Gestational weight gain and prepregnancy weight influence postpartum weight retention in a cohort of brazilian women

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

OBJECTIVE

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Postpartum weight retention and the early evolution of cardiovascular risk over the first 5 years after pregnancy

BACKGROUND

The cumulative effect of postpartum weight retention from each pregnancy in a woman's life may contribute to her risk of ultimately developing type 2 diabetes and cardiovascular disease. However, there is limited direct evidence supporting this hypothesis. Thus, we sought to characterize the impact of postpartum weight retention on the trajectories of cardiovascular risk factors over the first 5-years after pregnancy.

METHODS

In this prospective observational cohort study, 330 women (mean age 35.7 ± 4.3 years, mean pre-pregnancy body mass index 25.2 ± 4.8 kg/m2, 50.9% primiparous) underwent serial cardiometabolic characterization (anthropometry, blood pressure, lipids, oral glucose tolerance test, insulin sensitivity/resistance (Matsuda index, HOMA-IR), C-reactive protein (CRP), adiponectin) at 1-year, 3-years, and 5-years postpartum. Based on the magnitude of weight change between pre-pregnancy and 5-years postpartum, they were stratified into the following 3 groups: weight loss (n = 100), weight gain 0-6% (n = 110), and weight gain ≥ 6% (n = 120).

RESULTS

At 1-year postpartum, cardiovascular risk factors did not differ between the groups. However, an adverse risk factor profile progressively emerged in the weight retention groups at 3- and 5-years. Indeed, after covariate adjustment, there was stepwise worsening (from the weight loss group to weight gain 0-6% to weight gain ≥ 6% group) of the following cardiovascular risk factors at 5-years: triglycerides (p = 0.001), HDL (p = 0.02), LDL (p = 0.01), apolipoprotein-B (p = 0.003), Matsuda index (p < 0.0001), HOMA-IR (p < 0.0001), fasting glucose (p = 0.07), and CRP (p = 0.01). Moreover, on logistic regression analyses, weight gain ≥ 6% emerged as an independent predictor of pre-diabetes/diabetes at 5-years (adjusted OR = 3.40, 95%CI: 1.63-7.09).

CONCLUSION

Postpartum weight retention predicts trajectories of worsening cardiovascular risk factors and glucose intolerance over the first 5-years after delivery, consistent with its postulated contribution to future vascular disease in women.

Factors Associated With Postpartum Weight Retention in African Women: A Systematic Review

Background and Objective:

The obesity epidemic among women in Africa is a health problem, and many studies attribute it to childbearing. However, most studies of postpartum weight retention (PPWR) occur in high-income countries. Therefore, this review sought to identify the potential factors affecting PPWR among African women.

Methods:

Four databases were searched from January 2000 to December 2020: Medline/PubMed, Google scholar, Ajol research, FreeFullPDF. The quality of included studies was assessed using the Newcastle Ottawa Scale.

Results:

Fifteen studies (5 from west, 4 from south, 3 from east, 2 from central, and 1 from north) were included: 8 cohort and 7 prospective cohort studies. Two studies examined the effect of obesity and weight gain during pregnancy on PPWR, 3 studies assessed the effect of childbirth, 4 examined the effect of breastfeeding, 4 assessed the impact of morbidities such as HIV, and 2 looked at food insecurity. Five studies demonstrated that postpartum weight is due to residual pregnancy weight gain and childbirth weight gain and is accentuated as parity increases (n = 2). Breastfeeding has a controversial effect, while morbidity (n = 4) and food insecurity (n = 4) contributed to weight loss. The variation in weight was also influenced by cultural practices (n = 1), prepregnancy weight (n = 1), and socioeconomic status (n = 1). On all domains, only 3 included studies were of good quality.

Conclusions:

Pregnancy weight gain, childbirth, breastfeeding, morbidity, and food insecurity were associated with PPWR. However, preexisting factors must be considered when developing PPWR modification strategies. In addition, due to the limited number of studies included, robust conclusions cannot be drawn.

Gestational weight gain and postpartum weight retention in Tasmanian women: The Baby-bod Study

Many factors can negatively impact perinatal outcomes, including inappropriate gestational weight gain (GWG). Despite having the greatest potential to influence maternal and infant health, there is a lack of consensus regarding the GWG consistent with a healthy pregnancy. To date, GWG in Northern Tasmania remains understudied. We investigated how maternal pre-pregnancy body mass index (BMI) is related to weight gain during pregnancy and weight retention post-partum, and how maternal pre-pregnancy BMI is related to the mode of delivery. Approximately 300 Tasmanian mothers (n = 291 for mode of delivery and n = 282 for GWG) were included in this study. Analysis of variance and chi square tests were conducted to assess differences in BW of mothers across BMI categories and differences between categorical variables; respectively. Based on pre-pregnancy BMI, mothers were assigned to one of three groups, with healthy weight (<25 kg m-2), with overweight (25–29.9 kg m-2), or with obesity (>30 kg m-2). Pre-pregnancy BMI and body weight (BW) were significantly associated (p<0.001) with post-partum BW at 3 and 6 months. Only 25% of mothers with a normal weight BMI, 34% with overweight and 13% with obesity, achieved the Institute of Medicine (IOM) recommendation for GWG. Interestingly, a number of women in our cohort lost weight during gestation (1.5, 9 and 37% in <25, 25–29.9 and >30 kg m-2 groups, respectively). Further, women with obesity showed the lowest level of BW fluctuation and retained less weight post-partum. The highest number of caesarean sections were observed in mothers who exceeded GWG recommendations. Most mothers either exceeded or failed to achieve IOM recommendations for GWG. To improve the generalisability of these findings, this study should be replicated in a larger representative sample of the Tasmanian maternal population.

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

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

Preventing postpartum weight retention following antenatal lifestyle intervention: One year postpartum follow up of the Healthy Lifestyles in Pregnancy (HeLP-her) randomised controlled trial

Antenatal lifestyle interventions optimise gestational weight gain, yet longer-term efficacy on postpartum weight retention is unclear. Overall, 228 pregnant women <15 weeks gestation were randomised to intervention (four behavioural self-management sessions) or control (generic health information). Median weight retention at 12 months postpartum was significantly reduced in the intervention with a between group difference of -2.3 (-2.8 (-5.9 to 0.35) vs -0.5 (-2.6 to 2.1) kg, respectively P < 0.05, (n = 75) ± 6.3 kg vs -0.5 ± 4.7 kg, respectively, P < 0.05) and associated increased self-weighing behaviours, compared with the control group (regular weighing: 68% vs 43%, P < 0.01). Results demonstrate the efficacy of a low-intensity, behavioural lifestyle intervention in limiting postpartum weight retention.

