A Prospective Study of the Effect of Childbearing on Weight Gain in African-American Women

Is being childless associated with a woman's risk of overweight and obesity? Results from a national longitudinal study

AIM

To examine the association between motherhood status (mothers, voluntarily childless, involuntarily childless) and overweight and obesity over 22 years.

METHODS

A total of 4092 women aged 18-23 years were followed from 1996 to 2018. Motherhood status was defined by women's reports on their fertility, attempts to conceive, use of in vitro fertilisation and fertility hormones, and number of biological children. Associations between motherhood status and overweight and obesity were examined using generalised estimating equations models, adjusting for socio-demographic characteristics, lifestyle factors, depressive symptoms, early life factors, and polycystic ovary syndrome (PCOS).

RESULTS

At age 40-45 years, 12% of women were voluntarily childless and 5% were involuntarily childless. The prevalence of overweight and obesity increased with age and women who were voluntarily or involuntarily childless had higher prevalence of obesity than mothers in all surveys. After adjusting for covariates, compared with mothers, women who were voluntarily childless had higher odds of being overweight (odds ratio [OR], 95% confidence interval [CI]: 1.29, 1.09-1.52) and obese (OR, 95% CI: 1.65, 1.29-2.12). Involuntary childlessness was not associated with being overweight (OR, 95% CI: 1.05, 0.82-1.33), and its association with obesity was attenuated after adjusting for PCOS in the final model (OR, 95% CI: 1.40, 0.99-1.98).

CONCLUSIONS

Around one in nine Australian women remained voluntarily childless by their late reproductive years. On average, they had higher odds of being overweight and obese than mothers, suggesting that overweight and obesity prevention programs should consider tailoring their advice by motherhood status.

Eating behaviors, attitudes, and beliefs that contribute to overweight and obesity among women in Lilongwe City, Malawi: a qualitative study

Background

Obesity is increasingly a public health concern in low- and middle-income countries, including Malawi where 36% of women have body mass index in overweight/obese categories in urban areas. Eating behaviors, attitudes, and beliefs are associated with body size, but have not been studied in-depth in sub-Saharan African countries. This study therefore, explored eating behaviors, attitudes, and beliefs of women in Lilongwe, Malawi.

Methods

This was a descriptive ancillary qualitative study utilising in-depth interviews with 27 women (13 in normal weight range and 14 in overweight/obesity ranges) puporsively selected in Lilongwe City, Malawi from October to November 2017. The concept of data saturation guided data collection, and it was reached with the 27 interviewed participants when there was no new information coming from the participants. All interviews were conducted in the local language, transcribed verbatim, and translated into English. The transcripts were analysed manually using thematic content analysis.

Results

Majority of participants perceived overweight as an indication of good health such that with food affordability, women deliberately gain weight to demonstrate their good health. Most normal weight respondents said they ate less food than they wanted to because of financial constraints. Most women in overweight/obese ranges in our sample reported that they eat large portions and eat frequently due to the desire to portray a good image of their marital life since there is a societal expectation that when a woman is married, her weight should increase to show that the marriage is successful. The perceived contributors to weight gain include eating behaviors, feelings about weight gain, and gender roles and social expectations to gain weight.

Conclusion

Beliefs and attitudes related to eating behaviors may have contributed to women being in overweight range and should be considered in designing obesity prevention interventions targeting women in Malawi.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01811-0.

Age at childbirth and change in BMI across the life-course: evidence from the INCAP Longitudinal Study

Background

Parity has been associated with both short- and long-term weight gain in women. However, it is not clear if timing of parity across the reproductive age has different associations with BMI.

Methods

To prospectively assess the association between age at childbirth and maternal change in BMI, we analyzed data from the ongoing INCAP Longitudinal Study, which started in 1969 in four villages in Guatemala. Cohort women (n=778) provided information on reproductive history and anthropometric measures were measured in 1988-89 (adolescence, 15 to 25y), 2002-04 (early adulthood, 26 to 36y) and 2015-17 (mid adulthood, 37 to 55y). We evaluated the associations of number of live births in the period preceding each study wave (1969-77 to 1988-89, 1988-89 to 2002-04 and 2002-04 to 2015-17) with BMI change in the same period using multivariable linear regression models.

Results

Number of live births between 1988 and 89 and 2002-04 was positively associated with increased BMI, while there was not an association between number of live births and BMI in the other intervals. Women who had one, two, or three or more children between 1988 and 89 and 2002-04 had 0.90 (kg/m², 95% CI: -0.55, 2.35), 2.39 (kg/m², 95% CI: 1.09, 3.70) and 2.54 (kg/m², 95% CI: 1.26, 3.82) higher BMI, respectively, than women who did not give birth in the same period.

Conclusions

Our findings suggest that women who had three or more children during early adulthood gained more weight compared to women who had no children in the same period. In contrast, women who had children earlier or later in their reproductive lives did not gain additional weight compared to those who did not have children during that period. Childbirth may have different associations with BMI based on the mother’s age.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04485-6.

The causal effect of number of children on later-life overweight and obesity in parous women. An instrumental variable study

Many older women in Europe are overweight or obese. One of the factors linked to overweight and obesity among older women is childbearing. However, results of observational studies on the association between women’s number of children and excess weight should be interpreted with caution, because they may be prone to bias due to residual confounders or reverse causation. We use data of women aged 50 and older with at least two births from seven waves the Survey of Health, Ageing and Retirement in Europe (n = 113,932) collected between 2004 and 2020. We adopt an instrumental variable approach that exploits the well-established preference for mixed-sex offspring to estimate the causal effect of number of children on older parous women’s body mass index (BMI) and their risk of overweight (BMI >= 25 kg/m2) and obesity (BMI >= 30 kg/m2). The instrumental variable models provided evidence for a causal positive effect of having 3 + children as opposed to 2 children on mothers’ body mass index, overweight (BMI >= 25 kg/m2) risk and obesity (BMI >= 30 kg/m2) risk. Predicted BMI was 1.8 kg/m2 higher for mothers with 3 + children than for mothers with 2 children, and their predicted probability of overweight and obesity was 18.3 and 8.6 percentage points higher, respectively. Results remained virtually unchanged after adjusting for age, educational attainment, country and wave of data collection.

Breastfeeding history and the risk of overweight and obesity in middle-aged women

BACKGROUND

The increased metabolic activity required to sustain breastfeeding and its associated milk production helps to reduce maternal fat stores accumulated during pregnancy. This study aims to assess the association between breastfeeding duration and fatness indices in middle-aged women.

METHODS

The analysis was carried out in a group of 7500 parous 55.5 ± 5.3 year old women included body mass index, body fat percentage, and waist-to-height ratio. The likelihood of excessive weight or obesity in relation to total breastfeeding time using multivariate logistic regression analyses.

RESULTS

An analysis of adjusted odds ratios did not show significant associations between breastfeeding duration and the risk of excessive weight and obesity in premenopausal women. After menopause, women who gave birth to 2 children and breastfed 1-6 and > 12 months had a lower risk of abdominal obesity (OR 0.70; 95% CI 0.50-0.99; p = 0.042; and OR 0.68; 95% CI 0.47-0.98; p = 0.039). Women who gave birth to 3 or more children and breastfed for 1-6 months, also showed a lower risk of overweight (OR 0.52; 95% CI 0.27-0.99; p = 0.047), compared to those ones that have never breastfed. There was no relationship found between the duration of lactation and the risk of excessive body fat.

CONCLUSION

Breastfeeding may have some beneficial, long-term effect on the risk of excessive weight and abdominal obesity in women.

