Long-term Weight Retention Research Articles

Postpartum Obesity Is Associated With Increases in Child Adiposity in Midchildhood in a Cohort of Black and Dominican Youth

BackgroundObesity disproportionately affects marginalized and low-income populations. Birth parent obesity from the prenatal period and childhood has been associated with child obesity. It is unknown whether prenatal or postnatal birth parent obesity has differential effects on subsequent changes in adiposity and metabolic health in children. ObjectivesWe evaluated how birth parent obesity 7 y after delivery was associated with child body composition changes and cardiometabolic health in midchildhood and further assessed the influence of the perinatal and postpartum period on associations. MethodsBlack and Dominican pregnant individuals were enrolled, and dyads (n = 319) were followed up at child age 7 and 9 y. Measures included, height, weight, waist circumference (WC), and percent body fat (BF%). Multiple linear regression was used to relate postpartum weight status with child outcomes accounting for attrition, and a series of secondary analyses were conducted with additional adjustment for perinatal weight status, gestational weight gain (GWG), and/or long-term weight retention to evaluate how these factors influenced associations. ResultsAlmost one-quarter (23%) of birth parents and 24.1% children were classified with obesity at child age 7 y, while at 9 y, 30% of children had obesity. Birth parent obesity at child age 7 y was associated with greater changes, from ages 7 to 9 y, in child BMI z-score (β: 0.13; 95% CI: 0.02, 0.24) and BF% (β: 1.15; 95% CI: 0.22, 2.09) but not obesity at age 9 y. All observed associations crossed the null after additional adjustment for prenatal factors. ConclusionsBirth parent obesity at 7-y postpartum is associated with greater gains in child BMI z-score and BF% in midchildhood. These associations diminish after accounting for prenatal size, suggesting a lasting impact of the perinatal environment and that interventions supporting families from the prenatal period through childhood are needed.

Breastfeeding, socioeconomic status, and long-term postpartum weight retention

BackgroundAlmost 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.MethodsMaternal 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.ResultsAverage 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.ConclusionSix 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.

Characterizing the Impact of Breastfeeding and Socioeconomic Status on Maternal Weight Change From Pregnancy to Ten Years Postpartum

ObjectivesBreastfeeding is a potentially modifiable factor associated with less postpartum weight retention; however, in the United States women with lower socioeconomic status (SES) are less likely to initiate breastfeeding and, therefore, may be at higher risk for long-term weight retention. We sought to describe associations between duration of breastfeeding with postpartum weight retention and later BMI, and to determine whether associations varied by SES. MethodsMaternal and infant data (n = 2144 dyads) are from the Geographic Research on Wellbeing survey (GROW), a follow-up study of California’s annual statewide-representative Maternal and Infant Health Assessment. Pre-pregnancy BMI was obtained from self-report; at 4–10y postpartum, breastfeeding history and self-reported body weight were collected. Multivariable linear regression was used to examine associations between breastfeeding and long-term maternal body size. SES was calculated as a composite score of % federal poverty threshold plus education and was dichotomized. ResultsOverall, mean prepregnancy BMI was 24.9 kg/m2 while long-term weight retention 4–10 y postpartum was 4.0 kg. The sample average breastfeeding duration was 8.5 months with 61% meeting the World Health Organization (WHO) recommendations for 6 months of breastfeeding. In adjusted models, compared to women who did not meet recommendations, women who met WHO recommendations had slightly lower long-term postpartum weight retention (b = –1.06 kg, CI: –1.93, –0.25, p = 0.01) and a small reduction in BMI (b = –0.4 kg/m2 95% CI –0.74, –0.08; p = 0.02). Compared to higher SES women, fewer lower SES women ever breastfed (89% vs 74%, p < .0001) or met WHO recommendations (70% vs 51%, p < .0001). Lower SES women had higher prepregnancy BMI (25.9kg/m2 vs 23.5, p < .0001), and had greater long-term weight retention 4–10 y postpartum (5.68kg vs. 1.83, p < .0001). In SES stratified adjusted models, there were no differences in associations between breastfeeding with long-term weight retention or BMI. ConclusionsBreastfeeding was associated with long term maternal postpartum weight status. Six months of breastfeeding was associated with lower long-term postpartum weight retention and lower BMI at 4–10 years postpartum, and effects did not vary by socioeconomic status. Funding SourcesCDPH, UCSF.

Gestational weight gain and risk of epithelial ovarian cancer.

To examine the association between (GWG) and epithelial ovarian cancer (EOC). We compared GWG between 670 incident EOC cases and1,551 community controls from a population-based, case-control study conducted in Pennsylvania, Ohio, and New York from 2003 to 2008. Multivariable unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) associated with GWG adjusting for potential confounders. To explore the potential effect of maternal long-term weight retention after childbearing, we restricted analyses to women who began their childbearing years as normal/underweight and examined differences in EOC risk between those who were normal/underweight versus those who were overweight/obese at study baseline reference date. Average GWG per full-term pregnancy did not differ between cases and controls. Among women who were normal/underweight at study baseline, greater average GWG was not associated with EOC (OR = 0.9, 0.8, 0.7 for quartiles 2, 3 and 4 of GWG gain, respectively, compared to quartile 1). In contrast, among women who were overweight/obese at study baseline, greater average GWG was positively associated with EOC (OR = 1.4, 1.8, 1.2, for quartiles 2, 3, and 4 compared to quartile 1; interaction p = 0.04). We posit that maternal post-partum weight retention and not gestational weight gain itself among normal/underweight women may impact subsequent risk of EOC. If our hypothesis is supported in other studies designed to assess this question directly, then counseling women on the importance of healthy weight management after a pregnancy could provide another means to help women reduce their risk of this often-fatal malignancy.