Mental health and its associations with weight in women with gestational diabetes mellitus. A prospective clinical cohort study

OBJECTIVE

Despite the prevalence of depression in women with gestational diabetes mellitus (GDM) and the relationship between mental health (depression and well-being) and metabolic health, little is known about mental health or its metabolic impact in GDM pregnancy. This prospective clinical cohort study aimed to investigate associations between 1) well-being and depression, and 2) mental health and weight/weight gain in women with GDM.

METHODS

We included 334 pregnant women with GDM treated at a Swiss University Hospital between January 2016 and December 2018. They completed two self-report questionnaires: The World Health Organization well-being index (WHO-5) at the first (29 weeks of gestation) and last (36 weeks of gestation) GDM visits during pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) at the first GDM visit. A cut-off of ≥11 was selected for this questionnaire to indicate the presence of elevated depression scores.

RESULTS

There was an inverse association between the well-being and depression total scores at the first GDM visit during pregnancy (r = -0.55; p < 0.0001). Elevated depression scores at the first GDM visit were associated with subsequent weight gain in GDM pregnancy (β = 1.249; p = 0.019).

CONCLUSION

In women with GDM, elevated depression scores during pregnancy are prospectively associated with weight gain. Depression symptoms should therefore be screened for and treated in women with GDM to reduce the risks associated with excessive weight gain during pregnancy.

Factors Influencing Pregnancy and Postpartum Weight Management in Women of African and Caribbean Ancestry Living in High Income Countries: Systematic Review and Evidence Synthesis Using a Behavioral Change Theoretical Model

Background: Women of black African heritage living in high income countries (HIC) are at risk of obesity and weight-related complications in pregnancy. This review aimed to synthesize evidence concerning attitudes to weight management-related health behaviors in pregnancy and postpartum, in women of black African ancestry, living in high-income countries. Methods: A systematic review of the literature and thematic evidence synthesis using the Capability-Opportunity-Motivation Behavioral change theoretical model (COM-B). Databases searched included MEDLINE, EMBASE, Web of Science, and Scopus. The CASP tool was used to assess quality. Results: Twenty-four papers met the selection criteria, most of which were from the US. Motivational factors were most commonly described as influencers on behavior. Normative beliefs about "eating for two," weight gain being good for the baby, the baby itself driving food choice, as well as safety concerns about exercising in pregnancy, were evident and were perpetuated by significant others. These and other social norms, including a cultural acceptance of larger body shapes, and daily fast food, created a challenge for healthy behavior change. Women also had low confidence in their ability to lose weight in the postpartum period. Behavior change techniques, such as provision of social support, use of credible sources, and demonstration may be useful to support change. Conclusions: The women face a range of barriers to engagement in weight-related health behaviors at this life-stage. Using a theoretical behavior change framework can help identify contextual factors that may limit or support behavior change.

The influence of sleep quality on weight retention in the postpartum period

Poor sleep in the postpartum is often treated as an unavoidable consequence of childbirth. This study aims to compare objective and subjective measures of sleep, explore the relationship between sleep and postpartum weight retention (PPWR), and investigate factors that may contribute to sleep quality in the postpartum period. In this cross-sectional cohort, PPWR, sleep quality (Pittsburgh Sleep Quality Index (PSQI)), and objective sleep and physical activity (accelerometry) were assessed in 109 women 0–52 weeks postpartum. Anthropometric and demographic data were collected. Gestational weight gain (GWG) was classified as inadequate, appropriate, or excessive according to Institute of Medicine guidelines. Average GWG (33.7 lbs) and PPWR (5.39 lbs) were not different between “good” (PSQI < 6) and “bad” (PSQI ≥ 6) sleepers. Following adjustment, mothers with excessive GWG who were “bad” sleepers had 5.26 higher odds of PPWR ≥ 10 lbs compared with all other combinations of GWG and PSQI. PSQI was not correlated with total sleep time (accelerometer-derived). Light activity and moderate-to-vigorous physical activity (MVPA) were associated with reduced odds of being a “bad” sleeper. The influence of GWG on PPWR was modified by postpartum sleep quality. Both light activity and meeting the MVPA guidelines in the postpartum were associated with higher sleep quality.

Novelty Subjectively rated poor sleep may represent the number of awakenings and wake after sleep onset in postpartum women. Poor postpartum sleep quality increases excessive postpartum weight retention in women with excessive GWG. Women doing light-to-vigorous physical activity in the postpartum are less likely to experience poor sleep quality.

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

OBJECTIVE

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

DESIGN

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

SETTING

Mexico City.

PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

Rate of gestational weight gain trajectory is associated with adverse pregnancy outcomes

OBJECTIVE

To examine the gestational weight gain (GWG) trajectory and its possible association with pregnancy outcomes.

DESIGN

GWG trajectories were identified using the latent class growth model. Binary logistic regression was performed to examine the associations between adverse pregnancy outcomes and these trajectories.

SETTING

Negeri Sembilan, Malaysia.

PARTICIPANTS

Two thousand one hundred ninety-three pregnant women.

RESULTS

Three GWG trajectories were identified: 'Group 1 - slow initial GWG but followed by drastic GWG', 'Group 2 - maintaining rate of GWG at 0·58 kg/week' and 'Group 3 - maintaining rate of GWG at 0·38 kg/week'. Group 1 had higher risk of postpartum weight retention (PWR) (adjusted OR (AOR) 1·02, 95 % CI 1·01, 1·04), caesarean delivery (AOR 1·03, 95 % CI 1·01, 1·04) and having low birth weight (AOR 1·04, 95 % CI 1·02, 1·05) compared with group 3. Group 2 was at higher risk of PWR (AOR 1·18, 95 % CI 1·16, 1·21), preterm delivery (AOR 1·03, 95 % CI 1·01, 1·05) and caesarean delivery (AOR 1·02, 95 % CI 1·01, 1·03), but at lower risk of having small-for-gestational-age infants (AOR 0·97, 95 % CI 0·96, 0·99) compared with group 3. The significant associations between group 1 and PWR were observed among non-overweight/obese women; between group 1 and caesarean delivery among overweight/obese women; group 2 with preterm delivery and caesarean delivery were only found among overweight/obese women.

CONCLUSIONS

Higher GWG as well as increasing GWG trajectories was associated with higher risk of adverse pregnancy outcomes. Promoting GWG within the recommended range should be emphasised in antenatal care to prevent the risk of adverse pregnancy outcomes.

Targeting pregnancy-related weight gain to reduce disparities in obesity: Baseline results from the Healthy Babies trial

BACKGROUND

Obesity affects African American women more than any other group in the US. Pregnancy represents a critical life stage of heightened vulnerability for new or persistent obesity, yet few interventions have been effective in reducing excessive gestational weight gain among African American women. We describe the design and baseline findings of Healthy Babies, a two-arm randomized controlled trial testing a mobile health intervention to minimize excessive gestational weight gain versus usual care in this high risk group.

