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Minschart C, Myngheer N, Maes T, De Block C, Van Pottelbergh I, Abrams P, Vinck W, Leuridan L, Driessens S, Mathieu C, Billen J, Matthys C, Laenen A, Bogaerts A, Benhalima K. Weight retention and glucose intolerance in early postpartum after gestational diabetes. Eur J Endocrinol 2023:7173163. [PMID: 37204938 DOI: 10.1093/ejendo/lvad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES To determine risk factors for early postpartum weight retention (PPWR) and glucose intolerance (GI) in women with gestational diabetes (GDM). DESIGN & METHODS Prospective, multicenter (n=8) cohort study in 1201 women with a recent history of GDM. Pregnancy and postpartum characteristics, and data from self-administered questionnaires were collected at the 6-16 weeks postpartum 75g OGTT. RESULTS Of all participants, 38.6% (463) had moderate (>0 and ≤5 kg) and 15.6% (187) had high (>5kg) PPWR. Independent predictors for early PPWR were excessive gestational weight gain (GWG), lack of breastfeeding, higher dietary fat intake, insulin use during pregnancy, multiparity, lower prepregnancy BMI, and lower education degree. Compared to PPWR <5 kg, women with high PPWR had a more impaired postpartum metabolic profile, breastfed less often, had higher depression rates [23.1% (43) vs. 16.0% (74), p=0.035] and anxiety levels, and lower quality of life. Of all participants, 28.0% (336) had GI [26.1% (313) prediabetes and 1.9% (23) diabetes]. Women with high PPWR had more often GI compared to women without PPWR [33.7% (63) vs. 24.9% (137), p=0.020]. Only 12.9% (24) of women with high PPWR perceived themselves at high risk for diabetes but they were more often willing to change their lifestyle than women with moderate PPWR. CONCLUSIONS Modifiable risk factors such as lifestyle, prepregnancy BMI, GWG, and mental health can be used to identify a subgroup of women with GDM at the highest risk of developing early PPWR, allowing for a more personalized follow-up.
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Affiliation(s)
- Caro Minschart
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
| | - Nele Myngheer
- Department of Endocrinology, General Hospital Groeninge, 8500 Kortrijk, Belgium
| | - Toon Maes
- Department of Endocrinology, Imelda Hospital, 2820 Bonheiden, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, 2650 Edegem, Belgium
| | | | - Pascale Abrams
- Department of Endocrinology, GZA Hospital Sint-Vincentius, 2018 Antwerp, Belgium
- Department of Endocrinology, GZA Hospital Sint-Augustinus, 2610 Wilrijk, Belgium
| | - Wouter Vinck
- Department of Endocrinology, GZA Hospital Sint-Augustinus, 2610 Wilrijk, Belgium
| | - Liesbeth Leuridan
- Department of Endocrinology, General Hospital Klina, 2930 Brasschaat, Belgium
| | - Sabien Driessens
- Department of Endocrinology, General Hospital Klina, 2930 Brasschaat, Belgium
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Jaak Billen
- Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Annouschka Laenen
- Centre of Biostatics and Statistical Bioinformatics, KU Leuven, 3000 Leuven, Belgium
| | - Annick Bogaerts
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, 2610 Wilrijk, Belgium
| | - Katrien Benhalima
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, 3000 Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, 3000 Leuven, Belgium
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Yusuf HM, Koleilat M, Whaley SE. Prevalence and Predictors of Substantial Postpartum Weight Retention Among Participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Southern California. Am J Health Promot 2023:8901171221148840. [PMID: 36621898 DOI: 10.1177/08901171221148840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Identify the prevalence and predictors of substantial postpartum weight retention (SPPWR) among WIC mothers in Southern California during their first postpartum year. DESIGN Secondary data analysis. SETTING The 2020 Los Angeles County WIC Survey. SUBJECTS Mothers of children up to 1-year-old (N = 1019). MEASURES Outcome variable: SPPWR (≥5 kg above pre-pregnancy weight). Predictors: child's age, mother's age, race, education, employment status since having child, healthcare coverage, food insecurity, depressed mood, instrumental support, emotional support, spouse's participation in child's life, gestational weight gain (GWG), pre-pregnancy BMI, any breastfeeding, and gestational diabetes. ANALYSIS Weighted descriptive statistics and binary logistic regression. RESULTS The prevalence of SPPWR was 31%. We found that for every 1 month increase in the child's age (proxy for postpartum duration), the likelihood of SPPWR increased by 9% (AOR = 1.09, CI = 1.04-1.15). Mothers were more likely to have SPPWR when they exceeded GWG guidelines (AOR = 3.43, CI = 2.46-4.79). Compared to mothers with normal pre-pregnancy BMIs, mothers with overweight (AOR = .64, CI = .44-.94) and obese (AOR = .39, CI = .26-.58) pre-pregnancy BMIs were less likely to experience SPPWR. CONCLUSION Postpartum duration and maternal anthropometric characteristics were associated with SPPWR during the first postpartum year. Extending WIC eligibility for postpartum mothers to 2 years through the Wise Investment in Children Act may give WIC providers the opportunity to work closely with Southern California WIC mothers to achieve a healthy weight after pregnancy.
