Effect of pre-pregnancy body size on postpartum weight retention

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.

The relationship between body dissatisfaction and postpartum depressive symptoms: A cross-sectional study

BACKGROUND

Women are least satisfied with their bodies during the postpartum period. There is a potential correlation between body dissatisfaction and depressive symptoms post delivery.The aim of this study was to explore the relationship of appearance and body areas satisfaction with depressive symptoms and examine the risk factors of depressive symptoms at 4-6 weeks postpartum.

METHODS

A total of 330 postpartum women participated in the study. Body dissatisfaction was measured using the Appearance Evaluation (AE) scale and Body Areas Satisfaction Scale (BASS), while depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS), 4-6 weeks postpartum.

RESULTS

The prevalence of postpartum depressive symptoms among postpartum women was 40 % while 12.1 % of the women had thoughts of self-harm. Those with depressive symptoms or thoughts of self-harm had lower AE and BASS scores. Body dissatisfaction was significantly associated with factors such as postpartum weight retention of >5 kgs, no exercise, lower education level, and cesarean delivery. The three body areas that women were most dissatisfied with were weight, mid-torso, and lower torso. Education level, delivery method, and BASS score significantly predicted postpartum depressive symptoms.

LIMITATIONS

The selection bias might have occurred if those with depressive symptoms neglected routine postpartum care visits due to emotional distress.

CONCLUSIONS

The results indicate an association between body dissatisfaction and depressive symptoms at 4-6 weeks postpartum. Awareness of this relationship and focus on these risk factors will help healthcare providers plan peripartum programs to decrease the likelihood of postpartum depressive symptoms.

Simulation of 3D Body Shapes for Pregnant and Postpartum Women

Several studies have reported that pre-pregnant women’s body mass index (BMI) affects women’s weight gain with complications during pregnancy and the postpartum weight retention. It is important to control the BMI before, during and after pregnancy. Our objectives are to develop a technique that can compute and visualize 3D body shapes of women during pregnancy and postpartum in various gestational ages, BMI, and postpartum durations. Body changes data from 98 pregnant and 83 postpartum women were collected, tracked for six months, and analyzed to create 3D model shapes. This study allows users to simulate their 3D body shapes in real-time and online, based on weight, height, and gestational age, using multiple linear regression and morphing techniques. To evaluate the results, precision tests were performed on simulated 3D pregnant and postpartum women’s shapes. Additionally, a satisfaction test on the application was conducted on new 149 mothers. The accuracy of the simulation was tested on 75 pregnant and 74 postpartum volunteers in terms of relationships between statistical calculation, simulated 3D models and actual tape measurement of chest, waist, hip, and inseam. Our results can predict accurately the body proportions of pregnant and postpartum women.

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.

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.

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.

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

Excessive Postpartum Weight Retention (PWR) is postulated to increase the risk of adverse health outcomes for mothers and offspring. Using data from the Mother and Infant Nutritional Assessment (MINA) cohort in Lebanon and Qatar, this study aimed to examine PWR and its determinants at 6 months after delivery. Pregnant women (n = 183) were recruited during their first trimester and were followed up through pregnancy and after delivery. During this period, face-to-face interviews as well as extraction from medical charts were conducted to collect data regarding the socioeconomic, anthropometric and dietary intake of participants. The mean PWR (kg) among participants was 3.1 ± 5.6 at delivery, and 3.3 ± 5.3 and 2.7 ± 4.7 at 4 and 6 months after delivery, respectively. Results of the multiple logistic regression analyses showed that a Qatari nationality and excessive GWG were associated with higher odds of a high PWR (above median) while an insufficient GWG had lower odds. After adjustment for energy, participants with a high PWR reported a greater intake of proteins, Trans fat, cholesterol, sodium and lower intakes of mono and polyunsaturated fat as compared to those with a low PWR (below median). These findings suggested priority areas for interventions to prevent excessive PWR amongst women of childbearing age in Lebanon and Qatar.

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.

