogenic diet with or without exercise on postpartum weight retention, metabolic profile and physical activity performance in postpartum mice

OBJECTIVE

the present study examined the effect of the isocaloric low-carbohydrate ketogenic diet (LCKD) with or without exercise training for 6 weeks on postpartum weight retention (PPWR), body composition, metabolic profile and physical activity performance in postpartum mice.

METHODS

postpartum mice were assigned to 4 groups (n=8/group) as follows: (1) those on a control diet without aerobic exercise (CN); (2) those on a control diet with aerobic exercise (CN+EX), (3); those on a LCKD without aerobic exercise (LCKD); (4) those on a LCKD with aerobic exercise (LCKD+EX). CN+EX and LCKD+EX mice performed 6 weeks of exercise training on a treadmill. After the 6-week intervention, physical activity performance was determined.

RESULTS

postpartum mice in all groups experienced progressive reductions in body weight over the study period. The LCKD group had the smallest reduction in PPWR (p<0.05). The LCKD group had significantly higher total cholesterol, low-density lipoprotein cholesterol and lactate dehydrogenase levels, and liver lipid concentrations with a worsened glucose tolerance, compared to the CN group (p<0.05). The LCKD group showed significant reductions in physical activity performance, whilst the LCKD+EX group showed significantly improvement in endurance performance, and paralleled the concomitant elevation in blood ketone levels.

CONCLUSIONS

6-week LCKD feeding on its own was less effective for reducing PPWR, and more detrimental to postpartum metabolic outcomes and physical activity performance of the postpartum mice. The feasibility of a LCKD with or without exercise during the postpartum period as a strategy for managing PPWR and improving postpartum metabolic profiles should be carefully considered.

'I wish I had my pre-pregnancy body after birth… but I have to be supported': a theoretical study based on body image perception in working mothers during the postpartum period

The body image of women in the postpartum period can be far from society's idealised body, and this can cause body dissatisfaction. This qualitative study aimed to evaluate the body image perception of women who had started working in the postpartum period, based on the grounded theory research method. A total of 22 face-to-face interviews were conducted with participants who were actively involved in working life and between 3 months and 1 year postpartum. The data were collected through in-depth interviews with a personal information form and semi-structured interview form. Coding created four main categories ('weight fluctuations and body shape', 'body-related perception', 'body-related responses from the environment' and 'body perception improvement process') and eight sub-categories. The results found that the postpartum period is a sensitive one for working women, where they have both positive and negative experiences. Their responsibilities increase, they have little time for themselves and their bodies, they experience body image dissatisfaction, and they expect support from their spouses, families, social circles and health professionals.Impact StatementWhat is already known on this subject? Postpartum body image is an important research subject because it expands the scope of body image literature and has significant effects on gender problems. Not being able to lose the weight gained in postpartum period or the weight gained during pregnancy is an important problem for women. With women starting working life, this period seems to be a more sensitive and anxious one for some women.What do the results of this study add? Most of the women in this study experience body dissatisfaction in the postpartum period. Some women do not want to leave the house because of their negative body image perceptions. It is an important finding that women want their spouse to gain weight during this period.What are the implications of these findings for clinical practice and/or further research? The findings of our study revealed that working mothers in the postpartum period have difficulty in sparing time for themselves and their bodies due to increased responsibilities. Working women are in particular need for more support due to their increased workloads, roles and responsibilities in childcare. Our study may guide future studies focussing on women's body image perceptions and influencing factors.

Postpartum Weight Change in Relation to Pre-Pregnancy Weight and Gestational Weight Gain in Women in Low-Income Setting: Data from the KITE Cohort in the Northern Part of Ethiopia