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Affiliation(s)
- Hanan M Yusuf
- Department of Public Health, College of Health and Human Development, 158426California State University Fullerton, Fullerton, CA, USA
| | - Maria Koleilat
- Department of Public Health, College of Health and Human Development, 158426California State University Fullerton, Fullerton, CA, USA
| | - Shannon E Whaley
- Division of Research and Evaluation, PHFE WIC Program, A Program of Heluna Health, Irwindale, CA, USA
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Ringholm L, Nørgaard SK, Rytter A, Damm P, Mathiesen ER. Dietary Advice to Support Glycaemic Control and Weight Management in Women with Type 1 Diabetes during Pregnancy and Breastfeeding. Nutrients 2022; 14. [PMID: 36432552 DOI: 10.3390/nu14224867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
In women with type 1 diabetes, the risk of adverse pregnancy outcomes, including congenital anomalies, preeclampsia, preterm delivery, foetal overgrowth and perinatal death is 2-4-fold increased compared to the background population. This review provides the present evidence supporting recommendations for the diet during pregnancy and breastfeeding in women with type 1 diabetes. The amount of carbohydrate consumed in a meal is the main dietary factor affecting the postprandial glucose response. Excessive gestational weight gain is emerging as another important risk factor for foetal overgrowth. Dietary advice to promote optimized glycaemic control and appropriate gestational weight gain is therefore important for normal foetal growth and pregnancy outcome. Dietary management should include advice to secure sufficient intake of micro- and macronutrients with a focus on limiting postprandial glucose excursions, preventing hypoglycaemia and promoting appropriate gestational weight gain and weight loss after delivery. Irrespective of pre-pregnancy BMI, a total daily intake of a minimum of 175 g of carbohydrate, mainly from low-glycaemic-index sources such as bread, whole grain, fruits, rice, potatoes, dairy products and pasta, is recommended during pregnancy. These food items are often available at a lower cost than ultra-processed foods, so this dietary advice is likely to be feasible also in women with low socioeconomic status. Individual counselling aiming at consistent timing of three main meals and 2-4 snacks daily, with focus on carbohydrate amount with pragmatic carbohydrate counting, is probably of value to prevent both hypoglycaemia and hyperglycaemia. The recommended gestational weight gain is dependent on maternal pre-pregnancy BMI and is lower when BMI is above 25 kg/m2. Daily folic acid supplementation should be initiated before conception and taken during the first 12 gestational weeks to minimize the risk of foetal malformations. Women with type 1 diabetes are encouraged to breastfeed. A total daily intake of a minimum of 210 g of carbohydrate is recommended in the breastfeeding period for all women irrespective of pre-pregnancy BMI to maintain acceptable glycaemic control while avoiding ketoacidosis and hypoglycaemia. During breastfeeding insulin requirements are reported approximately 20% lower than before pregnancy. Women should be encouraged to avoid weight retention after pregnancy in order to reduce the risk of overweight and obesity later in life. In conclusion, pregnant women with type 1 diabetes are recommended to follow the general dietary recommendations for pregnant and breastfeeding women with special emphasis on using carbohydrate counting to secure sufficient intake of carbohydrates and to avoid excessive gestational weight gain and weight retention after pregnancy.
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Getahun D, Fassett MJ, Jacobsen SJ, Sacks DA, Murali SB, Peltier MR, Mulugeta W, Chiu VY, Wing DA, Coleman KJ. Perinatal outcomes after bariatric surgery. Am J Obstet Gynecol 2022; 226:121.e1-121.e16. [PMID: 34216568 DOI: 10.1016/j.ajog.2021.06.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/03/2021] [Accepted: 06/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bariatric surgery is a widely used treatment option for obesity that often provides long-term weight control and health benefits. Although a growing number of women are becoming pregnant after bariatric surgery, only a few population-based studies have assessed the impact thereof on perinatal outcomes. OBJECTIVE This study aimed to examine the association between bariatric surgery and adverse perinatal outcomes in pregnant women and to examine whether the risk for adverse perinatal outcomes is modified by the postsurgery weight, gestational weight gain, type of bariatric surgery, timing of pregnancy after bariatric surgery, and maternal comorbidities. STUDY DESIGN A retrospective cohort study was performed with the use of the Bariatric Surgery Registry and hospital inpatient and outpatient physician encounter records. The International Classification of Diseases, Ninth and Tenth Revision codes from hospitalizations during pregnancy and infant birth records were used to ascertain the outcomes of interest. Women eligible for BS who delivered at ≥20 weeks of gestation (n=20,213) at Kaiser Permanente Southern California hospitals (January 1, 2007 to December 31, 2018) were included in the study. Adjusted odds ratios were derived from logistic regression models with inverse probability of treatment weighting to adjust for confounding using propensity scores. RESULTS Bariatric surgery was associated with a reduction in the risks for gestational diabetes (adjusted odds ratio, 0.60; 95% confidence interval, 0.53-0.69; P<.001), preeclampsia (adjusted odds ratio, 0.53; 95% confidence interval, 0.46-0.61; P<.001), chorioamnionitis (adjusted odds ratio, 0.45; 95% confidence interval, 0.32-0.63; P<.001), cesarean delivery (adjusted odds ratio, 0.65; 95% confidence interval, 0.59-0.72; P<.001), large for gestational age neonate (adjusted odds ratio, 0.23; 95% confidence interval, 0.19-0.29; P<.001), macrosomia (adjusted odds ratio, 0.24; 95% confidence interval, 0.19-0.30; P<.001), and neonatal intensive care unit admission (adjusted odds ratio, 0.70; 95% confidence interval, 0.61-0.81; P<.001). However, bariatric surgery was also associated with a significantly increased risk for small for gestational age neonates (adjusted odds ratio, 2.46; 95% confidence interval, 2.16-2.79; P<.001). The risk for the adverse outcomes is independent of the time interval between the surgery and subsequent pregnancy. CONCLUSION These data suggest that there are many pregnancy outcome benefits for women with severe obesity who undergo bariatric surgery; however, women who have undergone bariatric surgery before pregnancy should be monitored closely to reduce the risk for small for gestational age neonates and postpartum hemorrhage.