Maternal body dissatisfaction in pregnancy, postpartum and early parenting: An overlooked factor implicated in maternal and childhood obesity risk

BACKGROUND

Current evidence indicates that to prevent the intergenerational transfer of overweight and obesity from parent to child, interventions are needed across the early life stages, from preconception to early childhood. Maternal body image is an important but often overlooked factor that is potentially implicated in both short- and long-term maternal and child health outcomes, including maternal gestational weight gain, postpartum weight retention, obesity, child feeding practices and early parenting.

AIM

The aim of this paper is to propose a conceptual model of the relationship between maternal body image (with a specific focus on body dissatisfaction) and maternal and child excess body weight risk across the pregnancy, postpartum and early childhood periods, as well as to highlight opportunities for intervention.

CONCLUSION

Our conceptual model proposes factors that mediate the associations between antenatal and postpartum maternal body dissatisfaction and maternal and childhood obesity risk. Pregnancy and postpartum present key risk periods for excess weight gain/retention and body dissatisfaction. Psychosocial factors associated with maternal body dissatisfaction, including psychopathology and disordered eating behaviours, may increase maternal and child obesity risk as well as compromise the quality of mother-child interactions underpinning child development outcomes, including physical weight gain. Our conceptual model may be useful for understanding modifiable psychosocial factors for preventing the intergenerational transfer of obesity risk from mothers to their children, from as early as pregnancy, and highlights next steps for multidisciplinary research focused on combatting maternal and child obesity during critical risk periods.

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.

Postpartum Weight Retention Risk Factors in a Taiwanese Cohort Study

OBJECTIVE

Excess postpartum weight retention (PPWR) is related to long-term weight gain. Therefore, this study was conducted to identify the risk factors for PPWR to provide guidance for preventive strategies.

METHODS

This cohort study surveyed 461 women who gave birth at a medical center between March 2014 and March 2016. The participants completed a questionnaire within 1 month of delivery, and their 6-month postpartum weight was tracked.

RESULTS

The results showed that the mean pre-pregnancy BMI was 21.4 ± 3.3 kg/m2, and the mean gestational weight gain (GWG) was 12.8 ± 4.1 kg. The mean PPWR was 4.6 ± 3.5 kg at 1 month and 2.1 ± 3.3 kg at 6 months. Multivariate analysis revealed that GWG (adjusted OR: 1.92 (1.70-2.17)), pre-pregnancy BMI (adjusted OR: 0.85 (0.77-0.94)), and exclusive breastfeeding (adjusted OR: 0.55 (0.32-0.94)) were significantly correlated with a 1-month PPWR higher than the median value. In addition, GWG (adjusted OR: 1.30 (1.22-1.39)) and exclusive breastfeeding (adjusted OR: 0.37 (0.24-0.58)) were significantly correlated with a 6-month PPWR higher than the median value.

CONCLUSION

Our findings indicate that the key to reducing PPWR is to control GWG and engage in exclusive breastfeeding.

The associations between depressive and anxiety symptoms, body image, and weight in the first year postpartum: a rapid systematic review

OBJECTIVE

The aim of this study was to conduct a rapid systematic review of the evidence of associations between postpartum depressive symptoms, anxiety symptoms, body image and weight status in the first 12 months post birth.

BACKGROUND

The postpartum period places the mother and infant at risk of a number of negative health outcomes. Mental health conditions such as depression and anxiety are common in the postpartum, as are poor body image and excessive weight retention as women adjust to their post pregnancy body. However, the associations between body image, weight status and psychological distress are not currently well understood.

METHODS

Articles in English, published between 2006 and 2017, involving singleton pregnancies of normally developing infants and maternal depression or anxiety were eligible for this systematic review.

RESULTS

From the total of 1805 articles located, 12 were identified as relevant and were subsequently reviewed in full. In the nine studies of depressive symptoms, body image or weight status, four found a significant relationship. Significant associations were not found in the three studies investigating postpartum anxiety symptoms, body image or weight. Body dissatisfaction was associated significantly with poorer postpartum weight status in all nine studies.