Parity, lactation, and long-term weight change in Mexican women

One post-partum behaviour that may be protective against post-partum weight retention and long-term weight gain among women of reproductive age is lactation because of its potential role in resetting maternal metabolism after pregnancy. However, most of the evidence focuses on weight retention at 6, 12, or 24 months post-partum, and data beyond 2 years after birth are sparse, and findings are inconclusive. Therefore, our aim was to assess the association of parity and mean duration of lactation per child with long-term weight change in Mexican women. We assessed the association of parity and mean duration of lactation per child with long-term weight change in 75,421 women from the Mexican Teachers' Cohort. Several multivariable regression models were fit to assess these associations. We also examined the non-linear association between duration of lactation and weight change using restricted cubic splines. We found that parous women (≥4 children) gained 2.81 kg more (95% CI [2.52, 3.10]) than did nulliparous women. The association between mean duration of lactation per child and weight change appeared to be non-linear. Women who breastfed on average 3-6 months per child had lower gain weight (-1.10, 95% CI [-1.58, -0.47 kg]) than had women who did not breastfeed. This association was linear up to 6 months of lactation per child. Our findings suggest that parity alters weight-gain trajectory in women and that lactation could reduce this alteration. These findings are important in the prevention of excessive weight gain through reproductive years and their future health implications.

Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status

OBJECTIVE

Allostatic load (AL) represents multisystem physiological "wear-and-tear" reflecting emerging chronic disease risk. We assessed AL during the first year postpartum in a diverse community sample with known health disparities.

STUDY DESIGN

The Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network enrolled 2,448 predominantly low-income African-American, Latina, and White women immediately after delivery of liveborn infants at ≥20 weeks' gestation, following them over time with interviews, clinical measures, and biomarkers. AL at 6 and 12 months postpartum was measured by body mass index, waist:hip ratio, blood pressure, pulse, hemoglobin A1c, high-sensitive C-reactive protein, total cholesterol and high-density lipoprotein, and diurnal cortisol slope.

RESULTS

Adverse AL health-risk profiles were significantly more prevalent among African-American women compared with non-Hispanic Whites, with Latinas intermediate. Breastfeeding was protective, particularly for White women. Complications of pregnancy were associated with higher AL, and disparities persisted or worsened through the first year postpartum.

CONCLUSION

Adverse AL profiles occurred in a substantial proportion of postpartum women, and disparities did not improve from birth to 1 year. Breastfeeding was protective for the mother.

Relationship Between Pregnancy Complications and Subsequent Coronary Artery Disease Assessed by Coronary Computed Tomographic Angiography in Black Women

BACKGROUND

Maternal pregnancy complications, particularly preeclampsia and gestational diabetes mellitus, are described to increase the risk for subsequent coronary artery disease (CAD). In addition, black women are at higher risk for CAD. The objective of this study was to compare the prevalence and extent of CAD as detected by coronary computed tomographic angiography (CCTA) in black women with and without a history of prior pregnancy complications.

METHODS

We retrospectively evaluated patient characteristics and CCTA findings in groups of black women with a prior history of preterm delivery (n=154), preeclampsia (n=137), or gestational diabetes mellitus (n=148), and a matched control group of black women who gave birth without such complications (n=445). Univariate and multivariate analyses were performed to assess risk factors of CAD.

RESULTS

All groups with prior pregnancy complications showed higher rates of any (≥20% luminal narrowing) and obstructive (≥50% luminal narrowing) CAD (preterm delivery: 29.2% and 9.1%; preeclampsia: 29.2% and 7.3%; and gestational diabetes mellitus: 47.3% and 15.5%) compared with control women (23.8% and 5.4%). After accounting for confounding factors at multivariate analysis, gestational diabetes mellitus remained a strong risk factor of any (odds ratio, 3.26; 95% CI, 2.03-5.22; P<0.001) and obstructive CAD (odds ratio, 3.00; 95% CI, 1.55-5.80; P<0.001) on CCTA.

CONCLUSIONS

Black women with a history of pregnancy complications, particularly gestational diabetes mellitus, have a higher prevalence of CAD on CCTA while only a history of gestational diabetes mellitus was independently associated with any and obstructive CAD on CCTA.

Cumulative Lactation and Onset of Hypertension in African-American Women

Hypertension affects nearly 1 of 3 women and contributes to cardiovascular disease, the leading cause of death in the United States. Breastfeeding leads to metabolic changes that could reduce risks of hypertension. Hypertension disproportionately affects black women, but rates of breastfeeding among black women lag behind those in the general population. In the Black Women's Health Study (n = 59,001), we conducted a nested case-control analysis using unconditional logistic regression to estimate the association between breastfeeding and incident hypertension at ages 40-65 years using data collected from 1995 to 2011. Controls were frequency-matched 2:1 to 12,513 hypertensive women by age and questionnaire cycle. Overall, there was little evidence of association between ever breastfeeding and incident hypertension (odds ratio = 0.97, 95% confidence interval: 0.92, 1.02). However, age modified the relationship (P = 0.02): Breastfeeding was associated with reduced risk of hypertension at ages 40-49 years (odds ratio = 0.92, 95% confidence interval: 0.85, 0.99) but not at older ages. In addition, risk of hypertension at ages 40-49 years decreased with increasing duration of breastfeeding (P for trend = 0.08). Our results suggest that long-duration breastfeeding may reduce the risk of incident hypertension in middle age. Addressing breastfeeding as a potential preventative health behavior is particularly compelling because it is required for only a discrete period of time.

Early Parturition: Is Young Maternal Age at First Birth Associated with Obesity?

STUDY OBJECTIVE

Examine the association of age at first birth with body mass index (BMI), and explore the role of young maternal age and subsequent obesity.

DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS

This study analyzed data from the Panel Study of Income Dynamics, a nationally representative longitudinal study of US families. Analyses were conducted using a mixed effects longitudinal linear regression with a random intercept to examine the effect of aging, age at first birth, and minority status using nested data. Study criteria yielded a final sample of 146 women with 707 observations.

MAIN OUTCOME MEASURES

BMI.

RESULTS

Age at first birth exhibited a significant association with BMI. The association of age at first birth with BMI was greatest for women age 21 and younger. Overall, women who experienced their first birth at age 21 or younger had a BMI 5 units greater than women who delayed childbearing until at least age 30 (point estimate, 5.02; P = .02; 95% confidence interval, 0.65-9.40).

CONCLUSION

Young maternal age at first birth might be associated with increased BMI. Minority women also experience their first birth at younger ages compared with white women, suggesting possible linkages between the timing of reproductive events and obesity disparities.

Ambient Air Pollution and 16-Year Weight Change in African-American Women

INTRODUCTION

Substantial research has been dedicated to understanding the reasons for the dramatic rise in obesity rates in the U.S. in the last 2 decades. Animal studies and epidemiologic studies in children have suggested that air pollution might contribute to weight gain. This study investigates the association between ambient air pollution and weight gain over 16 years of follow-up (1995-2011) in a large cohort of African-American women in the U.S.

METHODS

This study assessed associations of fine particulate matter, ozone, and nitrogen dioxide with weight gain using a linear random effects model. All analyses were conducted in 2015.

RESULTS

There was no statistically significant association between weight change and fine particulate matter (mean weight change over 16 years per interquartile range [2.9 μg/m(3)], 0.12 kg; 95% CI=-0.10, 0.35) and ozone (0.16 kg per interquartile range [6.7 ppb]; 95% CI=-0.11, 0.43). There was a small decrease in weight associated with nitrogen dioxide (-0.50 per interquartile range [9.7 ppb]; 95% CI=-0.77, -0.23).

CONCLUSIONS

The results do not provide support for an association of air pollution with weight gain in African-American adult women.

Differences in Obesity Rates Among Minority and White Women: The Latent Role of Maternal Stress

White and minority women experience different rates of obesity in the United States. Yet our understanding of the dynamics that give rise to this gap remains limited. This article presents a conceptual framework that considers pathways leading to these different rates. It draws upon the life-course perspective, allostatic load, and the weathering hypothesis to identify pathways linking childbearing, stress, and obesity. This conceptual framework extends prior work by identifying age at first birth as an important parameter that influences these pathways. Empirical evidence to test these pathways is needed.

Determinants of change in body weight and body fat distribution over 5.5 years in a sample of free-living black South African women

Objective

To identify socio-demographic and lifestyle determinants of weight gain in a sample of premenopasual black South African (SA) women.

Methods

Changes in body composition (dual-energy X-ray absorptiometry, computerised tomography), socio-economic status (SES) and behavioural/lifestyle factors were measured in 64 black SA women at baseline (27 ± 8 years) and after 5.5 years.

