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Ćwiek D, Malinowski W, Ogonowski J, Zimny M, Szymoniak K, Czechowska K, Dawid W, Sipak-Szmigiel O, Iwanowicz-Palus G. The Effects of Breastfeeding and Gestational Diabetes Mellitus on Body Mass Composition and the Levels of Selected Hormones after Childbirth. Nutrients 2023; 15:4828. [PMID: 38004222 PMCID: PMC10675250 DOI: 10.3390/nu15224828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Breastfeeding may have a positive effect on glucose metabolism and insulin sensitivity, which may reduce the risk of developing diabetes following gestational diabetes mellitus (GDM). This study aimed to evaluate the effect of breastfeeding and GDM on the body mass composition of the studied women, the levels of leptin, ghrelin, adiponectin, resistin, and insulin, and weight loss during the 6-8-week postpartum period and 1 year after childbirth. MATERIALS AND METHODS The study group included 42 women with a singleton pregnancy, diagnosed with GDM between the 24th and 28th week of gestation. The control group consisted of 28 non-diabetic women with a singleton pregnancy. This study was carried out at 6-8 weeks as well as at 1 year postpartum. The women were subjected to body weight measurements and body composition analysis performed using a professional body composition analyzer TANITA DC-430 S MA. Waist circumference and subcutaneous fat was measured. Blood for laboratory tests was taken in the morning, on an empty stomach. RESULTS It was shown that, regardless of diabetes, exclusive breastfeeding had a significant impact on weight loss at 6-8 weeks postpartum (p = 0.014785) and lower insulin levels (p = 0.047). However, there was no effect of breastfeeding on the women's anthropometric measurements or hormone levels one year after delivery, except for the thickness of subcutaneous adipose tissue, which was significantly lower in breastfeeding women (p = 0.03). One year after delivery, breastfeeding women had a lower BMI (p = 0.0014), less-thick subcutaneous adipose tissue (p < 0.001), and a lower risk of obesity (p = 0.016). There were also higher insulin and ghrelin levels in both breastfeeding and non-breastfeeding women (p < 0.001), and lower resistin levels in non-breastfeeding women (p = 0.004). Women who had diabetes during pregnancy had a significantly reduced waist circumference and subcutaneous fat thickness after one year (p < 0.001 and p = 0.05, respectively). CONCLUSIONS Having diabetes during pregnancy did not significantly affect the results of anthropometric measurements and hormone levels noted at 6-8 weeks after delivery (the only exception was the thickness of subcutaneous fat tissue, which was greater in women without GDM). This may indicate normalization of carbohydrate metabolism after childbirth; however, the observation period is too short to elucidate long-term metabolic effects. This suggests the need for further research related to GDM and breastfeeding.
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Affiliation(s)
- Dorota Ćwiek
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Witold Malinowski
- Faculty of Health Sciences in Płock, Masovian Public University, 09-402 Płock, Poland;
| | - Jarosław Ogonowski
- Diabetes Clinic—Independent Public Provincial Integrated Hospital in Szczecin, 71-455 Szczecin, Poland;
| | - Małgorzata Zimny
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Katarzyna Szymoniak
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Krystyna Czechowska
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Weronika Dawid
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Olimpia Sipak-Szmigiel
- Department of Obstetrics and Pathology of Pregnancy, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (D.Ć.); (K.S.); (K.C.); (W.D.); (O.S.-S.)
| | - Grażyna Iwanowicz-Palus
- Department of Specialist Care in Obstetric, Chair of Obstetrics Development of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 20-081 Lublin, Poland;
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Palmer JR, Cozier YC, Rosenberg L. Research on Health Disparities: Strategies and Findings From the Black Women's Health Study. Am J Epidemiol 2023; 192:1806-1810. [PMID: 35136921 PMCID: PMC11004793 DOI: 10.1093/aje/kwac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 01/10/2023] Open
Abstract
The American Journal of Epidemiology has been a platform for findings from the Black Women's Health Study (BWHS) that are relevant to health disparities. Topics addressed have included methods of follow-up of a large cohort of Black women, disparities in health-care delivery, modifiable risk factors for health conditions that disproportionately affect Black women, associations with exposures that are highly prevalent in Black women, and methods for genetic research. BWHS papers have also highlighted the importance of considering social context, including perceived experiences of racism, in understanding health disparities. In the future, BWHS investigators will contribute to documentation of the role that structural racism plays in health disparities.