CONCLUSIONS

Further research is needed to determine the nature of the relationships between body image, weight status and depressive and anxiety symptoms across the first year after birth. This information will assist health professionals to promote healthy lifestyle behaviours in the postpartum, as well as inform clinical interventions that target behaviour change to prevent the worsening of these issues and related negative outcomes.

[Anthropometric methods used in the evaluation of the postpartum weight retention: a systematic review]

This paper is a systematic review of scientific papers that studied postpartum weight retention. The identification of the studies was conducted in the Medline, Lilacs and Digital Library of Theses and Dissertations databases between 2000 until 2013. The main information evaluated was: author, year of publication, sample size, year of data collection, losses and analysis thereof, age, follow-up time, weight in the baseline and in the postpartum, assessment methods of weight retention and main results. Twenty studies were selected, of which 25% (n = 5) were national. Regarding the mode of analysis, in some works the result was analyzed in different ways as continuous and categorical. Of the selected papers, 45% (n = 9) analyzed the retained weight only continuously, 5% (n = 1) only categorically and 40% (n = 8) both ways. One of the studies used distribution in percentiles and the other evaluated continuously, categorical and by indicators of absolute and relative weight reduction. In conclusion, the results found reveal a lack of well-defined information about the forms of anthropometric measurements of women after delivery, indicating the need for developing national proposals, consistent with the reality of our population.

Associations Among Leisure-Time Physical Activity, Gestational Weight Gain, and Postpartum Weight Retention With Varying Estimates of Prepregnancy Weight

Prospective studies examining postpartum weight retention (PPWR) in relation to the appropriateness of gestational weight gain (GWG) and leisure-time physical activity (LTPA) during pregnancy and postpartum are lacking. While utilizing varying estimates of prepregnancy weight, we sought to prospectively examine associations among the aforementioned variables. Our sample consisted of a subset of women from the Archive for Research on Child Health Study (n = 68). Prepregnancy weight was obtained via questionnaire and birth certificates. GWG (2 estimates) was calculated by subtracting prepregnancy weight estimates from weight at delivery and classified as "excess" or "not excess." Pregnancy and postpartum LTPA were self-reported and dichotomized at recommended levels. Prepregnancy weight estimates were subtracted from self-reported postpartum weight to calculate 2 estimates of PPWR at 6 months. Linear regression was used to examine relationships among GWG and LTPA, and PPWR. Estimates of excess GWG were associated with increased PPWR (mean difference = 3.3-8.9 kg), even after adjustment for prepregnancy body mass index and breastfeeding. Meeting pregnancy and postpartum LTPA recommendations did not significantly predict PPWR. Our findings highlight the importance of encouraging appropriate GWG and provide insight into the impact varying estimates of prepregnancy weight may have when exploring associations among these variables.

Postpartum Weight Retention and Subsequent Pregnancy Outcomes

The effects of postpartum weight retention on gestational weight gain in successive pregnancies require elucidation. The purpose of the study was (1) to examine the association between postpartum weight retention and subsequent adherence to the Institute of Medicine gestational weight gain guidelines and (2) to determine whether the association varies by body mass index status and affects birth outcomes. Florida vital records for 2005-2010 were analyzed using χ tests and multivariable Poisson regression, adjusted for interpregnancy interval, tobacco use, maternal age, and race/ethnicity. Obese women who gained inadequate weight were more likely to retain weight between pregnancies than obese women who met or exceeded the recommended weight gain. Risks for preterm birth increased among women with inadequate weight and decreased among women with excessive weight gain. Gaining excessive weight was protective for small-for-gestational age infants in all body mass index categories but increased the risks for large-for-gestational age infants. Underweight and normal weight women who gained in excess were 40% more likely to develop hypertension than normal weight women who gained within the recommended amount. Obese women who retain or gain weight postpartum are at increased risk for inadequate weight gain in a successive pregnancy. Achieving Institute of Medicine-recommended gestational weight gain is essential for preventing adverse maternal and infant outcomes.

Lifestyle intervention to prevent excessive maternal weight gain: mother and infant follow-up at 12 months postpartum

Background

Excessive gestational weight gain (GWG) is associated with elevated weight retention in mothers and might be related to adiposity of their offspring. Little is known if lifestyle intervention during pregnancy has beneficial effects for mothers and children beyond gestation.

