Predictors of post-partum weight retention in a prospective longitudinal study

Impact of breastfeeding on risk of glucose intolerance in early postpartum after gestational diabetes

Aims

To determine the impact of breastfeeding on the risk of postpartum glucose intolerance in women with gestational diabetes.

Methods

Sub-analysis of two multi-centric prospective cohort studies (BEDIP-N and MELINDA) in 1008 women with gestational diabetes. Data were collected during pregnancy and at a mean of 12 weeks postpartum. Multivariate logistic regression was used to estimate the effect of breastfeeding on glucose intolerance, with adjustment for ethnicity, education, income, professional activity and BMI.

Results

Of all participants, 56.3% (567) breastfed exclusively, 10.1% (102) gave mixed milk feeding and 33.6% (339) did not breastfeed. Mean breastfeeding duration was 3.8 ± 2.4 and 3.7 ± 2.1 months in the breastfeeding and mixed milk feeding groups (p=0.496). The rate of glucose intolerance was lower in both the breastfeeding [22.3% (126)] and mixed milk feeding [25.5% (26)] groups compared to the no breastfeeding group [29.5% (100)], with an adjusted OR of 0.7 (95% CI 0.5-1.0) for glucose intolerance in the breastfeeding group compared to no breastfeeding group and an adjusted OR of 0.7 (95% CI 0.4-1.2) for the mixed milk feeding group compared to the no breastfeeding group. Postpartum, breastfeeding women had a lower BMI, less often postpartum weight retention, lower fasting triglycerides, less insulin resistance and a higher insulin secretion-sensitivity index-2 than the mixed milk feeding and no breastfeeding group. The mixed milk feeding group was more often from an non-White background, had a lower blood pressure and lower fasting triglycerides compared to the no breastfeeding group.

Conclusions

Breastfeeding (exclusive and mixed milk feeding) is associated with less glucose intolerance and a better metabolic profile in early postpartum in women with gestational diabetes.

Prospective associations between breast feeding, metabolic health, inflammation and bone density in women with prior gestational diabetes mellitus

INTRODUCTION

The aim of the study is to investigate prospective associations between breastfeeding and metabolic outcomes, inflammation, and bone density in women with prior gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

We prospectively included 171 women with GDM from the MySweetheart trial. Women were followed during pregnancy (from 24 up to 32 weeks' gestational age) up to 1 year postpartum. Outcomes included weight, weight retention, body composition, insulin resistance and secretion indices, C reactive protein (CRP), and bone density. We compared differences in the associations between breastfeeding and health outcomes between women who breast fed <6 months vs ≥6 months. Analyses were adjusted for potential medical and sociodemographic confounders.

RESULTS

Breastfeeding initiation was 94.2% (n=161) and mean breastfeeding duration was 6.6 months. Breastfeeding duration was independently associated with lower weight, weight retention, body fat, visceral adipose tissue, lean mass, CRP, insulin resistance (Homeostatic Model Assessment for Insulin Resistance), and insulin secretion (Homeostatic Model Assessment of β-cell index) at 1 year postpartum (all p≤0.04) after adjusting for confounders. Breastfeeding was associated with higher insulin resistance-adjusted insulin secretion (Insulin Secretion-Sensitivity Index-2) in the unadjusted analyses only. There was no association between breastfeeding duration and bone density. Compared with <6 months, breastfeeding duration ≥6 months was associated with lower weight, weight retention, body fat, fat-free mass as well as lower CRP at 1 year postpartum (all p<0.05) after adjusting for confounders.

CONCLUSIONS

Longer breastfeeding duration among women with prior GDM was associated with lower insulin resistance, weight, weight retention, body fat and inflammation, but not lower bone density at 1 year postpartum. Breastfeeding for ≥6 months after GDM can help to improve cardiometabolic health outcomes 1 year after delivery.

A cross-sectional study of the association between breastfeeding history and overweight/obesity in postmenopausal women

OBJECTIVES

This study endeavors to augment comprehension of the association between breastfeeding and maternal weight within Asian populations.

METHODS

Data were obtained from the comprehensive 2011 research titled "Risk Evaluation of Cancers in Chinese Diabetic Individuals (REACTION): a longitudinal analysis," focusing specifically on postmenopausal women residing in the metropolitan precincts of Guiyang. It presents a cross-sectional study involving 5,987 parous postmenopausal women, aged 60.1 ± 6.9 years, who underwent assessments of body mass index and waist-to-height ratio. The probability of excessive weight or obesity was evaluated in relation to the aggregate duration of breastfeeding, using single-factor and multivariate logistic regression analyses.

RESULTS

Following multiple adjustments for different confounders, the odds ratios (ORs) demonstrated that women who had borne a single child and breastfed for more than 12 months exhibited an increased prevalence of excessive weight (body mass index ≥24 kg/m 2 ) in contrast to those who abstained from breastfeeding (model I: OR, 1.481; 95% confidence interval, 1.124-1.952; P = 0.005; model II: OR, 1.471; 95% confidence interval, 1.113-1.944; P = 0.007). Conversely, among the subset of women who had given birth to two or more children, no noteworthy associations emerged between breastfeeding duration and the propensity for excessive weight or obesity (all models).

CONCLUSION

In the Asian population, the duration of breastfeeding does not appear to be necessarily linked to the prevalence of overweight or obesity in postmenopausal women.

The STAR-MAMA RCT: Bilingual Mobile Health Coaching for Postpartum Weight Loss

INTRODUCTION

Gestational diabetes and overweight during pregnancy are associated with future type 2 diabetes. Postpartum weight loss can reduce diabetes risk. However, effective interventions for postpartum weight loss are lacking, in particular for Latina populations, despite their disproportionate burdens of gestational diabetes, overweight, and diabetes.

STUDY DESIGN

This was a community-based RCT.

SETTING/PARTICIPANTS

Researchers recruited pregnant individuals with gestational diabetes or BMI>25 kg/m2 from safety-net health care settings and Women, Infants, and Children offices in Northern California in 2014-2018. Of 180 individuals randomized to intervention (n=89) or control (n=91), 78% identified as Latina, 61% were primarily Spanish speaking, and 76% perceived their diabetes risk to be low.