METHODS

African American women in early pregnancy were recruited from two large obstetric practices as well as Philadelphia Women, Infants, and Children's clinics. Participants randomized to the intervention received behavior change goals, daily text messages with feedback, web-based weight gain graphs, health coaching, and a Facebook support group. Data collection included baseline (<22 weeks' gestation), 36-38 weeks' gestation, and 6-month postpartum anthropometric measures and assessments of demographics, contextual factors and behavioral targets. The primary outcome was prevalence of excessive gestational weight gain.

RESULTS

Among participants at baseline (n = 262), the majority met criteria for obesity (63%), were multiparous (62%), single (77%), and were on average 25.6 ± 5.4 years old with a gestational age of 13.9 ± 4.1 weeks. While 82% completed high school, 61% met criteria for inadequate health literacy. Nearly 20% were food insecure. Eighty-eight percent reported a gestational weight gain goal discordant with Institute of Medicine guidelines. There were no significant differences in baseline characteristics between study arms.

CONCLUSIONS

Participants represent a high-risk group for excessive gestational weight gain with demonstrated need for intervention.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Influence of Sleep Duration on Postpartum Weight Change in Black and Hispanic Women

OBJECTIVE

The primary purpose of this study was to examine associations of objectively measured sleep duration with weight changes in black and Hispanic mothers over the first postpartum year.

METHODS

Data were from 159 mothers (69% black, 32% Hispanic). Nocturnal sleep duration was assessed using wrist actigraphy at 6 weeks and 5 months post partum, examined as a continuous variable and in categories (< 7 vs. ≥ 7 hours/night, consistent with American Academy of Sleep Medicine recommendations). Body weights were abstracted from medical records in pregnancy and measured at 6 weeks, 5 months, and 12 months post partum. Outcomes included early postpartum (6 weeks to 5 months) and late postpartum (5 to 12 months) weight changes.

RESULTS

The majority of participants slept < 7 hours/night at 6 weeks (75%) and 5 months (63%) post partum. Early postpartum weight change did not differ by 6-week sleep duration category. By contrast, adjusted average late postpartum weight gain (SE) was 1.8 (0.7) kg higher in participants sleeping < 7 hours/night at 5 months post partum compared with those sleeping ≥ 7 hours/night (P = 0.02). Results did not show statistically significant associations of continuous measures of sleep duration, nor of measures of sleep quality, with postpartum weight changes.

CONCLUSIONS

Sleeping < 7 hours/night was associated with late postpartum weight gain in minority mothers.

Lifestyle Interventions in Overweight and Obese Pregnant or Postpartum Women for Postpartum Weight Management: A Systematic Review of the Literature

Excessive gestational weight gain (GWG) and postpartum weight retention (PPWR) may predispose women to the development of obesity. The objective of this systematic review was to evaluate the effectiveness of lifestyle interventions in overweight or obese pregnant and/or postpartum women for managing postpartum weight up to 2 years after giving birth. Eighteen randomised controlled trials were included (2559 participants) and divided into three categories according to the timing of the intervention: pregnancy only (n = 3), postpartum only (n = 12) and pregnancy and postpartum (n = 3). The intervention duration varied from 10 weeks to 10 months and included diet only (n = 5) or diet and physical activity (n = 13). Seven postpartum only interventions reported significant improvements in postpartum weight when compared to the control group. Most of these interventions were short and intensive, lasting 10–16 weeks. One pregnancy only and one pregnancy and postpartum intervention reported reduced PPWR at 6 months. Nine trials did not report an effect of the intervention on postpartum weight. However, of these, four reported associations between GWG and PPWR. This review suggests that successful postpartum weight management is achievable with intensive lifestyle interventions starting in the postpartum period; however, there is insufficient evidence to conclude whether interventions starting in pregnancy are effective. Larger trials utilising comparative methodologies in the pregnancy and postpartum periods are required to inform the development of targeted strategies preventing PPWR or reducing postpartum weight.

Optimising gestational weight gain and improving maternal and infant health outcomes through antenatal dietary, lifestyle and physical activity advice: the OPTIMISE randomised controlled trial protocol

INTRODUCTION

Obesity represents a significant health burden, and WHO recognises the importance of preventing weight gain and subsequent development of obesity among adults who are within the healthy weight range. Women of reproductive age have demonstrated high rates of weight gain during pregnancy placing them at risk of becoming overweight or obese. We will evaluate the effects of dietary and physical activity advice on maternal, fetal and infant health outcomes, among pregnant women of normal body mass index (BMI).

METHODS AND ANALYSIS

We will conduct a randomised controlled trial, consenting and randomising women with a live singleton pregnancy between 10+0 and 20+0 weeks and BMI 18.5-24.9 kg/m2 at first antenatal visit, from a tertiary maternity hospital. Women randomised to the Lifestyle Advice Group will receive three face-to-face sessions (two with a research dietitian and one with a trained research assistant) and three telephone calls over pregnancy, in which they will be provided with dietary and lifestyle advice and encouraged to make change using a SMART goals approach. Women randomised to the Standard Care Group will receive routine antenatal care. The primary outcome is infant birth weight >4 kg. Secondary outcomes will include adverse infant and maternal outcomes, maternal weight change, maternal diet and physical activity changes, maternal quality of life and emotional well-being, fetal growth and costs of healthcare. We will recruit 624 women to detect a reduction from 8.72% to 3.87% (alpha 0.05 (two-tailed); power 70%) in infants with birth weight >4 kg. Analyses will be intention to treat with estimates reported as relative risks and 95% CIs.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Women's and Children's Hospital ethics committee. Findings will be disseminated widely via journal publication and conference presentation(s), and participants informed of results.

TRIAL REGISTRATION NUMBER

ACTRN12614000583640.

The influence of psychological factors on postpartum weight retention 12 months post-birth

Background During the first postpartum year 20% of women retain excessive weight from pregnancy (postpartum weight retention; PPWR), which predicts long-term overweight/obesity. Objective The aim of this study was to explore the associations between psychological factors (depression, anxiety and stress symptoms and body attitudes) in late gestation and at 12-months postpartum with PPWR one-year post-birth. Methods Pregnant women (N = 176) completed questionnaires in early-mid pregnancy (Time 1; mean (SD) = 16.97 (1.35) weeks), late pregnancy (Time 2; mean (SD) = 33.33 (2.05) weeks), and one year postpartum (Time 3; mean (SD) = 53.12 (3.34) weeks). Women provided demographic characteristics, height and pre-pregnancy weight at Time 1. At Times 2 and 3, weight, depressive, anxiety and stress symptoms and body attitudes (salience of weight and shape, attractiveness, feeling fat, and strength and fitness) were assessed in addition to physiological, socio-contextual and lifestyle factors. Gestational weight gain and PPWR were calculated. Hierarchical linear regression models were conducted to explore variance in 12-month PPWR. Results Overall, models explained 26-39% variance in PPWR. Gestational weight gain in late pregnancy and low attractiveness at 12 months postpartum were the only variables associated significantly with 12-month PPWR. Conclusion While psychological factors did not appear to be important direct contributors to PPWR at 12 months, the overall contribution of all variables suggests that such factors may be implicated in a small and incremental way. Exploration of the interactions between variables will help unpack potential mechanisms of the development of PPWR at 12 months post-birth.