Methods

A cluster-randomized controlled intervention trial was performed with 250 pregnant women in 8 gynaecological practices. Lifestyle intervention was carried out twice with individual counselling sessions on nutrition, physical activity and weight monitoring. Participants in the control group received routine prenatal care and an information leaflet. Follow-up data of women and their offspring were collected one year postpartum (pp) by phone call and/or via e-mail using a structured questionnaire. Maternal weight retention at 12 months pp and weight development of the children in their first year of life was compared between groups using linear regression. The association between energy and macronutrient intake during pregnancy with maternal weight retention and children weight development was also assessed.

Results

The intervention resulted in a trend towards lower mean weight retention 12 months pp (0.2 vs. 0.8 kg), but was not statistically significant (p = 0.321). Among women receiving lifestyle counselling, only 8 % retained more than 5 kg weight while 17 % in the control group retained >5 kg (OR: 0.40 (95 % CI: 0.16, 0.97)). For the whole study cohort, an association between higher GWG and increased 12 month weight retention was found (0.4 kg weight retention per 1 kg increase in GWG, p < 0.001). Weight development of the infants did not differ between groups in the first months after birth. At the 10^th–12^th month weight measurement, infants born to mothers in the intervention group tended towards lower body weights. Both energy intake and macronutrient composition of the diet during pregnancy did not affect maternal weight retention and weight development of the infants.

Conclusions

Lifestyle counselling during pregnancy to avoid GWG had a rather modest effect on maternal pp weight retention and weight development of the infants. However, larger intervention studies and longer follow-up are required to be able to draw definite conclusions.

Trial registration

German Clinical Trials Register DRKS00003801.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-015-0701-2) contains supplementary material, which is available to authorized users.

Patient report of guideline-congruent gestational weight gain advice from prenatal care providers: differences by prepregnancy BMI

BACKGROUND

Prenatal care provider weight gain advice consistent with the Institute of Medicine recommendations is related to guideline-adherent gestational weight gain (GWG), yet many women may not receive guideline-congruent advice. We examined pregnant women's recall of prenatal care provider GWG advice in relation to prepregnancy body mass index (BMI).

METHODS

We conducted a prospective cohort study of women (n = 149) receiving prenatal care for a singleton pregnancy at a large academic medical center in 2010. Data were collected via a survey during late pregnancy and medical record abstraction.

RESULTS

Thirty-three percent of women did not recall receiving the provider GWG advice; 33 percent recalled advice consistent with 2009 Institute of Medicine recommendations. Recalled advice differed by prepregnancy BMI; 29 percent of normal weight, 26 percent of overweight, and 45 percent of obese women reported not receiving advice, and 6, 37, and 39 percent, respectively, recalled advice exceeding Institute of Medicine recommendations. Among the 62 percent who recalled that their provider had labeled their prepregnancy BMI, 100 percent of normal weight, 32 percent of overweight, and 23 percent of obese women recalled the labels "normal weight," "overweight," and "obese," respectively.

CONCLUSIONS

Helping providers give their patients memorable and guideline-consistent GWG advice is an actionable step toward preventing excessive GWG and associated maternal and child health consequences.

Pre-pregnancy BMI, gestational weight gain and postpartum weight retention: a meta-analysis of observational studies

OBJECTIVE

To determine the association of gestational weight gain (GWG) or pre-pregnancy BMI with postpartum weight retention (PPWR).

DESIGN

Meta-analysis.

SETTING

PubMed, Cochrane Controlled Trials Register, EMBASE, Science Citation Index Expanded, Current Contents Connects and Biosis Previews were used to search articles.

SUBJECTS

Publications that described the influence of pre-pregnancy BMI or GWG on PPWR.