Effects on postpartum weight retention after antenatal lifestyle intervention - a secondary analysis of a randomized controlled trial.

High weight retention after pregnancy is related to an increased risk of future obesity. The objective was to evaluate whether an antenatal intervention, compared with standard care, could reduce postpartum weight retention (PPWR). Women with body mass index >19, age ≥18 years, knowledge of Swedish, and pregnancy ≤16 weeks' gestation were randomized. Standard care was compared with a composite intervention including a personalized weight graph, education on recommended weight gain, prescription of exercise, and monitoring of weight until 1 year after delivery. Mean (kg) PPWR was compared between the groups and risk estimates (odds ratio) for excessive weight retention were calculated. Of 445 women randomized, 267 remained for analysis at ≤16 weeks postpartum and 168 at 1 year postpartum. The intervention group had a significantly lower mean PPWR at ≤16 weeks [1.81 kg (standard deviation, SD, 4.52) vs. 3.19 kg (SD 4.77), p = 0.016]. At one year postpartum, mean retention was still 0.7 kg lower in the intervention group [0.30 kg (SD 5.52) vs. 1.00 kg (SD 5.46)]; the difference was not statistically significant (p = 0.414). Gestational weight gain above Institute of Medicine recommendations was a significant risk factor for excessive weight retention (>5 kg) one year after delivery (OR 2.44; 95% CI 1.08-5.52, p = 0.029). A composite lifestyle intervention during pregnancy reduced short-term weight retention, but the effect of the intervention did not remain at 1 year postpartum. A gestational weight gain above Institute of Medicine recommendations increases the risk of excessive long-term weight retention.

EMoms: Electronically-mediated weight interventions for pregnant and postpartum women. Study design and baseline characteristics

BackgroundThe influence of childbearing in the development of obesity is situated within two different but related contexts: pregnancy-related weight gain and weight gain prevention and control in young adult women. Pregnancy related weight gain contributes to long-term weight retention in childbearing women. ObjectiveTo present the study design, data collection procedures, recruitment challenges, and the baseline characteristics for the eMoms of Rochester study, a randomized clinical trial testing the effect of electronically-mediated behavioral interventions to prevent excessive gestational weight gain (GWG) and postpartum weight retention among women aged 18–35years of diverse income and racial/ethnic backgrounds in an urban setting. DesignRandomized double blind clinical trial. A total of 1722 women at or below 20weeks of gestation were recruited primarily from obstetric practices and randomized to 3 treatment groups: control arm; intervention arm with access to intervention during pregnancy and control at postpartum (e-intervention 1); and intervention arm with access to intervention during pregnancy and postpartum (e-intervention 2). Enrollment and consent were completed via study staff or online. Data were collected via online surveys, medical charts, and measurement of postpartum weights. The primary endpoints are gaining more weight than recommended by the Institution of Medicine guidelines and weight retained at 12months postpartum. ConclusionThis study will provide evidence on the efficacy of behavioral interventions in the prevention of excessive GWG and postpartum weight retention with potential dissemination to obstetric practices and/or health insurances.ClinicalTrials.gov #NCT01331564.

Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial

Excessive weight gain during pregnancy is a risk factor for postpartum weight retention and future weight gain and obesity. Whether a behavioral intervention in pregnancy can reduce long-term weight retention is unknown. This randomized trial tested whether a low-intensity behavioral intervention to prevent excessive gestational weight gain could increase the proportion of women who returned to prepregnancy weight by 12 mo postpartum. Women (n = 401, 13.5 wk of gestation, 50% normal weight, 50% overweight/obese) were randomly assigned into an intervention or control group; 79% completed the 12-mo assessment. The telephone-based intervention targeted gestational weight gain, healthy eating, and exercise and was discontinued at delivery. In modified intent-to-treat analyses that excluded women with miscarriages (n = 6), gestational diabetes (n = 32), or subsequent pregnancies (n = 32), the intervention had no significant effect on the odds of achieving prepregnancy weight at 12 mo postpartum (n = 331; 35.4% compared with 28.1%; P = 0.18). Completer analyses suggested that the intervention tended to increase the percentages of women who reached prepregnancy weight (n = 261; 45.3% compared with 35.3%; P = 0.09) and significantly reduced the magnitude of mean ± SD postpartum weight retained (1.4 ± 6.3 compared with 3.0 ± 5.7 kg; P = 0.046) at 12 mo. Women in the intervention group reported higher dietary restraint through 6 mo postpartum (P = 0.023) and more frequent self-monitoring of body weight (P < 0.02 for all) throughout the study. A low-intensity behavioral intervention in pregnancy can reduce 12-mo postpartum weight retention and improve dietary restraint and self-weighing in study completers. Future research is needed to test the long-term effects of more intensive behavioral interventions in pregnancy. This trial was registered at clinicaltrials.gov as NCT01117961.