INTERVENTION

The intervention consisted of a 5-month postpartum telephone-based health coaching intervention delivered in English or Spanish.

MAIN OUTCOME MEASURES

Data were collected through surveys at enrollment and 9-12 months after delivery and chart review up to 12 months after delivery. The primary outcome, weight change from prepregnancy to 9-12 months after delivery, was compared between the groups, overall and within strata defined a priori according to language (Spanish or English) and diabetes risk perception (none/slight or moderate/high).

RESULTS

The intent-to-treat estimated intervention effect was +0.7 kg (95% CI= -2.4 kg, +3.8 kg; p=0.67). In stratified analyses, intervention effects remained nonsignificant but varied in direction: effects were favorable among English speakers and those with higher perceived diabetes risk, and unfavorable among Spanish speakers and those with lower perceived risk. Analyses were conducted in 2021-2022.

CONCLUSIONS

A postpartum health coaching intervention, designed for low-income Latina women at increased risk for diabetes, did not reduce postpartum weight gain. Intervention effects were nonsignificantly more favorable among English speakers versus Spanish speakers, and among those who perceived their diabetes risk to be high versus low.

TRIAL REGISTRATION

This study is registered at www.

CLINICALTRIALS

gov NCT02240420.

Breastfeeding, socioeconomic status, and long-term postpartum weight retention

BACKGROUND

Almost half of all pregnant women in the United States gain weight above Institute of Medicine gestational weight gain guidelines. Breastfeeding has been shown to reduce weight retention in the first year postpartum; however, women with lower socioeconomic status (SES) tend to initiate breastfeeding less often than women with higher SES. We investigated associations between duration of breastfeeding with mother's long-term postpartum weight status at 4-10 years and evaluated whether the associations varied by SES.

METHODS

Maternal and infant dyads (N = 2144 dyads) are from the Geographic Research on Wellbeing survey (GROW), 2012-2013, a long-term, cross-sectional follow-up of the Maternal and Infant Health Assessment (MIHA) based in California, USA. Pre-pregnancy body mass index (BMI) was obtained from self-report of height and weight during MIHA, while breastfeeding history and self-report of current body weight was collected at the 4-10 year GROW postpartum visit. SES score was derived from a composite score of percent federal poverty level and education and was dichotomized into High and Low SES groups at a score of three. Multivariable linear regression was used to examine association between breastfeeding and maternal weight status, and to examine for effect modification by SES.

RESULTS

Average long-term weight retention 4-10 years postpartum was 4.0 kg. Fewer lower SES vs. higher SES women breast fed at least six months (51% versus 70%, p < .001) or ever breastfed (74% versus 89%, P < .001). Women who breastfed at least six months had lower long-term postpartum weight retention compared to those who did not (b = -1.06 kg, (-1.93, 0.25); p = 0.01); however, these association did not vary by SES.

CONCLUSION

Six months of breastfeeding is associated with lower BMI at 4-10 years and lower body weight, and effects do not vary by SES. Future policies and guidelines should consider building an infrastructure that is supportive of longer breastfeeding duration. Moreover, further research is needed to identify the impact of additional behavioral and environmental factors on long-term maternal weight status. Understanding the drivers of excessive weight retention pospartum can help us not only improve the pregnant person's health but the health of their children.

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

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

Modeling the Predictive Value of Evidence-Based Referral Criteria to Support Healthy Gestational Weight Gain among an Australian Pregnancy Cohort

Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight outside the Institute of Medicine (IOM)'s weight gain reference values are further recommended to be referred to a dietitian. However, professional and organizational barriers, including an absence of weight gain referral pathways and limited workforce resources, exist with the translation and scaling of these recommendations into practice. This study aimed to explore patterns of GWG among a cohort of Australian pregnant women and to determine if pregnancy weight gains of above or below 2 kg or 5 kg in the second and third trimester can be used to predict total GWG outside recommendations. Sensitivity, specificity, negative, and positive likelihood ratios were calculated. The most predictive time point was 24 weeks' gestation using the minimum weight change parameter of +/-2 kg, demonstrating reasonable sensitivity (0.81, 95% CI 0.61-0.83) and specificity (0.72, 95% CI 0.61-0.83), resulting in 55% (n = 72/131) of the cohort qualifying for dietetic referral. Given the current health service constraints, a review of dietetic services within maternity care is warranted.

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

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

Weight management in postpartum women - An Indian perspective

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.

Evolution of Postpartum Weight and Body Composition after Excessive Gestational Weight Gain: The Role of Lifestyle Behaviors-Data from the INTER-ACT Control Group

Women with excessive gestational weight gain are at increased risk of postpartum weight retention and potentially also unfavorable body composition. Insight into the lifestyle behaviors that play a role in the evolution of postpartum weight and body composition among these women could aid identification of those at highest risk of long-term adverse outcomes. This secondary analysis of the INTER-ACT randomized controlled trial investigates control group data only (n = 524). The evolution of weight retention, percentage loss of gestational weight gain, fat percentage, waist circumference, and associated lifestyle behaviors between 6 weeks and 12 months postpartum were assessed using mixed model analyses. At six weeks postpartum, every sedentary hour was associated with 0.1% higher fat percentage (P = 0.01), and a higher emotional eating score was associated with 0.2% higher fat percentage (P < 0.001) and 0.3 cm higher waist circumference (P < 0.001). Increase in emotional eating score between 6 weeks and 6 months postpartum was associated with a 0.4 kg (P = 0.003) increase in postpartum weight retention from six months onwards. Among women with overweight, an increase in the uncontrolled eating score between 6 weeks and 6 months postpartum was associated with a 0.3 kg higher postpartum weight retention (P = 0.04), and 0.3% higher fat percentage (P = 0.006) from six months onwards. In conclusion, sedentary and eating behaviors play important roles in postpartum weight and body composition of women with excessive gestational weight gain and should therefore be incorporated as focal points in lifestyle interventions for this population.

