828: Postpartum weight loss in women with class III obesity: do they lose what they gain?

Abstract

Excessive gestational weight gain (GWG) increases risk of postpartum weight retention in normal and overweight women. However, little is known about the risk of postpartum weight retention in morbidly obese women for whom weight management is of greater importance for long-term health. The Institute of medicine (IOM) recommends 11-20lbs of gestational weight gain for all women with BMI >30. We evaluated the impact of gestational weight gain(GWG) on postpartum weight retention in women with class III obesity Retrospective cohort of pregnancies at a single institution from 7/2013-12/2017 complicated by body mass index (BMI)≥40 at entry to care. Women were classified as GWG within (WITHIN), less than (LESS), or greater than (MORE) IOM recommendations. Women excluded for multiples, late prenatal care, preterm birth, fetal anomalies, intrauterine demise, weight loss in pregnancy, and missing BMI data. Primary outcome was achievement of intake weight at the postpartum visit. Correlation between GWG and weight change from entry to care to postpartum visit was also assessed. Groups compared using Fisher’s exact and Kruskal-Wallis test as appropriate. Logistic regression was used to adjust for confounding factors. Of 338 women, 93(27%) gained WITHIN, 101(30%) LESS, and 144(43%) MORE. Baseline characteristics between groups were similar except women gaining MORE were more likely to be parous. Women in the MORE group were less likely to achieve their intake weight at the postpartum visit (p<0.01) and this remained significant in the adjusted analysis with AOR=0.09 95% CI 0.05-0.17. Additionally, women in the MORE group were more likely to have a higher median postpartum BMI despite the median BMI at entry to care being similar (Table). Finally, women gaining MORE than IOM guidelines were the only group to demonstrate weight gain from their intake to prenatal care to their postpartum visit (p<0.01) Women with class III obesity gaining more than IOM guidelines were less likely to achieve their intake weight at their postpartum visit and were the only group to gain weight from their intake to their postpartum visit suggesting that excessive GWG in this group contributes to postpartum weight retentionView Large Image Figure ViewerDownload Hi-res image Download (PPT)