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Gallagher D, Spyreli E, Anderson AS, Bridges S, Cardwell CR, Coulman E, Dombrowski SU, Free C, Heaney S, Hoddinott P, Kee F, McDowell C, McIntosh E, Woodside JV, McKinley MC. Effectiveness and cost-effectiveness of a 12-month automated text message intervention for weight management in postpartum women with overweight or obesity: protocol for the Supporting MumS (SMS) multisite, parallel-group, randomised controlled trial. BMJ Open 2024; 14:e084075. [PMID: 38719295 PMCID: PMC11086389 DOI: 10.1136/bmjopen-2024-084075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The reproductive years can increase women's weight-related risk. Evidence for effective postpartum weight management interventions is lacking and engaging women during this life stage is challenging. Following a promising pilot evaluation of the Supporting MumS intervention, we assess if theory-based and bidirectional text messages to support diet and physical activity behaviour change for weight loss and weight loss maintenance, are effective and cost-effective for weight change in postpartum women with overweight or obesity, compared with an active control arm receiving text messages on child health and development. METHODS AND ANALYSIS Two-arm, parallel-group, assessor-blind randomised controlled trial with cost-effectiveness and process evaluations. Women (n=888) with body mass index (BMI) ≥25 kg/m2 and within 24 months of giving birth were recruited via community and National Health Service pathways through five UK sites targeting areas of ethnic and socioeconomic diversity. Women were 1:1 randomised to the intervention or active control groups, each receiving automated text messages for 12 months. Data are collected at 0, 6, 12 and 24 months. The primary outcome is weight change at 12 months from baseline, compared between groups. Secondary outcomes include weight change (24 months) and waist circumference (cm), proportional weight gain (>5 kg), BMI (kg/m2), dietary intake, physical activity, infant feeding and mental health (6, 12 and 24 months, respectively). Economic evaluation examines health service usage and personal expenditure, health-related quality of life and capability well-being to assess cost-effectiveness over the trial and modelled lifetime. Cost-utility analysis examines cost per quality-adjusted life-years gained over 24 months. Mixed-method process evaluation explores participants' experiences and contextual factors impacting outcomes and implementation. Stakeholder interviews examine scale-up and implementation. ETHICS AND DISSEMINATION Ethical approval was obtained before data collection (West of Scotland Research Ethics Service Research Ethics Committee (REC) 4 22/WS/0003). Results will be published via a range of outputs and audiences. TRIAL REGISTRATION NUMBER ISRCTN16299220.
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Affiliation(s)
- Dunla Gallagher
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Eleni Spyreli
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Ninewells Medical School, Dundee, UK
| | - Sally Bridges
- Bradford Institute for Health Research, Bradford, UK
| | | | - Elinor Coulman
- Centre for Trials Research (CTR), Cardiff University School of Medicine, Cardiff, UK
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Caroline Free
- Public Health Interventions Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzie Heaney
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Krukowski RA, Solomon E, Lang J, Stone E, You W, Burns RE, Copeland C, Bursac Z, Hare ME, Waters TM. Overweight/obesity, gestational weight gain, postpartum weight retention, and maternal/neonatal complications in the military. Obesity (Silver Spring) 2024; 32:900-910. [PMID: 38650523 DOI: 10.1002/oby.24016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The objective of this study was to examine the prevalence of overweight/obesity and excessive gestational weight gain (GWG) among military beneficiaries and to assess associations of these risk factors with maternal/neonatal complications and substantial postpartum weight retention (PPWR). METHODS We obtained data for 48,391 TRICARE beneficiaries who gave birth in 2018 or 2019 in the United States. We used logistic regression and ANOVA to examine relationships among overweight/obesity, GWG, maternal/neonatal complications, and substantial PPWR. RESULTS Most TRICARE beneficiaries (75%) had excessive GWG, and 42% had substantial PPWR. Dependents were less likely than active-duty women to have excessive GWG (odds ratio [OR] = 0.73, 95% CI: 0.60-0.88). Women with excessive GWG were three times more likely to have substantial PPWR (OR = 3.57, 95% CI: 3.14-4.06). Those with excessive GWG were more likely to have maternal/neonatal complications (e.g., pregnancy-induced hypertension, cesarean delivery). CONCLUSIONS Excessive GWG is frequent among TRICARE beneficiaries, particularly active-duty personnel, and is strongly associated with costly maternal/neonatal complications. Substantial PPWR is also common in this population, with excessive GWG as a key risk factor.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Erin Solomon
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Juan Lang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | | | - Wen You
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rosemary Estevez Burns
- 59th Medical Wing, Clinical Health Psychology, Joint Base San Antonio, Lackland, Texas, USA
| | - Carol Copeland
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- 59th Medical Wing, Clinical Health Psychology, Joint Base San Antonio, Lackland, Texas, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Teresa M Waters
- Augusta University, Institute for Public and Preventive Health, Augusta, Georgia, USA
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Hall WL. Long chain n-3 polyunsaturated fatty acid intake across the life span for cardiovascular disease prevention in women. Proc Nutr Soc 2024:1-12. [PMID: 38444046 DOI: 10.1017/s0029665124000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Cardiovascular diseases (CVDs) are a major health concern for women. Historically there has been a misconception that men are at greater risk because CVD tends to occur earlier in life compared to women. Clinical guidelines for prevention of heart disease are currently the same for both sexes, but accumulating evidence demonstrates that risk profiles diverge. In fact, several CVD risk factors confer an even greater risk in women relative to men, including high blood pressure, obesity, diabetes and raised triglycerides. Furthermore, many female-specific CVD risk factors exist, including early menarche, pregnancy complications, polycystic ovary syndrome, reproductive hormonal treatments and menopause. Little is known about how diet interacts with CVD risk factors at various stages of a woman’s life. Long chain (LC) n-3 polyunsaturated fatty acid (PUFA) intakes are a key dietary factor that may impact risk of CVD throughout the life course differentially in men and women. Oestrogen enhances conversion of the plant n-3 PUFA, alpha-linolenic acid, to LCn-3 PUFA. Increasing the frequency of oily fish consumption or LCn-3 PUFA supplementation may be important for reducing coronary risk during the menopausal transition, during which time oestrogen levels decline and the increase in CVD risk factors is accelerated. Women are under-represented in the evidence base for CVD prevention following LC n-3 PUFA supplementation. Therefore it is not clear whether there are sex differences in response to treatment. Furthermore, there is a lack of evidence on optimal intakes of LC n-3 PUFA across the lifespan for CVD prevention in women.
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Affiliation(s)
- Wendy Louise Hall
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Heidari Dehui P, Negarandeh R, Pashaeypoor S. Weight Management Challenges in Nulliparous Women Being Overweight or Obese Due to Pregnancy: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:190-200. [PMID: 37489224 PMCID: PMC10363267 DOI: 10.30476/ijcbnm.2023.97714.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
Background Getting overweight after pregnancy is a common phenomenon and getting back to pre-pregnancy weight in the postpartum period is a major concern for mothers. This study aimed to explain the challenges in performing post-pregnancy weight-management behaviors in nulliparous women being overweight and obese due to pregnancy. Methods The present qualitative study was conducted with the conventional qualitative content analysis method based on Granheim and Landman's approach from October to December in 2021. In this study, participants were 15 women who referred to comprehensive health service centers in Tehran, Iran; they were purposefully selected according to the inclusion criteria. Data were collected through individual, in-depth, and semi-structured face-to-face interviews and simultaneously analyzed using the MAXQ Data version 10 software. Results The mean age of the participants was 25.93±3.21 years. Data analysis resulted in three main categories: 1) failure to adhere to calorie-restricted diets, 2) inability to engage in physical activity, and 3) lack of adequate social support. Conclusion Women with obesity due to pregnancy face many challenges to improve their weight-control behaviors. As such, improving healthy behaviors not only requires relevant stakeholders' commitment, but also demands women, their families and communities' intention to engage in healthy behaviors.
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Affiliation(s)
- Pooran Heidari Dehui
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahzad Pashaeypoor
- Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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O’Hara H, Taylor J, Woodside JV. The Association of Specific Dietary Patterns with Cardiometabolic Outcomes in Women with a History of Gestational Diabetes Mellitus: A Scoping Review. Nutrients 2023; 15:nu15071613. [PMID: 37049454 PMCID: PMC10097232 DOI: 10.3390/nu15071613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Gestational diabetes mellitus is associated with a significantly increased risk of later type 2 diabetes (T2DM) and cardiovascular disease (CVD). Post-natal interventions aim to reduce this risk by addressing diet and lifestyle factors and frequently focus on restricting energy or macronutrient intake. With increased interest in the role of complete dietary patterns in the prevention of cardiometabolic disease, we sought to evaluate what is known about the role of dietary patterns in reducing cardiometabolic risk in women with previous GDM. A systematic search was conducted to identify studies relating to dietary pattern and cardiometabolic parameters in women with a history of GDM. The search criteria returned 6014 individual studies. In total, 71 full texts were reviewed, with 24 studies included in the final review. Eleven individual dietary patterns were identified, with the Alternative Health Eating Index (AHEI), Mediterranean diet (MD), and low glycaemic index (GI) as the most commonly featured dietary patterns. Relevant reported outcomes included incident T2DM and glucose tolerance parameters, as well as several cardiovascular risk factors. Dietary patterns which have previously been extensively demonstrated to reduce the risk of cardiovascular and metabolic disorders in the general population, including AHEI, MD, and DASH, were found to be associated with a reduction in the incidence of T2DM, hypertension, and additional risk factors for cardiometabolic disease in women with a history of GDM. Notable gaps in the literature were identified, including the relationship between dietary patterns and incident CVD, as well as the relationship between a low GI diet and the development of T2DM in this population.
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Lohr AN, Hoppe KK, Mei CC, Antony KM. Does Daily Self-Weighing Contribute to Postpartum Weight Loss? A Secondary Analysis of Daily Postpartum Weights among Women with Hypertensive Disorders of Pregnancy. Am J Perinatol 2023; 40:319-325. [PMID: 33902132 PMCID: PMC11073857 DOI: 10.1055/s-0041-1727217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study was aimed to examine the impact of daily self-weighing via remote monitoring on postpartum weight loss. STUDY DESIGN This was a secondary analysis of a nonrandomized controlled trial comprised of postpartum women with diagnosed hypertensive-related disorders in pregnancy who received a tablet device linked to Bluetooth-enabled equipment including a scale and blood pressure cuff. In addition to blood pressure monitoring, participants were instructed to perform daily self-weighing. The primary outcome of this study was to determine whether postpartum women who performed daily self-weighing lost more weight than those who did not, with a 42-day endpoint based on a 6-week postpartum visit weight. RESULTS Overall, 214 women participated in this program and 214 received usual care. Median weight loss for women participating in the remote blood pressure monitoring system was 23.0 (interquartile range [IQR]: 17-30) pounds versus 23.0 (IQR: 17-29) pounds among controls. Weight loss did not vary by prepregnancy obesity (median: 20 pounds [IQR: 17-28 pounds] for nonobese and 23 [IQR: 17-30] pounds for women with obesity, p = 0.16). Women who weighed themselves more than half of follow-up days lost a median of 24 pounds (IQR: 17-30 pounds) compared with 20.5 pounds (IQR: 14-29 pounds), p = 0.06. Women who weighed themselves more than half of follow-up days lost a mean of 11.4% (standard deviation [SD] = 0.41%) of body weight compared with 9.1% (SD = 0.74%; p = 0.01). The amount of weight loss in the telehealth group was correlated with the number of daily weights performed (Pearson's correlation coefficient 0.164, p = 0.025). Postpartum weight loss for daily self-weighing participants was most notable in the first 2 weeks with ongoing weight loss up to the 42-day (6-week) endpoint of this secondary analysis. CONCLUSION Daily self-weighing alone may be insufficient to promote postpartum weight loss. However, there was a slight trend toward more weight loss with more frequent weighing. KEY POINTS · Daily self-weighing is insufficient for postpartum weight loss.. · Women who weighed themselves more lost slightly more weight.. · Weight loss was the most notable in the first 2 weeks.. · Its use as one part of a program may be worth studying..