Modifiable Determinants of Postpartum Weight Loss in Women with Obesity: A Secondary Analysis of the UPBEAT Trial

Pregnancy can alter a woman's weight gain trajectory across the life course and contribute to the development of obesity through retention of weight gained during pregnancy. This study aimed to identify modifiable determinants associated with postpartum weight retention (PPWR; calculated by the difference in pre-pregnancy and 6 month postpartum weight) in 667 women with obesity from the UPBEAT study. We examined the relationship between PPWR and reported glycaemic load, energy intake, and smoking status in pregnancy, excessive gestational weight gain (GWG), mode of delivery, self-reported postpartum physical activity (low, moderate, and high), and mode of infant feeding (breast, formula, and mixed). At the 6 month visit, 48% (n = 320) of women were at or above pre-pregnancy weight. Overall, PPWR was negative (-0.06 kg (-42.0, 40.4)). Breastfeeding for ≥4 months, moderate or high levels of physical activity, and GWG ≤9 kg were associated with negative PPWR. These three determinants were combined to provide a modifiable factor score (range 0-3); for each added variable, a further reduction in PPWR of 3.0 kg (95% confidence interval 3.76, 2.25) occurred compared to women with no modifiable factors. This study identified three additive determinants of PPWR loss. These provide modifiable targets during pregnancy and the postnatal period to enable women with obesity to return to their pre-pregnancy weight.

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

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

Low selenium intake is associated with postpartum weight retention in Chinese women and impaired physical development of their offspring

The aim of this study was to investigate the association between daily Se intake and postpartum weight retention (PPWR) among Chinese lactating women, and the impact of their Se nutritional status on infants' physical development. Se contents in breast milk and plasma collected from 264 lactating Chinese women at the 42nd day postpartum were analysed with inductively coupled plasma MS. Daily Se intake was calculated based on plasma Se concentration. The dietary data of 24-h records on three consecutive days were collected. Infant growth status was evaluated with WHO standards by Z-scores. Linear regression analyses and multinomial logistic regression were conducted to examine the impact of Se disequilibrium (including other factors) on PPWR and growth of infants, respectively. The results indicated that: (1) the daily Se intake of the subjects was negatively associated with their PPWR (B = -0·002, 95 % CI - 0·003, 0·000, P = 0·039); (2) both insufficient Se daily intake (B = -0·001, OR 0·999, 95 % CI 0·998, 1·000, P = 0·014) and low level of Se in milk (B = -0·025, OR 0·975, 95 % CI 0·951, 0·999, P = 0·021) had potential associations with their infants' wasting, and low level of Se in milk (B = -0·159, OR 0·853, 95 % CI 0·743, 0·980, P = 0·024) had a significant association with their infants' overweight. In conclusion, the insufficient Se nutritional status of lactating Chinese women was first found as one possible influencing factor of their PPWR as well as low physical development of their offspring.

Predictors of patterns of weight change 1 year after delivery in a cohort of Mexican women

OBJECTIVE

To evaluate the associations of pregestational BMI, gestational weight gain (GWG) and breast-feeding at 1 month postpartum with four patterns of weight change during the first year after delivery: postpartum weight retention (PPWR), postpartum weight gain (PPWG), postpartum weight retention + gain (PPWR + WG) and return to pregestational weight.

DESIGN

In this secondary analysis of a prospective study, we categorised postpartum weight change into four patterns using pregestational weight and weights at 1, 6 and 12 months postpartum. We evaluated their associations with pregestational BMI, GWG and breast-feeding using multinomial logistic regression. Results are presented as relative risk ratios (RRR) and 95 % CI.

SETTING

Mexico City.

PARTICIPANTS

Women participating in the Programming Research in Obesity, Growth, Environment and Social Stressors pregnancy cohort.

RESULTS

Five hundred women were included (53 % of the cohort). Most women returned to their pregestational weight by 1 year postpartum (57 %); 8 % experienced PPWR, 14 % PPWG and 21 % PPWR + WG. Compared with normal weight, pregestational overweight (RRR 2·5, 95 % CI 1·3, 4·8) and obesity (RRR 2·2, 95 % CI 1·0, 4·7) were associated with a higher risk of PPWG. Exclusive breast-feeding, compared with no breast-feeding, was associated with a lower risk of PPWR (RRR 0·3, 95 % CI 0·1, 0·9). Excessive GWG, compared with adequate, was associated with a higher risk of PPWR (RRR 3·3, 95 % CI 1·6, 6·9) and PPWR + WG (RRR 2·4, 95 % CI 1·4, 4·2).

CONCLUSIONS

Targeting women with pregestational overweight or obesity and excessive GWG, as well as promoting breast-feeding, may impact the pattern of weight change after delivery and long-term women's health.

Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes: a cross-sectional analysis

BACKGROUND

It is well established that mothers with above-normal pre-pregnancy BMI are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain (PWG) is less well-defined. Excess PWG may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. Cesarean-section, gestational diabetes), and may make effective latch more difficult to achieve.

METHODS

Our objective was to determine the impact of PWG and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine's 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N = 1207). PWG category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of PWG). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models.

RESULTS

After adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended PWG had 1.39 (1.03-1.86) and 1.48 (1.06-2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended PWG were at increased risk of cessation, although not significantly (aHR [95% CI]: 1.29 [0.95-1.75]). No significant relationship was observed for exclusive breastfeeding cessation.

CONCLUSIONS

Pre-pregnancy BMI and PWG may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.