Impact of the REFRESH randomised controlled trial on the physical activity behaviours of mothers with young children

Introduction: Lifestyle factors relating to unhealthy diets and lack of physical activity have been implicated in excessive weight gain during pregnancy, interpregnancy weight gain, weight retention 12 months postpartum and long-term weight retention among women. Physical inactivity and unhealthy diets are among the modifiable risk factors that are associated with the major chronic diseases and are the risk factors which explain the vast majority of chronic disease deaths in the world. The aim of this abstract is to demonstrate the impact of REminder for Food Relaxation Exercise and Support for Health (REFRESH), a community based randomised controlled trial on mothers with young children's physical activity behaviours.

Effect of breastfeeding on weight retention from one pregnancy to the next: Results from the North Carolina WIC program

Objectives Pregnancy-related weight retention can contribute to obesity, and breastfeeding may facilitate postpartum weight loss. We investigated the effect of breastfeeding on long-term postpartum weight retention. Methods Using data from the North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC; 1996–2004), weight retention was assessed in women aged 18 years or older who had more than one pregnancy available for analysis (n = 32,920). Using multivariable linear regression, the relationship between duration of breastfeeding after the first pregnancy and change in pre-pregnancy weight from the first pregnancy to the second pregnancy was estimated, controlling for demographic and weight-related covariates. Results Mean time between pregnancies was 2.8 years (standard deviation (SD) 1.5), and mean weight retention from the first to the second pregnancy was 4.9 kg (SD 8.7). In covariate-adjusted analyses, breastfeeding for 20 weeks or more resulted in 0.39 kg (standard error (SE) 0.18) less weight retention at the beginning of the second pregnancy relative to no breastfeeding (p = 0.025). Conclusion In this large, racially diverse sample of low-income women, long-term weight retention was lower among those who breastfed for at least 20 weeks.

Does Excess Pregnancy Weight Gain Constitute a Major Risk for Increasing Long‐term BMI?

The objective was to assess the relevance of the recommendations of the Institute of Medicine (IOM), regarding gestational weight gain (GWG) for long-term BMI development. The Stockholm Pregnancy and Women's Nutrition is a follow-up study of 483 women who delivered children in 1984 to 1985. ANOVA was used to examine the change in body weight before pregnancy, at 6 months, and 1 year postpartum and 15 years after childbirth. Multiple linear regression was used to assess the predictors of BMI at 15-year follow-up. The weight increase from baseline to 15-year follow-up was 6.2 kg for IOM-insufficient, 6.7 kg for IOM-recommended, and 10.0 kg for IOM-excessive weight gain (p < 0.01). ANOVA showed a main effect of time, group and group by time interaction. The weight of the women who had excessive GWG was significantly greater at each time-point of follow-up than the weight of those who gained within or below recommendations. GWG was related to BMI at 15-year follow-up even after accounting for several confounders. Women who gained excessive weight during pregnancy had an increase of 0.72 kg/m(2) in long-term BMI compared with women who gained within recommendations. The findings support the adequateness of IOM guidelines, not only for the pregnancy-related health matters, but also for preventing long-term weight retention after delivery. Healthcare providers should give women appropriate advice for controlling GWG and motivate them to lose pregnancy-related weight during postpartum to prevent future overweight.

Lactation, weaning, and calcium supplementation: effects on body composition in postpartum women

Concern that long-term weight retention after pregnancy contributes to obesity underscores the need to identify factors that facilitate postpartum weight loss. Lactation is believed to facilitate postpartum weight loss and fat loss. Calcium intake also has been hypothesized to promote weight loss and fat loss. We addressed the following questions: 1) whether lactation enhances loss of fat mass, and 2) whether loss of fat mass during lactation and after weaning is greater in women receiving calcium supplementation than in women receiving placebo. We used data from 87 lactating and 81 nonlactating women enrolled in a randomized, double-blind, calcium supplementation trial from 2 wk to 6 mo postpartum and data from 76 previously lactating and 82 nonlactating women enrolled in a parallel trial from 6 to 12 mo postpartum. Body fat and lean masses were measured by using dual-energy X-ray absorptiometry. Nonlactating women lost whole-body, arm, and leg fat at a faster rate than did lactating women between 2 wk and 6 mo postpartum (lactation group x time effect, P < or = 0.01). Fat mass of the trunk, arms, and legs decreased between 6 and 12 mo postpartum regardless of previous lactation status (time effect, P < or = 0.001). Calcium supplementation did not affect postpartum fat loss. Body-composition changes occur differently in nonlactating and lactating women during the first 6 mo postpartum and occur at some sites until 12 mo postpartum regardless of previous lactation status. Clinicians should use caution when advising lactating mothers about expected rates of postpartum fat loss. Calcium supplementation (1 g/d) does not promote postpartum weight loss or fat loss.