Results

A lower body mass index (BMI) and nulliparity, together with access to sanitation, were significant determinants of weight gain and change in body fat distribution over 5.5 years. In addition, younger women increased their body weight more than their older counterparts, but this association was not independent of other determinants.

Conclusion

Further research is required to examine the effect of changing SES, as well as the full impact of childbearing on weight gain over time in younger women with lower BMIs. This information will suggest areas for possible intervention to prevent long-term weight gain in these women.

A biopsychosocial approach to the interrelation between motherhood and women's excessive weight

Portugal is characterized by a high prevalence of overweight and obesity among women, whose weight increases most rapidly in early adulthood. Individual genetic features and behaviours, along with social, cultural and environmental factors interact in complex relationships with body weight and with its variation throughout time. Motherhood may trigger an increase in weight, potentially influencing the associations between excessive weight and several other health determinants. Taking into account the quality of prenatal care within Portugal's health care system, regarding coverage and success in improved outcomes, we theoretically demonstrate why pregnancy and motherhood should be seen as opportunities for prevention and why a deeper knowledge about the interplay of biological, social and psychological determinants of weight at this stage of life can be useful to design more effective weight control interventions towards this population.

Effect of Maternal Age at Childbirth on Obesity in Postmenopausal Women: A Nationwide Population-Based Study in Korea

The object of this study was to assess the obesity in postmenopausal women, according to age at childbirth.We analyzed the association between age at first childbirth, age at last childbirth, parity, and subject obesity status (general obesity; BMI >25 kg/m, nongeneral obesity; BMI ≤25 kg/m, abdominal obesity; waist circumference >85 cm, nonabdominal obesity; waist circumference ≤85 cm), using data from a nationwide population-based survey, the 2010 to 2012 Korean National Health and Nutrition Examination Survey. Data from a total of 4382 postmenopausal women were analyzed using multivariate regression analysis with complex survey design sampling. And, the subjects were subdivided into groups according to obesity or not. Age, smoking, alcohol consumption, exercise, education, income level, number of pregnancies, oral contraceptive uses, breast feeding experience were adjusted as the confounders.The prevalence of general obesity among Korean postmenopausal women was 37.08%. Women with general obesity and abdominal obesity were significantly younger at first childbirth compared with women with nongeneral obesity and no abdominal obesity (23.89 ± 0.1 vs. 23.22 ± 0.1, P <0.001). Age at first childbirth was inversely associated with obesity, while age at last childbirth was not associated with obesity or abdominal obesity. Women with a higher number of pregnancies were also more likely to have obesity and abdominal obesity. Age at first childbirth remained significantly associated with obesity, after adjusting for confounding factors.Obesity in postmenopausal women is associated with first childbirth at a young age, and higher parity. Further research is needed to clarify the association between obesity and reproductive characteristics.

Lactation in Relation to Long-Term Maternal Weight Gain in African-American Women

We assessed the relationship of lactation to long-term maternal weight gain among African-American women, who have a lower prevalence of lactation and a higher prevalence of obesity than other US women. A pregnancy cohort of 3,147 African-American women from the Black Women's Health Study who gave birth for the first time between 1995 and 2003 was followed for 8 years postpartum. Participants provided data on weight, lactation, gestational weight gain, education, diet, and exercise. Mean differences in weight gain were estimated in multivariable models. Overall, lactation was not associated with mean weight gain. However, the association was modified by prepregnancy body mass index (BMI; weight (kg)/height (m)2) (P for interaction=0.03): Among women with BMI<30 prior to the pregnancy, mean weight gain decreased with increasing months of lactation (P for trend<0.01), whereas among obese women (BMI≥30), mean weight gain increased with increasing duration of lactation (P for trend=0.04). Adjusted mean differences for ≥12 months of lactation relative to no lactation were -1.56 kg (95% confidence interval: -2.50, -0.61) among nonobese women and 2.33 kg (95% confidence interval: -0.35, 5.01) among obese women. The differences in postpartum mean weight gain persisted over the 8-year study period. Residual confounding by factors more common in women who breastfeed longer may have influenced the results.

Short inter-pregnancy intervals, parity, excessive pregnancy weight gain and risk of maternal obesity

To investigate the relationship among parity, length of the inter-pregnancy intervals and excessive pregnancy weight gain in the first pregnancy and the risk of obesity. Using a prospective cohort study of 3,422 non-obese, non-pregnant US women aged 14-22 years at baseline, adjusted Cox models were used to estimate the association among parity, inter-pregnancy intervals, and excessive pregnancy weight gain in the first pregnancy and the relative hazard rate (HR) of obesity. Compared to nulliparous women, primiparous women with excessive pregnancy weight gain in the first pregnancy had a HR of obesity of 1.79 (95% CI 1.40, 2.29); no significant difference was seen between primiparous without excessive pregnancy weight gain in the first pregnancy and nulliparous women. Among women with the same pregnancy weight gain in the first pregnancy and the same number of inter-pregnancy intervals (12 and 18 months or ≥18 months), the HR of obesity increased 2.43-fold (95% CI 1.21, 4.89; p = 0.01) for every additional inter-pregnancy interval of <12 months; no significant association was seen for longer inter-pregnancy intervals. Among women with the same parity and inter-pregnancy interval pattern, women with excessive pregnancy weight gain in the first pregnancy had an HR of obesity 2.41 times higher (95% CI 1.81, 3.21; p < 0.001) than women without. Primiparous and nulliparous women had similar obesity risk unless the primiparous women had excessive pregnancy weight gain in the first pregnancy, then their risk of obesity was greater. Multiparous women with the same excessive pregnancy weight gain in the first pregnancy and at least one additional short inter-pregnancy interval had a significant risk of obesity after childbirth. Perinatal interventions that prevent excessive pregnancy weight gain in the first pregnancy or lengthen the inter-pregnancy interval are necessary for reducing maternal obesity.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

Postpartum weight retention risk factors and relationship to obesity at 1 year

OBJECTIVE

To explore risk factors for postpartum weight retention at 1 year after delivery in predominantly low-income women.

METHODS

Data were collected from 774 women with complete height and weight information from participants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Community Child Health Network, a national five-site, prospective cohort study. Participants were enrolled primarily in the hospitals immediately after delivery. Maternal interviews conducted at 1, 6, and 12 months postpartum identified risk factors for weight retention and included direct measurement of height and weight at 6 and 12 months. Logistic regression assessed the independent contribution of postpartum weight retention on obesity.

RESULTS

Women had a mean prepregnancy weight of 161.5 lbs (body mass index [BMI] 27.7). Women gained a mean of 32 lbs while pregnant and had a 1-year mean postpartum weight of 172.6 lbs (BMI 29.4). Approximately 75% of women were heavier 1 year postpartum than they were prepregnancy, including 47.4% retaining more than 10 lbs and 24.2% more than 20 lbs. Women retaining at least 20 lbs were more often African American, younger, poor, less educated, or on public insurance. Race and socioeconomic disparities were associated with high prepregnancy BMI and excessive weight gain during pregnancy, associations that were attenuated by breastfeeding at 6 months and moderate exercise. Of the 39.8 with normal prepregnancy BMI, one third became overweight or obese 1 year postpartum.

CONCLUSION

Postpartum weight retention is a significant contributor to the risk for obesity 1 year postpartum, including for women of normal weight prepregnancy. Postpartum, potentially modifiable behaviors may lower the risk.

LEVEL OF EVIDENCE

III.

Childbearing is not associated with young women's long-term obesity risk

OBJECTIVE

Contemporary childbearing is associated with greater gestational weight gain and postpartum weight retention than in previous decades, potentially leading to a more pronounced effect of childbearing on women's long-term obesity risk. Previous work on the association of childbearing with women's long-term obesity risk mostly examined births in the 1970s and 1980s and produced mixed results. The association of childbearing and obesity incidence in a diverse, contemporary sample of 2731 US women was estimated.

METHODS

Propensity-score (PS) matching was used for confounding control when estimating the effect of incident parity (1996-2001) on 7-year incident obesity (BMI≥30 kg/m(2) ) (2001-2008).