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Li HZ, Boyle JA, Harrison CL. Preventing postpartum weight retention following antenatal lifestyle intervention: One year postpartum follow up of the Healthy Lifestyles in Pregnancy (HeLP-her) randomised controlled trial. Aust N Z J Obstet Gynaecol 2021; 62:319-322. [PMID: 34893973 DOI: 10.1111/ajo.13463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022]
Abstract
Antenatal lifestyle interventions optimise gestational weight gain, yet longer-term efficacy on postpartum weight retention is unclear. Overall, 228 pregnant women <15 weeks gestation were randomised to intervention (four behavioural self-management sessions) or control (generic health information). Median weight retention at 12 months postpartum was significantly reduced in the intervention with a between group difference of -2.3 (-2.8 (-5.9 to 0.35) vs -0.5 (-2.6 to 2.1) kg, respectively P < 0.05, (n = 75) ± 6.3 kg vs -0.5 ± 4.7 kg, respectively, P < 0.05) and associated increased self-weighing behaviours, compared with the control group (regular weighing: 68% vs 43%, P < 0.01). Results demonstrate the efficacy of a low-intensity, behavioural lifestyle intervention in limiting postpartum weight retention.
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Affiliation(s)
- Heidi Z Li
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Diabetes and Endocrine Unit, Monash Health, Melbourne, Victoria, Australia
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Quansah DY, Gilbert L, Gross J, Horsch A, Puder JJ. Intuitive eating is associated with improved health indicators at 1-year postpartum in women with gestational diabetes mellitus. J Health Psychol 2019; 26:1168-1184. [PMID: 31434517 DOI: 10.1177/1359105319869814] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We evaluated the associations between intuitive eating during and after pregnancy with metabolic health at 1-year postpartum in women with gestational diabetes mellitus and in high-risk gestational diabetes mellitus subgroups. One hundred seventeen women who consented and completed the French intuitive eating questionnaire during and after pregnancy were included. We found an association between intuitive eating during and after pregnancy with lower body mass index, weight retention, fasting glucose, and HbA1c at 1-year postpartum in women with gestational diabetes mellitus and in high-risk gestational diabetes mellitus subgroups with overweight/obese or with prediabetes in the postpartum period. Our results suggest that intuitive eating could be an effective intervention for weight and glucose control in women with gestational diabetes mellitus.
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Affiliation(s)
- Dan Yedu Quansah
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Leah Gilbert
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Justine Gross
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland.,Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Switzerland.,Neonatology service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J Puder
- Obstetric service, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
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Hoffmann J, Günther J, Stecher L, Spies M, Meyer D, Kunath J, Raab R, Rauh K, Hauner H. Effects of a Lifestyle Intervention in Routine Care on Short- and Long-Term Maternal Weight Retention and Breastfeeding Behavior-12 Months Follow-up of the Cluster-Randomized GeliS Trial. J Clin Med 2019; 8:jcm8060876. [PMID: 31248138 PMCID: PMC6616390 DOI: 10.3390/jcm8060876] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
Postpartum weight retention (PPWR) is associated with an increased risk for maternal obesity and is discussed to be influenced by breastfeeding. The objective was to evaluate the effect of a lifestyle intervention delivered three times during pregnancy and once in the postpartum period on PPWR and on maternal breastfeeding behavior. In total, 1998 participants of the cluster-randomized “healthy living in pregnancy” (GeliS) trial were followed up until the 12th month postpartum (T2pp). Data were collected using maternity records and questionnaires. Data on breastfeeding behavior were collected at T2pp. At T2pp, mean PPWR was lower in women receiving counseling (IV) compared to the control group (C) (−0.2 ± 4.8 kg vs. 0.6 ± 5.2 kg), but there was no significant evidence of between-group differences (adjusted p = 0.123). In the IV, women lost more weight from delivery until T2pp compared to the C (adjusted p = 0.008) and showed a slightly higher rate of exclusive breastfeeding (IV: 87.4%; C: 84.4%; adjusted p < 0.001). In conclusion, we found evidence for slight improvements of maternal postpartum weight characteristics and the rate of exclusive breastfeeding in women receiving a lifestyle intervention embedded in routine care, although the clinical meaning of these findings is unclear.
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Affiliation(s)
- Julia Hoffmann
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
| | - Julia Günther
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
| | - Lynne Stecher
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
| | - Monika Spies
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
| | - Dorothy Meyer
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
| | - Julia Kunath
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
| | - Roxana Raab
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
| | - Kathrin Rauh
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
- Competence Centre for Nutrition (KErn), Am Gereuth 4, 85354 Freising, Bavaria, Germany.
| | - Hans Hauner
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Bavaria, Germany.