Postpartum Weight Retention Risk Factors in a Taiwanese Cohort Study

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Central and peripheral leptin and agouti-related protein during and after pregnancy in relation to weight change

OBJECTIVE

To study changes of neuropeptides and adipokines in cerebrospinal fluid (CSF) and serum from pregnancy to postpregnancy in relation to weight changes, fat mass and glucose metabolism.

CONTEXT

With high postpartum weight retention being a risk factor in future pregnancies and of lifelong obesity, we evaluated neuropeptide and adipokine changes in women who either gained weight or were weight stable.

DESIGN

Women were followed for 5 ± 1 years after pregnancy and divided into two groups, weight stable and weight gain, by weight change from start of pregnancy.

PATIENTS

Twenty-five women (BMI 27 ± 5 kg/m² ) recruited at admission for elective caesarean section.

MEASUREMENTS

CSF and serum levels of agouti-related protein (AgRP), leptin and insulin, and serum levels of adiponectin and soluble leptin receptor were measured during and after pregnancy. These measurements were further related to fat mass and insulin sensitivity (HOMA-IR).

RESULTS

S-AgRP levels during pregnancy were lower in the weight stable group and a 1 unit increase in s-AgRP was associated with 24% higher odds of pertaining to the weight gain group. After pregnancy, s-AgRP increased in the weight stable group but decreased in the weight gain group. Decreased transport of leptin into CSF during pregnancy was reversed by an increased CSF:serum leptin ratio after pregnancy. In women who returned to their prepregnancy weight, serum adiponectin increased after pregnancy and correlated negatively with HOMA-IR.

CONCLUSION

S-AgRP concentration in late pregnancy may be one factor predicting weight change after pregnancy, and circulating AgRP may be physiologically important in the long-term regulation of body weight.

Effect of multiparity and ethnicity on the risk of development of diabetes: a large population-based cohort study

AIMS

To investigate the relationship between increasing parity and diabetes in a large, population-based cohort, and to examine if this relationship is different among high-risk ethnic groups.

METHODS

A population-based, retrospective cohort study was performed in 738 440 women aged 18-50 years, who delivered babies in Ontario between 1 April 2002 and 31 March 2011. Diabetes incidence postpartum was calculated for each parity and ethnic group. A multivariable analysis of the effect of parity and ethnicity on the incidence of diabetes was performed using a Cox proportional hazards model, adjusting for confounders.

RESULTS

The diabetes incidence rate per 1000 person-years was 3.69 in women with 1 delivery, 4.12 in women with 3 deliveries and 7.62 in women with ≥5 deliveries. Women with ≥3 deliveries had a higher risk of developing diabetes compared with women with 1 delivery [adjusted hazard ratios 1.06 (95% CI 1.01-1.11) for 3 deliveries, 1.33 (95% CI 1.25-1.43) for 4 deliveries and 1.53 (95% CI 1.41-1.66) for ≥5 deliveries). A similar rise in risk could be seen in Chinese and South-Asian women, with the most influence in Chinese women [hazard ratio 4.59 (95% CI 2.36-8.92) for ≥5 deliveries].

CONCLUSIONS

There was a positive and graded relationship between increasing parity and risk of development of diabetes. The influence of parity was seen in all ethnicities. This association may be partly related to increasing weight gain and retention with increasing parity, or deterioration in β-cell function. This merits further exploration.

The effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on longer-term maternal and early childhood outcomes: protocol for an individual participant data (IPD) meta-analysis

BACKGROUND

The aim of this individual participant data meta-analysis (IPDMA) is to evaluate the effects of dietary and lifestyle interventions among pregnant women who are overweight or obese on later maternal and early childhood outcomes at ages 3-5 years.

METHODS/DESIGN

We will build on the established International Weight Management in Pregnancy (i-WIP) IPD Collaborative Network, having identified researchers who have conducted randomised dietary and lifestyle interventions among pregnant women who are overweight or obese, and where ongoing childhood follow-up of participants has been or is being undertaken. The primary maternal outcome is a diagnosis of maternal metabolic syndrome. The primary childhood outcome is BMI above 90%. We have identified 7 relevant trials, involving 5425 women who were overweight or obese during pregnancy, with approximately 3544 women and children with follow-up assessments available for inclusion in the meta-analysis.

DISCUSSION

The proposed IPDMA provides an opportunity to evaluate the effect of dietary and lifestyle interventions among pregnant women who are overweight or obese on later maternal and early childhood health outcomes, including risk of obesity. This knowledge is essential to effectively translate research findings into clinical practice and public health policy.

SYSTEMATIC REVIEW REGISTRATION

This IPD has been prospectively registered (PROSPERO), ID number CRD42016047165 .

Home visitation programs: an untapped opportunity for the delivery of early childhood obesity prevention

BACKGROUND

Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: (i) short duration and low intensity; (ii) late timing of implementation, when children are already overweight or obese; (iii) intervention delivery limiting their accessibility and sustainability; and (iv) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes.

OBJECTIVE

This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention.

CONCLUSION

The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (i) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health because of socio-economic and structural conditions; (ii) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (iii) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention.

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

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

The relationship between macro- and micro-nutrients intake and risk of preterm premature rupture of membranes in pregnant women of Isfahan

BACKGROUND

Since preterm premature rupture of membranes (PPROM) is one of the most important complications of pregnancy and its relationship with nutrition status have not been surveyed comprehensively, we decided to study the relationship of maternal received nutrients (36 macro- and micro-nutrients) in three trimesters and PPROM which could be considered as a unique study.

MATERIALS AND METHODS

In this prospective cohort study, data was collected by filling a questionnaire through interviews with 620 pregnant women who had no parameters to affect pregnancy outcome. 48-hr dietary recalls were completed for eligible women at 11th-15th, 26th, 34th-37th weeks of gestation. Physical activity was also assessed using a standard questionnaire. Also pregnant mother's reproductive and demographic characteristic and supplementation are considered.