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Affiliation(s)
- Ali N Lohr
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
| | - Kara K Hoppe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
| | - Chaoqun C Mei
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Kathleen M Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin Madison, Madison, Wisconsin
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Foster SF, Vazquez C, Cubbin C, Nichols AR, Rickman RR, Widen EM. Breastfeeding, socioeconomic status, and long-term postpartum weight retention. Int Breastfeed J 2023; 18:1. [PMID: 36600252 PMCID: PMC9814482 DOI: 10.1186/s13006-022-00534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/18/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Almost half of all pregnant women in the United States gain weight above Institute of Medicine gestational weight gain guidelines. Breastfeeding has been shown to reduce weight retention in the first year postpartum; however, women with lower socioeconomic status (SES) tend to initiate breastfeeding less often than women with higher SES. We investigated associations between duration of breastfeeding with mother's long-term postpartum weight status at 4-10 years and evaluated whether the associations varied by SES. METHODS Maternal and infant dyads (N = 2144 dyads) are from the Geographic Research on Wellbeing survey (GROW), 2012-2013, a long-term, cross-sectional follow-up of the Maternal and Infant Health Assessment (MIHA) based in California, USA. Pre-pregnancy body mass index (BMI) was obtained from self-report of height and weight during MIHA, while breastfeeding history and self-report of current body weight was collected at the 4-10 year GROW postpartum visit. SES score was derived from a composite score of percent federal poverty level and education and was dichotomized into High and Low SES groups at a score of three. Multivariable linear regression was used to examine association between breastfeeding and maternal weight status, and to examine for effect modification by SES. RESULTS Average long-term weight retention 4-10 years postpartum was 4.0 kg. Fewer lower SES vs. higher SES women breast fed at least six months (51% versus 70%, p < .001) or ever breastfed (74% versus 89%, P < .001). Women who breastfed at least six months had lower long-term postpartum weight retention compared to those who did not (b = -1.06 kg, (-1.93, 0.25); p = 0.01); however, these association did not vary by SES. CONCLUSION Six months of breastfeeding is associated with lower BMI at 4-10 years and lower body weight, and effects do not vary by SES. Future policies and guidelines should consider building an infrastructure that is supportive of longer breastfeeding duration. Moreover, further research is needed to identify the impact of additional behavioral and environmental factors on long-term maternal weight status. Understanding the drivers of excessive weight retention pospartum can help us not only improve the pregnant person's health but the health of their children.
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Affiliation(s)
- Saralyn F. Foster
- grid.89336.370000 0004 1936 9924Department of Nutritional Sciences, The University of Texas at Austin, 200 W. 24th Street, A2703, Austin, United States
| | - Christian Vazquez
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, United States ,grid.267315.40000 0001 2181 9515School of Social Work, The University of Texas at Arlington, 211 S Cooper St Arlington, Arlington, United States
| | - Catherine Cubbin
- grid.89336.370000 0004 1936 9924Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, United States ,grid.89336.370000 0004 1936 9924Departments of Population Health and Health Social Work, Dell Medical School, The University of Texas at Austin, 1601 Trinity Street, Austin, United States
| | - Amy R. Nichols
- grid.89336.370000 0004 1936 9924Department of Nutritional Sciences, The University of Texas at Austin, 200 W. 24th Street, A2703, Austin, United States
| | - Rachel R. Rickman
- grid.89336.370000 0004 1936 9924Department of Nutritional Sciences, The University of Texas at Austin, 200 W. 24th Street, A2703, Austin, United States
| | - Elizabeth M. Widen
- grid.89336.370000 0004 1936 9924Department of Nutritional Sciences, The University of Texas at Austin, 200 W. 24th Street, A2703, Austin, United States ,grid.89336.370000 0004 1936 9924Departments of Women’s Health & Pediatrics, Dell Pediatric Research Institute, The University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, United States
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Kent-Marvick J, Cloyes KG, Meek P, Simonsen S. Racial and ethnic disparities in postpartum weight retention: A narrative review mapping the literature to the National Institute on Minority Health and Health Disparities Research Framework. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231166822. [PMID: 37082834 PMCID: PMC10126608 DOI: 10.1177/17455057231166822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 04/22/2023]
Abstract
PLAIN LANGUAGE SUMMARY A Review of the Literature Using the National Institutes of Health, National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to Create a Roadmap of the Studies Investigating Racial and Ethnic Disparities in Excess Weight Retained After Pregnancy. WHY WAS THIS STUDY DONE? Three out of four people who give birth retain excess weight at 1-year post-pregnancy. This is concerning, as weight that is retained following pregnancy is associated with increased risk for the development of disease. People from racial and ethnic minority groups experience weight retention more frequently post-pregnancy. Black and Hispanic/Latina/o/x birthing people are more likely to begin pregnancy overweight or obese. They are also more likely to retain excess weight following pregnancy. Investigating these risks in people from racially/ethnically diverse backgrounds may be an important way to address disparities in excess weight retained post-pregnancy. WHAT DID THE RESEARCHERS DO? This review of the literature used a tool called the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to map the literature to date on racial and ethnic disparities in excess weight retained post-pregnancy. WHAT DID THE RESEARCHERS FIND? We used the NIMHD Research Framework as a visual guide of the existing research about excess weight retained following pregnancy. Results illustrate the levels and domains at which research has been investigated. These results reveal that efforts have been focused at the individual level, with most attention given to diet and activity. Mapping the literature to the NIMHD Research Framework sheds light on gaps in the research. WHAT DO THE FINDINGS MEAN? Mapping the literature has revealed a need for investigations that make connections between the levels and domains of the Framework, so that we may understand underlying factors that contribute to health disparities.
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Affiliation(s)
| | - Kristin G Cloyes
- College of Nursing, University of Utah, Salt Lake City, UT, USA
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Paula Meek
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sara Simonsen
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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The importance of sleep and parity in understanding changes in weight and breastfeeding behavior among postpartum women. Appetite 2021; 170:105889. [PMID: 34954303 DOI: 10.1016/j.appet.2021.105889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Breastfeeding duration has been linked with the health of both women and their children, but research that considers women's weight change postpartum and practical factors that may impact their quality of life (i.e., sleep quantity, number of children) is limited. METHOD A survey was administered to 568 women (M age = 31.32 years; SD = 4.21) who had given birth within the past year. The survey included assessments of pre- and post-pregnancy weight and height, breastfeeding practices, current sleep quantity, presence of breastfeeding-specific support, and other demographics including their total number of children. RESULTS Greater pre-pregnancy to postpartum weight increase was related to shorter duration of breastfeeding. Mothers who exclusively breastfed for the first six months had less postpartum weight increase (i.e., the discrepancy between their pre-pregnancy and post-pregnancy weight was smaller) than those who did not. Fewer children and greater hours of sleep were significantly associated with longer duration of breastfeeding. Sleep partially accounted for the relationship between body mass index change and breastfeeding duration. Breastfeeding-specific support did not impact the effect of low sleep on shorter breastfeeding duration. CONCLUSIONS Duration of breastfeeding may suffer due to fatigue. Sleep plays a key role in understanding the ways in which weight change impact breastfeeding behavior. Greater holistic support for mothers in the postpartum period is needed to foster an environment that encourages breastfeeding.
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Kaur D, Malhotra A, Ranjan P, Chopra S, Kumari A, Vikram NK. Weight management in postpartum women - An Indian perspective. Diabetes Metab Syndr 2021; 15:102291. [PMID: 34598009 DOI: 10.1016/j.dsx.2021.102291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS This narrative review is intended to present an evidence and opinion-based weight management module for Indian postpartum women to be used by clinicians. MATERIAL AND METHODS Electronic databases such as PubMed and Google Scholar were accessed to extract relevant studies to derive evidence-based information. The reference list of the extracted studies was also checked to obtain further relevant articles. The opinion-based information was achieved from the consensus among the gynaecologists, nutritionists and doctors from Medicine according to their practical experiences in real time. In this review, we have used the term "postpartum" to represent the time period of two years after delivery. RESULTS A postpartum weight management module consisting of information about diet, physical activity, sleep and breastfeeding was devised to be used in regular clinical practice, particularly in the Indian settings. CONCLUSION Postpartum women deal with various unique challenges as compared to other population groups. Individualised weight management strategies should be adopted to facilitate sustainable postpartum weight management.