RESULTS

In the sample, 19.3% of parous women became obese, whereas 16.1% of unmatched nulliparous women did. After PS matching without and with replacement, the differences in obesity incidence were, respectively, 0.0 percentage points (ppts) (95% CI: -4.7 to 4.7) and 0.9 ppts (95% CI: -4.9 to 6.7). Results were similar in analyses of prevalent parity and obesity in 2008 (n = 6601) conducted to explore possible selection bias.

CONCLUSIONS

These results imply that, in contemporary US parous women in their late 20s and early 30s, childbearing may not increase obesity incidence.

Parity and pancreatic cancer risk: a dose-response meta-analysis of epidemiologic studies

Background

Previous epidemiologic studies have reported inconsistent results between parity and pancreatic cancer (PC) risk. To our knowledge, a comprehensive and quantitative assessment of this association has not been conducted.

Methods

Relevant published studies of parity and PC were identified using MEDLINE (PubMed) and Web of Science databases until November 2013. Two authors (H-BG and LW) independently assessed eligibility and extracted data. Eleven prospective and 11 case-control studies reported relative risk (RR) estimates and 95% confidence intervals (CIs) of PC associated with parity. Fixed- and random-effects models were used to estimate the summary RR depending on the heterogeneity of effects.

Results

The summary RR for PC comparing the highest versus lowest parity was 0.86 (95% CI: 0.73–1.02; Q = 50.49, P<0.001, I² = 58.4%). Significant inverse associations were also observed in the studies that adjusted for cigarette smoking (RR = 0.81; 95% CI: 0.68–0.98), Type 2 diabetes mellitus (RR = 0.83; 95% CI: 0.75–0.93), and those that included all confounders or important risk factors (RR = 0.85; 95% CI: 0.76–0.96). Additionally, in the dose-response analysis, the summary RR for per one live birth was 0.97 (95% CI: 0.94–1.01; Q = 62.83, P<0.001, I² = 69.8%), which also indicated a borderline statistically significant inverse effect of parity on PC risk. No evidence of publication bias and significant heterogeneity between subgroups were detected by meta-regression analyses.

Conclusion

In summary, these findings suggest that higher parity is associated with a decreased risk of PC. Future large consortia or pooled studies are warranted to fully adjust for potential confounders to confirm this association.

Association between parity and obesity in Mexican and Mexican-American women: findings from the Ella binational breast cancer study

Obesity at diagnosis of breast cancer is associated with higher all-cause mortality and treatment-associated toxicities. We evaluated the association between parity and obesity in the Ella study, a population of Mexican and Mexican-American breast cancer patients with high parity. Obesity outcomes included body mass index (BMI) ≥30 kg/m(2), waist circumference (WC) ≥35 in (88 cm), and waist-to-hip-ratio (WHR) ≥0.85. Prevalence of obesity ([BMI] ≥ 30 kg/m(2)) was 38.9 %. For WC, the multivariate odds ratio (OR) (95 % confidence interval [CI]) for having WC ≥ 35 inches in women with ≥4 pregnancies relative to those with 1-2 pregnancies was 1.59 (1.01-2.47). Higher parity (≥4 pregnancies) was non-significantly associated with high BMI (OR = 1.10; 95 % CI 0.73-1.67). No positive association was observed for WHR. Our results suggest WC is independently associated with high parity in Hispanic women and may be an optimal target for post-partum weight loss interventions.

Prenatal smoking cessation intervention and gestational weight gain

BACKGROUND

Quitting smoking is often associated with weight gain and prenatal cessation may lead to increased gestational weight gain (GWG). Although previous reports have suggested a link between prenatal smoking cessation and GWG, no studies have examined the relationship between cessation and guideline-recommended GWG, and there is little information about the relationship between the timing of prenatal cessation and GWG. Thus, we examine GWG among women in a community prenatal smoking cessation program and assess the relationship between the timing of prenatal cessation GWG.

METHODS

Pregnant women from care clinics serving economically disadvantaged women who participated in a smoking cessation intervention offered free of charge, self-reported weight, and provided biochemical verification of smoking. Relationships between duration of cessation and GWG were evaluated in t-tests and regression models. GWG was calculated from self-reported weight before pregnancy and self-reported weight at the last visit before delivery.

FINDINGS

Women who quit earlier during pregnancy had greater GWG (16.9 ± 7.5 kg) than did those who never quit (13.6 ± 8.9). After adjusting for timing of weight assessment and prepregnancy body mass index, however, GWG was not different between women who did and did not quit.

CONCLUSION

Quitting earlier in pregnancy is associated with greater GWG, but women who do and do not quit do not differ on total GWG. Despite increased GWG with early cessation, the maternal and fetal health benefits of prenatal smoking cessation outweigh risks of potential risks of excessive GWG.

Propagation of obesity across generations: the roles of differential realized fertility and assortative mating by body mass index

BACKGROUND/AIMS

To quantify the extent to which the increase in obesity observed across recent generations of the American population is associated with the individual or combined effects of assortative mating (AM) for body mass index (BMI) and differential realized fertility by BMI.

METHODS

A Monte Carlo framework is formed and informed using data collected from the National Longitudinal Survey of Youth (NLSY). The model has 2 portions: one that generates childbirth events on an annual basis and another that produces a BMI for each child. Once the model is informed using the data, a reference distribution of offspring BMIs is simulated. We quantify the effects of our factors of interest by removing them from the model and comparing the resulting offspring BMI distributions with that of the baseline scenario.

RESULTS

An association between maternal BMI and number of offspring is evidenced in the NLSY data as well as the presence of AM. These 2 factors combined are associated with an increased mean BMI (+0.067, 95% CI: 0.056; 0.078), an increased BMI variance (+0.578, 95% CI: 0.418; 0.736) and an increased prevalence of obesity (RR 1.032, 95% CI: 1.023; 1.041) and BMIs >40 (RR 1.083, 95% CI: 1.053; 1.118) among offspring.

CONCLUSION

Our investigation suggests that both differential realized fertility and AM by BMI appear to play a role in the increasing prevalence of obesity in America.

Parity and body mass index in US women: a prospective 25-year study

OBJECTIVE

To investigate long-term body mass index (BMI) changes associated with childbearing.

DESIGN AND METHODS

Adjusted mean BMI changes were estimated by race-ethnicity, baseline BMI, and parity using longitudinal regression models for 3,943 young females over 10 and 25 year follow-up from the ongoing 1979 National Longitudinal Survey of Youth cohort.

RESULTS

Estimated BMI increases varied by group, ranging from a low of 2.1 BMI units for white, non-overweight nulliparas over the first 10 years to a high of 10.1 BMI units for black, overweight multiparas over the full 25-year follow-up. Impacts of parity were strongest among overweight multiparas and primaparas at 10 years, ranges 1.4-1.7 and 0.8-1.3 BMI units, respectively. Among non-overweight women, parity-related gain at 10 years varied by number of births among black and white but not Hispanic women. After 25 years, childbearing significantly increased BMI only among overweight multiparous black women.

CONCLUSION

Childbearing is associated with permanent weight gain in some women, but the relationship differs by maternal BMI in young adulthood, number of births, race-ethnicity, and length of follow-up. Given that overweight black women may be at special risk for accumulation of permanent, long-term weight after childbearing, effective interventions for this group are particularly needed.

How pregnant African American women view pregnancy weight gain

OBJECTIVE

To gain insight into how low-income, pregnant African American women viewed their weight gain while pregnant and how they managed their weight during pregnancy.

DESIGN

Descriptive study using three focus groups.

SETTING

Women were recruited from urban prenatal care sites and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) services in a medium-sized urban northeastern city.

PARTICIPANTS

Twenty-six adult, low-income, pregnant African American women, age 18 to 39; the majority were within the first 20 weeks of pregnancy.

METHODS

Three focus groups were conducted utilizing open-ended questions related to pregnancy weight gain. Content analysis was used to analyze the verbatim transcripts. Analysis focused on meaning, intention, and context. Groups were compared and contrasted at the within and between group levels to identify themes.

