Patterns of Weight Change One Year after Delivery Are Associated with Cardiometabolic Risk Factors at Six Years Postpartum in Mexican Women.

Diana C Soria-Contreras,Emily Oken,Alejandra Cantoral,Martha María Téllez-Rojo,Elena Colicino,Belem Trejo-Valdivia,Andrea L Deierlein,Ruy López-Ridaura,María Luisa Pizano-Zárate,Robert O Wright,Andrea A Baccarelli,Allan C Just

doi:10.3390/nu12010170

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.

Highlights

In Mexico, the prevalence of obesity among women from 20 to 49 years of age increased by almost 300% over the past three decades [1]
We evaluated direct associations between the patterns of postpartum weight change and each outcome, and indirect associations mediated through body mass index (BMI) at six years for glucose, homeostatic model assessment of insulin resistance (HOMA-IR), HDL-c, TG, systolic blood pressure (SBP), diastolic blood pressure (DBP), total-c, and LDL-c
59.6% had returned to their pregestational weight, while 6.6% experienced postpartum weight retention (PPWR), 13.9% PPWG, and 19.9% PPWR

Summary

Introduction

In Mexico, the prevalence of obesity among women from 20 to 49 years of age increased by almost 300% over the past three decades [1]. Pregnancy-related weight changes are possible contributors to the obesity epidemic in reproductive-aged women [2,3]. Parous, compared to nulliparous women, experience a significant increment in weight and waist circumference in the years following delivery [4]. The increased adiposity following pregnancy may put women at higher risk of obesity and metabolic dysfunction. According to studies conducted in high-income countries, less than 50% of women return to their pregestational weight one year after delivery [5,6,7]. Postpartum weight retention (PPWR) (i.e., weight retained from pregnancy) is a common problem with disparate consequences on women’s weight

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