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Affiliation(s)
- Divjyot Kaur
- Department of Home Science, University of Delhi, India
| | - Anita Malhotra
- Department of Home Science, Lakshmibai College, University of Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Sakshi Chopra
- Department of Home Science, University of Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Daley AJ, Jolly K, Ives N, Jebb SA, Tearne S, Greenfield SM, Yardley L, Little P, Tyldesley-Marshall N, Bensoussane H, Pritchett RV, Frew E, Parretti HM. Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT. Health Technol Assess 2021; 25:1-130. [PMID: 34382932 DOI: 10.3310/hta25490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies. OBJECTIVE The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable. DESIGN The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up. SETTING The trial took place in Birmingham, UK. PARTICIPANTS Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed. INTERVENTIONS The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet. MAIN OUTCOME MEASURES The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight. LIMITATIONS Fewer participants were recruited than planned. CONCLUSIONS Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention. FUTURE WORK Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN12209332. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK.,Department of Psychology, University of Southampton, Southampton, UK
| | - Paul Little
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Hannah Bensoussane
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ruth V Pritchett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen M Parretti
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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12
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Kirkegaard H, Bliddal M, Støvring H, Rasmussen KM, Gunderson EP, Køber L, Sørensen TIA, Nøhr EA. Maternal weight change from prepregnancy to 18 months postpartum and subsequent risk of hypertension and cardiovascular disease in Danish women: A cohort study. PLoS Med 2021; 18:e1003486. [PMID: 33798198 PMCID: PMC8051762 DOI: 10.1371/journal.pmed.1003486] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/16/2021] [Accepted: 03/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND One-fourth of women experience substantially higher weight years after childbirth. We examined weight change from prepregnancy to 18 months postpartum according to subsequent maternal risk of hypertension and cardiovascular disease (CVD). METHODS AND FINDINGS We conducted a cohort study of 47,966 women with a live-born singleton within the Danish National Birth Cohort (DNBC; 1997-2002). Interviews during pregnancy and 6 and 18 months postpartum provided information on height, gestational weight gain (GWG), postpartum weights, and maternal characteristics. Information on pregnancy complications, incident hypertension, and CVD was obtained from the National Patient Register. Using Cox regression, we estimated adjusted hazard ratios (HRs; 95% confidence interval [CI]) for hypertension and CVD through 16 years of follow-up. During this period, 2,011 women were diagnosed at the hospital with hypertension and 1,321 with CVD. The women were on average 32.3 years old (range 18.0-49.2) at start of follow-up, 73% had a prepregnancy BMI <25, and 27% a prepregnancy BMI ≥25. Compared with a stable weight (±1 BMI unit), weight gains from prepregnancy to 18 months postpartum of >1-2 and >2 BMI units were associated with 25% (10%-42%), P = 0.001 and 31% (14%-52%), P < 0.001 higher risks of hypertension, respectively. These risks were similar whether weight gain presented postpartum weight retention or a new gain from 6 months to 18 months postpartum and whether GWG was below, within, or above the recommendations. For CVD, findings differed according to prepregnancy BMI. In women with normal-/underweight, weight gain >2 BMI units and weight loss >1 BMI unit were associated with 48% (17%-87%), P = 0.001 and 28% (6%-55%), P = 0.01 higher risks of CVD, respectively. Further, weight loss >1 BMI unit combined with a GWG below recommended was associated with a 70% (24%-135%), P = 0.001 higher risk of CVD. No such increased risks were observed among women with overweight/obesity (interaction by prepregnancy BMI, P = 0.01, 0.03, and 0.03, respectively). The limitations of this observational study include potential confounding by prepregnancy metabolic health and self-reported maternal weights, which may lead to some misclassification. CONCLUSIONS Postpartum weight retention/new gain in all mothers and postpartum weight loss in mothers with normal-/underweight may be associated with later adverse cardiovascular health.
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Affiliation(s)
- Helene Kirkegaard
- Research Unit of Obstetrics and Gynecology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Mette Bliddal
- Open Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Henrik Støvring
- Department of Public Health, Biostatistics, Aarhus University, Aarhus, Denmark
| | - Kathleen M. Rasmussen
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Erica P. Gunderson
- Division of Research, Cardiovascular and Metabolic Conditions Section, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Thorkild I. A. Sørensen
- Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ellen A. Nøhr
- Research Unit of Obstetrics and Gynecology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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13
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Toro-Ramos T, Heaner M, Yang Q, DeLuca L, Behr H, Reynolds K, Kim Y, Michaelides A. Postpartum Weight Retention: A Retrospective Data Analysis Measuring Weight Loss and Program Engagement with a Mobile Health Program. J Womens Health (Larchmt) 2021; 30:1645-1652. [PMID: 33481655 DOI: 10.1089/jwh.2020.8584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Mobile health (mHealth) technology can circumvent barriers to participation in weight loss programs faced by new mothers. The objective of this study was to assess weight change and program engagement in postpartum women (n = 130) participating in a 24-week behavior change mHealth weight-loss intervention. Materials and Methods: Participants were recruited through a program offered on a commercial mHealth application that provided evidence-based lifestyle interventions. To meet inclusion criteria, women had to be 18-45 years of age, and given birth within 2 years before the start of the study. Participants signed up for the Noom Healthy Weight program between January and March of 2019 and were offered the program free of charge. Linear mixed models were conducted; the primary outcome was weight change from baseline at 16 and 24 weeks. Secondary outcomes were program engagement and their relationship with completion status. Results: Results showed that time was a significant predictor of weight at week 16 [t(-3.94) = -9.40; p < 0.001] and week 24 [t(-4.08) = -9.74; p < 0.001]; users lost 3.94 kgs at week 16 and 4.08 kgs at week 24, compared with baseline. In addition, body mass index significantly decreased at week 24 [t(112) = 7.33, p < 0.0001] with the majority of participants (80%) experiencing reductions by more than 2 units. On average, subjects who completed the program (completers) lost more weight compared with those who did not complete the program [t(-5.09) = -2.94; p = 0.004], losing 5.09 kgs (95% CI -8.48 to -1.69) throughout the 24 weeks. Conclusion: This cohort study shows that a uniquely mobile, behavior change intervention for weight management is effective at producing significant weight loss with potential to address postpartum weight retention.
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Affiliation(s)
- Tatiana Toro-Ramos
- Noom, Inc., New York, New York, USA
- Project Management, Seed Health, Venice, California, USA
| | - Martica Heaner
- Nutrition Department, School of Urban Public Health, Hunter College, New York, New York USA
| | - Qiuchen Yang
- Clinical Research, Noom, Inc., New York, New York, USA
| | - Laura DeLuca
- Clinical Research, Noom, Inc., New York, New York, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Heather Behr
- Clinical Research, Noom, Inc., New York, New York, USA
| | | | - Youngin Kim
- Clinical Research, Noom, Inc., New York, New York, USA
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine Seoul, Seoul, South Korea
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14
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Flores TR, Nunes BP, Miranda VIA, Silveira MFD, Domingues MR, Bertoldi AD. [Gestational weight gain and postpartum weight retention: data from the 2015 birth cohort in Pelotas, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2020; 36:e00203619. [PMID: 33237206 DOI: 10.1590/0102-311x00203619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/14/2020] [Indexed: 11/22/2022] Open
Abstract
The study's objectives were to describe the prevalence of gestational weight gain and weight retention at 3 and 12 months postpartum and to identify possible socioeconomic inequalities in adequate gestational weight gain. A longitudinal study was performed with data from the 2015 Pelotas, Rio Grande do Sul State, Brazil, birth cohort. Gestational weight gain was classified according to the US Institute of Medicine guidelines. Weight retention at 3 and 12 months was calculated according to the mother's weight at each period, subtracting pregestational weight. To identify possible inequalities, the study used Slope Index (SII) and Concentration Index (CIX). The sample included mothers with information on the study's outcome (n = 4,102). Prevalence of adequate gestational weight gain was 33.5% (95% confidence interval - 95%CI: 32.1; 35.0). Slight inequalities were observed in the prevalence of adequate weight gain in mothers with less schooling [CIX = 1.88 (95%CI: -0.76; 4.52); SII = 4.27 (95%CI: -0.87; 9.41)] and in mothers belonging to the poorest income quintile- 1st quintile- [CIX = 1.04 (95%CI: -1.60; 3.67); SII = 2.93 (95%CI: -2.06; 7.92)], but these differences were not statistically significant. Mean postpartum weight gain was 2.3kg (standard deviation - SD = 6.4) and 1.4kg (SD = 8.8) at 3 and 12 months, respectively. One-third of the women showed adequate weight gain. The observed inequalities in prevalence of adequate gestational weight gain in women with less schooling and in the poorest income quintile were not statistically significant.
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15
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Nansel TR, Lipsky LM, Faith M, Liu A, Siega-Riz AM. The accelerator, the brake, and the terrain: associations of reward-related eating, self-regulation, and the home food environment with diet quality during pregnancy and postpartum in the pregnancy eating attributes study (PEAS) cohort. Int J Behav Nutr Phys Act 2020; 17:149. [PMID: 33228724 PMCID: PMC7684737 DOI: 10.1186/s12966-020-01047-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/29/2020] [Indexed: 01/04/2023] Open
Abstract
Background Neurobehavioral factors, including reward-related eating and self-regulation, in conjunction with the food environment, may influence dietary behaviors. However, these constructs have not been examined in pregnancy and postpartum, a time of changing appetite and eating behaviors, and when dietary intake has implications for maternal and child health. This study examined associations of reward-related eating, self-regulation, and the home food environment with pregnancy and postpartum diet quality. Methods Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks gestation and followed through one-year postpartum. Pregnancy and postpartum Healthy Eating Index-2015 (HEI-total), and adequacy and moderation scores, respectively, were calculated by pooling 24-h diet recalls administered each trimester and during 2, 6, and 12 months postpartum. Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale (mYFAS), Power of Food Scale (PFS), Multiple Choice Procedure (MCP), and Reinforcing Value of Food Questionnaire (RVFQ); two measures of self-regulation – Barratt Impulsiveness Scale (BIS) and Delay of Gratification Inventory (DGI); and a Home Food Inventory (HFI), yielding obesogenic (OBES) and fruit/vegetables (FV) scores. Linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with diet quality during pregnancy and postpartum, adjusting for sociodemographic characteristics. Results Pregnancy HEI-total was inversely associated with PFS (β = − 0.14 ± 0.05, p = 0.009), mYFAS(β = − 0.14 ± 0.06, p = 0.02), 2 of the 5 RVFQ indices, MCP (β = − 0.14 ± 0.05, p = 0.01), and DGI food subscale (β = 0.23 ± 0.05, p < 0.001), but associations of postpartum HEI-total with reward-related eating measures and self-regulation were small and not statistically significant. Pregnancy and postpartum HEI-total were associated inversely with HFI-OBES (β = − 0.17 ± 0.06, p = 0.004 and β = − 0.19 ± 0.07, p = 0.006, respectively), and positively with HFI-FV (β = 0.21 ± 0.05, p < 0.001 and β = 0.17 ± 0.06, p = 0.009, respectively). Conclusions Associations of poorer diet quality with greater reward-related eating during pregnancy but not postpartum suggests the need to better understand differences in the determinants of eating behaviors and approaches to circumvent or moderate reward-related eating to facilitate more optimal diet quality across this critical period. Trial registration Clinicaltrials.gov. URL – Registration ID – NCT02217462. Date of registration – August 13, 2014.
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Affiliation(s)
- Tonja R Nansel
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr., MSC 7004, Bethesda, MD, 20892, USA.
| | - Leah M Lipsky
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr., MSC 7004, Bethesda, MD, 20892, USA
| | - Myles Faith
- Department of Counseling, School, and Educational Psychology, Graduate School of Education, 420 Baldy Hall, University at Buffalo - SUNY, Buffalo, NY, 14250-1000, USA.,Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Aiyi Liu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr., MSC 7004, Bethesda, MD, 20892, USA
| | - Anna Maria Siega-Riz
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, 27599, USA.,Departments of Nutrition and Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 109 Arnold House, 715 Pleasant St, Amherst, MA, 01003-9303, USA
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16
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Predictors of patterns of weight change 1 year after delivery in a cohort of Mexican women. Public Health Nutr 2020; 24:4113-4123. [PMID: 33000714 DOI: 10.1017/s1368980020002803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the associations of pregestational BMI, gestational weight gain (GWG) and breast-feeding at 1 month postpartum with four patterns of weight change during the first year after delivery: postpartum weight retention (PPWR), postpartum weight gain (PPWG), postpartum weight retention + gain (PPWR + WG) and return to pregestational weight. DESIGN In this secondary analysis of a prospective study, we categorised postpartum weight change into four patterns using pregestational weight and weights at 1, 6 and 12 months postpartum. We evaluated their associations with pregestational BMI, GWG and breast-feeding using multinomial logistic regression. Results are presented as relative risk ratios (RRR) and 95 % CI. SETTING Mexico City. PARTICIPANTS Women participating in the Programming Research in Obesity, Growth, Environment and Social Stressors pregnancy cohort. RESULTS Five hundred women were included (53 % of the cohort). Most women returned to their pregestational weight by 1 year postpartum (57 %); 8 % experienced PPWR, 14 % PPWG and 21 % PPWR + WG. Compared with normal weight, pregestational overweight (RRR 2·5, 95 % CI 1·3, 4·8) and obesity (RRR 2·2, 95 % CI 1·0, 4·7) were associated with a higher risk of PPWG. Exclusive breast-feeding, compared with no breast-feeding, was associated with a lower risk of PPWR (RRR 0·3, 95 % CI 0·1, 0·9). Excessive GWG, compared with adequate, was associated with a higher risk of PPWR (RRR 3·3, 95 % CI 1·6, 6·9) and PPWR + WG (RRR 2·4, 95 % CI 1·4, 4·2). CONCLUSIONS Targeting women with pregestational overweight or obesity and excessive GWG, as well as promoting breast-feeding, may impact the pattern of weight change after delivery and long-term women's health.