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8
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Tahir MJ, Haapala JL, Foster LP, Duncan KM, Teague AM, Kharbanda EO, McGovern PM, Whitaker KM, Rasmussen KM, Fields DA, Harnack LJ, Jacobs DR, Demerath EW. Association of Full Breastfeeding Duration with Postpartum Weight Retention in a Cohort of Predominantly Breastfeeding Women. Nutrients 2019; 11:nu11040938. [PMID: 31027268 PMCID: PMC6520964 DOI: 10.3390/nu11040938] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/16/2022] Open
Abstract
Full breastfeeding (FBF) is promoted as effective for losing pregnancy weight during the postpartum period. This study evaluated whether longer FBF is associated with lower maternal postpartum weight retention (PPWR) as compared to a shorter FBF duration. The MILK (Mothers and Infants Linked for Healthy Growth) study is an ongoing prospective cohort of 370 mother-infant dyads, all of whom fully breastfed their infants for at least 1 month. Breastfeeding status was subsequently self-reported by mothers at 3 and 6 months postpartum. Maternal PPWR was calculated as maternal weight measured at 1, 3, and 6 months postpartum minus maternal prepregnancy weight. Using linear mixed effects models, by 6 months postpartum, adjusted means ± standard errors for weight retention among mothers who fully breastfed for 1-3 (3.40 ± 1.16 kg), 3-6 (1.41 ± 0.69 kg), and ≥6 months (0.97 ± 0.32 kg) were estimated. Compared to mothers who reported FBF for 1-3 months, those who reported FBF for 3-6 months and ≥6 months both had lower PPWR over the period from 1 to 6 months postpartum (p = 0.04 and p < 0.01, respectively). However, PPWR from 3 to 6 months was not significantly different among those who reported FBF for 3-6 versus ≥6 months (p > 0.05). Interventions to promote FBF past 3 months may increase the likelihood of postpartum return to prepregnancy weight.
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Affiliation(s)
- Muna J Tahir
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Jacob L Haapala
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Laurie P Foster
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Katy M Duncan
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - April M Teague
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | | | - Patricia M McGovern
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA.
- Department of Epidemiology, University of Iowa, Iowa City, IA 52242, USA.
| | | | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Ellen W Demerath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
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9
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Kunath J, Günther J, Rauh K, Hoffmann J, Stecher L, Rosenfeld E, Kick L, Ulm K, Hauner H. Effects of a lifestyle intervention during pregnancy to prevent excessive gestational weight gain in routine care - the cluster-randomised GeliS trial. BMC Med 2019; 17:5. [PMID: 30636636 PMCID: PMC6330753 DOI: 10.1186/s12916-018-1235-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) leads to obstetric complications, maternal postpartum weight retention and an increased risk of offspring obesity. The GeliS study examines the effect of a lifestyle intervention during pregnancy on the proportion of women with excessive GWG and pregnancy and obstetric complications, as well as the long-term risk of maternal and infant obesity. METHODS The GeliS study is a cluster-randomised multicentre controlled trial including 2286 women with a pre-pregnancy BMI between 18.5 and 40.0 kg/m2 recruited from gynaecological and midwifery practices prior to the end of the 12th week of gestation in five Bavarian regions. In the intervention regions, four lifestyle counselling sessions covering a balanced healthy diet, regular physical activity and self-monitoring of weight gain were performed by trained healthcare providers alongside routine pre- and postnatal practice visits. In the control regions, leaflets with general recommendations for a healthy lifestyle during pregnancy were provided. RESULTS The intervention did not result in a significant reduction of women showing excessive GWG (adjusted OR 0.95, 95% CI 0.66-1.38, p = 0.789), with 45.1% and 45.7% of women in the intervention and control groups, respectively, gaining weight above the Institute of Medicine recommendations. Gestational diabetes mellitus was diagnosed in 10.8% and 11.1% of women in the intervention and control groups, respectively (p = 0.622). Mean birth weight and length were slightly lower in the intervention group (3313 ± 536 g vs. 3363 ± 498 g, p = 0.020; 51.1 ± 2.7 cm vs. 51.6 ± 2.5 cm, p = 0.001). CONCLUSION In the setting of routine prenatal care, lifestyle advice given by trained healthcare providers was not successful in limiting GWG and pregnancy complications. Nevertheless, the potential long-term effects of the intervention remain to be assessed. TRIAL REGISTRATION NCT01958307 , ClinicalTrials.gov, retrospectively registered October 9, 2013.
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Affiliation(s)
- Julia Kunath
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Julia Günther
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Kathrin Rauh
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.,Competence Centre for Nutrition (KErn), Am Gereuth 4, 85354, Freising, Germany
| | - Julia Hoffmann
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Lynne Stecher
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.,Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Eva Rosenfeld
- Competence Centre for Nutrition (KErn), Am Gereuth 4, 85354, Freising, Germany
| | - Luzia Kick
- Competence Centre for Nutrition (KErn), Am Gereuth 4, 85354, Freising, Germany
| | - Kurt Ulm
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
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Zhang H, Ma X, Jiang C, Shi R. [Impacts of acupoint catgut embedding therapy on postpartum weight retention]. Zhongguo Zhen Jiu 2017; 37:725-728. [PMID: 29231545 DOI: 10.13703/j.0255-2930.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To observe the impacts of acupoint catgut embedding therapy on postpartum weight retention. METHODS Seventy-one women of postpartum weight retention were divided into an observation group (35 cases) and a control group (36 cases) according to their own wishes when re-examination in 42 days after delivery. In the control group, the nutrition consultation was provided and the calories intake was controlled continuously for 20 weeks. In the observation group, on the basis of the treatment as the control group, the acupoint embedding therapy was applied to Zhongwan (CV 12), Zhongji (CV 3), Qihai (CV 6), Guanyuan (CV 4), Tianshu (ST 25), Guilai (ST 29), Shuifen (CV 9), Shousanli (LI 10), Zusanli (ST 36), Fenglong (ST 40) and Yinlingquan (SP 9). The sutures, No. 4-0 were cut as 2 to 4 mm in length and put into the embedding needle. After qi arrival, the sutures were pushed into the acupoints with the needle core and the needle was removed quickly. The treatment was given once every two weeks, continuously for 20 weeks. Totally, 10 times of acupoint catgut embedding therapy were required. Before and after treatment, the body mass, weight retention, body mass index (BMI), percentage of body fat (PBF), waist circumference (WC), waist-hip ratio (WHR) and health promoting lifestyle profile (HPLP-Ⅱ) were observed in the participants of the two groups. RESULTS After treatment, body mass, weight retention, BMI, PBF, WC and WHR were all reduced as compared with those before treatment in the participants of the two groups, indicating the significant differences (all P<0.05). After treatment, the body mass, weight retention, BMI, PBF, WC and WHR in the participants of the observation group were lower than those in the control group, indicating the significant differences (all P<0.05). The score of every dimension of HPLP-Ⅱ after treatment was higher than that before treatment in the participants of the observation group, indicating the significant differences (all P<0.05); and the scores of health responsibility, sports and spiritual growth in the observation group were higher than those in the control group, indicating the significant differences (all P<0.05). CONCLUSIONS The acupoint catgut embedding therapy improves in the postpartum weight retention and achieves the satisfactory clinical therapeutic effects.