RESULTS

The mean value of received saturated fatty acids, polyunsaturated fatty acids and energy, in the first trimester (P < 0.001, P = 0.007, and P < 0.001 respectively), the mean values of calcium, sodium intake in the second trimester (P = 0.045, P = 0.006, and P = 0.004 respectively), Vitamins C, A (mg), β-carotene, cartenoids intake in the second trimester (P = 0.03, P = 0.001, P = 0.007, and P = 0.01 respectively), and higher Vitamin C intake during the first trimester (P = 0.02) was significantly greater among subjects with PPROM compared to the others.

CONCLUSIONS

The mean value of mentioned received nutrients in subjects who experienced PPROM later in pregnancy was higher than the others, which is independent of demographic and reproductive characteristic, estimated physical activity, and supplementation. Therefore, these findings could be considered in the nutritional programming for pregnant women to manage the risk of PPROM.

Determinants of change in body weight and body fat distribution over 5.5 years in a sample of free-living black South African women

Objective

To identify socio-demographic and lifestyle determinants of weight gain in a sample of premenopasual black South African (SA) women.

Methods

Changes in body composition (dual-energy X-ray absorptiometry, computerised tomography), socio-economic status (SES) and behavioural/lifestyle factors were measured in 64 black SA women at baseline (27 ± 8 years) and after 5.5 years.

Results

A lower body mass index (BMI) and nulliparity, together with access to sanitation, were significant determinants of weight gain and change in body fat distribution over 5.5 years. In addition, younger women increased their body weight more than their older counterparts, but this association was not independent of other determinants.

Conclusion

Further research is required to examine the effect of changing SES, as well as the full impact of childbearing on weight gain over time in younger women with lower BMIs. This information will suggest areas for possible intervention to prevent long-term weight gain in these women.

Pre-Pregnancy Weight Status Is Associated with Diet Quality and Nutritional Biomarkers during Pregnancy

Although the positive association between pre-pregnancy overweight and obesity with excessive gestational weight gain is well known, it is not clear how pre-pregnancy weight status is associated with gestational weight gain through maternal diet during pregnancy. This study aimed to examine the relationship between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Our study included 795 U.S. pregnant women from the National Health and Nutrition Examination Survey, 2003–2012. Pre-pregnancy body mass index (BMI) was calculated based on self-reported pre-pregnancy weight and height. The cutoff points of <18.5 (underweight), 18.5–24.9 (normal), 25.0–29.9 (overweight), and 30 kg/m² (obese) were used to categorize pregnant women’s weight status. Diet quality during pregnancy was assessed by the Healthy Eating Index (HEI)-2010 based on a 24-h recall. Multivariable logistic regressions were used to estimate the odds ratios (OR) and 95% confidence intervals (CI). For all pregnant women included in this study, the mean HEI-2010 (±standard error of the mean (SEM)) was 50.7 (±0.9). Women with obese pre-pregnancy BMI demonstrated significantly lower HEI-2010 compared to those with underweight and normal pre-pregnancy BMI, respectively. In an unadjusted model, women with pre-pregnancy obesity BMI had increased odds for being in the lowest tertile of HEI-2010 (33.4 ± 0.5) compared to those with underweight pre-pregnancy BMI (OR 5.0; 95% CI 2.2–11.4). The inverse association between pre-pregnancy overweight and obesity status and diet quality during pregnancy persisted even after we controlled for physical activity levels (adjusted OR (AOR) 3.8; 95% CI 1.2–11.7, AOR 5.4; 95% CI 2.0–14.5, respectively). Serum folate concentration (ng/mL) was significantly higher in underweight women compared to overweight women (23.4 ± 1.7 vs. 17.0 ± 0.8, p < 0.05). Serum iron concentration (ng/dL) was significantly higher in normal weight women compared to overweight women (86.2 ± 5.0 vs. 68.9 ± 3.0, p < 0.05). An inverse association was found between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Poor diet quality as measured by HEI-2010 was shown among overweight and obese women. Nutrition education and interventions need to be targeted to those women entering pregnancy as overweight and obese.

Low Gestational Weight Gain in Obese Women and Pregnancy Outcomes

Obesity during pregnancy and excessive weight gain during this period are associated with several maternal-fetal and neonatal complications. Moreover, a significant percentage of women have weight retention in the postpartum period, especially those with excessive weight gain during pregnancy. The recommendations of the 2009 Institute of Medicine were based on observational studies that have consistently shown that women with weight gain within the recommended range had better outcomes during pregnancy. In patients with obesity, however, there is no recommendation for weight gain, according to the class of obesity. This review, therefore, aims to evaluate the evidence on key maternal and fetal complications related to low weight gain during pregnancy in obese and overweight patients.

Systematic review of antenatal dietary and lifestyle interventions in women with a normal body mass index

INTRODUCTION

Women who commence pregnancy with a normal body mass index (BMI) are at the greatest risk of excessive gestational weight gain, impacting on infant birthweight, pregnancy-related complications and postpartum weight retention. Our aim was to review systematically the effect of antenatal dietary and lifestyle interventions in pregnant women with a normal BMI on maternal and infant outcomes.

MATERIAL AND METHODS

We searched the Cochrane Controlled Trials Register, PubMed, Medline, and the Australian and International Clinical Trials Registry with the date of the last search in July 2015. We included all published, unpublished and ongoing randomized trials recruiting women of a normal BMI, comparing dietary and/or lifestyle interventions with standard antenatal care.

RESULTS

Twelve randomized controlled trials were identified, involving a total of 2713 pregnant women, with five studies reporting clinical data for 714 women with a normal BMI. Women who received a dietary and lifestyle intervention were less likely to experience gestational weight gain [four studies, 446 women; mean difference -1.25 kg; 95% confidence interval (CI) -2.39 to -0.11], weight gain above the Institute of Medicine guidelines (four studies, 446 women; risk ratio 0.66; 95% CI 0.53-0.83) and hypertension (two studies; 243 women; risk ratio 0.34; 95% CI 0.13-0.91). There were no statistically significant differences in the occurrence of gestational diabetes, cesarean section or birthweight greater than 4 kg.

CONCLUSIONS

While providing an antenatal dietary and lifestyle intervention for pregnant women of normal BMI appears to reduce gestational weight gain, the review was limited by the relatively small available sample size. Further well-designed randomized controlled trials are required.

'Fit Moms/Mamás Activas' internet-based weight control program with group support to reduce postpartum weight retention in low-income women: study protocol for a randomized controlled trial

BACKGROUND

High postpartum weight retention is a strong independent risk factor for lifetime obesity, cardiovascular disease, and type 2 diabetes in women. Interventions to promote postpartum weight loss have met with some success but have been limited by high attrition. Internet-based treatment has the potential to overcome this barrier and reduce postpartum weight retention, but no study has evaluated the effects of an internet-based program to prevent high postpartum weight retention in women.