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17
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Li N, Su X, Liu T, Sun J, Zhu Y, Dai Z, Zhang Y, Pan L, Jiang W, Zhu W. Dietary patterns of Chinese puerperal women and their association with postpartum weight retention: Results from the mother-infant cohort study. MATERNAL AND CHILD NUTRITION 2020; 17:e13061. [PMID: 33135839 PMCID: PMC7729653 DOI: 10.1111/mcn.13061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
Dietary intake may affect maternal health, but it remains unclear about puerperal dietary intake and its association with maternal health. This study investigated the dietary patterns and their related factors and association with postpartum weight retention (PPWR) in Chinese puerperal women. Participants were from the mother-infant cohort study, in which both mothers and infants were followed up from childbirth to the next 2 years, in seven cities around China. Maternal puerperal dietary patterns were derived by a food frequency questionnaire and principal component analysis (PCA) within 1 month postpartum. PPWR was assessed by the difference of weight at 42 days and 6 months postpartum minus the pre-pregnancy weight. Of 503 postpartum women, four dietary patterns were identified, including 'plant food' pattern (rice and vegetables as dominant foods), 'diverse' pattern (starchy roots, fruit, livestock meat and aquatic products), 'traditional northern' pattern (poultry, eggs and soup) and 'marine-flour' pattern (flour, coarse food grains and marine fish). The diverse pattern was associated with professional puerperal family care and counselling service (p < .05). PPWRs at 42 days and 6 months postpartum were 6.37 and 4.70 kg averagely. The plant food dietary pattern tended to be associated with higher 42-day PPWR (β = .105, p < .05), and diverse pattern was associated with lower 6-months PPWR (β = -.137, p < .05). Conclusively, this study presented four dominant dietary patterns in Chinese postpartum women and showed a lower PPWR in adherence to diverse dietary pattern. The results would provide evidence to furtherly guide dietary practice and improve maternal health.
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Affiliation(s)
- Niuniu Li
- Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Xiao Su
- Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Tan Liu
- Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Jing Sun
- Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yimin Zhu
- Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Zhiyong Dai
- Peking-Ausnutria Maternal and Infant Nutrition Research Center, Peking University, Beijing, China
| | - Yanchun Zhang
- Peking-Ausnutria Maternal and Infant Nutrition Research Center, Peking University, Beijing, China
| | - Lina Pan
- Peking-Ausnutria Maternal and Infant Nutrition Research Center, Peking University, Beijing, China
| | - Wei Jiang
- Peking-Ausnutria Maternal and Infant Nutrition Research Center, Peking University, Beijing, China
| | - Wenli Zhu
- Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing, China.,National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
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18
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McGirr C, Rooney C, Gallagher D, Dombrowski SU, Anderson AS, Cardwell CR, Free C, Hoddinott P, Holmes VA, McIntosh E, Somers C, Woodside JV, Young IS, Kee F, McKinley MC. Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period.
Objective
The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period.
Design
Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control.
Setting
This study was set in Northern Ireland; women were recruited via community-based approaches.
Participants
A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited.
Interventions
The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months.
Main outcome measures
The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context.
Results
The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income of < £29,999 per annum. Fifteen women became pregnant during the follow-up (intervention, n = 9; control, n = 6) and withdrew from the study for this reason. At the end of the 12-month study, the majority of women remained in the study [85.7% (36/42) in the intervention group and 90.7% (39/43) in the active control group]. The research procedures were well accepted by women. Both groups indicated a high level of satisfaction with the short message service intervention that they were receiving. There was evidence to suggest that the intervention may have a positive effect on weight loss and prevention of weight gain during the postpartum period.
Limitations
The interviews at 3 and 12 months were conducted by the same researchers who collected other outcome data.
Conclusions
An evidence- and theory-based intervention delivered by short message service was successfully developed in conjunction with postpartum women with overweight and obesity. The intervention was acceptable to women and was feasible to implement in the 12-month pilot randomised controlled trial. The progression criteria for a full randomised controlled trial to examine effectiveness and cost-effectiveness were met.
Future work
Some minor refinements need to be made to the intervention and trial procedures based on the findings of the pilot trial in preparation for conducting a full randomised controlled trial.
Trial registration
Current Controlled Trial ISRCTN90393571.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. The intervention costs were provided by the Public Health Agency, Northern Ireland.
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Affiliation(s)
- Caroline McGirr
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ciara Rooney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Dunla Gallagher
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | | | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Ninewells Medical School, Dundee, UK
| | - Christopher R Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Caroline Free
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Valerie A Holmes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Camilla Somers
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ian S Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Michelle C McKinley
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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19
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Yu YH, Bodnar LM, Himes KP, Brooks MM, Naimi AI. Association of Overweight and Obesity Development Between Pregnancies With Stillbirth and Infant Mortality in a Cohort of Multiparous Women. Obstet Gynecol 2020; 135:634-643. [PMID: 32028483 PMCID: PMC7147965 DOI: 10.1097/aog.0000000000003677] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify the association of newly developed prepregnancy overweight and obesity with stillbirth and infant mortality. METHODS We studied subsequent pregnancies of mothers who were normal weight at fertilization of their first identified pregnancy, from a population-based cohort that linked birth registry with death records in Pennsylvania, 2003-2013. Women with newly developed prepregnancy overweight and obesity were defined as those whose body mass index (BMI) before second pregnancy was between 25 and 29.9 or 30 or higher, respectively. Our main outcomes of interest were stillbirth (intrauterine death at 20 weeks of gestation or greater), infant mortality (less than 365 days after birth), neonatal death (less than 28 days after birth) and postneonatal death (29-365 days after birth). Associations of both prepregnancy BMI categories and continuous BMI with each outcome were estimated by nonparametric targeted minimum loss-based estimation and inverse-probability weighted dose-response curves, respectively, adjusting for race-ethnicity, smoking, and other confounders (eg, age, education). RESULTS A cohort of 212,889 women were included for infant mortality analysis (192,941 women for stillbirth analysis). The crude rate of stillbirth and infant mortality in these final analytic cohorts were 3.3 per 1,000 pregnancies and 2.9 per 1,000 live births, respectively. Compared with women who stayed at a normal weight in their second pregnancies, those becoming overweight had 1.4 (95% CI 0.6-2.1) excess stillbirths per 1,000 pregnancies. Those becoming obese had 3.6 (95% CI 1.3-5.9) excess stillbirths per 1,000 pregnancies and 2.4 (95% CI 0.4-4.4) excess neonatal deaths per 1,000 live births. There was a dose-response relationship between prepregnancy BMI increases of more than 2 units and increased risk of stillbirth and infant mortality. In addition, BMI increases were associated with higher risks of infant mortality among women with shorter interpregnancy intervals (less than 18 months) compared with longer intervals. CONCLUSION Transitioning from normal weight to overweight or obese between pregnancies was associated with an increased risk of stillbirth and neonatal mortality.
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Affiliation(s)
- Ya-Hui Yu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Lisa M. Bodnar
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh
- Magee-Womens Research Institute, Pittsburgh, PA
| | - Katherine P. Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh
- Magee-Womens Research Institute, Pittsburgh, PA
| | - Maria M. Brooks
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| | - Ashley I. Naimi
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
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20
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Patterns of Weight Change One Year after Delivery Are Associated with Cardiometabolic Risk Factors at Six Years Postpartum in Mexican Women. Nutrients 2020; 12:nu12010170. [PMID: 31936138 PMCID: PMC7019329 DOI: 10.3390/nu12010170] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022] Open
Abstract
Pregnancy is a contributor to the obesity epidemic in women, probably through postpartum weight retention (PPWR), weight gain (PPWG), or a combination of both (PPWR + WG). The contribution of these patterns of postpartum weight change to long-term maternal health remains understudied. In a secondary analysis of 361 women from the prospective cohort PROGRESS, we evaluated the associations between patterns of weight change one year after delivery and cardiometabolic risk factors at six years postpartum. Using principal component analysis, we grouped cardiometabolic risk factors into: (1) body mass index (BMI), waist circumference (WC), homeostatic model assessment of insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), and glucose; (2) systolic (SBP) and diastolic blood pressure (DBP); and (3) low-density lipoprotein cholesterol and total cholesterol. Using path analysis, we studied direct (patterns of weight change-outcomes) and indirect associations through BMI at six years postpartum. Around 60% of women returned to their pregestational weight (reference) by one year postpartum, 6.6% experienced PPWR, 13.9% PPWG, and 19.9% PPWR + WG. Women with PPWR + WG, vs. the reference, had higher BMI and WC at six years (2.30 kg/m2, 95% CI [1.67, 2.93]; 3.38 cm [1.14, 5.62]). This was also observed in women with PPWR (1.80 kg/m2 [0.80, 2.79]; 3.15 cm [−0.35, 6.65]) and PPWG (1.22 kg/m2 [0.53, 1.92]; 3.32 cm [0.85, 5.78]). PPWR + WG had a direct association with HOMA-IR (0.21 units [0.04, 0.39]). The three patterns of weight change, vs. the reference, had significant indirect associations with HOMA-IR, glucose, TG, HDL-c, SBP, and DBP through BMI at six years. In conclusion, women with PPWR + WG are at high-risk for obesity and insulin resistance. Interventions targeting women during pregnancy and the first year postpartum may have implications for their long-term risk of obesity and cardiovascular disease.