(1) Background: Postpartum weight may increase compared to pre-pregnancy due to weight retention or decrease due to weight loss. Both changes could pose deleterious effects on maternal health and subsequent pregnancy outcomes. Therefore, this study aimed to assess postpartum weight change and its associated factors. (2) Methods: A total of 585 women from the KIlte-Awlaelo Tigray Ethiopia (KITE) cohort were included in the analysis. (3) Results: The mean pre-pregnancy body mass index and weight gain during pregnancy were 19.7 kg/m2 and 10.8 kg, respectively. At 18 to 24 months postpartum, the weight change ranged from -3.2 to 5.5 kg (mean = 0.42 kg [SD = 1.5]). In addition, 17.8% of women shifted to normal weight and 5.1% to underweight compared to the pre-pregnancy period. A unit increase in weight during pregnancy was associated with higher weight change (β = 0.56 kg, 95% CI [0.52, 0.60]) and increased probability to achieve normal weight (AOR = 1.65, 95% CI [1.37, 2.00]). Food insecurity (AOR = 5.26, 95% CI [1.68, 16.50]), however, was associated with a shift to underweight postpartum. Interestingly, high symptoms of distress (AOR = 0.13, 95% CI [0.03, 0.48]) also negatively impacted a change in weight category. (4) Conclusions: In low-income settings such as northern Ethiopia, higher weight gain and better mental health during pregnancy may help women achieve a better nutritional status after pregnancy and before a possible subsequent pregnancy.

Association of the low-carbohydrate dietary pattern with postpartum weight retention in women

Low-carbohydrate diets (LCD) have been considered a popular dietary strategy for weight loss. However, the association of the low-carbohydrate dietary pattern with postpartum weight retention (PPWR) in women remains unknown. The present study involved 426 women from a prospective mother-infant cohort study. Overall, animal or plant LCD scores, which represent adherence to different low-carbohydrate dietary patterns, were calculated using diet intake information assessed by three consecutive 24 h dietary surveys. PPWR was assessed by the difference of weight at 1 year postpartum minus the pre-pregnancy weight. After adjusting for potential confounding variables, women in higher quartiles of total and animal-based LCD scores had a significantly lower body weight and weight retention at 1 year postpartum (P < 0.05). The multivariable-adjusted ORs of substantial PPWR (≥5 kg), comparing the highest with the lowest quartile, were 0.47 (95% confidence interval 0.23-0.96) for the total LCD score (P = 0.021 for trend) and 0.38 (95% confidence interval 0.19-0.77) for the animal-based LCD score (P = 0.019 for trend), while this association was significantly attenuated by rice, glycemic load, fish, poultry, animal fat and animal protein (P for trend <0.05). A high score for plant-based LCD was not significantly associated with the risk of PPWR (P > 0.05). The findings suggested that a low-carbohydrate dietary pattern, particularly with high protein and fat intake from animal-source foods, is associated with a decreased risk of weight retention at 1 year postpartum. This association was mainly due to low intake of glycemic load and high intake of fish and poultry.

Influence of prenatal perceived stress on postpartum weight retention is mediated by high gestational weight gain in women with overweight

Women with excessive gestational weight gain (GWG) are at risk for poor psychosocial well-being and postpartum weight retention (PPWR). Scant research has examined longitudinal interrelations of GWG, psychosocial factors, and PPWR. This study examined: (a) pre-pregnancy weight status (ie, normal, overweight, obesity) differences in PPWR and its psychosocial determinants (perceived social support, perceived stress, depression) in women with excessive GWG (ie, above 2009 Institute of Medicine guidelines); and (b) whether GWG mediated associations between psychosocial determinants and PPWR. Women (N = 1352) reported third trimester perceived social support, perceived stress, and depressive symptoms, GWG, and 6- and 12-month PPWR via telephone interviews. Multivariate ANOVA analyses showed women with normal weight had higher 6-month PPWR than women with obesity; univariate ANOVA showed no group differences in psychosocial factors. Hayes mediation analyses indicated that GWG mediated the association between perceived stress and PPWR in women with overweight but not women with normal weight or obesity; perceived stress predicted GWG, and in turn, PPWR. Prenatal perceived stress may be a modifiable target of GWG and PPWR. Future research is needed to examine the utility of tailoring perinatal weight regulation interventions to reduce perceived stress in pregnant women with overweight.

Effectiveness of a normative nutrition intervention in Chilean pregnant women on maternal and neonatal outcomes: the CHiMINCs study

BACKGROUND

Some nutritional interventions have shown their efficacy in reducing gestational weight gain (GWG); however, their applicability in routine care is limited.

