Maternal Postpartum Weight Retention Research Articles

Racial Disparities in Neighborhood and Household Socioeconomic Disadvantage Predict Postpartum Weight Retention

Structural racism leads to neighborhood-level socioeconomic disadvantage, which determines adverse birth outcomes. Individual socioeconomic disadvantage is associated with compromised healthy pregnancy outcomes. This study aimed to investigate the pathways by which race, neighborhood socioeconomic disadvantage, and household socioeconomic disadvantage predict subsequent maternal postpartum weight retention. A total of 176 (N=176) racially diverse women were studied from the third trimester to 6 months after delivery. Neighborhood socioeconomic disadvantage was defined by information from the American Community Survey based on women's census tract and self-reports of neighborhood healthy food availability, safety, violence, and walking environment. Household socioeconomic disadvantage included food insecurity, income-to-needs ratio, and maternal education. Pregnancy health risk was operationalized using a summative index that included prepregnancy overweight/obesity, excessive gestational weight gain, and diagnosed hypertensive disorders during pregnancy. Postpartum weight retention was operationalized as a 6-month postpartum weight minus prepregnancy weight. Data were analyzed using structural equation modeling with bootstrapped CIs to estimate indirect effects. One third of participants retained more than 22 lbs. of pregnancy weight gain 6 months after delivery. Increased household socioeconomic disadvantage (β=0.64, p=0.039) and pregnancy health risk (β=0.34, p=0.002) were directly associated with higher postpartum weight retention. Maternal race/ethnicity had an indirect impact on postpartum weight retention through neighborhood socioeconomic disadvantage and household socioeconomic disadvantage. Non-Hispanic Black women had greater neighborhood socioeconomic disadvantage than non-Hispanic White women (White vs Black β= -0.62; p<0.001) and all other women (other vs Black β= -0.22; p=0.013). In addition, Black women had greater household socioeconomic disadvantage than White women (White vs Black β= -0.35; p=0.004), both of which in turn predicted higher postpartum weight retention. To prevent postpartum weight retention, education on behavior change to lose weight is essential, but it must be offered in the context of basic resources, at both the neighborhood and household levels.

Effect of prenatal lifestyle intervention on maternal postpartum weight retention and child body mass index z-score at 36 months

Background/ObjectivesWe previously reported results from a randomized trial showing that a behavioral intervention during pregnancy reduced excess gestational weight gain but did not impact maternal weight at 12 months. We now examine the longer-term effects of this prenatal intervention on maternal postpartum weight retention and toddler body-mass-index z scores (BMIz) over 36 months.Subjects/MethodsPregnant women (N = 264; 13.7 weeks’ gestation; 41.6% Hispanic) with overweight or obesity were randomized into usual care or prenatal intervention. Anthropometric assessments in mothers and toddlers occurred at baseline, 35 weeks’ gestation and after delivery at 6, 12, 18, 24, and 36 months.ResultsAt 36 months, prenatal intervention vs. usual care had no significant effect on the proportion of participants who returned to their early pregnancy weight or below (33.3% vs. 39.5%; p = 0.12) and had no effect on the magnitude of weight retained (2.8 [0.8, 4.8] vs 3.0 kg [1.0, 4.9], respectively; mean difference = 0.14 [−3.0, 2.7]). There was also no statistically significant intervention vs. usual care effect on infant BMIz or skinfold changes over time; toddler BMIz increased by 1.4 [−1.7, 1.0] units in the intervention group and 1.6 [−1.2, 1.8] units in the usual care group from delivery to 36 months (difference = 0.16 [−0.32. 0.63]). The proportion of toddlers at risk for obesity at 36 months was similar in intervention and usual care groups (28/77 [36.4%] vs 30/80 [37.5%]; p = 0.77).ConclusionsCompared with usual care, lifestyle intervention during pregnancy resulted in similar maternal and toddler anthropometric outcomes at 36-months postpartum in a diverse US sample of women with overweight and obesity. To sustain improved maternal weight management initiated during pregnancy, continued intervention during the postpartum years may be needed.

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.

Association of sugar-sweetened beverage intake with maternal postpartum weight retention.

During the perinatal period, modifiable behaviours contributing to excess weight gain, including sugar-sweetened beverage (SSB) intake, are understudied. We examined the extent to which perinatal SSB intake affects postpartum weight retention (PPWR). We measured SSB intake frequency in the third trimester and 1-month postpartum using the NHANES Dietary Screener Questionnaire. We assessed the association between SSB intake and PPWR (difference between 6-month postpartum and pregravid weight) using multivariable regression adjusted for socio-demographic and anthropometric variables. Greater Boston area. Three hundred forty-eight mother-infant pairs in the Rise and SHINE prospective birth cohort. Mean age was 32·7 (sd 5·0) years; the sample was 47 % white, 32 % Hispanic, 14 % Asian and 7 % Black. Women reported mean daily SSB intake frequencies of 0·9 (sd 1·2) and 0·7 (sd 1·0) times/d in the third trimester and 1-month postpartum, respectively. At 6-month postpartum, average weight retention was 3·4 (sd 5·7) kg; 108 (sd 31 %) women had substantial PPWR, defined as a ≥ 5 kg increase between pregravid and 6-month postpartum weight. Each 1-time/d increment in SSB intake frequency during the third trimester (β = 0·46 kg (95 % CI, 0·07, 0·86)) and 1-month postpartum (β = 0·52 kg (95 % CI 0·03, 1·00)) was associated with higher weight retention at 6 months. Increased SSB intake frequency in the third trimester (OR: 1·37; 95 % CI 1·10, 1·75) and 1-month postpartum (OR: 1·17; 95 % CI 0·92, 1·52) resulted in higher odds of substantial PPWR. SSB consumption during the perinatal period is associated with higher weight retention at 6-month postpartum. Avoiding SSB may reduce the risk of excess weight retention.