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21
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Christiansen PK, Skjøth MM, Rothmann MJ, Vinter CA, Lamont RF, Draborg E. Lifestyle interventions to maternal weight loss after birth: a systematic review. Syst Rev 2019; 8:327. [PMID: 31842988 PMCID: PMC6912999 DOI: 10.1186/s13643-019-1186-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decades, there has been an increase in overweight and obesity in women of childbearing age, as well as the general population. Overweight and obesity are related to a later, increased risk of type 2 diabetes and cardiovascular diseases. Increasing weight between pregnancies has a negative impact on the development of the fetus in a subsequent pregnancy. It is also related to long-term obesity and overweight for the woman. Accordingly, weight control in women of the childbearing age is important for both women and their offspring. Information and communication technology (ICT) has become an integrated part of many peoples' lives, and it has the potential to prevent disease. In this systematic review, we summarize the evidence from randomized controlled trials to compare effects of different ICT-based interventions to support postpartum women to achieve weight loss. METHODS A systematic search was performed in PubMed, Embase, PsycInfo, CINAHL, Web of Science, Scopus, and Cochrane, searching on terms, such as postpartum, weight loss, telemedicine, and randomized controlled trials. Two independent researchers undertook study selection and data extraction. Results were reported narratively. The systematic review only included studies that were randomized controlled trials. RESULTS Eight studies were included in the systematic review. All of them were characterized by applying one or more ICT components to assist postpartum women in weight control, and had weight loss as an outcome measure. A significant difference was found in weight loss between control group and intervention group in the majority of the studies. However, five of the studies had a relatively short follow-up period (40 days to 16 weeks), six of the studies had a relatively small sample size (18 to 66 women), and half of the studies indicated challenges with adherence to the interventions over time. CONCLUSION ICT-based interventions can support postpartum women to achieve a healthy lifestyle and weight control. Future studies should focus on larger sample sizes, longer follow-up periods, and adherence to the interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018080731.
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Affiliation(s)
- Pernille Kjaergaard Christiansen
- Department of Public Health, University of Southern Denmark, Odense, Denmark. .,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark. .,Department of Multimedia and IT, University College Lillebaelt, Odense, Denmark. .,OPEN, University of Southern Denmark, Odense, Denmark.
| | - Mette Maria Skjøth
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,OPEN, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,OPEN, University of Southern Denmark, Odense, Denmark.,Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina Anne Vinter
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ronald Francis Lamont
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Division of Surgery, University College London, London, UK.,Northwick Park Institute of Medical Research Campus, London, UK
| | - Eva Draborg
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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22
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Murray-Davis B, Grenier L, Atkinson SA, Mottola MF, Wahoush O, Thabane L, Xie F, Vickers-Manzin J, Moore C, Hutton EK. Experiences regarding nutrition and exercise among women during early postpartum: a qualitative grounded theory study. BMC Pregnancy Childbirth 2019; 19:368. [PMID: 31638920 PMCID: PMC6805669 DOI: 10.1186/s12884-019-2508-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/13/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Excess gestational weight gain has long- and short-term implications for women and children, and postpartum weight retention is associated with an increased risk of long-term obesity. Despite the existence of dietary and exercise guidelines, many women struggle to return to pre-pregnancy weight. Experiences of women in tackling postpartum weight loss are poorly understood. We undertook this study to explore experiences related to nutrition, exercise and weight in the postpartum in women in Ontario, Canada. METHODS This was a nested qualitative study within The Be Healthy in Pregnancy Study, a randomized controlled trial. Women randomized to the control group were invited to participate. Semi-structured focus groups were conducted at 4-6 months postpartum. Focus groups were audio recorded, transcribed verbatim, coded and analyzed thematically using a constructivist grounded theory approach. RESULTS Women experienced a complex relationship with their body image, due to unrealistic expectations related to their postpartum body. Participants identified barriers and enablers to healthy habits during pregnancy and postpartum. Gestational weight gain guidelines were regarded as unhelpful and unrealistic. A lack of guidance and information about weight management, healthy eating, and exercise in the postpartum period was highlighted. CONCLUSION Strategies for weight management that target the unique characteristics of the postpartum period have been neglected in research and in patient counselling. Postpartum women may begin preparing for their next pregnancy and support during this period could improve their health for subsequent pregnancies. TRIAL REGISTRATION NCT01689961 registered September 21, 2012.
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Affiliation(s)
- Beth Murray-Davis
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON Canada
| | - Lindsay Grenier
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON Canada
| | | | - Michelle F. Mottola
- R. Samuel McLaughlin Foundation- Exercise and Pregnancy Lab, School of Kinesiology, The University of Western Ontario, London, ON Canada
| | - Olive Wahoush
- Global Health, McMaster University, Hamilton, ON Canada
- School of Nursing, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Jennifer Vickers-Manzin
- Public Health Services-Healthy Families, Healthy & Safe Communities, City of Hamilton, Hamilton, ON Canada
| | - Caroline Moore
- Department of Pediatrics, McMaster University, Hamilton, ON Canada
| | - Eileen K. Hutton
- McMaster Midwifery Research Center, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON Canada
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23
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Michel S, Raab R, Drabsch T, Günther J, Stecher L, Hauner H. Do lifestyle interventions during pregnancy have the potential to reduce long-term postpartum weight retention? A systematic review and meta-analysis. Obes Rev 2019; 20:527-542. [PMID: 30548769 DOI: 10.1111/obr.12809] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 01/21/2023]
Abstract
Reducing postpartum weight retention is a promising strategy for addressing the rising prevalence of overweight and obesity in women. This systematic review and meta-analysis explored whether lifestyle interventions during pregnancy have the potential to reduce weight retention at 4 months postpartum and beyond. A search of five electronic databases for randomized controlled trials comparing the effect of weight-related lifestyle interventions beginning in pregnancy on postpartum weight retention to standard prenatal care groups was performed. Postpartum weight retention data was synthesized in a random-effects meta-analysis. Data from 14 studies of 7116 participants showed that the intervention group retained statistically significant less weight than the control group (weighted mean difference: -0.73 kg, 95% CI: -1.32 to -0.14, P = 0.015). Subgroup analysis showed this effect to be largest in studies with follow-ups from 4 to 6 months (weighted mean difference: -1.32 kg, 95% CI: -2.11 to -0.53, P = 0.001), but it remained significant until 12 months postpartum (weighted mean difference: -0.68 kg, 95% CI: -1.28 to -0.09, P = 0.023). In studies of women with a body mass index above 25.0 kg/m2 , no significant intervention effect was observed. More high-quality studies with a follow-up beyond 12 months postpartum are needed.
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Affiliation(s)
- Sophie Michel
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roxana Raab
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Theresa Drabsch
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Günther
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lynne Stecher
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Institute of Medical Informatics, Statistics and Epidemiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- Else Kroener-Fresenius Center for Nutritional Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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24
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Pereira LCR, Purcell SA, Elliott SA, McCargar LJ, Bell RC, Robson PJ, Prado CM. The use of whole body calorimetry to compare measured versus predicted energy expenditure in postpartum women. Am J Clin Nutr 2019; 109:554-565. [PMID: 30793166 PMCID: PMC6408201 DOI: 10.1093/ajcn/nqy312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Accurate assessment of energy expenditure may support weight-management recommendations. Measuring energy expenditure for each postpartum woman is unfeasible; therefore, accurate predictive equations are needed. OBJECTIVES This study compared measured with predicted resting energy expenditure (REE) and total energy expenditure (TEE) in postpartum women. METHODS This was a longitudinal observational study. REE was measured at 3 mo postpartum (n = 52) and 9 mo postpartum (n = 49), whereas TEE was measured once at 9 mo postpartum (n = 43) by whole body calorimetry (WBC). Measured REE (REEWBC) was compared with 17 predictive equations; measured TEE plus breast milk energy output (ERWBC) was compared with the estimated energy requirements/Dietary Reference Intakes equation (EERDRI). Fat and fat-free mass were measured by dual-energy X-ray absorptiometry. Group-level agreement was assessed by the Pearson correlation, paired t test, and Bland-Altman (bias) analyses. Individual-level accuracy was assessed with the use of Bland-Altman limits of agreement, and by the percentage of women with predicted energy expenditure within 10% of measured values ("accuracy"). RESULTS The cohort was primarily Caucasian (90%). At a group level, the best equation predicting REEWBC was the DRI at 3 mo postpartum (-7 kcal, -0.1%; absolute and percentage bias, respectively), and the Harris-Benedict at 9 mo postpartum (-17 kcal, -0.5%). At an individual level, the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) height and weight equation was the most accurate at 3 mo postpartum (100% accuracy) and 9 mo postpartum (98% accuracy), with the smallest limits of agreement. Equations including body composition variables were not more accurate. Compared with ERWBC, EERDRI bias was -36 kcal, with inaccurate predictions in 33% of women. CONCLUSIONS Many REE predictive equations were accurate for group assessment, with the FAO/WHO/UNU height and weight equation having the highest accuracy for individuals. EERDRI performed well at a group level, but inaccurately for 33% of women. A greater understanding of the physiology driving energy expenditure in the postpartum period is needed to better predict TEE and ultimately guide effective weight-management recommendations.
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Affiliation(s)
- Leticia C R Pereira
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Canada
| | - Sarah A Purcell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Canada
| | - Sarah A Elliott
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Canada
| | - Linda J McCargar
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Canada
| | - Paula J Robson
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Canada,CancerControl Alberta, Alberta Health Services, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Canada,Address correspondence to CMP (e-mail: )
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25
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Aiken CE, Tarry-Adkins JL, Ashmore TJ, Ozanne SE. Early life environment influences the trajectory of post-partum weight loss in adult female rats. Reprod Biomed Online 2018; 38:779-786. [PMID: 30885667 PMCID: PMC6491499 DOI: 10.1016/j.rbmo.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/21/2018] [Accepted: 12/10/2018] [Indexed: 01/09/2023]
Abstract
RESEARCH QUESTION The physiological processes of pregnancy and lactation require profound changes in maternal metabolism and energy balance. The timescale of metabolic reversion after pregnancy, in particular post-partum weight loss, is highly variable between individuals. Currently, mechanisms influencing post-partum metabolic recovery are not well understood. The hypothesis tested here is that, in common with other metabolic and obesity-related outcomes, capacity for post-partum weight loss is influenced by developmental programming. DESIGN Adult female Wistar rats exposed to a maternal low-protein diet in utero then weaned onto a control diet post-natally (recuperated group) were compared with controls. Adult females from both groups underwent pregnancy at 3 months of age. Weight changes and metabolic parameters during pregnancy and lactation were compared between control and recuperated groups, and also with non-pregnant littermates. RESULTS Pregnancy weight gain was not different between the control and recuperated groups, but post-partum recuperated animals remained significantly heavier than both post-partum control animals (P<0.05) and their non-pregnant recuperated littermates (P<0.05) at the end of lactation. Post-partum recuperated animals had more intra-abdominal fat mass (P<0.05) and higher serum triglyceride concentrations (P<0.01) than controls. Post-partum recuperated animals also had increased expression of IL6, NRF2 and ALOX12 (key regulators of inflammation and lipoxygenase activity) in the intra-abdominal adipose tissue compared with control groups. CONCLUSIONS Mothers who themselves have been exposed to adverse early life environments are likely to have slower metabolic recovery from pregnancy than controls. Failure to return to pre-pregnancy weight after delivery predisposes to persisting sequential inter-pregnancy weight gain, which can represent a significant metabolic burden across a life course involving several pregnancies.