OBJECTIVE

We assessed the effectiveness of a low-intensity and high-coverage nutritional intervention on maternal and offspring outcomes; the intervention enhanced existing nutritional health care standards and practices at the primary health care level in Chile.

METHODS

This study was a cluster-randomized controlled trial of 12 primary health care centers (PHCCs) from Santiago, Chile. PHCCs were randomly allocated to either nutritional intervention [intervention group (IG), n = 5] or routine care [control group (CG), n = 7]. A total of 4631 pregnant women were recruited (IG, n = 2565; and CG, n = 2066). Primary outcomes were adequate GWG and glycemic control in mothers and birth weight, birth length, macrosomia, and large for gestational age in neonates. The intervention consisted of 4 key actions: training of health care professionals on nutritional recommendations, counseling of pregnant women on diet and physical activity recommendations, offering a physical activity program implemented in the participating PHCCs, and adequate referral to dietitians. Women randomly assigned to the CG received routine antenatal care.

RESULTS

At baseline, the mean age was 26.1 y; 45% of women were primipara and 24% were obese. No differences were found in the percentage of women achieving adequate GWG (IG: 30.3%, compared with CG: 31.3%; OR: 0.94; 95% CI: 0.81, 1.09), but women in the IG had lower GWG than those in the CG (11.3 compared with 11.9 kg; mean difference: -0.63 kg; 95% CI: -1.19, -0.08). Effects of the intervention were significantly higher in women with obesity at the begining of pregnancy (mean difference: -1.24 kg; 95% CI: -2.18, -0.30; P for interaction < 0.05). No differences were found between groups regarding maternal glycemic control or neonatal outcomes.

CONCLUSIONS

Our findings demonstrate that a low-intensity, high-coverage intervention delivered through the Chilean public health care system under standard operating conditions reduces GWG and has the potential for successful scale-up. This trial was registered at clinicaltrials.gov as NCT01916603.

Weight Changes and Body Image in Pregnant Women: A Challenge for Health Care Professionals

Body changes concerns and body image dissatisfaction are common during pregnancy. We aimed to examine whether health care professionals (HCPs): (i) believe that women are concerned about body image during pregnancy; (ii) consider it important to question, support, and intervene when pregnant women express body image concerns; (iii) feel comfortable enough in their abilities to question pregnant women with concerns; and (iv) have sufficient knowledge and skills to provide adequate support. A 36-item e-survey, developed by ÉquiLibre in collaboration with an expert committee, was sent to HCPs via email. HCPs believe that some situations are associated with body image concerns: postpregnancy weight loss (74.0%), perceived changes in their appearance (65.9%), excessive weight gain (65.3%), and feeling less in control of their body (36.8%). Among 321 responders, 60% considered it important to question pregnant women's concerns. One in four (25.4%) considered themselves "totally comfortable" asking about weight and body image concerns. Our study showed that HCPs need to be better supported in developing their abilities to help weight-preoccupied pregnant women. There is an urgent need to clarify HCPs' roles and to delineate the referral process as well as to ensure staff availability, in terms of time and personnel.

A Randomised Trial to Optimise Gestational Weight Gain and Improve Maternal and Infant Health Outcomes through Antenatal Dietary, Lifestyle and Exercise Advice: The OPTIMISE Randomised Trial

There are well-recognised associations between excessive gestational weight gain (GWG) and adverse pregnancy outcomes, including an increased risk of pre-eclampsia, gestational diabetes and caesarean birth. The aim of the OPTIMISE randomised trial was to evaluate the effect of dietary and exercise advice among pregnant women of normal body mass index (BMI), on pregnancy and birth outcomes. The trial was conducted in Adelaide, South Australia. Pregnant women with a body mass index in the healthy weight range (18.5–24.9 kg/m²) were enrolled in a randomised controlled trial of a dietary and lifestyle intervention versus standard antenatal care. The dietitian-led dietary and lifestyle intervention over the course of pregnancy was based on the Australian Guide to Healthy Eating. Baseline characteristics of women in the two treatment groups were similar. There was no statistically significant difference in the proportion of infants with birth weight above 4.0 kg between the Lifestyle Advice and Standard Care groups (24/316 (7.59%) Lifestyle Advice versus 26/313 (8.31%) Standard Care; adjusted risk ratio (aRR) 0.91; 95% confidence interval (CI) 0.54 to 1.55; p = 0.732). Despite improvements in maternal diet quality, no significant differences between the treatment groups were observed for total GWG, or other pregnancy and birth outcomes.