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Affiliation(s)
- Huimin Zhang
- Department of TCM, Beijing United Family Rehabilitation Hospital, Beijing 100016, China
| | - Xuehong Ma
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of CM
| | - Chao Jiang
- Department of TCM, Beijing United Family Rehabilitation Hospital, Beijing 100016, China
| | - Rongxing Shi
- Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital
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Aşcı Ö, Rathfisch G. Effect of lifestyle interventions of pregnant women on their dietary habits, lifestyle behaviors, and weight gain: a randomized controlled trial. J Health Popul Nutr 2016; 35:7. [PMID: 26911204 PMCID: PMC5025976 DOI: 10.1186/s41043-016-0044-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 02/16/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Although it is known that lifestyle behaviors of pregnant women are closely related to maternal and fetal health, number of data concerning efficacy of intervention on lifestyle during pregnancy is limited. The purpose of this study is to determine the effect of lifestyle interventions on improving dietary habits and lifestyle behaviors, ensuring gestational weight gain (GWG) within recommended levels and limiting postpartum weight retention (PWR). METHODS The study was conducted as a randomized controlled trial in a family health center located in Istanbul, Turkey, between June 2011 and July 2012. The primary outcomes were GWG, and the proportion of pregnant women whose GWG was within the Institute of Medicine (IOM) guidelines. One hundred two pregnant women with gestation ≤12 weeks, age ≥18 years, gravidity ≤2, and who did not intend to lose weight in prepregnancy period were randomly included in this study as intervention (n = 51) and control (n = 51) groups. The study was completed with 45 women for each group. The control group received routine antenatal care. The intervention group was received an individualized lifestyle intervention focusing on healthy lifestyle, diet, exercise, and weight monitoring as four sessions at 12-15, 16-18, 20-24, and 37 weeks gestation. Lifestyle behaviors were evaluated with Health-Promoting Lifestyle Profile-II. Dietary habits were assessed by 3-day dietary recalls, and weight was followed from pregnancy until 6 weeks postpartum. RESULTS The lifestyle interventions had a significant effect on improving lifestyle behaviors, protein intake, percentage of energy from protein, calcium, magnesium, iron, zinc, and vegetable intakes when adjusted for confounders (p < 0.05). The proportion of women who were within the IOM recommendations was higher in the intervention group (51.1 %) than in the control group (28.9 %) The odds ratio for GWG within IOM was statistically significant between the groups (OR = 0.59, 95 % CI, 0.45-0.72). There were no difference between groups in terms of the other dietary intakes, total GWG, and PWR (p > 0.05). CONCLUSIONS Lifestyle intervention improves the lifestyle behaviors during pregnancy and increases the appropriate GWG for prepregnancy body mass index (BMI), but it has a limited effect in terms of improving dietary habits and has no effect on PWR.
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Affiliation(s)
- Özlem Aşcı
- Nursing Department of Health Sciences Faculty, Artvin Çoruh University, Çayağzı Mah. Liflevha Sok., 0800, Artvin, Turkey.
| | - Gülay Rathfisch
- Nursing Faculty of Obstetrics Nursing Department, Florence Nightingale School of Nursing, Istanbul University, Abidei Hurriyet cad., 34381, Istanbul, Turkey.