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Affiliation(s)
| | | | - Lynn Rosenberg
- Correspondence to Dr. Lynn Rosenberg, Slone Epidemiology Center at Boston University, 72 East Concord Street L7, Boston, MA 02118 (e-mail: )
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Zhang Q, Li K, Wouk K, Lamichhane R, Guthrie J. Prenatal Perception of WIC Breastfeeding Recommendations Predicts Breastfeeding Exclusivity and Duration in the Infants' First Year. J Nutr 2022; 152:2931-2940. [PMID: 36149318 PMCID: PMC9839998 DOI: 10.1093/jn/nxac221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pregnant participants who perceived that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) recommends breastfeeding only were more likely to have better early breastfeeding outcomes. OBJECTIVES Our objective was to examine the association between prenatal perception of WIC's breastfeeding recommendations and breastfeeding duration through the first year of infant life. METHODS This observational study used a national longitudinal sample of 1594 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 in 2013. Four measures of breastfeeding duration were used: 1) a discrete measure of exclusive breastfeeding through 5 mo; 2) a continuous measure of exclusive breastfeeding (in days up to 7 mo); 3) a discrete measure of any breastfeeding through 11 mo; and 4) a continuous measure of any breastfeeding (in days up to 13 mo). The primary explanatory variable was the participant's prenatal perception of whether WIC recommended breastfeeding only. The univariate analyses of time to breastfeeding cessation were performed using Kaplan-Meier curves. The Cox regression model was adopted to estimate the likelihood of breastfeeding outcomes over time. All analyses accounted for complex survey design effects. RESULTS Compared with their peers who perceived WIC to recommend formula only or both breastfeeding and formula equally, participants who perceived WIC as recommending breastfeeding only were less likely to stop exclusive breastfeeding through 5 mo (HR = 0.83; 95% CI: 0.69, 0.99) or to stop any breastfeeding through 11 mo (HR = 0.80; 95% CI: 0.69, 0.92), without controlling for prenatal infant feeding intentions. Similar patterns were observed in the 2 continuous measures, as they were also less likely to stop exclusive breastfeeding by 7 mo (HR = 0.78; 95% CI: 0.69, 0.90) or to stop any breastfeeding by 13 mo (HR = 0.82; 95% CI: 0.71, 0.95). CONCLUSIONS Prenatal perception of WIC's breastfeeding recommendation can be a useful predictor of breastfeeding duration in WIC participants.
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Affiliation(s)
- Qi Zhang
- Address correspondence to QZ (e-mail: )
| | - Kelin Li
- Department of Sociology, California State University-Dominguez Hills, Carson, CA, USA
| | - Kathryn Wouk
- Pacific Institute for Research and Evaluation, Chapel Hill, NC, USA
| | - Rajan Lamichhane
- Department of Clinical and Translational Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Joanne Guthrie
- US Department of Agriculture/Economic Research Service, Washington, DC, USA
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Kaur D, Malhotra A, Ranjan P, Chopra S, Kumari A, Vikram NK. Weight management in postpartum women - An Indian perspective. Diabetes Metab Syndr 2021; 15:102291. [PMID: 34598009 DOI: 10.1016/j.dsx.2021.102291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS This narrative review is intended to present an evidence and opinion-based weight management module for Indian postpartum women to be used by clinicians. MATERIAL AND METHODS Electronic databases such as PubMed and Google Scholar were accessed to extract relevant studies to derive evidence-based information. The reference list of the extracted studies was also checked to obtain further relevant articles. The opinion-based information was achieved from the consensus among the gynaecologists, nutritionists and doctors from Medicine according to their practical experiences in real time. In this review, we have used the term "postpartum" to represent the time period of two years after delivery. RESULTS A postpartum weight management module consisting of information about diet, physical activity, sleep and breastfeeding was devised to be used in regular clinical practice, particularly in the Indian settings. CONCLUSION Postpartum women deal with various unique challenges as compared to other population groups. Individualised weight management strategies should be adopted to facilitate sustainable postpartum weight management.