The influence of energy metabolism on postpartum weight retention

BACKGROUND

Profiling postpartum energy metabolism may assist in optimizing weight management following childbirth.

OBJECTIVES

The aims of this study were to profile total energy expenditure (TEE), resting energy expenditure (REE), exercise energy expenditure, sleep energy expenditure, and respiratory quotient in women at 3 and 9 mo postpartum (3M-PP, 9M-PP, respectively), and to examine the association between energy metabolism and postpartum weight retention (PPWR).

METHODS

In this cohort study, 1-h REE (measured in a whole body calorimetry unit, WBCU) and body composition (BC, measured by dual-energy X-ray absorptiometry) were measured at 3M-PP and 9M-PP (n = 49). Cardiorespiratory fitness [measured by the predicted maximal volume of oxygen consumption (p$\dot{V}$O2 max), n = 47] and 24-h TEE (WBCU, n = 43) were assessed only at 9M-PP. Women were stratified as high (>4.8 kg) or low (≤ 4.8 kg) weight retainers. Two-way mixed repeated-measures ANOVA and longitudinal regression models were applied. Linear regression was used to generate an equation at 3M-PP from the BC data, to predict the REE at 9M-PP.

RESULTS

The fat mass at 3M-PP was positively associated with PPWR at 3M-PP (mean ± SE β: 0.09 ± 0.03; P = 0.005) and 9M-PP (β: 0.11 ± 0.04; P = 0.008), and negatively associated with REE at 3M-PP (β: -0.16 ± 0.02; P < 0.001) and TEE at 9M-PP (β: -0.15 ± 0.03; P < 0.001). REE was negatively associated with PPWR (β: -0.74; 95% CI: -1.29, -0.19; P = 0.0087). REE was 2 kcal/kg higher in low- vs. high-retainers at 3M-PP, and REE and TEE were both 4 kcal/kg higher in low- vs. high-retainers at 9M-PP. Low-retainers demonstrated an increase in REE greater than expected for changes in BC. PPWR was negatively associated with TEE (β: -0.08 ± 0.02; P = 0.0009) and p$\dot{V}$O2 max (β: -0.02 ± 0.01; P = 0.047); p$\dot{V}$O2 max was 7 mL · kg-1 · min-1 higher in low- vs. high-retainers (P = 0.047).

CONCLUSIONS

Energy metabolism, BC, and cardiorespiratory fitness may be associated with weight regulation and its trajectory during the postpartum period. This provides the foundation for future strategies to promote appropriate postpartum weight management.

Relationship Between Psychosocial Factors, Dietary Intake and Gestational Weight Gain: A Narrative Review

Inadequate gestational weight gain (GWG), which has reached almost two-thirds of Canadian pregnant women, is associated with several adverse effects both in the mother and her child. The aim of this review was to establish how psychosocial factors, diet and GWG are interrelated during pregnancy. More specifically, it aimed to evaluate how psychosocial factors can impact on diet and, thus, influence GWG. Studies published through May 2017 that examined factors related to GWG were included. Of 3268 non-duplicate titles and abstract, 77 articles underwent full-text review. Regarding dietary intakes, the majority of the included studies demonstrated that a higher caloric intake was associated with an elevated GWG. Also, a negative body image and attitude toward weight gain as well as a poor knowledge of GWG recommendations and inadequate prenatal care is associated with an increased GWG. Only few studies examined altogether the factors included and conclusions about how psychosocial factors can impact on diet and, thus, influence GWG cannot be drawn at this point. In the few studies that evaluated the interrelationships between psychosocial factors, diet and GWG, energy intake was not identified as a mediator of the association between psychosocial factors and GWG. This review highlights the scarcity of findings regarding psychosocial and dietary factors in relation to GWG and the need for high quality prospective cohort studies that will include all these factors to provide a better understanding of how they are interrelated to influence short- and long-term health.