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Affiliation(s)
- C E Aiken
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Obstetrics and Gynaecology, University of Cambridge, Box 223, The Rosie Hospital and NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge CB2 0SW, United Kingdom.
| | - J L Tarry-Adkins
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - T J Ashmore
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - S E Ozanne
- University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
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26
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Salehi-Pourmehr H, Niroomand S, Shakouri SK, Asgarlou Z, Farshbaf-Khalili A. Association Between Antenatal and Postpartum Depression and Anxiety with Weight Retention 1 Year After Childbirth: A Longitudinal Study. Community Ment Health J 2018; 54:1284-1294. [PMID: 30140991 DOI: 10.1007/s10597-018-0324-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/07/2018] [Indexed: 01/11/2023]
Abstract
This was an observational, longitudinal study investigated the association between anxiety and depression in trimesters of pregnancy and early postpartum with weight retention 1 year after childbirth. Sixty-two pregnant women aged 18-35 years with a BMI of 35 or higher and 245 pregnant women with normal BMI (BMI 18.5-24.9 kg/m2) were recruited at their initial prenatal visit in the health centers. The Edinburgh Postnatal Depression Scale (EPDS) and Beck Anxiety Inventory (BAI-II) were completed in five time points, the first, second, third trimester of pregnancy, 6-8 weeks and 12 months after delivery. Pre-pregnancy weight and weight retention at 1 year postpartum was measured. A significant relationship was found between first trimester (adjusted mean difference: aMD 3.416; 95% CI 1.392-5.441) and postpartum (aMD 3.042; 95% CI 0.538-5.547) depression as well as first trimester's anxiety (aMD 3.050; 95% CI 0.631-5.470) with weight retention at 1 year after childbirth.
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Affiliation(s)
- Hanieh Salehi-Pourmehr
- Evidence Based Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soudabeh Niroomand
- Midwifery Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Seyed Kazem Shakouri
- Aging Research Institute, Physical Medicine and Rehabilitation Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zoleikha Asgarlou
- Midwifery Department, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Azizeh Farshbaf-Khalili
- Aging Research Institute, Physical Medicine and Rehabilitation Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
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27
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Abstract
It is important to pay attention to weight management before and between pregnancies, as women have an increased risk of weight gain during the reproductive years. Having a baby is a life-changing event for women and the challenge of weight management amidst this period of major physiological, psychological and social change should not be underestimated. However, the postpartum period offers an opportune time for lifestyle interventions, as women may have heightened awareness of their own and their wider families' health. Systematic reviews indicate that interventions including both diet and physical activity along with individualised support and self-monitoring are more likely to be successful in promoting postpartum weight loss. However, high levels of attrition and poor engagement have been an issue in previous trials in this area. Since postpartum women are difficult to reach and retain, future research must consider how to make weight-management interventions an attractive and attainable proposition for women who are juggling multiple, competing demands on their time. Ideally, intervention approaches need to be flexible and allow sustained contact with women, to facilitate a focus on maintenance of weight loss, as well as opportunities for re-engagement after life events that may disrupt weight-management progress. Using technology to deliver or support interventions holds promise but trials are needed to generate a range of appealing, effective and scalable options for postpartum women. What works at other life stages may not necessarily work here owing to specific barriers to weight management encountered in the postpartum period.
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28
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Wright C, Mogul M, Acevedo G, Aysola J, Momplaisir F, Schwartz S, Shea J. Preparing for a trial to test a postpartum weight retention intervention among low income women: feasibility of a protocol in a community-based organization. BMC WOMENS HEALTH 2018; 18:27. [PMID: 29370795 PMCID: PMC5785896 DOI: 10.1186/s12905-018-0517-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/14/2018] [Indexed: 11/29/2022]
Abstract
Background Postpartum weight retention (PPWR) causes intergenerational harm, negatively affecting a mother’s cardiovascular health and ability to have future healthy pregnancies. Low-income minority women are at highest risk for PPWR with little guidance concerning timeline or strategy to lose weight after delivery. An academic-community partnership conducted observational and focus group work to develop an intervention for PPWR among low-income mothers. This study’s objective is to determine the feasibility of implementing a PPWR intervention trial in partnership with a community-based organization (CBO) serving low-income families with social service support. Methods We analyzed five implementation outcomes in this feasibility study: acceptability, adoption, appropriateness, penetration, and sustainability. Other secondary outcomes were the change in psychosocial and clinical outcomes from baseline to one year following the intervention delivery. Results An academic-community partnership developed and piloted a postpartum weight retention intervention among 17 participants that included 1) six weeks of interactive daily health texting, 2) exercise assistance with baby carrier, home exercise program, and pedometer provision, 3) two live healthy eating and baby feeding workshops, and 4) two 45-min home visits over one year to provide social support and acquire followup data. Implementation outcomes demonstrate an intervention supported by the organization and accepted by end-users, with increased capacity of the CBO to test and deliver an effective intervention. Weight loss was achieved by the majority of participants at one year (Md − 5 pounds (IQR = − 14.5 - 0.3). Conclusion We made protocol enhancements to the developed intervention based on the analysis of this study, and now prepare for a funded randomized controlled trial (RCT) in a community-based setting. Our central hypothesis is that low-income women who participate in a multi-component, low cost-intervention delivered by a CBO will have less postpartum weight retention than those women who do not participate in the program. Trial registration The trial was retrospectively registered, ID NCT02867631, 8/11/16.
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Affiliation(s)
- Charmaine Wright
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA.
| | - Marjie Mogul
- Maternity Care Coalition, 2000 Hamilton Avenue, Suite 205, Philadelphia, PA, 19130, USA
| | - Glamarys Acevedo
- Maternity Care Coalition, 2000 Hamilton Avenue, Suite 205, Philadelphia, PA, 19130, USA
| | - Jaya Aysola
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Florence Momplaisir
- Drexel School of Medicine, Department of Medicine, Infectious Diseases, Partnership Comprehensive Care Practice, 1427 Vine Street, 2nd Floor, Philadelphia, PA, 19102, USA
| | - Sandy Schwartz
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Judy Shea
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
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29
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Maternal obesity and gestational weight gain: associations with maternal and infant outcomes. Proc Nutr Soc 2018. [DOI: 10.1017/s0029665118000678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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McManus R, Miller D, Mottola M, Giroux I, Donovan L. Translating Healthy Living Messages to Postpartum Women and Their Partners After Gestational Diabetes (GDM): Body Habitus, A1C, Lifestyle Habits, and Program Engagement Results From the Families Defeating Diabetes (FDD) Randomized Trial. Am J Health Promot 2017; 32:1438-1446. [PMID: 29108443 DOI: 10.1177/0890117117738210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The Families Defeating Diabetes intervention evaluated a postpartum healthy living program for women with recent gestational diabetes mellitus (GDM). DESIGN Randomized controlled trial. SETTING Tertiary centers in London, Calgary, and Victoria, Canada. PARTICIPANTS Women with GDM and partners; 46% of eligible maternal participants agreed to participate. INTERVENTION Interventional (INT) participants received a healthy living seminar at 3 months; access to a walking group/Website; biweekly e-mails. Control (CON) participants received a contemporary postpartum diabetes prevention handout. MEASURES Maternal, partner, and offspring demographics at baseline, 3, and 12 months. ANALYSIS Percentages of women losing ≥7% of postpartum weight were compared by χ2 testing; body habitus comparisons by analysis of covariance (ANCOVA); maternal A1C comparisons by unpaired t tests; participant outcome associations by Pearson correlation coefficients. RESULTS Maternal participants were 170 (89 INT and 81 CON) with 63 partners (30 INT and 33 CON); 103 (73 maternal; 30 partners) were lost to follow-up; 57% of maternal participants completed 12 months; 33% INT women (n = 50) lost ≥7% weight versus 25% CON women (n = 47), P = .43. Interventional participant results did not correlate with accession of study elements. Maternal completion was significantly associated with partner involvement, breastfeeding, higher income, and education. Paternal weights correlated significantly with maternal and offspring weights. CONCLUSION Families Defeating Diabetes outcomes were not significantly different for INT maternal or paternal participants versus CON participants. Secondary outcomes of future value included statistically significant positive associations between paternal participation, socioeconomic indicators, and maternal study completion, significant correlations between maternal, paternal, and offspring weights as well as insights into study component engagement.
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Affiliation(s)
- R McManus
- 1 The Division of Endocrinology and Metabolism, Department of Medicine, the University of Western Ontario, London, Ontario, Canada
| | - D Miller
- 2 The Division of Endocrinology and Metabolism, Department of Medicine, the University of Victoria, Victoria, British Columbia, Canada
| | - M Mottola
- 3 The School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
| | - I Giroux
- 4 The School of Nutrition Sciences, Faculty of Health Sciences, The University of Ottawa, Ottawa, Ontario, Canada
| | - L Donovan
- 5 The Division of Endocrinology and Metabolism, Department of Medicine, the University of Calgary, Calgary, Alberta, Canada
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Leonard SA, Rasmussen KM, King JC, Abrams B. Trajectories of maternal weight from before pregnancy through postpartum and associations with childhood obesity. Am J Clin Nutr 2017; 106:1295-1301. [PMID: 28877895 PMCID: PMC5657288 DOI: 10.3945/ajcn.117.158683] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Prepregnancy body mass index [BMI (in kg/m2)], gestational weight gain, and postpartum weight retention may have distinct effects on the development of child obesity, but their combined effect is currently unknown.Objective: We described longitudinal trajectories of maternal weight from before pregnancy through the postpartum period and assessed the relations between maternal weight trajectories and offspring obesity in childhood.Design: We analyzed data from 4436 pairs of mothers and their children in the National Longitudinal Survey of Youth 1979 (1981-2014). We used latent-class growth modeling in addition to national recommendations for prepregnancy BMI, gestational weight gain, and postpartum weight retention to create maternal weight trajectory groups. We used modified Poisson regression models to assess the associations between maternal weight trajectory group and offspring obesity at 3 age periods (2-5, 6-11, and 12-19 y).Results: Our analysis using maternal weight trajectories based on either latent-class results or recommendations showed that the risk of child obesity was lowest in the lowest maternal weight trajectory group. The differences in obesity risk were largest after 5 y of age and persisted into adolescence. In the latent-class analysis, the highest-order maternal weight trajectory group consisted almost entirely of women who were obese before pregnancy and was associated with a >2-fold increase in the risk of offspring obesity at ages 6-11 y (adjusted RR: 2.39; 95% CI: 1.97, 2.89) and 12-19 y (adjusted RR: 2.74; 95% CI: 2.13, 3.52). In the analysis with maternal weight trajectory groups based on recommendations, the risk of child obesity was consistently highest for women who were overweight or obese at the beginning of pregnancy.Conclusion: These findings suggest that high maternal weight across the childbearing period increases the risk of obesity in offspring during childhood, but high prepregnancy BMI has a stronger influence than either gestational weight gain or postpartum weight retention.