Dose-Response Relationships between Breastfeeding and Postpartum Weight Retention Differ by Pre-Pregnancy Body-Mass Index in Taiwanese Women

Postpartum weight retention (PWR) is a risk factor for future obesity. The role of breastfeeding in reducing PWR is not fully understood. We examined the relationship between PWR and the duration of exclusive/partial breastfeeding in 52,367 postpartum women from 2012–2016 Taiwan national breastfeeding surveys. The women were interviewed at 7–14 months postpartum. Non-linear models were fit to examine the association between PWR and breastfeeding duration. PWR adjusted means and 95% confidence intervals were plotted and compared for the duration of exclusive/partial breastfeeding in the total sample and between pre-pregnancy body-mass index (BMI) groups (underweight, normal, overweight, and obese). Women who breastfed exclusively for >30 days showed significantly lower PWR than those who did not breastfeed and those who breastfed partially for the same duration, thereafter each additional duration of 30 days being associated with an average of 0.1–0.2 kg less PWR. Women who breastfed partially for 120 days showed lower PWR than those who did not or those who ceased to breastfeed, thereafter each additional duration of 30 days being associated with an average of 0.1 kg less PWR. Duration of breastfeeding needed to achieve significantly less PWR differed between pre-pregnancy BMI groups, but the effect of exclusive breastfeeding appeared earlier in the normal weight group. Women with obesity who breastfed exclusively for >30 or partially for >180 days, had lower PWR than non-obese groups. The observed dose–response relationship between breastfeeding duration and PWR supports the “every feeding matters” approach in breastfeeding promotion. The larger effect of exclusive and partial breastfeeding on PWR in women with obesity may draw special attention of breastfeeding promotion.

Postpartum Physical Activity and Weight Retention within One Year: A Prospective Cohort Study in Vietnam

After delivery, mothers are encouraged to increase physical activity (PA) gradually to regulate body weight; however, data on PA in relation to postpartum weight retention remains scarce, particularly among Asian women. In a cohort of 1617 Vietnamese mothers, we investigated the prospective association between habitual PA exposures at 3-month postpartum and weight retention at 6-month and 12-month postpartum. Detailed information on PA intensity and domains was collected from participants using a validated instrument specifically for Vietnamese women. Linear regression analyses and a general linear model for the repeated weight retention measures were used to ascertain the apparent relationships. On average, the participants reported 3.6 (SD 3.9) and 2.6 (SD 3.8) kg weight loss at 6- and 12-month postpartum, respectively. Total and light-intensity PA were inversely associated with the postpartum weight retention (p for trend <0.05). Our findings highlight the importance of resuming PA in the early postpartum period as an appropriate weight management strategy.

Patterns of Weight Change One Year after Delivery Are Associated with Cardiometabolic Risk Factors at Six Years Postpartum in Mexican Women

Pregnancy is a contributor to the obesity epidemic in women, probably through postpartum weight retention (PPWR), weight gain (PPWG), or a combination of both (PPWR + WG). The contribution of these patterns of postpartum weight change to long-term maternal health remains understudied. In a secondary analysis of 361 women from the prospective cohort PROGRESS, we evaluated the associations between patterns of weight change one year after delivery and cardiometabolic risk factors at six years postpartum. Using principal component analysis, we grouped cardiometabolic risk factors into: (1) body mass index (BMI), waist circumference (WC), homeostatic model assessment of insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), and glucose; (2) systolic (SBP) and diastolic blood pressure (DBP); and (3) low-density lipoprotein cholesterol and total cholesterol. Using path analysis, we studied direct (patterns of weight change-outcomes) and indirect associations through BMI at six years postpartum. Around 60% of women returned to their pregestational weight (reference) by one year postpartum, 6.6% experienced PPWR, 13.9% PPWG, and 19.9% PPWR + WG. Women with PPWR + WG, vs. the reference, had higher BMI and WC at six years (2.30 kg/m², 95% CI [1.67, 2.93]; 3.38 cm [1.14, 5.62]). This was also observed in women with PPWR (1.80 kg/m² [0.80, 2.79]; 3.15 cm [−0.35, 6.65]) and PPWG (1.22 kg/m² [0.53, 1.92]; 3.32 cm [0.85, 5.78]). PPWR + WG had a direct association with HOMA-IR (0.21 units [0.04, 0.39]). The three patterns of weight change, vs. the reference, had significant indirect associations with HOMA-IR, glucose, TG, HDL-c, SBP, and DBP through BMI at six years. In conclusion, women with PPWR + WG are at high-risk for obesity and insulin resistance. Interventions targeting women during pregnancy and the first year postpartum may have implications for their long-term risk of obesity and cardiovascular disease.

Perceived Motivators, Barriers and Intervention Strategies Related to Weight Loss After Childbirth Among WIC Participants in Southern California

PURPOSE

To explore perceived motivators and barriers to weight loss after childbirth and ideas for postpartum weight loss interventions among participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

APPROACH

Four (2 with English-speaking and 2 with Spanish-speaking participants) focus groups were conducted.

SETTING

A WIC clinic in Southern California.

PARTICIPANTS

Of 22 participants, the majority were Hispanic/Latina. The mean age of the mothers' infants was 6.18 months.

MEASURES

A structured focus group guide was used.

ANALYSIS

Audio-recordings were transcribed verbatim. The Spanish transcriptions were reviewed for discrepancies by a bilingual coinvestigator and translated into English for analysis. Transcriptions of the focus group audio-recordings were organized in ATLAS.ti version 8.0. and analyzed using content analysis.

RESULTS

Participants had a mean age of 30.5 and a mean prepregnancy body mass index of 32.4. Motivators for weight loss after childbirth included modeling healthy behavior for children and a fear of developing chronic illness. Barriers to weight loss included lack of knowledge, self-efficacy, time, child care and support, postpartum depression, the 40-day rule, and having a c-section. Intervention ideas included providing accountability and peer support for weight loss, providing nutrition/exercise weight loss strategies, and integrating mobile phone technologies into weight loss programs.

CONCLUSIONS

Weight loss strategies for postpartum WIC participants should provide knowledge, support, accountability, and preferably integrate technology.