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Affiliation(s)
- Divjyot Kaur
- Department of Home Science, University of Delhi, India
| | - Anita Malhotra
- Department of Home Science, Lakshmibai College, University of Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Sakshi Chopra
- Department of Home Science, University of Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Hemingway S, Forson-Dare Z, Ebeling M, Taylor SN. Racial Disparities in Sustaining Breastfeeding in a Baby-Friendly Designated Southeastern United States Hospital: An Opportunity to Investigate Systemic Racism. Breastfeed Med 2021; 16:150-155. [PMID: 33539272 DOI: 10.1089/bfm.2020.0306] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Racial disparities in breastfeeding rates persist in the United States with Black women having the lowest rates of initiation and continuation. A literature review attributes this to many factors-historical roles, cultural norms, lack of social support, and systemic racism in the health care and lactation support system. The Baby-Friendly Hospital Initiative (BFHI) is an evidence-based program to increase breastfeeding through standardized protocols, and, in a Southeastern U.S. academic center, it was associated with increased breastfeeding, but the effect on racial disparities in breastfeeding was unknown. Methods: Through an institutional Perinatal Information Systems database, breastfeeding rates were compared before and after BFHI implementation. Breastfeeding initiation, sustained breastfeeding 24-hours before discharge, and patient demographics were assessed. Results: After BFHI implementation, mothers were overall 1.17 (95% confidence interval: 1.13-1.19) times more likely to initiate breastfeeding. For Black mothers, breastfeeding initiation increased significantly from 52% to 66%, but they were significantly less likely to sustain in-hospital breastfeeding compared to nonBlack mothers (69.4% versus 84.6%, p < 0.0001). Several demographic and medical comorbidities were significantly associated with failure to sustain breastfeeding to hospital discharge. When controlling for these factors, the racial disparity persisted. Conclusions: Since BFHI implementation, the racial gap in breastfeeding initiation decreased, but a significant disparity remained for sustained in-hospital breastfeeding. This study highlights the success of the BFHI program, but in the context of the current literature, also reveals the need for further work to ensure interventions are culturally competent and delivered equitably to support sustained breastfeeding for Black women.
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Affiliation(s)
- Shauna Hemingway
- Medical University of South Carolina Department of Obstetrics and Gynecology, Charleston, South Carolina, USA
| | - Zaneta Forson-Dare
- Yale School of Medicine Department of Pediatrics, New Haven, Connecticut, USA
| | - Myla Ebeling
- Medical University of South Carolina Department of Pediatrics, Charleston, South Carolina, USA
| | - Sarah N Taylor
- Yale School of Medicine Department of Pediatrics, New Haven, Connecticut, USA
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Mazariegos M, Ortiz-Panozo E, González de Cosío T, Lajous M, López-Ridaura R. Parity, lactation, and long-term weight change in Mexican women. MATERNAL AND CHILD NUTRITION 2020; 16:e12988. [PMID: 32207579 PMCID: PMC7296806 DOI: 10.1111/mcn.12988] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/02/2020] [Accepted: 02/18/2020] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Mónica Mazariegos
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Eduardo Ortiz-Panozo
- Population Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Martín Lajous
- Population Health Research Center, National Institute of Public Health, Cuernavaca, Mexico.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ruy López-Ridaura
- Population Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
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7
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Zachou G, Armeni E, Lambrinoudaki I. Lactation and maternal cardiovascular disease risk in later life. Maturitas 2019; 122:73-79. [PMID: 30797534 DOI: 10.1016/j.maturitas.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/09/2019] [Accepted: 01/22/2019] [Indexed: 01/20/2023]
Abstract
Cardiovascular disease is the leading cause of death worldwide. The identification of protective factors against cardiovascular disease is important with regard to public health policies. Lactation has multiple beneficial effects for both mother and child. This review summarizes the evidence on the association between lactation and maternal cardiovascular risk in later life. Lactation may help to reverse the metabolic and cardiovascular changes that take place during pregnancy. Overall, lactation seems to exert a protective effect against the development of hypertension, metabolic syndrome, and diabetes, whilst data on postpartum weight and lipidemic profile are less conclusive. Both subclinical and clinical cardiovascular disease are negatively associated with a history of lactation. Increased energy expenditure and a favorable hormonal and adipokine profile during lactation may explain these associations.
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Affiliation(s)
- Georgia Zachou
- 2nd Department of Obstetrics and Gynecology, Medical School, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Str., GR 11528, Athens, Greece
| | - Eleni Armeni
- 2nd Department of Obstetrics and Gynecology, Medical School, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Str., GR 11528, Athens, Greece
| | - Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, Medical School, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Str., GR 11528, Athens, Greece.