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Affiliation(s)
| | | | - Janet C King
- Nutrition and Metabolism Center, Children’s Hospital Oakland Research Institute, Oakland, CA
| | - Barbara Abrams
- Division of Epidemiology, University of California, Berkeley, CA
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Huseinovic E, Bertz F, Brekke HK, Winkvist A. Two-year follow-up of a postpartum weight loss intervention: Results from a randomized controlled trial. MATERNAL AND CHILD NUTRITION 2017; 14:e12539. [PMID: 28984033 DOI: 10.1111/mcn.12539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/21/2017] [Accepted: 09/11/2017] [Indexed: 12/31/2022]
Abstract
We recently reported that a 12-week diet intervention among postpartum women produced a weight loss of 12% after 1 year, compared to 5% in controls. Here, we present 2-year results after 1 year of unsupervised follow-up. In total, 110 women with a self-reported body mass index of ≥27 kg/m2 at 6-15-week postpartum were randomized to diet group (D-group) or control group (C-group). D-group received a 12-week diet intervention by a dietitian followed by monthly e-mails up to the 1-year follow-up. C-group received a brochure on healthy eating. No contact was provided from 1 to 2 years to either group. Eighty-nine women (81%) completed the 2-year follow-up. Median (1st; 3rd quartile) weight change from 0 to 2 years was -6.9 (-11.0; -2.2) kg in D-group and -4.3 (-8.7; -0.2) kg in C-group. There was no group by time interaction at 2 years (p = .082); however, when women with a new pregnancy between 1 and 2 years were excluded, the interaction became significant (-8.2 vs. -4.6 kg, p = .038). From 1 to 2 years, women in D- and C-group gained 2.5 ± 5.0 kg and 1.1 ± 4.4 kg, respectively (p = .186). Women who gained weight from 1 to 2 years reported a decrease in self-weighing frequency compared to women who maintained or lost weight (p = .008). Both groups achieved clinically relevant 2-year weight loss, but the significant between-group-difference observed at 1 year was not maintained at 2 years in the main analysis. However, when women with a new pregnancy between 1 and 2 years were excluded, a significant weight loss effect was observed also at 2 years.
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Affiliation(s)
- Ena Huseinovic
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Bertz
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hilde Kristin Brekke
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chagas DCD, Silva AAMD, Ribeiro CCC, Batista RFL, Alves MTSSDBE. [Effects of gestational weight gain and breastfeeding on postpartum weight retention among women in the BRISA cohort]. CAD SAUDE PUBLICA 2017; 33:e00007916. [PMID: 28614443 DOI: 10.1590/0102-311x00007916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 06/24/2016] [Indexed: 12/18/2022] Open
Abstract
This study analyzed the effects of gestational weight gain and breastfeeding on postpartum weight retention. The study followed 2,607 women from the BRISA cohort. The variables were age, socioeconomic status, parity, pre-gestational body mass index, gestational weight gain, duration of maternal breastfeeding, length of postpartum follow-up, and postpartum weight gain. Structural equation modeling was used to evaluate the total, direct, and indirect effects of the explanatory variables on postpartum weight retention. An increase of one standard deviation in gestational weight gain corresponded to a significant increase of 0.49 standard deviations in postpartum weight retention (p < 0.001). An increase of one standard deviation in duration of breastfeeding corresponded to mean decrease of 0.10 standard deviations in postpartum weight retention (p < 0.001). Independently of pre-gestational BMI, gestational weight gain is a risk factor and duration of breastfeeding is a protective factor against postpartum weight retention.
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Bogaerts A, De Baetselier E, Ameye L, Dilles T, Van Rompaey B, Devlieger R. Postpartum weight trajectories in overweight and lean women. Midwifery 2017; 49:134-141. [DOI: 10.1016/j.midw.2016.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/11/2016] [Accepted: 08/31/2016] [Indexed: 01/13/2023]
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Huberty J, Leiferman JA, Kruper AR, Jacobson LT, Waring ME, Matthews JL, Wischenka DM, Braxter B, Kornfield SL. Exploring the need for interventions to manage weight and stress during interconception. J Behav Med 2017; 40:145-158. [PMID: 27858206 PMCID: PMC5358329 DOI: 10.1007/s10865-016-9813-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 11/12/2016] [Indexed: 12/23/2022]
Abstract
Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers' understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.
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Affiliation(s)
- Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
| | - Jenn A Leiferman
- Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Abbey R Kruper
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lisette T Jacobson
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Molly E Waring
- Departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeni L Matthews
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | | | - Betty Braxter
- School of Nursing, University of Pittsburg, Pittsburgh, PA, USA
| | - Sara L Kornfield
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Nogueira JL, Saunders C, Leal MDC. [Anthropometric methods used in the evaluation of the postpartum weight retention: a systematic review]. CIENCIA & SAUDE COLETIVA 2016; 20:407-20. [PMID: 25715134 DOI: 10.1590/1413-81232015202.08112013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/23/2013] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Jamile Lima Nogueira
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil,
| | - Cláudia Saunders
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil,
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Hung YC, Hung IL, Hu WL, Tseng YJ, Kuo CE, Liao YN, Wu BY, Tsai CC, Tsai PY, Chen HP, Huang MH, Su FY. Reduction in postpartum weight with laser acupuncture: A randomized control trial. Medicine (Baltimore) 2016; 95:e4716. [PMID: 27559981 PMCID: PMC5400348 DOI: 10.1097/md.0000000000004716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Gestational weight gain and weight retention at 1 year after delivery are associated with long-term obesity. We aimed to investigate the effect of laser acupuncture therapy on postpartum weight control. METHODS We randomly assigned 66 subjects with postpartum weight retention to a laser acupuncture group and control group. The subjects were treated at acupoints including the stomach and hunger points of the ear, ST25, ST28, ST40, SP15, CV9, and SP6 by using verum or sham laser acupuncture over 5 sessions per week. After 12 treatment sessions, the differences in the body mass index (BMI), body fat percentage (BFP), and waist-to-buttocks ratio (WBR) of the patients were analyzed and compared between the laser acupuncture and control groups via analysis of variance, chi-square tests, and stepwise regression tests. RESULTS The characteristics of the patients did not significantly differ between the laser acupuncture and control groups. Analysis of repeated measures data between the laser acupuncture and control groups indicated the presence of significant differences in postpartum BMI (P < 0.001) and BFP (P < 0.001); however, no significant difference was observed for WBR (P = 0.09). CONCLUSION Laser acupuncture reduces postpartum weight retention by improving BMI and BFP, but does not impact the WBR following short-term treatment.
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Affiliation(s)
- Yu-Chiang Hung
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
- School of Chinese Medicine for Post Baccalaureate, I-Shou University
| | - I-Ling Hung
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Wen-Long Hu
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
- Fooyin University College of Nursing
- Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Jung Tseng
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Chun-En Kuo
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Yen-Nung Liao
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Bei-Yu Wu
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Ching-Chang Tsai
- Department of Gynecology and Obstetrics
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Pei-Yuan Tsai
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Hsin-Ping Chen
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Meng-Hsuan Huang
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Fang-Yen Su
- Department of Chinese Medicine
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
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Dunlop AL, Mulle JG, Ferranti EP, Edwards S, Dunn AB, Corwin EJ. Maternal Microbiome and Pregnancy Outcomes That Impact Infant Health: A Review. Adv Neonatal Care 2015; 15:377-85. [PMID: 26317856 PMCID: PMC4658310 DOI: 10.1097/anc.0000000000000218] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The maternal microbiome is recognized as a key determinant of a range of important maternal and child health outcomes, and together with perinatal factors influences the infant microbiome. This article provides a summary review of research investigating (1) the role of the maternal microbiome in pregnancy outcomes known to adversely influence neonatal and infant health, including preterm birth, cardiometabolic complications of pregnancy such as preeclampsia and gestational diabetes, and excessive gestational weight gain; (2) factors with an established link to adverse pregnancy outcomes that are known to influence the composition of the maternal microbiome; and (3) strategies for promoting a healthy maternal microbiome, recognizing that much more research is needed in this area.
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Affiliation(s)
- Anne L. Dunlop
- Emory University School of Nursing, 1520 Clifton Road NE, Atlanta, GA 30322, 404-712-8520 (phone); 404-727-6945 (fax)
| | - Jennifer G. Mulle
- Rollins School of Public Health & School of Medicine, Department of Human Genetics, Emory University Atlanta, GA 30322
| | - Erin P. Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
| | - Sara Edwards
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
| | - Alexis B. Dunn
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
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Miech RA, Shanahan MJ, Boardman J, Bauldry S. The Sequencing of a College Degree during the Transition to Adulthood: Implications for Obesity. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2015; 56:281-95. [PMID: 26022787 PMCID: PMC5007865 DOI: 10.1177/0022146515581618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this study we consider the health implications of the sequencing of a college degree vis-à-vis familial roles during the transition to adulthood. We hypothesize that people who earned a college degree before assuming familial roles will have better health than people who earned a college degree afterwards. To test this hypothesis, we focus on obesity and use data from the National Longitudinal Study of Adolescent Health. Results show that marriage before completion of college was associated with a 50% higher probability of becoming obese when compared with marriage after completion of college. Parenthood before college completion was associated with a greater than twofold increase in the probability of becoming obese when compared to parenthood afterwards for black men. These findings suggest that the well-established association of education with health depends on its place in a sequence of roles.
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Affiliation(s)
| | | | | | - Shawn Bauldry
- University of Alabama at Birmingham, Birmingham, AL, USA
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Kirkegaard H, Stovring H, Rasmussen KM, Abrams B, Sørensen TIA, Nohr EA. Maternal weight change from prepregnancy to 7 years postpartum--the influence of behavioral factors. Obesity (Silver Spring) 2015; 23:870-8. [PMID: 25820258 DOI: 10.1002/oby.21022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/11/2014] [Accepted: 12/15/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We studied the influence of maternal behavior on weight change from prepregnancy to 7 years postpartum. METHODS We used linear regression to study the independent and combined associations between self-reported behavior in pregnancy (dietary intake, leisure-time exercise, sedentary activity, smoking) and postpartum (breastfeeding duration and smoking) on weights at 6 months, 18 months, and 7 years postpartum. RESULTS Women's average 7-year weight gain was 2.07 kg, with 23% gaining >5 kg. Multivariable analyses suggested that women with healthier dietary intake, more leisure-time exercise, less sedentary behavior, and longer duration of breastfeeding on average gained 1.66 kg [95% confidence interval (CI): 1.40; 1.91] with a significantly reduced odds [OR 0.56 (95% CI: 0.49; 0.64)] of gaining >5 kg from prepregnancy to 7 years postpartum compared to women with none or one of these behaviors [mean gain 3.03 kg (95% CI: 2.68; 3.39)]. Women who ceased smoking had higher long-term weight gain than nonsmokers, but not smokers. CONCLUSIONS Adherence to healthy behaviors during pregnancy lowered long-term weight gain considerably by lowering postpartum weight retention and subsequent weight gain. Public health efforts to help mothers achieve healthy behaviors might prevent childbearing-related weight gain.