RESULTS

Seventeen studies that satisfied the eligibility criteria were included in the analyses. Women with inadequate and excessive GWG had significantly lower mean PPWR of -2·14 kg (95 % CI -2·43, -1·85 kg) and higher PPWR of 3·21 kg (95 % CI 2·79, 3·62 kg), respectively, than women with adequate GWG. When postpartum time spans were stratified into 1-3 months, 3-6 months, 6-12 months, 12-36 months and ≥15 years, the association between inadequate GWG and PPWR faded over time and became insignificant (-1·42 kg; 95 % CI -3·08, 0·24 kg) after ≥15 years. However, PPWR in women with excess GWG exhibited a U-shaped trend; that is, a decline during the early postpartum time span (year 1) and then an increase in the following period. Meta-analysis of qualitative studies showed a significant relationship between excessive GWG and higher PPWR risk (OR=2·08; 95 % CI 1·60, 2·70). Moreover, meta-analysis of pre-pregnancy BMI on PPWR indicated that mean PPWR decreased with increasing BMI group.

CONCLUSIONS

These findings suggest that GWG, rather than pre-pregnancy BMI, determines the shorter- or longer-term PPWR.

The impact of sleep, stress, and depression on postpartum weight retention: a systematic review

OBJECTIVE

To review the impact of sleep, stress, and/or depression on postpartum weight retention.

METHODS

We searched three electronic databases, PubMed, ISI Web of Science, and PsycInfo. Studies were included if they were published between January 1990 and September 2013 in English, measured sleep, stress, and/or depression in the postpartum period, and assessed the association of these factors with postpartum weight retention. Two reviewers reviewed included articles and rated study quality using a modified version of the Downs and Black scale.

RESULTS

Thirteen studies met our pre-defined eligibility criteria, reporting on 9 study samples. Two were cross-sectional studies and eleven were longitudinal studies. The study sample size ranged from 74 to 37,127. All four studies examining short sleep duration and postpartum weight retention reported a positive association. The four studies examining postpartum stress and weight retention reported non-significant associations only. Of 7 studies examining postpartum depression and weight retention, 3 reported non-significant associations, and 4 reported positive associations.

CONCLUSION

Research investigating the impact of postpartum sleep, stress, depression on weight retention is limited. Future longitudinal studies are needed.

Body weight, body image and primary postpartum haemorrhage: a review of the literature

The prevalence of obesity during pregnancy is rising. Elevated BMI is a significant risk factor for adverse maternal and fetal outcomes, including primary postpartum haemorrhage (PPH). Addressing the issues surrounding obesity in pregnancy presents many biological, social and psychological challenges. BMI is an easily measured and modifiable anthropometrical risk factor and should be recorded in all pregnancies. BMI should be proactively managed prior to and during pregnancy. All women should be educated as to the risks of an elevated BMI during pregnancy and those at risk should have access to specialist medical and surgical support if required. Our aim was to investigate the associations between elevated BMI and adverse maternal and fetal outcomes including PPH, and to explore the psychological challenges of having an elevated BMI during pregnancy.

Relationship between body mass index and women’s body image, self-esteem and eating behaviours in pregnancy: A cross-cultural study

This study examined the relationship between self-esteem, restrained eating, body image and body mass index during pregnancy. A total of 110 pregnant Israeli and UK women completed the Rosenberg Self-Esteem Questionnaire, the Dutch Eating Behaviour Questionnaire, scales to assess body image and demographics. Body mass index was calculated from antenatal records. Regression modelling determined the relationship between variables, countries and body mass index categories. High correlations were found between body image and body mass index with significantly higher body dissatisfaction for Israeli women. Self-esteem scores for pregnant women were similar to those reported for non-pregnant women. Poorer body image and higher prevalence of restrained eating were found in healthy weight Israeli women.

Postpartum Weight Self-Management: A Concept Analysis

Aim: The aim of this concept analysis is to create a clear definition and framework to guide weight self-management research and promotion of healthy weight self-management during the postpartum period. Background: A woman’s ability to manage her weight through the postpartum transition has lifelong implications for her weight status. Methods: This concept analysis was guided by Walker and Avant (2005). A broad search of sources was performed, yielding 56 articles in which postpartum weight self-management was the main focus. Results: From consideration of the attributes of postpartum weight self-management, a descriptive, situation-specific theory emerged: Postpartum weight self-management is a process by which the transition to motherhood is viewed by the woman as an opportunity to intentionally engage in healthy weight self-management behaviors by minimizing the salient inhibitors and maximizing the salient facilitators to action. Conclusion: This analysis provides a clarification of the process concept of postpartum weight self-management and its consequences, giving direction for measurement, clinical application, and further research. Future nursing interventions and research should be aimed at helping women to view the postpartum period as a normative transition in which they have the opportunity to take charge of their own health and the health of their family.