Association of early pregnancy body mass index with post-partum weight change among African-American women

Post-partum weight retention is relatively common and increases the risk for future obesity. Women who are overweight or obese prior to pregnancy, or who gain excessively during pregnancy, are more likely to retain weight post-partum. Much of the existing research is limited by a single post-partum body-weight measure and therefore cannot distinguish post-partum weight retention from post-partum weight accrual. This study tested the hypothesis that early pregnancy body mass index (BMI) is positively associated with post-partum weight change, independent of gestational weight gain (GWG) and breastfeeding (BF) among African-American women, a demographic group with greater risk for obesity. Healthy African-American women (n = 32) were weighed at 2 weeks and 3 months post-partum to derive post-partum weight change. Data from prenatal care records were retrieved to calculate BMI at the first prenatal care visit and GWG. BF status at 2 weeks post-partum was self-reported. Early pregnancy BMI was positively associated with post-partum weight change (partial r = 0.53, P < 0.005), independent of GWG and BF status at 2 weeks post-partum. These results extend the literature by suggesting that the association between early pregnancy BMI and post-partum weight retention may be at least partially attributable to the accrual of new weight during the post-partum period. Future research in a larger and more diverse cohort is warranted and should explore potential mechanisms contributing to post-partum weight change.

Optimising gestational weight gain and improving maternal and infant health outcomes through antenatal dietary, lifestyle and physical activity advice: the OPTIMISE randomised controlled trial protocol

INTRODUCTION

Obesity represents a significant health burden, and WHO recognises the importance of preventing weight gain and subsequent development of obesity among adults who are within the healthy weight range. Women of reproductive age have demonstrated high rates of weight gain during pregnancy placing them at risk of becoming overweight or obese. We will evaluate the effects of dietary and physical activity advice on maternal, fetal and infant health outcomes, among pregnant women of normal body mass index (BMI).

METHODS AND ANALYSIS

We will conduct a randomised controlled trial, consenting and randomising women with a live singleton pregnancy between 10+0 and 20+0 weeks and BMI 18.5-24.9 kg/m2 at first antenatal visit, from a tertiary maternity hospital. Women randomised to the Lifestyle Advice Group will receive three face-to-face sessions (two with a research dietitian and one with a trained research assistant) and three telephone calls over pregnancy, in which they will be provided with dietary and lifestyle advice and encouraged to make change using a SMART goals approach. Women randomised to the Standard Care Group will receive routine antenatal care. The primary outcome is infant birth weight >4 kg. Secondary outcomes will include adverse infant and maternal outcomes, maternal weight change, maternal diet and physical activity changes, maternal quality of life and emotional well-being, fetal growth and costs of healthcare. We will recruit 624 women to detect a reduction from 8.72% to 3.87% (alpha 0.05 (two-tailed); power 70%) in infants with birth weight >4 kg. Analyses will be intention to treat with estimates reported as relative risks and 95% CIs.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Women's and Children's Hospital ethics committee. Findings will be disseminated widely via journal publication and conference presentation(s), and participants informed of results.

TRIAL REGISTRATION NUMBER

ACTRN12614000583640.

Greater early and mid-pregnancy gestational weight gain are associated with increased risk of gestational diabetes mellitus: A prospective cohort study

BACKGROUND & AIMS

Gestational diabetes mellitus is associated with adverse short- and long-term consequences for both the mother and the offspring. To examine the relationship between the rates of gestational weight gain (RGWG) during early and mid-pregnancy and the risk of gestational diabetes mellitus (GDM).

METHODS

2090 singleton pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) without overt diabetes before pregnancy were analyzed in our study. Gestational weight were measured regularly in every antenatal visit. Gestational diabetes mellitus was assessed with the 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Multivariable logistic regression was performed to estimate effect of RGWG on GDM.

