Postpartum Weight Retention and Its Determinants in Lebanon and Qatar: Results of the Mother and Infant Nutrition Assessment (MINA) Cohort

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

OBJECTIVE

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

METHODS

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

FINDINGS

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

CONCLUSION

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

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

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

Dietary patterns and their associations with postpartum weight retention: results of the MINA cohort study

PURPOSE

To examine the association of prepregnancy dietary patterns with postpartum weight retention at 6 months (PPWR6) among Lebanese and Qatari women.

METHODS

Data for this study were derived from the Mother and Infant Nutrition Assessment (MINA) prospective cohort study conducted in Lebanon and Qatar. Pregnant women were recruited during their first trimester and were followed up for three years. For the purpose of this study, data belonging to sociodemographic characteristics of participants, prepregnancy dietary intake, prepregnancy BMI as well as weight retention at 6 months were used. Dietary intake was examined using a 98-item food frequency questionnaire. Principal component analysis was used for the derivation of dietary patterns. The associations of dietary patterns with PPWR6 were examined using simple and multiple linear regressions.

RESULTS

Data was available for 177 participants (Lebanon: 93; Qatar: 84). Mean PPWR6 was 4.05 ± 5.29 kg. Significantly higher PPWR6 was observed among participants with pre-pregnancy overweight/obesity and among those with excessive gestational weight gain. Two dietary patterns were identified: the "Western" and the "Varied" patterns. After adjustment for confounders, a positive association was observed between the 'Western' pattern scores and PPWR6 (ß = 1.27; 95% CI 0.68-1.86; p value: < 0.0001).

CONCLUSION

Higher adherence to the Western pattern was associated with higher PPWR6 amongst women, hence underscoring the importance of public health interventions aimed at fostering healthier dietary habits during this crucial stage of the lifecycle.

A Cross-Sectional Survey of 505 Postpartum Women to Assess Lifestyle-Related Behaviour, Barriers, and Myths Affecting Postpartum Weight Retention and Its Management

Background/Purpose

This study aims to assess lifestyle-related factors such as diet, physical activity and sleep along with common myths, beliefs, and barriers to a healthy lifestyle and resultant postpartum weight retention. It has also explored the association of the aforementioned factors with socio-demographic variables.

Methods

A cross-sectional survey was conducted using a comprehensive pre-validated questionnaire on a convenience sample of postpartum women using a telephonic interview schedule.

Results

A total of 505 postpartum women were recruited with median postpartum weight retention of 5 kg. More than half of the participants had incorrect dietary practices with less than one-tenth of women indulging in low/moderate-intensity physical activity. Postpartum women had poorer diet (p < 0.05) and sleep (p < 0.01) in the initial phase postpartum as compared to late postpartum. These women were also less physically active in the initial months and as the postpartum period progressed their physical activity also improved significantly (p < 0.001). Socio-demographic variables such as socio-economic status, education, and employment status were significantly associated with unhealthy lifestyle practices. Common barriers were lack of knowledge, time constraints, lack of childcare support and cultural myths and beliefs.

Conclusion

The findings of the study will help in developing a comprehensive women-centric weight management module focusing on practical guidelines for lifestyle, breastfeeding and other confounding factors associated with postpartum weight management.

Postpartum weight retention and its association with socio-demographic and obstetrics correlates: A cross-sectional hospital-based preliminary survey in India

BACKGROUND AND AIMS

Postpartum weight retention can predispose women to an elevated risk of obesity and associated complications. The study aims to assess the magnitude of postpartum weight retention and its association with socio-demographic and obstetrics correlates.

METHODS

A cross-sectional survey was carried out in February and March 2022 via telephonic interviews. Convenience sampling technique was used for recruiting postpartum women in first three months, four to six months and beyond six months post-delivery (date of delivery January 2021 to January 2022). Chi² test and regression analysis were employed to study the association of socio-demographic and obstetrics correlates with postpartum weight retention.

RESULTS

The final sample comprised 505 postpartum women with a mean age of 29 ± 4 years. The mean postpartum weight retention was 4.96 ± 3.64 kg, 5.38 ± 3.93 kg and 5.80 ± 3.95 kg in the first three months, four to six months and beyond six months post-delivery respectively. In the first three months, socio-economic status and gestational weight gain were associated with weight retention (p < 0.05). In four-six months, type of family, education qualification, and gestational weight gain were associated with weight retention (p < 0.05). Beyond six months post-delivery, gestational weight gain was associated with postpartum weight retention (p < 0.05).