Patterns of Women's Postpartum Weight Retention and Its Associations with Maternal Obesity-Related Factors and Parity

Background: There is not much data on the effects of the timing of gestational weight gain (GWG), pre-pregnancy waist circumference (WC), pre-pregnancy body mass index (BMI), and parity, with postpartum weight retention (PPWR) trajectories. Methods: This study was based on a longitudinal cohort. Latent growth mixture models were applied to identify the latent trajectories of PPWR and test the effects of the predictors on distinct classes of PPWR trajectories. Results: Three PPWR trajectories were identified. About 2.8% (n = 26) of women were classified into Class 1, with an inverted U-shape trajectory; 6.6% (n = 61) were assigned to Class 2, with a rapid increase trajectory; 90.6% (n = 837) were classified into Class 3, with a significant decrease. Women who had a lower pre-pregnancy BMI (β = −0.279), higher pre-pregnancy WC (β = 0.111) and GWG (β = 0.723) were at a higher risk of retaining more weight at 1 month postpartum. Only GWG, especially GWG during late pregnancy, was associated with the rate of PPWR change. Parity was not associated with the changes in PPWR, while, compared to Class 1 trajectory, multiparous women were protected from having a Class 2 trajectory. Conclusions: Early targeted interventions should be taken to prevent women who were primiparous, and/or had a lower pre-pregnancy BMI and higher pre-pregnancy WC and GWG, from excessive PPWR.

Postpartum Weight Retention in Primiparous Women and Weight Outcomes in Their Offspring

INTRODUCTION

To explore the effect of prepregnancy body mass index (BMI) and gestational weight gain on postpartum weight retention in nulliparous women and weight-for-length percentiles of offspring to 2 years following birth.

METHODS

A retrospective secondary analysis of a large, prospective longitudinal study of women conducted during pregnancy and after their first birth was completed to examine outcomes associated with postpartum weight retention. A chart review of the offspring of these women was completed to explore the relationship between maternal prepregnancy BMI and gestational weight gain on offspring weight-for-length percentiles.

RESULTS

Data from 652 woman-infant dyads were available for analysis. Average postpartum weight retention was 4.0 kg at one year for all groups. At 6 weeks postpartum, women who were obese prior to pregnancy retained significantly less weight than did women who were normal weight prior to pregnancy (P < .05). Women who were normal weight or overweight at the onset of pregnancy and had gestational weight gain within Institute of Medicine recommendations retained significantly less weight at 6 weeks, 6 months, and 1 year postpartum (P < .01) when compared with women in those same weight groups who had a gestational weight gain in excess of the recommended guideline. Women who entered pregnancy obese and who had a gestational weight gain within the recommended weight range during pregnancy retained significantly less weight compared with women who were obese and who gained in excess of the guideline at 6 weeks postpartum only (P < .05). No statistically significant differences were seen in offspring weight-for-length percentiles at any time point based on maternal prepregnancy BMI or weight gain within guidelines.

DISCUSSION

Many women retained weight up to one year postpartum. In this study, we saw no statistically significant differences between the prepregnant BMI groups or between gestational weight gain within guidelines or in excess of guidelines on offspring weight-for-length percentiles.

The influence of energy metabolism on postpartum weight retention

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Postpartum weight retention in relation to gestational weight gain and pre-pregnancy body mass index: A prospective cohort study in Vietnam

BACKGROUND

The prevalence of maternal overweight and obesity is increasing in Asia. This study prospectively investigated the association between pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and 12-month postpartum weight retention (PPWR) in a large cohort of Vietnamese mothers.

METHODS

Of the 2030 pregnant women recruited from three cities in Vietnam at 24-28 weeks of gestation, a total of 1666 mothers were followed up for 12 months after delivery and available for analysis. The outcome variable PPWR was determined by subtracting the pre-pregnancy weight from the 12-month postpartum measured weight, while GWG and pre-pregnancy BMI were classified according to the Institute of Medicine and WHO criteria for adults, respectively. Linear regression models were used to ascertain the association between pre-pregnancy BMI, GWG and PPWR accounting for the effects of plausible confounding factors.

RESULTS

Both pre-pregnancy BMI and GWG were significantly associated with PPWR (P<0.001). The adjusted mean weight retention in underweight women before pregnancy (3.71kg, 95% confidence interval (CI) 3.37-4.05) was significantly higher than that in those with normal pre-pregnancy weight (2.34kg, 95% CI 2.13-2.54). Women with excessive GWG retained significantly more weight (5.07kg, 95% CI 4.63-5.50) on average at 12 months, when compared to mothers with adequate GWG (2.92kg, 95% CI 2.67-3.17).

CONCLUSIONS

Being underweight before pregnancy and excessive GWG contribute to greater weight retention twelve months after giving birth. Interventions to prevent postpartum maternal obesity should target at risk women at the first antenatal visit and control their weight gain during the course of pregnancy.

The use of whole body calorimetry to compare measured versus predicted energy expenditure in postpartum women

BACKGROUND

Accurate assessment of energy expenditure may support weight-management recommendations. Measuring energy expenditure for each postpartum woman is unfeasible; therefore, accurate predictive equations are needed.

OBJECTIVES

This study compared measured with predicted resting energy expenditure (REE) and total energy expenditure (TEE) in postpartum women.

METHODS

This was a longitudinal observational study. REE was measured at 3 mo postpartum (n = 52) and 9 mo postpartum (n = 49), whereas TEE was measured once at 9 mo postpartum (n = 43) by whole body calorimetry (WBC). Measured REE (REEWBC) was compared with 17 predictive equations; measured TEE plus breast milk energy output (ERWBC) was compared with the estimated energy requirements/Dietary Reference Intakes equation (EERDRI). Fat and fat-free mass were measured by dual-energy X-ray absorptiometry. Group-level agreement was assessed by the Pearson correlation, paired t test, and Bland-Altman (bias) analyses. Individual-level accuracy was assessed with the use of Bland-Altman limits of agreement, and by the percentage of women with predicted energy expenditure within 10% of measured values ("accuracy").