RESULTS

A total of 8.3% (n = 173) of pregnant women were diagnosed with GDM. Women with elevated rate of gestational weight gain prior to glucose screening test (RGWG-PG) increased the risk of GDM (adjusted p-trend = 0.004; odds ratios (OR) 1.64, 95% confidence intervals (CI) 1.01-2.68 and OR 2.30,95% CI 1.44-3.66 for 0.297-0.384 kg/wk and 0.385 kg/wk or more vs. 0.213 kg/wk or less, respectively). Women with greater rate of gestational weight gain in the first trimester (RGWG-F) increased the risk of GDM (adjusted p-trend = 0.048; OR 1.83, 95% CI 1.14-2.94 and OR 1.76, 95% CI 1.10-2.83 for 0.086-0.200 kg/wk and 0.201 kg/wk or more vs. -0.025 kg/wk or less, respectively). The rate of gestational weight gain in the second trimester (RGWG-S) was significantly associated with GDM only among women with RGWG-F more than 0.086 kg/wk (adjusted p-trend = 0.035; OR 2.04, 95% CI 1.16-3.59 for 0.658 kg/wk or more vs. 0.418 kg/wk or less).

CONCLUSIONS

Greater early pregnancy weight gain are associated with increased risk of GDM. Elevated weight gain in mid-pregnancy increased the risk of GDM only among pregnant women with greater weight gain in the first trimester.

Association between breastfeeding duration and postpartum weight retention of lactating mothers: A meta-analysis of cohort studies

BACKGROUND & AIMS

To clarify the relationship between different breastfeeding duration and postpartum weight retention through meta-analysis.

METHODS

In this study, all relevant studies that described the effect of breastfeeding duration on postpartum weight retention were identified from Pubmed, Cochrane, and WANGFANG databases and so on (1960-2016). This meta-analysis had been registered in International Prospective Register of Systematic Reviews (CRD42016038409).

RESULTS

Fourteen cohort studies involving 66 comparisons were included. Compared with bottle-feeding mothers, breastfeeding mothers had significantly lower postpartum weight retention of -0.38 kg (95% confidence interval: -0.64, -0.11 kg). Subgroup analysis showed that, mothers who were primipara, less than 30 years old or normal pre-pregnancy body mass index had lower postpartum weight retention. When breastfeeding duration were stratified into <12 weeks, 12 weeks-24 weeks, 24 weeks-48 weeks, and ≥48 weeks, postpartum weight retention in breastfeeding women presented a U-shaped trend: a decline during early breastfeeding duration (year 1) (from 0.23 kg at < 12 weeks to -1.58 kg at 24-48 weeks) and then an increase in the follow-up duration (from -1.58 kg at 24-48 weeks to -0.97 kg at more than 48 weeks).

CONCLUSIONS

Our results indicated that breastfeeding including exclusive breastfeeding and mixed breastfeeding were inversely related to postpartum weight retention. The decreasing influence of breastfeeding was more significant when the lactating mothers were less than 30 years old, primipara, normal pre-pregnant body mass index, or breastfeeding duration for 6-12 months.

Prepregnancy Body Mass Index as a Significant Predictor of Total Gestational Weight Gain and Birth Weight

Purpose: We aimed to describe adherence to gestational weight gain (GWG) recommendations and identify determinants of excessive GWG in a sample of women from Quebec, Canada.

Methods: Data were collected from the multi-centre 3D (Design, Develop, Discover) pregnancy cohort study, which included women who delivered between May 2010 and August 2012 at 9 obstetrical hospitals in Quebec, Canada. GWG was calculated for 1145 women and compared to the 2009 Institute of Medicine (IOM) recommendations.

Results: Overall, 51% of participants exceeded the recommendations. Approximately 68% of women with obesity gained weight in excess of the IOM recommendations. The corresponding numbers were 75%, 44%, and 27% in overweight, normal weight, and underweight women, respectively. A prepregnancy BMI of 25 kg/m2 or more was the only significant predictor of exceeding GWG recommendations (OR 3.35, 95% CI 2.44–4.64) in a multivariate model. Birth weight was positively associated with GWG. GWG and prepregnancy BMI could explain 3.13% and 2.46% of the variance in birth weight, respectively.