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12
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Moore Simas TA, Corvera S, Lee MM, Zhang N, Leung K, Olendzki B, Barton B, Rosal MC. Understanding multifactorial influences on the continuum of maternal weight trajectories in pregnancy and early postpartum: study protocol, and participant baseline characteristics. BMC Pregnancy Childbirth 2015; 15:71. [PMID: 25885002 PMCID: PMC4389494 DOI: 10.1186/s12884-015-0490-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/25/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Maternal and offspring immediate and long-term health are affected by pregnancy weight gain and maternal weight. This study was designed to determine feasibility of: 1) recruiting a socio-economically and racially/ethnically diverse sample of pregnant women into a longitudinal observational study, including consenting the women for serial biologic specimen evaluations; 2) implementing comprehensive assessments (including biologic, anthropometric, behavioral, cognitive/psychosocial and socio-demographic, and cultural measures) at multiple time points over the study period, including collecting biologic specimens at planned and unplanned pregnancy delivery times; and 3) retaining the sample for one year into the postpartum period. Additionally, the study will provide preliminary data of associations among hypothesized predictors, mediators and moderators of pregnancy and post-partum maternal and infant weight trajectories. The study was conceptualized under a Biopsychosocial Model using a lifespan approach. Study protocol and baseline characteristics are described. METHODS/DESIGN We sought to recruit a sample of 100 healthy women age 18-45 years, between 28-34 weeks gestation, with singleton pregnancies, enrolled in care prior to 17 weeks gestation. Women provide written consent for face-to-face (medical history, anthropometrics, biologic specimens), and paper-and-pencil assessments, at five time points: baseline (third trimester), delivery-associated, and 6-weeks, 3-months and 6-months postpartum. Additional telephone-based assessments (diet, physical activity and breastfeeding) administered baseline and three-months postpartum. Infant weights are collected until 1-year of life. We seek to retain 80% of participants at six-months postpartum and 80% of offspring at 12-months. 110 women were recruited. Sample characteristics include: mean age 28.3 years, BMI 25.7 kg/m(2), and gestational age at baseline visit of 32.5 weeks. One-third of cohort was non-white, over a quarter were Latina, and almost a quarter were non-US born. The cohort majority was multigravida, had graduated high school and/or had higher levels of education, and worked outside the home. DISCUSSION Documentation of study feasibility and preliminary data for theory-driven hypothesis of maternal and child factors associated with weight trajectories will support future large scale longitudinal studies of risk and protective factors for maternal and child health. This research will also inform intervention targets facilitating healthy maternal and child weight.
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Affiliation(s)
- Tiffany A Moore Simas
- Department of Obstetrics & Gynecology, Division of Research, University of Massachusetts Medical School/UMass Memorial Health Care, Memorial Campus - 119 Belmont Street, Worcester, MA, 01605, USA.
| | - Silvia Corvera
- Department of Medicine, Program in Molecular Medicine, University of Massachusetts Medical School, Biotech 2 - 373 Plantation Street, Worcester, MA, 01605, USA.
| | - Mary M Lee
- Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Health Care, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - NingNing Zhang
- Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Health Care, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - Katherine Leung
- Department of Obstetrics & Gynecology, Division of Research, University of Massachusetts Medical School/UMass Memorial Health Care, Memorial Campus - 119 Belmont Street, Worcester, MA, 01605, USA.
| | - Barbara Olendzki
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - Bruce Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - Milagros C Rosal
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, University Campus - 55 Lake Avenue, Worcester, MA, 01655, USA.
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Phelan S, Brannen A, Erickson K, Diamond M, Schaffner A, Muñoz-Christian K, Stewart A, Sanchez T, Rodriguez VC, Ramos DI, McClure L, Stinson C, Tate DF. 'Fit Moms/Mamás Activas' internet-based weight control program with group support to reduce postpartum weight retention in low-income women: study protocol for a randomized controlled trial. Trials 2015; 16:59. [PMID: 25887964 PMCID: PMC4347547 DOI: 10.1186/s13063-015-0573-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 01/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High postpartum weight retention is a strong independent risk factor for lifetime obesity, cardiovascular disease, and type 2 diabetes in women. Interventions to promote postpartum weight loss have met with some success but have been limited by high attrition. Internet-based treatment has the potential to overcome this barrier and reduce postpartum weight retention, but no study has evaluated the effects of an internet-based program to prevent high postpartum weight retention in women. METHODS/DESIGN Fit Moms/Mamás Activas targets recruitment of 12 Women, Infants and Children (WIC) Supplemental Nutrition Program clinics with a total of 408 adult (>18 years), postpartum (<1 year) women with 14.5 kg or more weight retention or a body mass index of 25.0 kg/m(2) or higher. Clinics are matched on size and randomly assigned within county to either a 12-month standard WIC intervention or to a 12-month WIC enhanced plus internet-based weight loss intervention. The intervention includes: monthly face-to-face group sessions; access to a website with weekly lessons, a web diary, instructional videos, and computer-tailored feedback; four weekly text messages; and brief reinforcement from WIC counselors. Participants are assessed at baseline, six months, and 12 months. The primary outcome is weight loss over six and 12 months; secondary outcomes include diet and physical activity behaviors, and psychosocial measures. DISCUSSION Fit Moms/Mamás Activas is the first study to empirically examine the effects of an internet-based treatment program, coupled with monthly group contact at the WIC program, designed to prevent sustained postpartum weight retention in low-income women at high risk for weight gain, obesity, and related comorbidities. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov (identifier: NCT01408147 ) on 29 July 2011.
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Affiliation(s)
- Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Anna Brannen
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Karen Erickson
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, 318 Rosenau Hall, Campus Box 7400, Chapel Hill, NC, 27599-7440, USA.
| | - Molly Diamond
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, 318 Rosenau Hall, Campus Box 7400, Chapel Hill, NC, 27599-7440, USA.
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Karen Muñoz-Christian
- Department of Modern Languages, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Ana Stewart
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Teresa Sanchez
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Vanessa C Rodriguez
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Dalila I Ramos
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Linda McClure
- San Luis Obispo County Women, Infants, and Children Supplemental Nutrition Program, 2191 Johnson Ave, San Luis Obispo, CA, 93401, USA.
| | - Caro Stinson
- Santa Barbara County Women, Infants, and Children Supplemental Nutrition Program, 315 Camino del Remedio, Santa Barbara, CA, 93110, USA.
| | - Deborah F Tate
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, 318 Rosenau Hall, Campus Box 7400, Chapel Hill, NC, 27599-7440, USA.