METHODS/DESIGN

Fit Moms/Mamás Activas targets recruitment of 12 Women, Infants and Children (WIC) Supplemental Nutrition Program clinics with a total of 408 adult (>18 years), postpartum (<1 year) women with 14.5 kg or more weight retention or a body mass index of 25.0 kg/m(2) or higher. Clinics are matched on size and randomly assigned within county to either a 12-month standard WIC intervention or to a 12-month WIC enhanced plus internet-based weight loss intervention. The intervention includes: monthly face-to-face group sessions; access to a website with weekly lessons, a web diary, instructional videos, and computer-tailored feedback; four weekly text messages; and brief reinforcement from WIC counselors. Participants are assessed at baseline, six months, and 12 months. The primary outcome is weight loss over six and 12 months; secondary outcomes include diet and physical activity behaviors, and psychosocial measures.

DISCUSSION

Fit Moms/Mamás Activas is the first study to empirically examine the effects of an internet-based treatment program, coupled with monthly group contact at the WIC program, designed to prevent sustained postpartum weight retention in low-income women at high risk for weight gain, obesity, and related comorbidities.

TRIAL REGISTRATION

This trial was registered with Clinicaltrials.gov (identifier: NCT01408147 ) on 29 July 2011.

Gestational weight gain among American Samoan women and its impact on delivery and infant outcomes

BACKGROUND

As obesity has increased worldwide, so have levels of obesity during pregnancy and excess gestational weight gain (GWG). The aim of this paper was to describe GWG among American Samoan women and examine the association between GWG and four adverse pregnancy and infant outcomes: cesarean delivery, small- and large-for-gestational age (SGA/LGA), and infant overweight/obesity.

METHODS

Data were extracted from prenatal care records of 632 Samoan women. Mixed-effects growth models were used to produce individual weight-for-gestational week curves from which second and third trimester weight gain was estimated. Binary logistic regression was used to examine associations between GWG and the outcomes of interest.

RESULTS

Most women were overweight/obese in early pregnancy (86%) and 78% exceeded the Institute of Medicine GWG guidelines. Greater GWG in the second trimester and early pregnancy weight were independently associated with increased odds of a c-section (OR 1.40 [95% CI: 1.08, 1.83]) and OR 1.51 [95% CI: 1.17, 1.95], respectively). Risk of delivering a LGA infant increased with greater third trimester weight gain and higher early pregnancy weight, while second trimester weight gain was negatively associated with SGA. Risk of infant overweight/obesity at 12 months increased with early pregnancy weight (OR: 1.23 [95% CI: 1.01, 1.51]) and infant birthweight.

CONCLUSIONS

The high levels of pregnancy obesity and excessive GWG in American Samoa suggest that it is important for physicians to encourage women into prenatal care early and begin education about appropriate GWG and the potential risks of excess weight gain for both the mother and baby.

How much weight are women gaining during pregnancy? An Italian cohort study

INTRODUCTION

The 2009 Institute of Medicine (IOM) guidelines define adequate gestational weight gain (GWG) in the attempt to prevent maternal and neonatal adverse outcomes. The aim of this study was to assess whether the IOM guidelines are met in pregnant women with different pre-gestational body mass index (BMI).

METHODS

The study included 230 pregnant women recruited at the University Hospital of Pisa (Italy) at their screening visit (24-28 weeks of gestation) for gestational diabetes (GDM). GWG was determined at screening time and before delivery to be compared with GWG recommended by IOM for each pre-pregnancy BMI category.

RESULTS

A total of 48% of women had a GWG exceeding IOM recommendations. The prevalence of GWG excess was higher in over-weight (OW, 63.2%) and obese (OB, 63.8%) women as compared to normal-weight (NW, 27.7%; p < 0.0001) women. The upper limit of the recommended IOM weight gain range was already exceeded at screening time in 15.5% of women. The percentage increased 27% and 18% in OW and OB, respectively, compared with 1.5% in NW (p < 0.001).

CONCLUSION

About half of pregnant women had a GWG greater than the IOM recommended. GWG excess is particularly evident in OW and OB women.

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

OBJECTIVE

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

DESIGN

Meta-analysis.

SETTING

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

SUBJECTS

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

RESULTS

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

CONCLUSIONS

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

Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial

BACKGROUND

Pregnancy is a recognised high risk period for excessive weight gain, contributing to postpartum weight retention and obesity development long-term. We aimed to reduce postpartum weight retention following a low-intensity, self-management intervention integrated with routine antenatal care during pregnancy.

METHODS

228 women at increased risk of gestational diabetes, <15 weeks gestation were randomised to intervention (4 self-management sessions) or control (generic health information). Outcomes, collected at baseline and 6 weeks postpartum, included anthropometrics (weight and height), physical activity (pedometer) and questionnaires (health behaviours).

RESULTS

Mean age (32.3 ± 4.7 and 31.7 ± 4.4 years) and body mass index (30.4 ± 5.6 and 30.3 ± 5.9 kg/m2) were similar between intervention and control groups, respectively at baseline. By 6 weeks postpartum, weight change in the control group was significantly higher than the intervention group with a between group difference of 1.45 ± 5.1 kg (95% CI: -2.86,-0.02; p < 0.05) overall, with a greater difference in weight found in overweight, but not obese women. Intervention group allocation, higher baseline BMI, GDM diagnosis, country of birth and higher age were all independent predictors of lower weight retention at 6 weeks postpartum on multivariable linear regression. Other factors related to weight including physical activity, did not differ between groups.

CONCLUSIONS

A low intensity intervention, integrated with standard antenatal care is effective in limiting postpartum weight retention. Implementation research is now required for scale-up to optimise antenatal health care.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry Number: ACTRN12608000233325. Registered 7/5/2008.

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

Post-partum weight retention (WR) occurs in 60-80% of women with some retaining ≥10 kg with contributing factors reported as pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and breastfeeding. A longitudinal study of pregnancy, with 12-month post-partum follow-up was conducted to determine factors associated with WR. Pregnant women (n = 152) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Pre-pregnancy weight was self-reported; weight was measured four times during pregnancy (for GWG) and in the first 12 months post-partum. Infant feeding data were obtained via questionnaires. Breastfeeding was categorised as exclusive, predominant, complementary or not breastfeeding. Linear mixed models tested the predictors of WR, with and without adjustment for potential confounders. Compared with pre-pregnancy weight, 68% of women retained weight at 12 months, median (interquartile range) [4.5 kg (2.1-8.9)]. After adjustment, GWG was positively associated with WR (P < 0.01), but pre-pregnancy weight did not predict WR. For each additional week of any breastfeeding, 0.04 kg less weight was retained. Compared with women who retained weight, those women who did retain had higher rates of exclusive breastfeeding at three months (P < 0.05), but the number of weeks of exclusive breastfeeding failed to predict WR for all women. WR following childbirth is common and associated with GWG, while the number of weeks of 'any' breastfeeding contributed to post-partum weight loss. Whether these factors are modifiable strategies to optimise the weight status of women at this life stage requires further research.