RESULTS

The cohort was primarily Caucasian (90%). At a group level, the best equation predicting REEWBC was the DRI at 3 mo postpartum (-7 kcal, -0.1%; absolute and percentage bias, respectively), and the Harris-Benedict at 9 mo postpartum (-17 kcal, -0.5%). At an individual level, the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) height and weight equation was the most accurate at 3 mo postpartum (100% accuracy) and 9 mo postpartum (98% accuracy), with the smallest limits of agreement. Equations including body composition variables were not more accurate. Compared with ERWBC, EERDRI bias was -36 kcal, with inaccurate predictions in 33% of women.

CONCLUSIONS

Many REE predictive equations were accurate for group assessment, with the FAO/WHO/UNU height and weight equation having the highest accuracy for individuals. EERDRI performed well at a group level, but inaccurately for 33% of women. A greater understanding of the physiology driving energy expenditure in the postpartum period is needed to better predict TEE and ultimately guide effective weight-management recommendations.

Reprint of characterizing gestational weight gain in a cohort of indigenous Australian women

OBJECTIVE

to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index.

DESIGN

analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy.

SETTING

women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program.

PARTICIPANTS

110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child.

MEASUREMENTS AND FINDINGS

measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on pre-pregnancy body mass index, the rate of adequate gestational weight gain in this cohort was low (26%). 33% of women had inadequate weight gain and 41% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (65%), with rates of 39% and 31% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.2, p < 0.01) and hypertension (coefficient 4.3, p = 0.049) were found to be significantly associated with gestational weight gain in mixed model linear regression.

CONCLUSIONS

few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring.

IMPLICATIONS FOR PRACTICE

a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.

Human Milk Composition and Dietary Intakes of Breastfeeding Women of Different Ethnicity from the Manawatu-Wanganui Region of New Zealand

Human milk is nutrient rich, complex in its composition, and is key to a baby’s health through its role in nutrition, gastrointestinal tract and immune development. Seventy-eight mothers (19–42 years of age) of Asian, Māori, Pacific Island, or of European ethnicity living in Manawatu-Wanganui, New Zealand (NZ) completed the study. The women provided three breast milk samples over a one-week period (6–8 weeks postpartum), completed a three-day food diary and provided information regarding their pregnancy and lactation experiences. The breast milk samples were analyzed for protein, fat, fatty acid profile, ash, selected minerals (calcium, magnesium, selenium, zinc), and carbohydrates. Breast milk nutrient profiles showed no significant differences between the mothers of different ethnicities in their macronutrient (protein, fat, carbohydrate, and moisture) content. The breast milk of Asian mothers contained significantly higher levels of polyunsaturated fatty acids (PUFAs), omega-3 (n-3) and omega-6 (n-6) fatty acids, docosahexaenoic acid (DHA), and linoleic acids. Arachidonic acid was significantly lower in the breast milk of Māori and Pacific Island women. Dietary intakes of protein, total energy, saturated and polyunsaturated fat, calcium, phosphorus, zinc, iodine, vitamin A equivalents, and folate differed between the ethnic groups, as well as the number of serves of dairy foods, chicken, and legumes. No strong correlations between dietary nutrients and breast milk components were found.

Weight loss after pregnancy: challenges and opportunities

It is important to pay attention to weight management before and between pregnancies, as women have an increased risk of weight gain during the reproductive years. Having a baby is a life-changing event for women and the challenge of weight management amidst this period of major physiological, psychological and social change should not be underestimated. However, the postpartum period offers an opportune time for lifestyle interventions, as women may have heightened awareness of their own and their wider families' health. Systematic reviews indicate that interventions including both diet and physical activity along with individualised support and self-monitoring are more likely to be successful in promoting postpartum weight loss. However, high levels of attrition and poor engagement have been an issue in previous trials in this area. Since postpartum women are difficult to reach and retain, future research must consider how to make weight-management interventions an attractive and attainable proposition for women who are juggling multiple, competing demands on their time. Ideally, intervention approaches need to be flexible and allow sustained contact with women, to facilitate a focus on maintenance of weight loss, as well as opportunities for re-engagement after life events that may disrupt weight-management progress. Using technology to deliver or support interventions holds promise but trials are needed to generate a range of appealing, effective and scalable options for postpartum women. What works at other life stages may not necessarily work here owing to specific barriers to weight management encountered in the postpartum period.

Characterizing gestational weight gain in a cohort of Indigenous Australian women

OBJECTIVE

to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index.

DESIGN

analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy.

SETTING

women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program.

PARTICIPANTS

110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child.

MEASUREMENTS AND FINDINGS

measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on prepregnancy body mass index, the rate of adequate gestational weight gain in this cohort was very low (15%). 32% of women had inadequate weight gain and 54% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (74%), with rates of 48% and 50% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.5, p<0.01) and hypertension (coefficient 4.8, p = 0.04) were found to be significantly associated with gestational weight gain in mixed model linear regression.

CONCLUSIONS

few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring.

IMPLICATIONS FOR PRACTICE

a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.

Postpartum Women's Perspectives of Engaging with a Dietitian and Exercise Physiologist via Video Consultations for Weight Management: A Qualitative Evaluation

Optimising weight status after childbirth is important. Video consultations are an unexplored opportunity to deliver real-time support to postpartum women to improve lifestyle behaviours. This study aims to provide insight into postpartum women's perspectives of engaging with a dietitian and exercise physiologist through video consultations for tailored nutrition and exercise care. A qualitative study using individual telephone interviews (13-36 min) was undertaken. 21 women (body mass index (BMI): 28.1 ± 3.8 kg/m²; age: 32.3 ± 3.0 years; parity: 1.6 ± 0.9 children) who had completed the 8 week "Video-coaching to assist lifestyle (VITAL) change for mums" intervention participation included up to five video consultations with a dietitian and exercise physiologist. The interviews were audiorecorded and transcribed. Thematic data analysis was conducted by an independent researcher using NVIVO11. Themes relating to the video consultation experience included feeling that they did not differ from other consultations, they were convenient, and the length of time and flexible options were appropriate; however there was a desire for increased contact frequency. The dietitian and exercise physiologist were perceived to increase the participants' knowledge and confidence to improve health behaviours. The approach to setting realistic and tailored goals was well received. Tailored advice from a dietitian and exercise physiologist received via video consultations is acceptable for postpartum women and offers a viable alternative to in-person care.