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Abstract
Post-partum weight retention (WR) occurs in 60-80% of women with some retaining ≥10 kg with contributing factors reported as pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and breastfeeding. A longitudinal study of pregnancy, with 12-month post-partum follow-up was conducted to determine factors associated with WR. Pregnant women (n = 152) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Pre-pregnancy weight was self-reported; weight was measured four times during pregnancy (for GWG) and in the first 12 months post-partum. Infant feeding data were obtained via questionnaires. Breastfeeding was categorised as exclusive, predominant, complementary or not breastfeeding. Linear mixed models tested the predictors of WR, with and without adjustment for potential confounders. Compared with pre-pregnancy weight, 68% of women retained weight at 12 months, median (interquartile range) [4.5 kg (2.1-8.9)]. After adjustment, GWG was positively associated with WR (P < 0.01), but pre-pregnancy weight did not predict WR. For each additional week of any breastfeeding, 0.04 kg less weight was retained. Compared with women who retained weight, those women who did retain had higher rates of exclusive breastfeeding at three months (P < 0.05), but the number of weeks of exclusive breastfeeding failed to predict WR for all women. WR following childbirth is common and associated with GWG, while the number of weeks of 'any' breastfeeding contributed to post-partum weight loss. Whether these factors are modifiable strategies to optimise the weight status of women at this life stage requires further research.
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Affiliation(s)
- Julia Elizabeth Martin
- Mothers and Babies Research Centre, Faculty of Healthniversity of NewcastleCallaghanAustralia
- Hunter Medical Research InstituteJohn Hunter HospitalNew LambtonAustralia
- Priority Research Centre in Physical Activity and NutritionUniversity of NewcastleCallaghanAustralia
| | - Alexis Jayne Hure
- Mothers and Babies Research Centre, Faculty of Healthniversity of NewcastleCallaghanAustralia
- Research Centre for Gender, Health and Ageing, School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
| | - Lesley Macdonald‐Wicks
- Hunter Medical Research InstituteJohn Hunter HospitalNew LambtonAustralia
- School of Health Sciences, Faculty of HealthUniversity of NewcastleCallaghanAustralia
- Priority Research Centre in Physical Activity and NutritionUniversity of NewcastleCallaghanAustralia
| | - Roger Smith
- Mothers and Babies Research Centre, Faculty of Healthniversity of NewcastleCallaghanAustralia
- Hunter Medical Research InstituteJohn Hunter HospitalNew LambtonAustralia
| | - Clare Elizabeth Collins
- Hunter Medical Research InstituteJohn Hunter HospitalNew LambtonAustralia
- School of Health Sciences, Faculty of HealthUniversity of NewcastleCallaghanAustralia
- Priority Research Centre in Physical Activity and NutritionUniversity of NewcastleCallaghanAustralia
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Brandhagen M, Lissner L, Brantsaeter AL, Meltzer HM, Häggkvist AP, Haugen M, Winkvist A. Breast-feeding in relation to weight retention up to 36 months postpartum in the Norwegian Mother and Child Cohort Study: modification by socio-economic status? Public Health Nutr 2014; 17:1514-23. [PMID: 23915637 PMCID: PMC10282327 DOI: 10.1017/s1368980013001869] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 05/28/2013] [Accepted: 06/13/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We investigated the association between full breast-feeding up to 6 months as well as partial breast-feeding after 6 months and maternal weight retention at 6, 18 and 36 months after delivery in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. DESIGN Cohort study. Information on exposure and outcome was collected by questionnaire. SETTING Norway. SUBJECTS Women at 6 months (n 49 676), 18 months (n 27 187) and 36 months (n 17 343) postpartum. RESULTS Longer duration of full breast-feeding as well as partial breast-feeding was significantly related to lower weight retention at 6 months. At 18 months full breast-feeding (0-6 months) and partial breast-feeding for 12-18 months were significantly related to lower weight retention. At 36 months only full breast-feeding (0-6 months) was significantly related to lower weight retention. For each additional month of full breast-feeding, maternal weight was lowered by 0·50 kg/month at 6 months, 0·10 kg/month at 18 months and 0·14 kg/month at 36 months (adjusted for pre-pregnant BMI, pregnancy weight gain, age and parity). Partial breast-feeding resulted in 0·25 kg/month lower maternal weight at 6 months. Interactions were found between household income and full breast-feeding in relation to weight retention at 6, 18 and 36 months, indicating most benefit among women with low income. CONCLUSIONS The present study supports the hypothesis that full breast-feeding contributes to lower postpartum weight retention and shows that the effect is maintained for as long as 3 years postpartum.