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8
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Schneider CR, Biggio JR, Chandler-Laney PC. Association of early pregnancy body mass index with post-partum weight change among African-American women. Clin Obes 2018; 8:170-175. [PMID: 29377636 PMCID: PMC5940495 DOI: 10.1111/cob.12241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Camille R Schneider
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1720 2 Avenue South, Birmingham, AL, 35294
| | - Joseph R Biggio
- Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health, University of Alabama at Birmingham, 1700 6 Avenue South, Women and Infant’s Center STE 10270Q, Birmingham, AL, 35249
| | - Paula C Chandler-Laney
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1720 2 Avenue South, Birmingham, AL, 35294
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Griswold MK, Crawford SL, Perry DJ, Person SD, Rosenberg L, Cozier YC, Palmer JR. Experiences of Racism and Breastfeeding Initiation and Duration Among First-Time Mothers of the Black Women's Health Study. J Racial Ethn Health Disparities 2018; 5:1180-1191. [PMID: 29435898 DOI: 10.1007/s40615-018-0465-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/16/2018] [Accepted: 01/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Breastfeeding rates are lower for black women in the USA compared with other groups. Breastfeeding and lactation are sensitive time points in the life course, centering breastfeeding as a health equity issue. In the USA, experiences of racism have been linked to poor health outcomes but racism relative to breastfeeding has not been extensively investigated. AIMS This study aims to investigate the association between experiences of racism, neighborhood segregation, and nativity with breastfeeding initiation and duration. METHODS This is a prospective secondary analysis of the Black Women's Health Study, based on data collected from 1995 through 2005. Daily and institutional (job, housing, police) racism, nativity, and neighborhood segregation in relation to breastfeeding were examined. Odds ratios and 95% confidence intervals were calculated using binomial logistic regression for the initiation outcomes (N = 2705) and multinomial logistic regression for the duration outcomes (N = 2172). RESULTS Racism in the job setting was associated with lower odds of breastfeeding duration at 3-5 months. Racism with the police was associated with higher odds of breastfeeding initiation and duration at 3-5 and 6 months. Being born in the USA or having a parent born in the USA predicted lower odds of breastfeeding initiation and duration. Living in a segregated neighborhood (primarily black residents) as a child was associated with decreased breastfeeding initiation and duration relative to growing up in a predominantly white neighborhood. CONCLUSION Experiences of institutionalized racism influenced breastfeeding initiation and duration. Structural-level interventions are critical to close the gap of racial inequity in breastfeeding rates in the USA.
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Affiliation(s)
- Michele K Griswold
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sybil L Crawford
- Department of Medicine, Division of Preventive and Behavioral Medicine University of Massachusetts Medical School , Worcester, MA, USA
| | - Donna J Perry
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA. .,, Boston, USA.
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Dutton HP, Borengasser SJ, Gaudet LM, Barbour LA, Keely EJ. Obesity in Pregnancy: Optimizing Outcomes for Mom and Baby. Med Clin North Am 2018; 102:87-106. [PMID: 29156189 PMCID: PMC6016082 DOI: 10.1016/j.mcna.2017.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Obesity is common in women of childbearing age, and management of this population around the time of pregnancy involves specific challenges. Weight and medical comorbidities should be optimized both before and during pregnancy. During pregnancy, gestational weight gain should be limited, comorbidities should be appropriately screened for and managed, and fetal health should be monitored. Consideration should be given to the optimal timing of delivery and to reducing surgical and anesthetic complications. In the postpartum period, breastfeeding and weight loss should be promoted. Maternal obesity is associated with adverse metabolic effects in offspring, promoting an intergenerational cycle of obesity.
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Affiliation(s)
- Heidi Pauline Dutton
- University of Ottawa, 1967 Riverside Dr., Ottawa On Canada, K1h7W9, , 613 738 8400 ext 81946
| | - Sarah Jean Borengasser
- University of Colorado – Anschutz, 12631 E. 17 Ave. Mailstop F561, Aurora, CO 80045, USA, , 303 724 9550
| | - Laura Marie Gaudet
- University of Ottawa, 1053 Carling Ave, Ottawa On Canada, K1Y 4E9, , 613 737 8899 ext 73056
| | - Linda A Barbour
- Professor of Endocrinology and Maternal-Fetal Medicine, University of Colorado School of Medicine, 12801 E 17 Ave RC1 South Room 7103, Aurora, CO 80405, , 303 724 3921
| | - Erin Joanne Keely
- University of Ottawa, 1967 Riverside Dr., Ottawa On Canada, K1h7W9, , 613 738 8400 ext 81941
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Oken E, Fields DA, Lovelady CA, Redman LM. TOS Scientific Position Statement: Breastfeeding and Obesity. Obesity (Silver Spring) 2017; 25:1864-1866. [PMID: 29086503 PMCID: PMC9048856 DOI: 10.1002/oby.22024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Emily Oken
- Department of Population Medicine, Harvard Medical and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Cheryl A Lovelady
- Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Leanne M Redman
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Chetwynd EM, Stuebe AM, Rosenberg L, Troester M, Rowley D, Palmer JR. Cumulative Lactation and Onset of Hypertension in African-American Women. Am J Epidemiol 2017; 186:927-934. [PMID: 28535171 DOI: 10.1093/aje/kwx163] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/08/2016] [Indexed: 12/16/2022] Open
Abstract
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.