RESULTS

Four themes were identified that provided insight into how women viewed their pregnancy weight gain and managed weight gain during pregnancy: (a) pregnancy weight gain: no matter how much means a healthy baby; (b) weight retention: it happens; (c) there is a limit: weight gain impact on appearance; and (d) watching and waiting: plans for controlling weight.

CONCLUSION

Low-income African American women, though cognizant of the likelihood of retention of weight following pregnancy, are not focused on limiting their gestational weight gain. The cultural acceptance of a larger body size along with the belief that gaining more weight is indicative of a healthy infant present challenges for interventions to limit excessive gestational weight gain.

Changes in maternal weight 5-10 years after a first delivery

AIM

The objective of this study was to identify maternal, obstetrical and reproductive factors associated with long-term changes in maternal weight after delivery.

MATERIALS & METHODS

Participants were enrolled in a longitudinal cohort study of maternal health 5-10 years after childbirth. Data were obtained from obstetrical records and a self-administered questionnaire. Weight at the time of first delivery (5-10 years prior) was obtained retrospectively and each woman's weight at the time of her first delivery was compared with her current weight.

RESULTS

Among 948 women, obesity was associated with race, parity, education, history of diabetes and history of cesarean at the time of first delivery. On average, the difference between weight at the time of first delivery and weight 5-10 years later was -11 kg (11 kg weight loss). In a multivariate model, black race and diabetes were associated with significantly less weight loss. Cesarean delivery, parity and breastfeeding were not associated with changes in maternal weight.

CONCLUSION

Black women and those with a history of diabetes may be appropriate targets for interventions that promote a long-term healthy weight after childbirth.

Gestational weight gain as a predictor of longitudinal body mass index transitions among socioeconomically disadvantaged women

BACKGROUND

Socioeconomically disadvantaged women are at greater risk for gestational weight gain and postpartum weight retention compared to socioeconomically advantaged women. This study examines the effect of gestational weight gain on body mass index (BMI) transitions 5 years after pregnancy in socioeconomically disadvantaged women.

METHODS

Gestational weight gain was assessed in 2136 postpartum women participating in the Fragile Families and Child Well-being study who experienced full-term, singleton gestations. Longitudinal BMI transitions were defined as a change or stability in BMI category between two time points: BMI before the index pregnancy and BMI 5 years after the index pregnancy. Logistic regression models estimated the association between gestational weight gain and longitudinal BMI transitions, controlling for health before the index pregnancy, pregnancy history, and sociodemographic characteristics.

RESULTS

Excessive gestational weight gain was related to transitioning to a higher BMI category 5 years after the index pregnancy. Compared to white women, black and Hispanic women were more likely to transition or maintain a higher BMI category. Pregnancy history (i.e., parity at index pregnancy, interim pregnancy) and public assistance participation were associated with transitioning to a higher BMI category.

CONCLUSIONS

Among socioeconomically disadvantaged women, excessive gestational weight gain is related to transitioning to, but not maintaining, a higher weight category 5 years after the index pregnancy. Black and Hispanic women who are also socioeconomically disadvantaged and overweight or obese before conception may benefit from preconception or postpartum counseling about the long-term effect of gaining excessive weight during pregnancy and in the years immediately after childbirth.

Perceived weight gain, risk, and nutrition in pregnancy in five racial groups

OBJECTIVE

Examine perceived pregnancy weight gain needed, perceived risks to mother, and infant of excessive weight and underweight, perceptions of actual, ideal, realistic body size, nutritional intake in five racial/ethnic groups.

DESIGN

Cross-sectional Setting: Physicians' offices Participants: A total of 54 women <20 weeks gestation.

METHODS

Questionnaires-perceived weight gain needed, risks of weight gain for mother, infant, perceptions of body size, food frequency.

RESULTS

A total of 39% of women are overweight or obese (57% Caribbean Black, 50% African American). Perceived pregnancy weight gain needed highest in Central American Hispanic women, lowest Caribbean Black women. African-American women had low perceived risk for mother and infant of gaining too much pregnancy weight, highest perceived risk for both of gaining too little. Caribbean Black women perceived highest risk to mother of gaining too much pregnancy weight, highest risk to infant of gaining too little. White Non-Hispanic women reported smaller prepregnant, ideal, realistic body sizes than other four groups. Daily caloric intake ranged from 599 to 5856 calories. African-American women had significantly more calories; protein, total fats, monounsaturated, polyunsaturated, and saturated fats; carbohydrates, sugar; and iron than White Non-Hispanic women. Women in each racial/ethnic group had less than recommended intake of protein, carbohydrates, calcium, iron, folate, and fiber.

CONCLUSIONS

Education is needed to raise awareness of risks of prepregnancy weight and excessive weight gain for mother and infant. The need for prenatal nutritional counseling to reduce the intake of calories, fats, sweets, and snacks; increase intake of vegetables, fruits, foods with iron, folate, and fiber.

Epidemiologic behavior of obesity in the Maracaibo City metabolic syndrome prevalence study

Introduction

Obesity is a worldwide public health issue. Since the epidemiological behaviour of this disease is not well established in our country, the purpose of this study was to determinate its prevalence in the Maracaibo City, Zulia State- Venezuela.

Materials and Methods

A cross-sectional study was undertaken using the data set from the Maracaibo City Metabolic Syndrome Prevalence Study. The sample consists of 2108 individuals from both genders and randomly selected: 1119 (53.09%) women and 989 (46.91%) men. The participants were interrogated for a complete clinical history and anthropometric measurements. To classify obesity, the WHO criteria for Body Mass Index (BMI), and Waist Circumference (WC) from the IDF/NHLBI/AHA/WHF/IAS/IASO-2009 (IDF-2009) and ATPIII statements were applied.

Results

For BMI, obesity had an overall prevalence of 33.3% (n = 701), and according to gender women had 32.4% (n = 363) and men had 34.2% (n = 338). Overweight had a prevalence of 34.8% (n = 733), Normal weight had 29.8% (n = 629), and Underweight had 2.1% (n = 45). Adding Obesity and Overweight results, the prevalence of elevated BMI (>25 Kg/m²) was 68.1%. Using the IDF-2009 WC's cut-off, Obesity had 74.2% prevalence, compared to 51.7% using the ATPIII parameters.

Conclusions

These results show a high prevalence of abdominal obesity in our locality defined by the WHO, IDF-2009 and ATPIII criteria, which were not designed for Latin-American populations. We suggest further investigation to estimate the proper values according to ethnicity, genetic background and sociocultural aspects.

Etiology of overactive bladder: a diet and lifestyle model for diabetes and obesity in older women

OBJECTIVE

To evaluate a coherent, evidence-based hypothesis that specific modifiable lifestyle factors implicated in the development of diabetes and associated obesity are related to the onset of OAB.

METHODS

A hypothetical causative model for OAB involving modifiable lifestyle factors implicated in the development of diabetes and obesity was constructed, based on a systematic literature review. Secondary analysis of data was undertaken in a prospective cohort of women aged 40 and over, living in Leicestershire, UK. Subjects included 3,411 women free from OAB at baseline and 277 incident cases of OAB. Reported diet, lifestyle, morbid, and social factors were measured at baseline and incident cases at 1-year follow-up. Graphical chain modeling was used to estimate the associations between variables and identify likely pathways involved.

RESULTS

All hypothesized lifestyle factors (physical activity, high glycemic index, and high energy intake) plus diabetes and obesity were retained within the graph as potential contributors. However, low physical activity was the only direct risk factor linked prospectively to the onset of OAB (RR 2.47; 95% CI 1.82, 3.36), in addition to older age.

CONCLUSIONS

Poor lifestyle factors causally linked to diabetes and obesity may contribute to the onset of OAB; low physical activity appears to be an important modifiable causal factor for OAB operating directly as well as indirectly via pathways involving obesity or diabetes. Further research is needed to demonstrate a causal link between lifestyle and OAB.