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Affiliation(s)
- Helene Kirkegaard
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
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Effects of breastfeeding on postpartum weight loss among U.S. women. Prev Med 2014; 69:146-50. [PMID: 25284261 PMCID: PMC4312189 DOI: 10.1016/j.ypmed.2014.09.018] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/12/2014] [Accepted: 09/24/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the effects of breastfeeding on maternal weight loss in the 12months postpartum among U.S. women. METHODS Using data from a national cohort of U.S. women conducted in 2005-2007 (N=2102), we employed propensity scores to match women who breastfed exclusively and non-exclusive for at least three months to comparison women who had not breastfed or breastfed for less than three months. Outcomes included postpartum weight loss at 3, 6, 9, and 12months postpartum; and the probability of returning to pre-pregnancy body mass index (BMI) category and the probability of returning to pre-pregnancy weight. RESULTS Compared to women who did not breastfeed or breastfed non-exclusively, exclusive breastfeeding for at least 3months resulted in 3.2 pound (95% CI: 1.4,4.7) greater weight loss at 12months postpartum, a 6.0-percentage-point increase (95% CI: 2.3,9.7) in the probability of returning to the same or lower BMI category postpartum; and a 6.1-percentage-point increase (95% CI: 1.0,11.3) in the probability of returning to pre-pregnancy weight or lower postpartum. Non-exclusive breastfeeding did not significantly affect any outcomes. CONCLUSION Our study provides evidence that exclusive breastfeeding for at least three months has a small effect on postpartum weight loss among U.S. women.
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Lipsky LM, Strawderman MS, Olson CM. Weight-related self-efficacy in relation to maternal body weight from early pregnancy to 2 years post-partum. MATERNAL AND CHILD NUTRITION 2014; 12:569-78. [PMID: 25244078 DOI: 10.1111/mcn.12149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Excessive gestational weight gain may lead to long-term increases in maternal body weight and associated health risks. The purpose of this study was to examine the relationship between maternal body weight and weight-related self-efficacy from early pregnancy to 2 years post-partum. Women with live, singleton term infants from a population-based cohort study were included (n = 595). Healthy eating self-efficacy and weight control self-efficacy were assessed prenatally and at 1 year and 2 years post-partum. Body weight was measured at early pregnancy, before delivery, and 6 weeks, 1 year and 2 years post-partum. Behavioural (smoking, breastfeeding) and sociodemographic (age, education, marital status, income) covariates were assessed by medical record review and baseline questionnaires. Multi-level linear regression models were used to examine the longitudinal associations of self-efficacy measures with body weight. Approximately half of the sample (57%) returned to early pregnancy weight at some point by 2 years post-partum, and 9% became overweight or obese at 2 years post-partum. Body weight over time was inversely related to healthy eating (β = -0.57, P = 0.02) and weight control (β = -0.99, P < 0.001) self-efficacy in the model controlling for both self-efficacy measures as well as time and behavioural and sociodemographic covariates. Weight-related self-efficacy may be an important target for interventions to reduce excessive gestational weight gain and post-partum weight gain.
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Affiliation(s)
- Leah M Lipsky
- Health Behavior Branch, Division of Intramural Public Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Myla S Strawderman
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Christine M Olson
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Williamson JA, O'Hara MW, Stuart S, Hart KJ, Watson D. Assessment of postpartum depressive symptoms: the importance of somatic symptoms and irritability. Assessment 2014; 22:309-18. [PMID: 25059681 DOI: 10.1177/1073191114544357] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessing postpartum depressive symptoms is complicated by the fact that irritability, fatigue, insomnia, and appetite disruptions are also related to normative aspects of the childbearing process. We used multigroup confirmatory factor analysis to compare symptoms in 271 postpartum women with those of 820 non-postpartum women. We found that (a) irritability, insomnia, fatigue, and appetite loss were substantially associated with depressed mood among postpartum women whereas increased appetite was not; (b) irritability, insomnia, fatigue, and appetite changes were as strongly related to depression among postpartum women as they were among non-postpartum women; and (c) after controlling for overall depressed mood, postpartum women reported more irritability, insomnia, and appetite loss than the non-postpartum women. Irritability, fatigue, insomnia, and appetite loss are valid indicators and should be used to measure postpartum depressive symptoms. However, scores on these symptoms should be adjusted downward to account for their higher baseline rates in the postpartum population.
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Affiliation(s)
| | | | | | - Kimberly J Hart
- University of Illinois College of Medicine at Rockford, IL, USA
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Claesson IM, Josefsson A, Sydsjö G. Weight six years after childbirth: A follow-up of obese women in a weight-gain restriction programmme. Midwifery 2014; 30:506-11. [DOI: 10.1016/j.midw.2013.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 05/08/2013] [Accepted: 06/08/2013] [Indexed: 02/06/2023]
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He X, Hu C, Chen L, Wang Q, Qin F. The association between gestational weight gain and substantial weight retention 1-year postpartum. Arch Gynecol Obstet 2014; 290:493-9. [DOI: 10.1007/s00404-014-3235-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/24/2014] [Indexed: 12/12/2022]
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Sui Z, Moran LJ, Dodd JM. Physical activity levels during pregnancy and gestational weight gain among women who are overweight or obese. Health Promot J Austr 2014; 24:206-13. [PMID: 24314306 DOI: 10.1071/he13054] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/09/2013] [Indexed: 12/24/2022] Open
Abstract
ISSUE ADDRESSED There is contradictory research assessing physical activity patterns during pregnancy and postpartum among women who are overweight or obese. The aim of this study was to evaluate physical activity among overweight and obese women over the course of pregnancy and the initial postpartum period. METHODS Three hundred and five overweight or obese pregnant women completed physical-activity questionnaires at three time points during pregnancy and at 4-months postpartum. RESULTS Physical activity declined between early pregnancy and 28-weeks gestation (P<0.001) and declined further at 36-weeks gestation (P<0.001) before increasing significantly at 4-months postpartum (P<0.001). However, reported activity at 4-months postpartum remained significantly lower than that reported in early pregnancy (P<0.001). There was no significant difference either cross-sectionally or for changes over pregnancy and postpartum for total levels or categories of physical activity for women with different body mass index (BMI) or gestational weight gain (GWG). BMI was the only independent predictor of the change in total physical activity over the study and GWG, with women with higher BMI having larger decline of physical activity (β=0.114, s.e.=0.750, P=0.032) and less GWG (β=-0.253, s.e.=0.063, P<0.001). CONCLUSIONS Physical activity declined significantly between early pregnancy and 28-weeks gestation, with a further decline to 36-weeks gestation. At 4-months postpartum, physical activity significantly increased but not to the level of that reported at early pregnancy. SO WHAT?: The promotion of appropriate physical activity should be implemented early in pregnancy and postpartum to prevent the decline in activity we have observed in overweight and obese women. Future research should also explore the barriers and enablers to women engaging in exercise during pregnancy and the postpartum period.
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Affiliation(s)
- Zhixian Sui
- The Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia
| | - Lisa J Moran
- The Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia
| | - Jodie M Dodd
- The Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5006, Australia
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Robinson CA, Cohen AK, Rehkopf DH, Deardorff J, Ritchie L, Jayaweera RT, Coyle JR, Abrams B. Pregnancy and post-delivery maternal weight changes and overweight in preschool children. Prev Med 2014; 60:77-82. [PMID: 24370455 PMCID: PMC4069123 DOI: 10.1016/j.ypmed.2013.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/12/2013] [Accepted: 12/14/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES High maternal weight before and during pregnancy contributes to child obesity. To assess the additional role of weight change after delivery, we examined associations between pre- and post-pregnancy weight changes and preschooler overweight. METHODS SAMPLE 4359 children from the Children and Young Adults of the 1979 National Longitudinal Survey of Youth (NLSY) born to 2816 NLSY mothers between 1979 and 2006 and followed to age 4-5years old. EXPOSURES gestational weight gain (GWG) and post-delivery maternal weight change (PDWC). OUTCOME child overweight (body mass index (BMI) ≥85th percentile). RESULTS Adjusted models suggested that both increased GWG (OR: 1.08 per 5kg GWG, 95% CI: 1.01, 1.16) and excessive GWG (OR: 1.29 versus adequate GWG, 95% CI: 1.06, 1.56) were associated with preschooler overweight. Maternal weight change after delivery was also independently associated with child overweight (OR: 1.12 per 5kg PDWC, 95% CI: 1.04, 1.21). Associations were stronger among children with overweight or obese mothers. CONCLUSIONS Increased maternal weight gain both during and after pregnancy predicted overweight in preschool children. Our results suggest that healthy post-pregnancy weight may join normal pre-pregnancy BMI and adequate GWG as a potentially modifiable risk factor for child overweight.
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Affiliation(s)
- Camille A Robinson
- University of California -San Francisco, School of Medicine, San Francisco, CA, USA; University of California -Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA, USA
| | - Alison K Cohen
- University of California -Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA, USA
| | - David H Rehkopf
- Stanford University School of Medicine, Division of General Medical Disciplines, Stanford, CA, USA
| | - Julianna Deardorff
- University of California -Berkeley, School of Public Health, Division of Community Health and Human Development, Berkeley, CA, USA
| | - Lorrene Ritchie
- University of California -Berkeley, Atkins Center for Weight and Health, Berkeley, CA, USA
| | - Ruvani T Jayaweera
- University of California -Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA, USA
| | - Jeremy R Coyle
- University of California -Berkeley, School of Public Health, Division of Biostatistics, Berkeley, CA, USA
| | - Barbara Abrams
- University of California -Berkeley, School of Public Health, Division of Epidemiology, Berkeley, CA, USA; University of California -Berkeley, School of Public Health, Division of Community Health and Human Development, Berkeley, CA, USA.
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Boghossian NS, Yeung EH, Lipsky LM, Poon AK, Albert PS. Dietary patterns in association with postpartum weight retention. Am J Clin Nutr 2013; 97:1338-45. [PMID: 23576044 PMCID: PMC3652926 DOI: 10.3945/ajcn.112.048702] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postpartum weight retention (PPWR) can contribute to obesity development in women of reproductive age. Few studies have examined the association between postnatal diet and PPWR. OBJECTIVE We examined both PPWR and substantial PPWR (≥4.55 kg) in association with the following dietary patterns: the alternate Mediterranean Diet Score (aMED) and the Alternative Healthy Eating Index-2010 (AHEI-2010). DESIGN Women (n = 1136) in the Infant Feeding Practices Study II (2005-2007) self-reported their prepregnancy and postpartum weights at ~4, 7, 10, and 14 mo. Dietary patterns were calculated from a food-frequency questionnaire administered ~4 mo postpartum. Linear mixed models and generalized estimating equations for repeated measurements were used to examine PPWR and substantial PPWR, respectively, in association with the dietary patterns with adjustment for energy intake, breastfeeding, age, education, smoking, and marital status. RESULTS At 14 mo postpartum, the mean (±SD) PPWR was 1.1 ± 6.7 kg, and 22.4% of women had substantial PPWR. Although the change in PPWR over time seemed to differ by diet quality 4-7 mo postpartum, no differences were ultimately observed in the total mean PPWR or probability of substantial PPWR across aMED and AHEI-2010 categories during the rest of the follow-up (P > 0.12). Instead, PPWR and substantial PPWR were associated with total energy intake (at ~7-14 mo postpartum: 0.97 kg/1000 kcal (95% CI: 0.40, 1.55 kg/1000 kcal); OR: 1.25/1000 kcal (95% CI: 1.03, 1.52/1000 kcal), respectively]. CONCLUSIONS Postpartum diet quality assessed by 2 patterns was not associated with weight retention. Total energy intake, regardless of the diet composition, plays a more important role in weight retention.
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Affiliation(s)
- Nansi S Boghossian
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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