Cardiometabolic implications of postpartum weight changes in the first year after delivery

OBJECTIVE

The cumulative effect of postpartum weight retention from each pregnancy in a woman's life may contribute to her ultimate risk of diabetes and vascular disease. However, there is little direct evidence supporting this hypothesis. In this context, we sought to evaluate the cardiometabolic implications of patterns of postpartum weight change and the time course thereof in the first year after pregnancy.

RESEARCH DESIGN AND METHODS

Three hundred five women underwent cardiometabolic characterization at recruitment in pregnancy and at 3 and 12 months postpartum. Based on their respective weight changes between prepregnancy and 3 months postpartum (loss or gain) and between 3 and 12 months postpartum (loss or gain), participants were stratified into four groups: loss/loss, gain/loss, loss/gain, and gain/gain.

RESULTS

Most women (81.0%) had higher weight at 3 months postpartum compared with prepregnancy. Between 3 and 12 months, most women (74.4%) lost weight. At 3 months, there were modest differences between the four groups in mean adjusted LDL cholesterol (P = 0.01) and apolipoprotein-B (apoB; P = 0.02) but no significant differences in adjusted blood pressure, fasting and 2-h glucose, HDL, triglycerides, homeostasis model assessment of insulin resistance (HOMA-IR), adiponectin, and C-reactive protein. By 12 months postpartum, however, clear gradients emerged, with mean adjusted diastolic blood pressure (P = 0.02), HOMA-IR (P = 0.0003), LDL (P = 0.001), and apoB (P < 0.0001) all progressively increasing from the loss/loss group to gain/loss to loss/gain to gain/gain. Similarly, at 12 months, mean adjusted adiponectin showed a stepwise decrease from loss/loss to gain/loss to loss/gain to gain/gain (P = 0.003).

CONCLUSIONS

An adverse cardiometabolic profile emerges as early as 1 year postpartum in women who do not lose weight between 3 and 12 months after delivery.

Weight during the postpartum period: what can health care workers do?

To describe the gestational month-to-month weight change, obstetric and lifestyle factors influencing postpartum weight retention (PPWR) and to suggest possible interventions to prevent PPWR. This study was part of a larger research project concerning maternal weight change after childbirth. 343 women were recruited on five maternity wards in the Antwerp region, Belgium. Weight and height were assessed by the researchers during two home visits at 3 and 14 months postpartum and participants completed a questionnaire investigating obstetric and lifestyle factors during the first home visit. The monthly weights in between the home visits were self-reported by the participants. Full data were available for 75 women. One year after childbirth 52.0 % of the women faced postpartum weight retention. The different monthly weight points within the changes differed significantly from each other up to sixth months postpartum. Prepregnancy weight, exceeding the recommendations from the Institute of Medicine (IOM) concerning weight gain during pregnancy, smoking behaviour and exercising during pregnancy significantly influenced the postpartum weight change. The amount of weight gained during pregnancy, breastfeeding, possible postpartum depression and experiencing a shortage of information concerning the weight change after childbirth significantly influenced postpartum weight retention. Weight gain during pregnancy, exceeding IOM-criteria, breastfeeding, depression and lack of information determine PPWR and can be modulated by interventions such as routine weighing or screening of pregnant women. Several of these influencing factors can be preventively influenced by health care workers. Overall, we believe women could benefit from more guidance before, during and after pregnancy. Moreover, we recommend to reintroduce routine weighing of pregnant women as weight gain during pregnancy seems one of the most important factors involved in PPWR.

Risk factors for excessive gestational weight gain in a healthy, nulliparous cohort

OBJECTIVE

Excessive gestational weight gain (GWG) is associated with adverse maternal and child outcomes and contributes to obesity in women. Our aim was to identify early pregnancy factors associated with excessive GWG, in a contemporary nulliparous cohort.

METHODS

Participants in the SCOPE study were classified into GWG categories ("not excessive" versus "excessive") based on pregravid body mass index (BMI) using 2009 Institute of Medicine (IOM) guidelines. Maternal characteristics and pregnancy risk factors at 14-16 weeks were compared between categories and multivariable analysis controlled for confounding factors.

RESULTS

Of 1950 women, 17% gained weight within the recommended range, 74% had excessive and 9% inadequate GWG. Women with excessive GWG were more likely to be overweight (adjOR 2.9 (95% CI 2.2-3.8)) or obese (adjOR 2.5 (95% CI 1.8-3.5)) before pregnancy compared to women with a normal BMI. Other factors independently associated with excessive GWG included recruitment in Ireland, younger maternal age, increasing maternal birthweight, cessation of smoking by 14-16 weeks, increased nightly sleep duration, high seafood diet, recent immigrant, limiting behaviour, and decreasing exercise by 14-16 weeks. Fertility treatment was protective.

CONCLUSIONS

Identification of potentially modifiable risk factors for excessive GWG provides opportunities for intervention studies to improve pregnancy outcome and prevent maternal obesity.

Childhood obesity prevention: a life-course framework

Overweight/obese women are more likely to deliver newborns that also have a predisposition to store excessive amounts of fat since the early infancy period. Two evidence-based cycles are considered on the explanation of the maternal–child life-course approach for obesity prevention. The ‘maternal' cycle indicates that pre-pregnancy overweight primiparous women are more likely to gain excessive weight during gestation and to retain excessive weight postpartum. The ‘offspring' cycle indicates that newborns of pre-pregnancy overweight/obese women are more likely themselves to store excessive body fat starting very early on in life. The social ecological model (SEM) has been adopted as the framework needed to guide obesity prevention initiatives. The SEM considers the complex interrelationship among highly interconnected systems embedded within each other and having the individual on its inner most. Recommendations to women should include prevention of overweight/obesity prenatally, to attain adequate gestational weight and to lose the weight normally gained as part of the physiological response to pregnancy in the postpartum period. For the ‘offspring' the aims should be to promote optimal breastfeeding and complementary feeding practices, and to foster physical activity and adequate dietary habits. Well-coordinated inter-sectorial national obesity prevention programs built upon the life-course framework foundation requires in-depth early life systems analyses driven by the SEM.