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Affiliation(s)
- Martin Brandhagen
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, PO Box 459, SE-405 30 Göteborg, Gothenburg, Sweden
| | - Lauren Lissner
- Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Lise Brantsaeter
- Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Anna-Pia Häggkvist
- Norwegian Resource Centre for Breastfeeding, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Margaretha Haugen
- Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, PO Box 459, SE-405 30 Göteborg, Gothenburg, Sweden
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van der Pligt P, Willcox J, Hesketh KD, Ball K, Wilkinson S, Crawford D, Campbell K. Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth. Obes Rev 2013; 14:792-805. [PMID: 23773448 DOI: 10.1111/obr.12053] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/06/2013] [Accepted: 05/22/2013] [Indexed: 01/21/2023]
Abstract
Postpartum weight retention can predict future weight gain and long-term obesity. Moreover, failure to lose weight gained during pregnancy can lead to increased body mass index for subsequent pregnancies, increasing the risk of adverse maternal and foetal pregnancy outcomes. This systematic review evaluates the effectiveness of lifestyle interventions aimed at reducing postpartum weight retention. Seven electronic databases were searched for intervention studies and trials enrolling women with singleton pregnancies and published in English from January 1990 to October 2012. Studies were included when postpartum weight was a main outcome and when diet and/or exercise and/or weight monitoring were intervention components. No limitations were placed on age, body mass index or parity. Eleven studies were identified as eligible for inclusion in this review, of which 10 were randomized controlled trials. Seven studies were successful in decreasing postpartum weight retention, six of which included both dietary and physical activity components, incorporated via a range of methods and delivered by a variety of health practitioners. Few studies utilized modern technologies as alternatives to traditional face-to-face support and cost-effectiveness was not assessed in any of the studies. These results suggest that postpartum weight loss is achievable, which may form an important component of obesity prevention in mothers; however, the optimal setting, delivery, intervention length and recruitment approach remains unclear.
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Affiliation(s)
- P van der Pligt
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Groth SW, Holland ML, Kitzman H, Meng Y. Gestational weight gain of pregnant African American adolescents affects body mass index 18 years later. J Obstet Gynecol Neonatal Nurs 2013; 42:541-50. [PMID: 24003870 DOI: 10.1111/1552-6909.12230] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine if gestational weight gain (GWG) in adolescents is associated with long-term weight increases 12 years and 18 years after delivery of a first child and the differential effects of weight gain during pregnancy that is inadequate, the appropriate amount, and excessive based on the 2009 Institute of Medicine (IOM) recommendations. DESIGN Secondary data analysis of data from a randomized controlled trial. SETTING Memphis, Tennessee. PARTICIPANTS Two hundred ninety-eight (298) primiparous low-income Black women who were adolescents at the time of their first pregnancies. METHOD Linear regression was used to examine the relationship between body mass index (BMI) at 12 and 18 years postdelivery and GWG, parity, prepregnancy BMI, and smoking. RESULTS The total sample experienced a significant BMI increase from prepregnancy to 12 years and 18 years postdelivery. More than 50% of the women had a BMI increase greater than 10 kg/m(2) . By 18 years postdelivery, 85% were overweight or obese. Prepregnancy BMI and GWG had a positive significant effect on BMI 12 and 18 years later, whereas smoking had a negative effect. Those who gained excessive weight based on the IOM recommendations had a significantly higher BMI compared with those who gained appropriately. CONCLUSION Gestational weight gain had long-term effects on BMI in a minority adolescent population. Excessive pregnancy weight gain is likely to contribute to long-term weight retention, especially if adolescents are overweight or obese when they become pregnant with their first children. Intervention during pregnancy to limit GWG has the potential of limiting long-term negative health consequences that result from overweight and obesity in minority women.
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Knoph C, Holle AV, Zerwas S, Torgersen L, Tambs K, Stoltenberg C, Bulik CM, Reichborn-Kjennerud T. Course and predictors of maternal eating disorders in the postpartum period. Int J Eat Disord 2013; 46:355-68. [PMID: 23307499 PMCID: PMC3622173 DOI: 10.1002/eat.22088] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate course and predictors of eating disorders in the postpartum period. METHOD A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM-IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS-P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum. RESULTS Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS-P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED. DISCUSSION This is the first large-scale population-based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors.
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Affiliation(s)
- Cecilie Knoph
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leila Torgersen
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristian Tambs
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Stoltenberg
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway,Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ted Reichborn-Kjennerud
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway,Department of Psychiatry, University of Oslo, Oslo, Norway
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Siega-Riz AM, Herring AH, Carrier K, Evenson KR, Dole N, Deierlein A. Sociodemographic, perinatal, behavioral, and psychosocial predictors of weight retention at 3 and 12 months postpartum. Obesity (Silver Spring) 2010; 18:1996-2003. [PMID: 20035283 PMCID: PMC2902688 DOI: 10.1038/oby.2009.458] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Postpartum weight retention plays an important role in the pathway leading to obesity among women of childbearing age. The objective of this study was to examine predictors of moderate (1-10 pounds) and high (>10 pounds) postpartum weight retention using data from a prospective pregnancy cohort that followed women into the postpartum period; n = 688 and 550 women at 3 and 12 months, respectively. Analysis included descriptive statistics and predictive modeling using log-binomial techniques. The average weight retained at 3 and 12 months postpartum in this population was 9.4 lb (s.d. = 11.4) and 5.7 lb (s.d. = 13.2), respectively. At 3 months postpartum, prepregnancy weight, gestational weight gain, and hours slept during the night were associated with moderate or high weight retention, whereas having an infant hospitalized after going home and scoring in the upper 75th percentile of the Eating Attitudes Test (EAT) were associated only with high weight retention. At 12 months postpartum, prepregnancy weight, gestational weight gain, and maternal education were associated with moderate weight retention; and gestational weight gain, maternal age, race, employment status, and having an infant hospitalized at birth were associated with high weight retention. The results of this study illustrate the importance of prepregnancy weight and gestational weight gain in predicting postpartum weight retention. Furthermore, given the lack of successful intervention studies that exist to date to help women lose weight in the postpartum period, the results of this study may help to inform future interventions that focus on such aspects as hours of sleep, dealing with stress associated with a hospitalized infant, and nonclinical eating disorder symptomatology.
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Affiliation(s)
- Anna Maria Siega-Riz
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
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