Relapse to smoking and postpartum weight retention among women who quit smoking during pregnancy

Postpartum weight retention contributes to obesity risk in women. Given that most women who quit smoking as a result of pregnancy will resume smoking within 6 months postpartum and that there is a robust association between smoking and weight, we sought to evaluate postpartum weight retention as a function of postpartum smoking status among women who had quit smoking during pregnancy. Women (N = 183) with biochemically confirmed cigarette abstinence at the end of pregnancy were recruited between February 2003 and November 2006. Women self-reported demographic information and weight before pregnancy. Smoking status and weight were documented at the end of pregnancy and at 6, 12, and 24 weeks postpartum. Breastfeeding was reported at 6 weeks postpartum. Differences in weight retention by relapse status at each assessment were evaluated. To examine weight retention in the presence of conceptually relevant covariates, mixed models with log-transformed weight data were used. At 24 weeks postpartum, 34.6% of women remained abstinent. Women who remained abstinent throughout the 24-week period retained 4.7 ± 2.1 kg more than did women who had relapsed by 6 weeks postpartum, P = 0.03. This difference in postpartum weight retention was significant after controlling for relevant covariates (age, race, breastfeeding, and pregravid BMI). Resumption of smoking within the first 6 weeks following childbirth is associated with decreased postpartum weight retention, even after controlling for breastfeeding and pregravid weight. Interventions to sustain smoking abstinence postpartum might be enhanced by components designed to minimize weight retention.

Post-partum weight retention in women in Asia: a systematic review

Obesity is a health issue for people in Asia, and many studies support that childbearing may contribute to women's obesity. However, most studies of post-partum weight retention (PWR) focus on Western countries. This paper aimed to review recent data on PWR and discuss the related factors of PWR for women in Asia. Three electronic databases - MEDLINE, CINAHL and PsycINFO - were searched for data from January 1990 to August 2010. Twelve studies were identified as containing information related to PWR. Chinese, Taiwanese and Korean women tend to have higher gestational weight gain and PWR than women in other Asian countries in this review. The average reported gestational weight gain in these studies ranged from 8.3 kg to 18.0 kg, and the average weight retention at 6 months post partum in various countries ranged from 1.56 kg to 4.1 kg. Gestational weight gain had a positive effect on PWR, but there were no consistent conclusions for other factors. Only a few psychosocial and behavioural factors have been studied. Moreover, no one has assessed changes in waist circumference and waist-to-hip ratio for measuring central obesity and ensuring risk of chronic disease. Focusing on changes in maternal weight and body composition, and considering the impact of psychological and behavioural factors are suggested for future studies in Asia.

The DHHS Office on Women's Health Initiative to Improve Women's Heart Health: focus on knowledge and awareness among women with cardiometabolic risk factors

Abstract Background: The diversity of the U.S. population and disparities in the burden of cardiovascular disease (CVD) require that public health education strategies must target women and racial/ethnic minority groups to reduce their CVD risk factors, particularly in high-risk communities, such as women with the metabolic syndrome (MS).

METHODS

The data reported here were based on a cross-sectional face-to-face survey of women recruited from four participating sites as part of the national intervention program, Improving, Enhancing and Evaluating Outcomes of Comprehensive Heart Care in High-Risk Women. Measures included baseline characteristics, sociodemographics, CVD related-knowledge and awareness, and Framingham risk score (FRS).

RESULTS

There were 443 of 698 women (63.5%) with one or more risk factors for the MS: non-Hispanic white (NHW), 51.5%; non-Hispanic black (NHB), 21.0%; Hispanic, 22.6%. Greater frequencies of MS occurred among Hispanic women (p<0.0001), those with less than a high school education (70.0%) (p<0.0001), Medicaid recipients (57.8%) (p<0.0001), and urbanites (43.3%) (p<0.001). Fewer participants with MS (62.6%) knew the leading cause of death compared to those without MS (72.1%) (p<0.0001). MS was associated with a lack of knowledge of the composite of knowing the symptoms of a heart attack plus the need to call 911 (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.17-0.97, p=0.04).

CONCLUSIONS

Current strategies to decrease CVD risk are built on educating the public about traditional factors, including hypertension, smoking, and elevated low-density lipoprotein cholesterol (LDL-C). An opportunity to broaden the scope for risk reduction among women with cardiometabolic risk derives from the observation that women with the MS have lower knowledge about CVD as the leading cause of death, the symptoms of a heart attack, and the ideal option for managing a CVD emergency.

Association of maternal short sleep duration with adiposity and cardiometabolic status at 3 years postpartum

The purpose of this study was to examine the association of short sleep duration among women in the first year postpartum with adiposity and cardiometabolic status at 3 years postpartum. We studied 586 women in Project Viva, a prospective cohort. At 6 months and 1 year postpartum, women reported the number of hours they slept in a 24-h period, from which we calculated a weighted average of daily sleep. We used multivariable regression analyses to predict the independent effects of short sleep duration (≤5 h/day vs. >5 h/day) on adiposity, glucose metabolism, lipid metabolism, and adipokines at 3 years postpartum. Women's mean (s.d.) hours of daily sleep in the first year postpartum was 6.7 (0.97) h. After adjusting for age, race/ethnicity, education, parity, prepregnancy BMI, and excessive gestational weight gain, we found that postpartum sleep ≤5 h/day was associated with higher postpartum weight retention (β 1.50 kg; 95% confidence interval (CI): 0.02, 2.86), higher subscapular + triceps skinfold thickness (β 3.94 mm; 95% CI: 1.27, 6.60) and higher waist circumference (β 3.10 cm; 95% CI: 1.25, 4.94) at 3 years postpartum. We did not observe associations of short sleep duration with measures of cardiometabolic status at 3 years postpartum. In conclusion, short sleep duration in the first year postpartum is associated with higher adiposity at 3 years postpartum.

Fatores associados à retenção de peso pós-parto em uma coorte de mulheres, 2005-2007

OBJETIVO: investigar fatores associados à retenção de peso pós-parto. MÉTODOS: estudo de coorte com 104 gestantes recrutadas em uma Unidade Básica de Saúde no município do Rio de Janeiro, da 8ª a 13ª semana de gestação e acompanhadas até aproximadamente 55 dias pós-parto. As variáveis incluíram informações sócio-demográficas, econômicas, bioquímicas, antropométricas e reprodutivas. A retenção de peso pós-parto (diferença entre o peso pós-parto e o peso pré-gestacional) foi utilizada como variável dependente. RESULTADOS: a média de peso retido foi 3,2 kg ± 3,7 kg. As mulheres com ganho de peso gestacional (GPG) excessivo retiveram 5,0 kg ± 3,9 em comparação a 3,6 kg ± 3,0 em mulheres com GPG adequado e 1,4 kg ± 3,1 para as com GPG insuficiente. O GPG e o Índice de Massa corporal (IMC) pré-gestacional mantiveram associação significativa com a retenção de peso no modelo final. Observou-se que a cada quilo de peso ganho na gestação, quase 50% ficaram retidos no pós-parto (β = 0,494; p<0,001) e a cada 1,0 kg/m² a menos no IMC pré-gestacional correspondeu a uma retenção de aproximadamente 150g (β = -0,149;p<0,05). CONCLUSÃO: o GPG está positivamente e o IMC pré-gestacional inversamente associado à retenção de peso pós-parto. Orientações nutricionais sobre o controle do ganho ponderal podem ajudar a minimizar a incidência de obesidade entre mulheres no pós-parto.

Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: evidence from 21 y postpartum follow-up

BACKGROUND

The contribution of gestational weight gain (GWG) to the development of obesity may have important implications for mothers in their later lives. However, whether GWG is a strong predictor of body mass index (BMI) 2 decades after the index pregnancy is unknown.

OBJECTIVE

We examined the long-term effect of GWG by using a community-based birth cohort study.

DESIGN

We followed a subsample of 2055 women from an original cohort of 7223 women who gave birth in Brisbane, Australia, between 1981 and 1983. Multivariable regression and multinomial regression were used to examine the independent associations of GWG per gestational week and Institute of Medicine (IOM) categories of combined prepregnancy BMI and GWG with BMI and its categories 21 y after the index pregnancy.