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Chagas DCD, Silva AAMD, Ribeiro CCC, Batista RFL, Alves MTSSDBE. [Effects of gestational weight gain and breastfeeding on postpartum weight retention among women in the BRISA cohort]. CAD SAUDE PUBLICA 2017; 33:e00007916. [PMID: 28614443 DOI: 10.1590/0102-311x00007916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 06/24/2016] [Indexed: 12/18/2022] Open
Abstract
This study analyzed the effects of gestational weight gain and breastfeeding on postpartum weight retention. The study followed 2,607 women from the BRISA cohort. The variables were age, socioeconomic status, parity, pre-gestational body mass index, gestational weight gain, duration of maternal breastfeeding, length of postpartum follow-up, and postpartum weight gain. Structural equation modeling was used to evaluate the total, direct, and indirect effects of the explanatory variables on postpartum weight retention. An increase of one standard deviation in gestational weight gain corresponded to a significant increase of 0.49 standard deviations in postpartum weight retention (p < 0.001). An increase of one standard deviation in duration of breastfeeding corresponded to mean decrease of 0.10 standard deviations in postpartum weight retention (p < 0.001). Independently of pre-gestational BMI, gestational weight gain is a risk factor and duration of breastfeeding is a protective factor against postpartum weight retention.
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Effects of lactation on postpartum blood pressure among women with gestational hypertension and preeclampsia. Am J Obstet Gynecol 2016; 215:241.e1-8. [PMID: 26945604 DOI: 10.1016/j.ajog.2016.02.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/18/2016] [Accepted: 02/24/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Women with a history of hypertensive disorders of pregnancy are at an increased risk of hypertension and cardiovascular disease in later life. Lactation has been associated with a reduced risk of maternal hypertension, both in the postpartum period and later life. However, little is known about whether lactation is also cardioprotective in women with hypertensive disorders of pregnancy such as preeclampsia or gestational hypertension. OBJECTIVE This study aimed to characterize the relationship between lactation and postpartum blood pressure among women with preeclampsia and gestational hypertension. STUDY DESIGN Data were obtained from women who participated in the Prenatal Exposures and Preeclampsia Prevention study (n = 379; 66% African American; 85% overweight or obese). Women enrolled during pregnancy and attended a postpartum visit (on average, 9.1 months after delivery) during which data on lactation duration and blood pressure were collected. The significance of the associations between postpartum blood pressure and lactation among women who remained normotensive during pregnancy, developed gestational hypertension, or developed preeclampsia were assessed with an analysis of variance. Linear regression models were used to adjust for maternal age, race, education, prepregnancy weight, and time since delivery. RESULTS Gestational hypertension affected 42 subjects (11%) and preeclampsia affected 33 (9%). Lactation was reported by 217 (57%) with 78 (21%) reporting ≥ 6 months of lactation. Women who lactated were somewhat older, more educated, and had higher socioeconomic status. Among women who had gestational hypertension, lactation was associated with lower systolic blood pressure (P = .02) and diastolic blood pressure (P = .02). This association persisted after adjustment for age, race, education, prepregnancy weight, and time since delivery. However, for women who had preeclampsia and women who remained normotensive during pregnancy, lactation was not associated with postpartum blood pressure in either bivariate or multivariate analyses. CONCLUSION This study found that lactation is associated with lower postpartum blood pressure among overweight women who develop gestational hypertension but not among women who develop preeclampsia. Future studies are needed to explore the association of lactation and blood pressure in later life for women with hypertensive disorders of pregnancy.
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Schwarz EB. Invited Commentary: Breastfeeding and Maternal Cardiovascular Health--Weighing the Evidence. Am J Epidemiol 2015; 181:940-3. [PMID: 25944888 DOI: 10.1093/aje/kwv029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/13/2015] [Indexed: 01/13/2023] Open
Abstract
Recently, there has been growing interest in understanding the ways in which lactation affects maternal health. The accompanying article by Palmer et al. (Am J Epidemiol. 2015;181(12):932-939), particularly their finding that prepregnancy obesity modifies the relationship between lactation and postpartum weight gain, makes an important contribution to this field. In this commentary, I discuss these findings within the context of other recent literature which indicates that whether or not a mother breastfeeds her newborn appears to be a powerful predictor of the mother's future risk of developing diabetes, hypertension, and cardiovascular disease, independent of maternal weight or body mass index in later life.
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