Conclusion: About half of women exceeded GWG recommendations, and this was correlated with infant birth weight. This reinforces the need to develop and evaluate strategies, including nutritional interventions, for pregnant women to achieve optimal GWG.

Nutrient Intakes of Pregnant Women and their Associated Factors in Eight Cities of China: A Cross-sectional Study

Background:

During the last 3 decades, China has dramatic changes of the dietary pattern among its citizens, particularly in urban cities. This study aimed to determine the nutrient intake status and factors associated with nutrient intakes of urban Chinese pregnant women now-a-day.

Methods:

The multistage stratified random sampling method was applied in the cross-sectional study. 479 women in three trimesters of pregnancy from eight cities of China were recruited. Nutrient intakes were evaluated with one 24 h dietary recall, and compared with the Chinese Dietary Reference Intakes (DRIs) 2013 for available nutrients.

Results:

Most pregnant women had imbalanced macronutrient distribution with excessive energy derived from fat. Intakes of Vitamin A, B₆, calcium, magnesium, and selenium were below Chinese Recommended Nutrient Intake (RNI) and Estimated Average Requirements (EARs) in all trimesters. Most pregnant women took more folic acid in the first trimester with a significant decrease in the second and third trimester (P < 0.05). Shortfall in iron intake was found in the third trimester whereas some women may be at the risk of excessive iron intake. Intakes of thiamin met RNI in the first trimester but were below EAR in all trimesters. Trimester phasing was positively associated with most nutrients (P < 0.05). Prepregnancy body mass index was inversely associated with energy, fat, Vitamin C, and calcium intake (P < 0.05). Educational level and household income were positively associated with folic acid intake (P < 0.05).

Conclusions:

Current prenatal dietary choices of urban pregnant women in China are imbalanced in the nutrient intake when compared with national DRIs 2013, particularly in intakes of energy derived from fat and micronutrients. Appropriate dietary advice to pregnant women should promote a balanced diet with emphasis on avoidance of foods of high fat content and incorporation of foods that are good sources of the key micronutrients that are usually lacking in a regular pregnancy diet. Further research is needed to understand the eating habits and food patterns that contribute to this imbalanced diet in order to be able to effectively improve prenatal women's nutrient intake status.

Systematic review of antenatal dietary and lifestyle interventions in women with a normal body mass index

INTRODUCTION

Women who commence pregnancy with a normal body mass index (BMI) are at the greatest risk of excessive gestational weight gain, impacting on infant birthweight, pregnancy-related complications and postpartum weight retention. Our aim was to review systematically the effect of antenatal dietary and lifestyle interventions in pregnant women with a normal BMI on maternal and infant outcomes.

MATERIAL AND METHODS

We searched the Cochrane Controlled Trials Register, PubMed, Medline, and the Australian and International Clinical Trials Registry with the date of the last search in July 2015. We included all published, unpublished and ongoing randomized trials recruiting women of a normal BMI, comparing dietary and/or lifestyle interventions with standard antenatal care.

RESULTS

Twelve randomized controlled trials were identified, involving a total of 2713 pregnant women, with five studies reporting clinical data for 714 women with a normal BMI. Women who received a dietary and lifestyle intervention were less likely to experience gestational weight gain [four studies, 446 women; mean difference -1.25 kg; 95% confidence interval (CI) -2.39 to -0.11], weight gain above the Institute of Medicine guidelines (four studies, 446 women; risk ratio 0.66; 95% CI 0.53-0.83) and hypertension (two studies; 243 women; risk ratio 0.34; 95% CI 0.13-0.91). There were no statistically significant differences in the occurrence of gestational diabetes, cesarean section or birthweight greater than 4 kg.

CONCLUSIONS

While providing an antenatal dietary and lifestyle intervention for pregnant women of normal BMI appears to reduce gestational weight gain, the review was limited by the relatively small available sample size. Further well-designed randomized controlled trials are required.