RESULTS

In analyses using GWG per week as a continuous exposure variable, maternal BMI (in kg/m(2)) increased, on average, by 0.52 (95% CI: 0.31, 0.73) for a 0.1-kg/wk greater GWG. This association became stronger when adjusted for maternal prepregnancy BMI. Analyses with IOM categories showed a greater postnatal increase in BMI for women defined as having excessive GWG (3.72, on average; 95% CI: 3.12, 4.31) than for women with adequate GWG. The women who gained excess weight during pregnancy had increased odds of being overweight [odds ratio (OR): 2.15; 95% CI: 1.64, 2.82] or obese (OR: 4.49; 95% CI; 3.42, 5.89) 21 y after the index pregnancy. These associations were independent of other potential factors.

CONCLUSION

Weight gain during pregnancy independently predicts the long-term weight gain and obesity of women.

Ten putative contributors to the obesity epidemic

The obesity epidemic is a global issue and shows no signs of abating, while the cause of this epidemic remains unclear. Marketing practices of energy-dense foods and institutionally-driven declines in physical activity are the alleged perpetrators for the epidemic, despite a lack of solid evidence to demonstrate their causal role. While both may contribute to obesity, we call attention to their unquestioned dominance in program funding and public efforts to reduce obesity, and propose several alternative putative contributors that would benefit from equal consideration and attention. Evidence for microorganisms, epigenetics, increasing maternal age, greater fecundity among people with higher adiposity, assortative mating, sleep debt, endocrine disruptors, pharmaceutical iatrogenesis, reduction in variability of ambient temperatures, and intrauterine and intergenerational effects as contributing factors to the obesity epidemic are reviewed herein. While the evidence is strong for some contributors such as pharmaceutical-induced weight gain, it is still emerging for other reviewed factors. Considering the role of such putative etiological factors of obesity may lead to comprehensive, cause specific, and effective strategies for prevention and treatment of this global epidemic.

Low-income women's reproductive weight patterns empirically based clusters of prepregnant, gestational, and postpartum weights

BACKGROUND

Women have varying weight responses to pregnancy and the postpartum period. The purpose of this study was to derive sub-groups of women based on differing reproductive weight clusters; to validate clusters by reference to adequacy of gestational weight gain (GWG) and postpartum incremental weight shifts; and to examine associations between clusters and demographic, behavioral, and psychosocial variables.

METHOD

A cluster analysis was conducted of a multi-ethnic/racial sample of low-income women (n = 247). Clusters were derived from three weight variables: prepregnant body mass index, GWG, and postpartum retained weight.

RESULTS

Five clusters were derived: Cluster 1, normal weight-high prenatal gain-average retain; cluster 2, normal weight-low prenatal gain-zero retain; cluster 3, high normal weight-high prenatal gain-high retain; cluster 4, obese-low prenatal gain-average retain; and cluster 5, overweight-very high prenatal gain-very high retain. Clusters differed with regard to postpartum weight shifts (p < .001), with clusters 3, 4, and 5, mostly gaining weight between 6 weeks and 12 months postpartum, whereas clusters 1 and 2 were losing weight. Clusters were also associated with race/ethnicity (p < .01), breastfeeding immediately postdelivery (p < .01), smoking at 12 months (p < .05), and reaching weight goals at 6 and 12 months (p < .001), but not depressive symptoms, fat intake habits, or physical activity.

CONCLUSION

In a five-cluster solution, postpartum weight shifts, ethnicity, and initial breastfeeding were among factors associated with clusters. Monitoring of weight and appropriate intervention beyond the 6 weeks after birth is needed for low-income women in high normal weight, overweight, and obese clusters.

Parity and breastfeeding in relation to obesity among black and white women in the southern community cohort study

OBJECTIVE

This research sought to describe associations among parity, breastfeeding, and adult obesity in black and white women in the southeastern United States.

METHODS

Cross-sectional data from 7,986 white women and 23,198 black women (age 40-79 years) living in the southeastern United States and enrolled in the Southern Community Cohort Study during 2002-2006 were used to examine self-reported body mass index (BMI) and weight change since age 21 in association with parity and breastfeeding. Multiple linear regression and logistic regression with adjustment for demographic and lifestyle factors were used.

RESULTS

At all levels of parity and breastfeeding, black women had higher BMI and weight gain since age 21 than white women. Compared to nulliparity, five or more live births was associated with increased odds of obesity in white women (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.08-1.74) and, to a lesser extent, in black women (OR = 1.22, 95% CI = 1.07-1.38). In white women, breastfeeding for more than 12 months compared to none was associated with decreased odds of obesity (OR = 0.68, 95% CI = 0.56-0.82), whereas in black women, no association between obesity and breastfeeding was seen.

CONCLUSIONS

The associations between childbearing factors and measures of adult obesity appear to be larger in white women compared to black women but relatively small overall. However, when considered as part of the constellation of factors that lead to obesity, even these small associations may be important in an overall obesity prevention strategy.

Childbearing and obesity in women: weight before, during, and after pregnancy

Weight gain and the development of obesity during midlife are strong independent predictors of cardiovascular disease, particularly among women, as well as the metabolic syndrome, type 2 diabetes, and early mortality. Primiparity and maternal body size before pregnancy affect long-term postpartum weight retention and the development of obesity among women of reproductive age. As a modifiable risk factor, body weight during the preconception, prenatal, and postpartum periods may present critical windows to implement interventions to prevent weight retention and the development of overweight and obesity in women of childbearing age.

Determinantes nutricionais e sóciodemográficos da variação de peso no pós-parto: uma revisão da literatura

Trata-se de um estudo de revisão sobre os fatores nutricionais e sócio-demográficos da variação de peso no pós-parto. Foi realizada uma busca bibliográfica nas bases de dados eletrônicas Scientific Eletronic Library On-line (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE) referente a literatura publicada na última década (1997-2008). Treze artigos, um informe técnico e dois livros considerados relevantes sobre o assunto e publicados anteriormente ao ano 1997 foram citados na revisão. A revisão priorizou estudos de ensaios clínicos randomizados e de seguimento realizados com gestantes e mulheres no pós-parto. Os resultados obtidos mostram como principais fatores associados com a variação de peso no pós-parto o ganho de peso gestacional acima das recomendações do Institute of Medicine, Índice de Massa Corporal Pré-Gestacional > 25 kg/m2, dieta, tempo e intensidade do aleitamento materno e os fatores sócio-demográficos: raça negra, primiparidade, idade materna, baixa renda e baixa escolaridade. A prática regular de atividade física é recomendada como uma estratégia para evitar o ganho de peso excessivo e melhorar a perda de peso durante o pós-parto. No Brasil não existe uma estratégia nacional para prevenir o ganho de peso excessivo e garantir a adequada perda de peso nesse período. Durante o pós-parto, a maioria das ações de saúde visa basicamente garantir o aleitamento materno.

Parity is associated with increased waist circumference and other anthropometric indices of obesity

BACKGROUND

There is growing interest in the effect of childbearing on the development of chronic medical conditions. In the present study we aim at seeing whether parity is associated with increased waist circumference (WC) and other anthropometric indices of obesity, or not, in a sample of Iraqi women.

METHODS

This was a cross sectional study conducted during the period from January 2006 to the end of December 2007. Subjects were women attending two primary health care centers in a rural district population in Basrah (Abu-Al-khasib district), Iraq.

RESULTS

A total of 9135 women with a mean age of 46.4+/-15.5 years were included in the study. The mean weight was 69.9+/-16.9 kg and the mean WC was 92.7+/-15.0 cm with 78.9% of women having WC >or=80 cm. The mean and the standard deviation of other anthropometric variables were 27.0+/-6.25 for body mass index (BMI), 0.57+/-0.09 for waist-to-height ratio (WHtR) and 0.89+/-0.08 for waist-to-hip ratio (WHpR). Body weight, WC, BMI, WHpR, and WHtR progressively and significantly increased with increasing parity (p<0.001). Increasing age and higher number of births were associated with a consistent significant increase in the risk of increasing WC. While the reverse was true with respect to education, the risk of increased WC significantly decreased with the increase in education. The risk of increased WC was higher among housewives compared to employed women. On multiple logistic regression analyses of parity and risk of increasing WC, the number of births remained significantly and independently associated with increased WC after adjustment for a range of potential confounders (age, BMI, employment, education, and marital status). However, when parity was analyzed as a dichotomous variable (parous versus nulliparous), no significant association was found (p>0.05).