Nutrition transition and obesity prevention through the life-course

The aim of this paper is to discuss concepts regarding the nutrition transition (NT), the several stages it has encompassed over human history, dietary shifts it is associated with and its implications to the life-course approach for obesity prevention. NT is a phenomenon characterized by an inversion of the nutrition profile, that is, an increase in obesity and a reduction in undernutrition. Obesity and associated chronic diseases are the most important expressions of NT today. Some important dietary changes happened in the last decades as a result of the complex determinants of NT, such as urbanization, the economic growth dynamic, cultural and behavioral shifts. The NT has involved an increased consumption of caloric beverages, ultra-processed products, animal foods, edible oils and soft drinks, accompanied by a significant reduction in the consumption of fruits, vegetables, pulses and milk. Global obesity prevalence increased from 4.8% in 1980 to 9.8% in 2008 for men, and from 7.9% in 1980 to 13.8% in 2008 for women, representing 205 million men and 297 million women with obesity and 1.46 billion with overweight in 2008. The context of the NT needs to be taken into account when developing effective obesity prevention strategies across the life-course.

Association between weight gain during pregnancy and postpartum weight retention and obesity: a bias-adjusted meta-analysis

Gestational weight gain (GWG) is associated with postpartum weight retention (PPWR) in women. The strength of the association between GWG and long-term PPWR and body mass index (BMI), however, is still unclear. Publications from different databases were systematically extracted and the articles relevant to this study were reviewed to quantify the effect estimate of GWG on PPWR and BMI using a bias-adjusted method. The Institute of Medicine categories of "inadequate," "adequate," and "excess" were used to define GWG. The time span for PPWR was divided into three periods (<1 year, 1 year to 9 years, and ≥15 years) to determine outcome at different times postpartum. Twelve studies met the eligibility criteria and were included in the analyses. Women with an inadequate GWG had a significantly lower mean PPWR of -2.14 kg (95%CI, -2.61 to -1.66) than women with an adequate GWG, who had a mean PPWR of 3.15 kg (95%CI, 2.47 to 3.82) up to 21 years postpartum. Over the postpartum time span, a U-shaped relationship was observed between the weighted mean difference calculated for women with excess GWG and the weighted mean difference calculated for women with adequate GWG, and this relationship was time independent between these two groups. Postpartum BMI showed a similar relationship and magnitude of change, but the exact loss or gain was difficult to assess due to fewer studies (n = 5) with considerable heterogeneity of BMI measurements. The findings of this study suggest that GWG outside of the Institute of Medicine recommendations can lead to both short-term and long-term postpartum weight imbalance.

The Maternal Obesity Management (MOM) Trial Protocol: a lifestyle intervention during pregnancy to minimize downstream obesity

BACKGROUND

Maternal obesity and/or high gestational weight gain (GWG) are associated with downstream child obesity. Pregnancy represents a critical period for prevention as women are highly motivated and more receptive to behavior change.

OBJECTIVE

This pilot study was developed to test the feasibility of intervening with the mother, specifically keeping her GWG within the Institute of Medicine (IOM) limits, with the intended target of preventing obesity in her child downstream. We are testing the practicality of delivering a structured physical activity and nutrition intervention to pregnant women during gestation and then following mom and baby to 24 months of age.

STUDY DESIGN

This study is a two-arm, parallel group, randomized controlled trial being conducted in Ottawa. Pregnant women, with pregravid BMI >18.5, between 12 and 20 weeks gestation are randomized to one of two groups: intervention (n=30) who receive the MOM trial Handbook (guide to healthy gestation) plus a structured physical activity and nutrition program, or a standard clinical care control group (n=30). The intervention lasts 25-28 weeks (6 months) depending on anticipated delivery date, with follow-up assessment on mother and child at 3, 6, 12 and 24 months post-delivery.

SIGNIFICANCE

Pregnancy, a critical time of growth, development and physiological change, provides an opportunity for early lifestyle intervention. The goal of identifying an effective lifestyle program for the gestational period that leads to healthy fetal development and subsequently normal weight offspring, less likely to develop obesity and its co-morbidities, is unique and could possibly attenuate the inter-generational cycle of obesity.

Produção científica sobre nutrição no âmbito da Atenção Primária à Saúde no Brasil: uma revisão de literatura

INTRODUÇÃO: Ações de nutrição na Atenção Primária à Saúde (APS) têm importante papel na promoção da saúde e na prevenção e tratamento de agravos. OBJETIVO: Mapear, sistematizar e avaliar a produção científica da nutrição no âmbito da APS no Brasil. MÉTODOS: Trata-se de uma revisão de literatura. A busca de artigos foi feita no PubMed e Lilacs, utilizando descritores referentes à APS e à nutrição. Foram levantados estudos conduzidos no Brasil, com profissionais ou população atendida pelo SUS na APS e publicados até março de 2011. Ainda, foram consultadas as referências dos artigos selecionados, a fim de identificar outros estudos. RESULTADOS: Do total de artigos localizados, 68 foram elegíveis e 49 foram identificados nas listas de referências, totalizando 117 artigos analisados. Estes foram, em sua maioria, artigos originais, quantitativos, conduzidos no estado de SP, pela USP e publicados de 2002 a 2011. Abordavam o diagnóstico, tendo como objeto a avaliação do estado nutricional e envolviam crianças. CONCLUSÃO: A produção na área é crescente, porém há necessidade de redirecionar a abordagem e o objeto de futuros estudos, focando em modelos de intervenção e em avaliação de programas.

Prevention and management of excessive gestational weight gain: a survey of overweight and obese pregnant women

BACKGROUND

Excessive gestational weight gain is associated with adverse infant, childhood and maternal outcomes and research to develop interventions to address this issue is ongoing. The views of women on gestational weight gain and the resources they would consider helpful in addressing this are however largely unknown. This survey aimed to determine the views of newly pregnant women, living in areas of social disadvantage, on 1) their current body weight and potential gestational weight gain and 2) the resources or interventions they would consider helpful in preventing excessive gestational weight gain.

METHODS

A convenience sample of overweight and obese pregnant women living in Fife, UK, were invited to complete a short anonymised questionnaire at their 12 week booking visit.

RESULTS

428 women, BMI>25 kg/m(2), completed the questionnaire. Fifty-four per cent of respondents were obese (231) and 62% were living in areas of mild to moderate deprivation. Over three-quarters of participants felt dissatisfied with their current weight (81%). The majority of women (60%) expressed some concern about potential weight gain. Thirty-nine percent were unconcerned about weight gain during their pregnancy, including 34 women (19%) who reported having retained weight gained in earlier pregnancies. Amongst those concerned about weight gain advice on physical activity (41%) and access to sports/leisure facilities were favoured resources (36%). Fewer women (12%) felt that group sessions on healthy eating or attending a clinic for individualised advice (14%) would be helpful. "Getting time off work" was the most frequently cited barrier (48%) to uptake of resources other than leaflets.

CONCLUSIONS

These data suggest a lack of awareness amongst overweight and obese women regarding excessive gestational weight gain. Monitoring of gestational weight gain, and approaches for its management, should be formally integrated into routine antenatal care. Barriers to the uptake of resources to address weight gain are numerous and must be considered in the design of future interventions and services.