The Effect of an Exercise Intervention on Gestational Weight Gain: The Behaviors Affecting Baby and You (B.A.B.Y.) Study: A Randomized Controlled Trial

PURPOSE

To examine the effect of a prenatal exercise intervention on gestational weight gain (GWG) and to update meta-analyses.

DESIGN

Randomized controlled trial and meta-analysis.

SETTING

Obstetrical practices in a Western Massachusetts hospital.

PATIENTS

We analyzed 241 ethnically diverse pregnant participants at high risk for gestational diabetes in the Behaviors Affecting Baby and You (B.A.B.Y.) study. A total of 118 participants were randomized to an exercise intervention group and 123 to a comparison health and wellness intervention group.

INTERVENTION

A 12-week individually tailored, motivationally matched program designed to increase the compliance with guidelines for exercise during pregnancy (30 min/day).

MEASURES

The GWG and compliance with 2009 Institute of Medicine (IOM) guidelines for GWG abstracted from medical records.

ANALYSIS

Unadjusted logistic regression, intent-to-treat. Results were added to the existing meta-analyses using a random effects model.

RESULTS

Women randomized to the exercise group had a lower mean GWG than the comparison group (-0.97 kg, P value = .39) and were less likely to exceed IOM guidelines (odds ratio = 0.69, 95% confidence interval [CI] 0.34-1.40), but results were not statistically significant. Meta-analyses yielded a -0.63 kg (95% CI -1.17 to -0.08, P = .02) reduction in GWG and a 20% reduction in odds of exceeding IOM guidelines (95% CI 0.73 to 0.89) for the exercise intervention.

CONCLUSION

Findings from this randomized trial among ethnically diverse women contribute to the results of meta-analyses supporting exercise as a means of attenuating GWG.

Modifiable risk factors of maternal postpartum weight retention: an analysis of their combined impact and potential opportunities for prevention

BACKGROUND/OBJECTIVES

Pregnancy triggers a physiological change in weight status. Postpartum weight retention in the childbearing years can substantially alter a woman's weight gain trajectory, with several potential contributing factors identified. Most research has relied on women's recall of pre-pregnancy weight during pregnancy or later, and not considered risk factors in combination. Using measured pre-pregnancy weight, this study aimed to examine the associations of maternal postpartum weight retention with parity, pre-pregnancy BMI, excessive gestational weight gain (GWG), maternal serum vitamin D concentration and dietary Glycaemic Index in early and late pregnancy, and breastfeeding duration, including analysis of the combined impact of potentially modifiable risk factors.

SUBJECTS/METHODS

Prospective cohort study of 12 583 non-pregnant women aged 20-34 years in Southampton (UK) who were assessed prior to pregnancy, with those who subsequently became pregnant followed up in early and late gestation, and after delivery (n=2559 in the final sample). Linear regression models examined potential predictors of weight retention in adjusted individual and multivariate analyses, and as a risk factor score.

RESULTS

Compared with pre-pregnancy weight, 73% of women retained some weight at 6 months postpartum (mean (s.d.): 3.5 (6.2) kg). In the adjusted multivariate model, women who were primiparous, had a lower pre-pregnancy BMI, excessive GWG, a lower early pregnancy vitamin D concentration and breastfed for <6 months had greater weight retention 6 months postpartum (P<0.05 for all variables). For each additional modifiable risk factor (excessive GWG, low vitamin D concentration in early pregnancy and short breastfeeding duration; scale 0-3), women retained an additional 2.49 kg (95% CI: 2.16, 2.82; P<0.001).

CONCLUSIONS

Having a greater number of modifiable risk factors was associated with greater weight retention 6 months postpartum. Initiatives supporting women to target these risk factors in the years prior to, during and after pregnancy could impact on their weight gain trajectory and later risk of adverse weight-related outcomes.

The Relationship Among Breastfeeding, Postpartum Depression, and Postpartum Weight in Mexican American Women

OBJECTIVE

To determine if symptoms of postpartum depression and postpartum weight varied according to the level of breastfeeding among women of Mexican origin at 1 month and 6 months postpartum.

DESIGN

Secondary quantitative analysis to study the differences in postpartum weight and depression among the mothers in the study who breastfed and those who did not.

SETTING

A heavily Hispanic community located in a major Southwestern U.S. city.

PARTICIPANTS

Women of Mexican origin (N = 150) who enrolled during their third trimesters in a local Special Supplemental Nutrition Program for Women, Infants, and Children clinic and were followed for 6 months.

METHODS

Weight was measured at 1 month and at 6 months postpartum at home visits with validated digital scales. Breastfeeding was measured according to World Health Organization criteria and recorded after monthly phone calls. Depression was measured at home visits at 1 month and 6 months with the Edinburgh Postnatal Depression Scale.

RESULTS

At 6 months postpartum, participants who did not breastfeed had the highest scores on the Edinburgh Postnatal Depression Scale; participants who breastfed nonexclusively had the lowest scores (p = .067). At both time points, there was a significant difference in weight (p = .017) between women who were doing any breastfeeding and women who were not breastfeeding.

CONCLUSION

Breastfeeding, even if not exclusive, contributed to lower depression scores and significantly lower postpartum weight among this sample of Mexican American women.

Lactation and Maternal Cardio-Metabolic Health

Researchers hypothesize that pregnancy and lactation are part of a continuum, with lactation meant to "reset" the adverse metabolic profile that develops as a part of normal pregnancy, and that when lactation does not occur, women maintain an elevated risk of cardio-metabolic diseases. Several large prospective and retrospective studies, mostly from the United States and other industrialized countries, have examined the associations between lactation and cardio-metabolic outcomes. Less evidence exists regarding an association of lactation with maternal postpartum weight status and dyslipidemia, whereas more evidence exists for an association with diabetes, hypertension, and subclinical and clinical cardiovascular disease.

Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study

BACKGROUND

Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain.

OBJECTIVE

To evaluate lactation and the 2-year incidence of DM after GDM pregnancy.

DESIGN

Prospective, observational cohort of women with recent GDM. (ClinicalTrials.gov: NCT01967030).

SETTING

Integrated health care system.

PARTICIPANTS

1035 women diagnosed with GDM who delivered singletons at 35 weeks' gestation or later and enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy from 2008 to 2011.

MEASUREMENTS

Three in-person research examinations from 6 to 9 weeks after delivery (baseline) and annual follow-up for 2 years that included 2-hour, 75-g oral glucose tolerance testing; anthropometry; and interviews. Multivariable Weibull regression models evaluated independent associations of lactation measures with incident DM adjusted for potential confounders.

RESULTS

Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years later; 113 (11.8%) developed incident DM. There were graded inverse associations for lactation intensity at baseline with incident DM and adjusted hazard ratios of 0.64, 0.54, and 0.46 for mostly formula or mixed/inconsistent, mostly lactation, and exclusive lactation versus exclusive formula feeding, respectively (P trend = 0.016). Time-dependent lactation duration showed graded inverse associations with incident DM and adjusted hazard ratios of 0.55, 0.50, and 0.43 for greater than 2 to 5 months, greater than 5 to 10 months, and greater than 10 months, respectively, versus 0 to 2 months (P trend = 0.007). Weight change slightly attenuated hazard ratios.

LIMITATION

Randomized design is not feasible or desirable for clinical studies of lactation.

CONCLUSION

Higher lactation intensity and longer duration were independently associated with lower 2-year incidences of DM after GDM pregnancy. Lactation may prevent DM after GDM delivery.

PRIMARY FUNDING SOURCE

National Institute of Child Health and Human Development.

Reducing postpartum weight retention and improving breastfeeding outcomes in overweight women: a pilot randomised controlled trial

Overweight and obesity is prevalent among women of reproductive age (42% BMI > 25 kg/m2) and parity is associated with risk of weight gain. Weight gain greater than that recommended by the Institute of Medicine (IOM )is also associated with lower rates of breastfeeding initiation and duration in women. The aim of this pilot randomised controlled trial is to examine the feasibility of recruiting and maintaining a cohort of pregnant women with the view of reducing postpartum weight retention and improving breastfeeding outcomes. Women (BMI of 25-35 kg/m2 (n = 36)) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Participants were stratified by BMI and randomised to one of three groups with follow-up to six months postpartum. Women received a dietary intervention with or without breastfeeding support from a lactation consultant, or were assigned to a wait-list control group where the dietary intervention was issued at three months postpartum. Feasibility and acceptability was assessed by participation rates and questionnaire. Analysis of variance and covariance was conducted to determine any differences between groups. Sixty-nine per cent of the participants were still enrolled at six months postpartum. This pilot demonstrated some difficulties in recruiting women from antenatal clinics and retaining them in the trial. Although underpowered; the results on weight; biomarkers and breastfeeding outcomes indicated improved metabolic health.

Adherence to breastfeeding guidelines and maternal weight 6 years after delivery

OBJECTIVES

There is a dearth of information on the long-term maternal effects of breastfeeding. The objective of this study was to examine adherence to breastfeeding recommendations of exclusive breastfeeding for ≥4 months and continuation of breastfeeding for ≥1 year and maternal weight retention 6 years after delivery.

METHODS

Using data from the Infant Feeding Practices Study II (IFPS II), we categorized women by the degree to which they met breastfeeding recommendations. Mothers' self-reported weight 6 years after delivery (IFPS Year 6 Follow-Up) was compared with self-reported prepregnancy weight from IFPS II. Using linear regression models, adjusting for covariates, we examined associations between breastfeeding recommendation adherence and weight retention.

RESULTS

Of the 726 women in our study, 17.9% never breastfed. Among those who initiated breastfeeding, 29.0% breastfed exclusively for ≥4 months, and 20.3% breastfed exclusively for ≥4 months and continued breastfeeding for ≥12 months. Prepregnancy BMI modified the association between breastfeeding recommendation adherence and weight retention. Adjusting for covariates, we found no association between breastfeeding recommendations adherence and weight retention among normal and overweight mothers. Among obese mothers, there was a significant linear trend (P = .03), suggesting that those who fully adhered to breastfeeding recommendations retained less weight (-8.0 kg) than obese women who never breastfed.

CONCLUSIONS

This study suggests that improving adherence to breastfeeding recommendations may help reduce long-term maternal weight retention among obese mothers. Larger studies, with diverse populations and similar longitudinal designs, are needed to explore this relationship.

Pregnancy and post-delivery maternal weight changes and overweight in preschool children

OBJECTIVES

High maternal weight before and during pregnancy contributes to child obesity. To assess the additional role of weight change after delivery, we examined associations between pre- and post-pregnancy weight changes and preschooler overweight.

METHODS

SAMPLE

4359 children from the Children and Young Adults of the 1979 National Longitudinal Survey of Youth (NLSY) born to 2816 NLSY mothers between 1979 and 2006 and followed to age 4-5years old.

EXPOSURES

gestational weight gain (GWG) and post-delivery maternal weight change (PDWC).

OUTCOME

child overweight (body mass index (BMI) ≥85th percentile).

RESULTS

Adjusted models suggested that both increased GWG (OR: 1.08 per 5kg GWG, 95% CI: 1.01, 1.16) and excessive GWG (OR: 1.29 versus adequate GWG, 95% CI: 1.06, 1.56) were associated with preschooler overweight. Maternal weight change after delivery was also independently associated with child overweight (OR: 1.12 per 5kg PDWC, 95% CI: 1.04, 1.21). Associations were stronger among children with overweight or obese mothers.

CONCLUSIONS

Increased maternal weight gain both during and after pregnancy predicted overweight in preschool children. Our results suggest that healthy post-pregnancy weight may join normal pre-pregnancy BMI and adequate GWG as a potentially modifiable risk factor for child overweight.