CONCLUSION

The findings provide preliminary data on the magnitude of weight retention in Indian postpartum women. Postpartum women are at an increased risk of weight retention with the overall shift to a higher body mass index category as compared to the pre-pregnancy period. It is crucial to timely screen women at risk and implement weight management strategies.

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.

Development of national dietary and lifestyle guidelines for pregnant women in Lebanon

Although a number of international diet and lifestyle guidelines during pregnancy (DLGP) exist in the literature, contextualization to low- and middle-income settings is less common. The aim of this study was to present the Lebanese DLGP and to describe the process followed for their development. A mixed-method approach was used including a review and synthesis of existing international DLGP and a consensus building nominal group technique (NGT) with a multidisciplinary group of experts (n = 11). During the meeting, participants identified the themes of the guidelines, formulated the wording of each themes' guideline and translated the guidelines to the Arabic language. Consensus was defined as an agreement of 80%. Reviewing the literature, a list of 17 main topics were found to be common themes for the DLGP. For the Lebanese DLGP, participants in the NGT meeting selected seven themes from this list: gestational weight gain, diet diversity, hydration, food safety, harmful foods, physical activity and breastfeeding. In addition, the group formulated three themes based on merging/modifying existing themes: supplementation, alcohol and smoking and religious fasting. Two context-specific new themes emerged: wellbeing and nutrition resilience. For each of the identified themes, the group agreed upon the wording of its guidelines and description. This study is the first from the Eastern Mediterranean Region to develop through consensus building, context and culture-specific dietary and lifestyle guidelines for pregnant women. Putting maternal nutrition at the heart of tackling malnutrition and its detrimental health outcomes is a core investment for a better maternal and child health.

Adherence to the Mediterranean diet during pregnancy is associated with lower odds of excessive gestational weight gain and postpartum weight retention: results of the Mother-Infant Study Cohort

During the first 1000 d of life, gestational weight gain (GWG) and postpartum weight retention (PPWR) are considered critical determinants of nutritional status. This study examined the effect of adherence to the Mediterranean diet (MD) during pregnancy on GWG and PPWR at 2 and 6 months among women in the United Arab Emirates (UAE), using data from the Mother-Infant Study Cohort. The latter is a prospective study, for which pregnant women were recruited (n 243) during their third trimester and were followed up for 18 months. Data on socio-demographic characteristics and anthropometric measurements were obtained. An eighty-six-item FFQ was used to examine dietary intake during pregnancy. Adherence to the MD was assessed using the alternate MD (aMED) and the Lebanese MD (LMD). Adherence to the MD, PPWR2 (2 months) and PPWR6 (6 months) were considered high if participants belonged to the third tertile of the respective measures. Results indicated that 57·5 % of participants had excessive GWG while 50·7 % and 45 % retained ≥ 5 kg at 2 and 6 months postpartum, respectively. After adjustment, adherence to both MD scores was associated with lower odds of excessive GWG (aMED, OR:0·41, 95 % CI:0·18, 0·93; LMD, OR:0·40, 95 % CI: 0·16, 0·98). Adherence to MD was also associated with PPWR2 (aMED: OR: 0·23, 95 % CI: 0·06, 0·88) and PPWR6 (aMED OR:0·26; 95 % CI:0·08-0·86; LMD, OR:0·32; 95 % CI: 0·1, 0·98). The findings of this study showed that adherence to the MD may reduce GWG and PPWR and, hence, underscored the importance of promoting the MD for better health of the mother and infant.

Maternal and Early-Life Nutrition and Health

Nutritional challenges prior to and during gestation, lactation, and early life are known to influence the lifelong health of the infant. In this editorial, I briefly discuss the 13 articles published in this Special Issue, “Maternal and Early-Life Nutrition and Health”. This Special Issue discusses topics including maternal nutrition behaviors, maternal overnutrition/obesity, maternal iron deficiency, breastfeeding, and others. This issue paves the way to better understand perinatal nutrition and how it can impact maternal and offspring health.