CONCLUSION

Parity was associated with increased WC and other anthropometric indices of obesity in a sample of rural Iraqi women attending two primary health care centers.

Longitudinal study of growth and adiposity in parous compared with nulligravid adolescents

OBJECTIVE

To examine the impact of pregnancy on adolescent growth and adiposity relative to nulligravidas of similar maturation stage.

DESIGN

Prospective cohort study.

SETTING

The multicenter National Heart, Lung and Blood Growth and Health Study with annual examinations from 1987-1988 through 1996-1997.

PARTICIPANTS

One thousand eight hundred ninety girls (983 black and 907 white) aged 9 to 10 years at enrollment.

MAIN EXPOSURE

Self-reported number of pregnancies and births during adolescence and young adulthood (age, 15-19 years): 311 primiparas (17%), 84 multiparas (4%), 196 nulliparous gravidas (10%), and 1299 nulligravidas (69%).

OUTCOME MEASURES

Estimated race-specific changes in body weight, height, body mass index, waist circumference, hip circumference, waist to hip ratio, and percent body fat, defined as the difference between baseline and measurements 9 to 10 years later.

RESULTS

Thirty-one percent of black and 10% of white girls gave birth during adolescence and young adulthood. We found evidence of race by pregnancy interactions (P < .10) for changes in weight, body mass index, hip circumference, and percent body fat. Black primiparas and multiparas, respectively, had smaller decrements in waist to hip ratio (0.019 and 0.023) and greater increments in weight (3.6 and 6.0 kg), body mass index (1.3 and 2.3), waist circumference (3.5 and 5.2 cm), hip circumference (2.1 and 4.0 cm), and percent body fat (3.4% and 4.6%) than black nulligravidas after adjustment for baseline measurements, age, study center, family income, parental education, age at menarche, hours of television and video viewing, and height at visit 9 or 10 in weight models (P < .01). White primiparas had borderline greater increments in waist circumference (2.4 cm) and percent body fat (0.9%) and smaller decrements in waist to hip ratio (0.017) than white nulligravidas (P < .05). Height did not differ by pregnancy status.

CONCLUSIONS

Women who give birth during adolescence and young adulthood have substantially greater increments in overall and central adiposity than adolescents who do not experience pregnancy independent of other known correlates of weight gain.

Racial, ethnic, and socioeconomic differences in the incidence of obesity related to childbirth

OBJECTIVES

We investigated the relationship between childbirth and 5-year incidence of obesity.

METHODS

We performed a prospective analysis of data on 2923 nonobese, nonpregnant women aged 14 to 22 years from the 1979 National Longitudinal Survey of Youth Cohort, which was followed from 1980 to 1990. We used multivariable logistic regression analyses to determine the adjusted relative risk of obesity for mothers 5 years after childbirth compared with women who did not have children.

RESULTS

The 5-year incidence of obesity was 11.3 per 100 parous women, compared with 4.5 per 100 nulliparous women (relative risk [RR] = 3.5; 95% confidence interval [CI] = 2.4, 4.9; P < .001). The 5-year incidence of obesity was 8.6 for primiparous women (RR = 2.8; 95% CI = 1.5, 5.0) and 12.2 for multiparous women (RR = 3.8; 95% CI = 2.6, 5.6). Among parous women, White women had the lowest obesity incidence (9.1 per 100 vs 15.1 per 100 for African Americans and 12.5 per 100 for Hispanics).

CONCLUSIONS

Parous women have a higher incidence of obesity than do nulliparous women, and minority women have a higher incidence of parity-related obesity than do White women. Thus, efforts to reduce obesity should target postpartum women and minority women who give birth.

Overweight and obesity in postpartum Hispanic women

Overweight and obesity vary in prevalence among particular groups, and are especially problematic for childbearing Hispanic women. The complex interaction between physical changes associated with pregnancy, role changes accompanying birth, and family and cultural values related to childbearing are superimposed upon the underlying mechanisms that create or perpetuate obesity. In this article we review biological and behavioral research on obesity in postpartum Hispanic women to identify critical components for intervention studies focused on weight management. Recommendations are offered for health care providers and researchers.

Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on population and prevention science)

Obesity is a major influence on the development and course of cardiovascular diseases and affects physical and social functioning and quality of life. The importance of effective interventions to reduce obesity and related health risks has increased in recent decades because the number of adults and children who are obese has reached epidemic proportions. To prevent the development of overweight and obesity throughout the life course, population-based strategies that improve social and physical environmental contexts for healthful eating and physical activity are essential. Population-based approaches to obesity prevention are complementary to clinical preventive strategies and also to treatment programs for those who are already obese. This American Heart Association scientific statement aims: 1) to raise awareness of the importance of undertaking population-based initiatives specifically geared to the prevention of excess weight gain in adults and children; 2) to describe considerations for undertaking obesity prevention overall and in key risk subgroups; 3) to differentiate environmental and policy approaches to obesity prevention from those used in clinical prevention and obesity treatment; 4) to identify potential targets of environmental and policy change using an ecological model that includes multiple layers of influences on eating and physical activity across multiple societal sectors; and 5) to highlight the spectrum of potentially relevant interventions and the nature of evidence needed to inform population-based approaches. The evidence-based experience for population-wide approaches to obesity prevention is highlighted.

Weight retention from early pregnancy to three years postpartum: a study in Iranian women

OBJECTIVES

to examine weight retention from early pregnancy to three years postpartum in Iranian women.

DESIGN

a prospective cohort study.

SETTING

12 health centres selected at random in urban and rural areas in Guilan.

PARTICIPANTS

1315 pregnant women (705 in urban areas and 610 in rural areas) who regularly attended health centres for antenatal care and growth monitoring of their babies.

MEASUREMENTS

details of weight, height, pregnancy weight gain, body weight at one to three years postpartum, mother's age, parity, duration of any breast feeding, education and employment status of women who carried singleton fetuses and delivered at term were collected at the first antenatal visit. The women were categorised based on their pre-pregnancy body mass index, weight retention at one to three years postpartum, employment status and educational levels.

FINDINGS

women who gained more weight than recommended during pregnancy tended to be heavier at three years postpartum than women who gained weight within the recommended ranges during pregnancy (7.0 + or - 5.3 versus 4.8 + or - 6.7 kg; p < 0.0001). Less-educated women were at greater risk for inadequate pregnancy weight gain than other educational groups, and they had less weight retention at three years postpartum than other educational groups. Also, weight retention for primiparous women was higher than that for multiparous women (5.4 + or - 6.6 versus 3.8 + or - 6.3 kg; p < 0.0001). The results of logistic regression analysis revealed that only total pregnancy weight gain was independently related to major weight retention (> or = 4 kg) at three years postpartum (odds ratio 1.34, 95% confidence intervals 1.03-1.74; p = 0.02).

CONCLUSION

a high body mass index before pregnancy is not associated with increased risk of retaining more weight after pregnancy. On the other hand, total pregnancy weight gain was the most important determinant of weight retention at three years postpartum in this population of Iranian women.

Managing Excessive Weight Gain During Pregnancy and the Postpartum Period

Childbearing is a period in the life cycle during which some women may gain weight, become overweight, or become obese. Despite guidelines issued in 1990 for gestational weight gain, many women exceed them. Women who are overweight before pregnancy are most vulnerable to excessive gestational weight gain. Prenatal interventions to prevent excessive gain have had mixed results. During the postpartum period, 14% to 20% of women may retain weight from pregnancy, which elevates risk of later health problems. Although postpartum weight loss interventions have been shown to have efficacy, these have been tested primarily with White women. Continued efforts are needed in practice and research to develop effective approaches for managing weight during pregnancy and postpartum, especially for low-income and ethnic minority women.