Gestational weight gain within recommended ranges in consecutive pregnancies: a retrospective cohort study

OBJECTIVE

to examine whether, among parous women, adherence to gestational weight gain (GWG) recommendations in the most recent previous pregnancy is associated with adherence to GWG recommendations in the current pregnancy.

DESIGN

retrospective cohort study.

SETTING

review of labour and delivery records from a Massachusetts tertiary-care centre.

PARTICIPANTS

1,325 women who delivered two consecutive singletons from April 2006 to March 2010.

MEASUREMENTS

pre-pregnancy weight status and adherence to GWG recommendations were categorised using 1990 Institute of Medicine (IOM) guidelines. Analyses were stratified by weight status before the second pregnancy.

FINDINGS

56% and 46% of women gained more than 1990 IOM recommendations during the first and second of consecutive pregnancies; 57% gained within the same adherence category in both pregnancies. Excessive GWG during the first pregnancy was strongly associated with excessive gain during the second pregnancy (adjusted odds ratio [AOR]=5.4 [95% CI: 1.7-16.4] for underweight, 3.7 [95% CI: 2.4-5.5] for normal weight, 3.0 [95% CI: 1.2-7.6] for overweight, and 5.3 [95% CI: 2.4-11.7] for obese women). Inadequate gain in the first of consecutive pregnancies was strongly associated with subsequent inadequate GWG for underweight women (AOR=13.7; 95% CI: 3.9-48.0), normal weight women (AOR=2.9; 95% CI: 1.7-5.1), and obese women (AOR=3.6; 95% CI: 1.4-9.3). Results were similar in sensitivity analyses using IOM 2009 guidelines.

KEY CONCLUSIONS

adherence to GWG recommendations in consecutive pregnancies is highly concordant.

IMPLICATIONS FOR PRACTICE

consideration of GWG during previous pregnancies may facilitate discussions about GWG during prenatal care.

Gestational weight gain and long-term postpartum weight retention: a meta-analysis

BACKGROUND

Gestational weight gain (GWG) is known to be a potential risk factor for short-term postpartum weight retention (PPWR) and thus for overweight in women. Does GWG also determine the long-term risk of overweight in women?

OBJECTIVE

We aimed to study the short- and long-term effects of GWG in accordance with the Institute of Medicine (IOM) recommendations on postpartum weight retention.

DESIGN

We systematically reviewed 5 databases and bibliographies of various publications supplemented by hand search for relevant articles published in English or German and performed meta-analyses to quantify the effect estimate of PPWR by using a random-effects model. We split the data into 4 categories of follow-up: <0.5, 0.5-1, ∼3, and ≥15 y.

RESULTS

Of 1770 search hits, 9 observational studies remained suitable for the analysis. PPWR increased after longer time spans after delivery irrespective of whether GWG had been below, within, or above the guidelines. Compared with women with GWG within the recommendations, those with a GWG above the recommendations retained an additional 3.06 kg (95% CI: 1.50, 4.63 kg) after 3 y and 4.72 kg (95% CI: 2.94, 6.50 kg) on average after ≥15 y postpartum. Inadequate GWG was associated with less PPWR (-2.99 kg; 95% CI: -3.72, -2.27 kg) <6 mo after pregnancy. This association faded over time and became nonsignificant (-1.41 kg; 95% CI: -3.03, 0.21 kg) after ≥15 y. The results remained stable in sensitivity analyses that accounted for changes in IOM criteria over time and potential effect modification by low social class. A funnel plot did not suggest publication bias.

CONCLUSION

GWG in accordance with the IOM recommendations is associated with long-term effects on PPWR.

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

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

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

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