Preventing Excess Gestational Weight Gain and Obesity in Pregnancy: the Potential of Targeting Psychological Mechanisms.

Overweight and obesity are now the most common high-risk conditions in pregnancy in the United States and increase risk of adverse outcomes during pregnancy, delivery, and the postpartum. Importantly, excess gestational weight gain is highly predictive of maternal postpartum weight retention and risk of overweight and obesity in mothers and their children later in life. This makes pregnancy a unique window of opportunity in the fight against obesity across the lifespan. This narrative review critically evaluates research on the efficacy of interventions targeting excess gestational weight gain, highlighting the potential of targeting psychological mechanisms to facilitate positive weight-related behavior change specifically in pregnancy. The PUBMED and PsycInfo databases were searched for relevant articles, including meta-analyses, systematic reviews, and randomized controlled trials with the primary or secondary aim of reducing gestational weight gain. There is currently no gold standard for preventing excess gestational weight gain, especially in women with pre-pregnancy overweight and obesity. Existing interventions primarily target diet and physical activity but lack broad empirical support and typically have only modest effects on weight gain in pregnancy, with few successfully preventing excess weight gain. Furthermore, interventions that successfully target gestational weight gain have minimal positive impact on weight- and diet-related maternal and fetal health outcomes. A growing evidence points to the utility of targeting psychological mechanisms in the prevention of excess gestational weight gain, including cognitive and affective factors, food cravings, and self-efficacy. Given the lack of broad evidence to support the efficacy of interventions targeting diet and physical activity, there is a notable need for research to develop and evaluate interventions targeting psychological factors that could positively impact diet- and weight-related behavioral change in pregnancy.

Adjusting DBI-2016 to dietary balance index for Chinese maternal women and assessing the association between maternal dietary quality and postpartum weight retention: A longitudinal study.

Diet is believed to play a major role in maternal recovery, postpartum weight retention (PPWR) is one of the challenges for Chinese women. However, the association between puerperal women’s diet and PPWR remained unclear and complicated in China. The study assessed the dietary quality of puerperal women using adjusted Chinese Dietary Balance Index-16 (DBI-16) and explored its associations with PPWR. Participants were enrolled in the Mother-Infant Cohort Study of China. Dietary intake and demographic characteristics were obtained by a semi-quantitative food frequency questionnaire and a self-designed questionnaire at 0–3 months postpartum. PPWR was calculated by the weight difference at 0-3months and 6-8months postpartum minus pre-pregnancy weight. Dietary quality was assessed using adjusted DBI-16. 316 puerperal women were enrolled. According to adjusted DBI-16, 84.8% of participants had an insufficient dietary intake (vegetables 84.8%, fruits 91.8%, dairy 87.3%, soybean 61.4% and aquatic foods 79.4%, respectively), 67.1% had an excessive intake (cereals 60%, meat 57.3% and eggs 64.9%, respectively), 98.4% had an imbalanced diet consumption. PPWR at 0–3, and 6–8 months were 6.0 (±5.1) kg and 5.2 (±7.7) kg, and the percentage of PPWR (≥5kg) were 63.0% and 52.8% respectively. Multivariable linear regression showed the intake of fish and shrimp at 0–3 months postpartum was negatively associated with PPWR at 6–8 months (β = -0.114, SE = 0.279, p < 0.05). The diet quality of Chinese puerperal women was unreasonable and imbalanced. Fish intake tended to be a favorable factor for postpartum weight loss.

Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes

(Abstracted from JAMA 2019;321(17):1702–1715) Increased gestational weight gain is associated with higher risk of pregnancy complications, maternal postpartum weight retention, and offspring obesity. It can be caused by maternal fat accumulation, fluid expansion, fetal growth, placental growth, and uterine growth; the weight gain during pregnancy is necessary for a healthy fetus, but the optimal gestational weight gain is uncertain and not well defined for all prepregnancy weight ranges.

One-year postpartum anthropometric outcomes in mothers and children in the LIFE-Moms lifestyle intervention clinical trials

Background/objectivesExcess gestational weight gain (GWG) is a risk factor for maternal postpartum weight retention and excessive neonatal adiposity, especially in women with overweight or obesity. Whether lifestyle interventions to reduce excess GWG also reduce 12-month maternal postpartum weight retention and infant weight-for-length z score is unknown. Randomized controlled trials from the LIFE-Moms consortium investigated lifestyle interventions that began in pregnancy and tested whether there was benefit through 12 months on maternal postpartum weight retention (i.e., the difference in weight from early pregnancy to 12 months) and infant-weight-for-length z scores.Subjects/methodsIn LIFE-Moms, women (N = 1150; 14.1 weeks gestation at enrollment) with overweight or obesity were randomized within each of seven trials to lifestyle intervention or standard care. Individual participant data were combined and analyzed using generalized linear mixed models with trial entered as a random effect. The 12-month assessment was completed by 83% (959/1150) of women and 84% (961/1150) of infants.ResultsCompared with standard care, lifestyle intervention reduced postpartum weight retention (2.2 ± 7.0 vs. 0.7 ± 6.2 kg, respectively; difference of −1.6 kg (95% CI −2.5, −0.7; p = 0.0003); the intervention effect was mediated by reduction in excess GWG, which explained 22% of the effect on postpartum weight retention. Lifestyle intervention also significantly increased the odds (OR = 1.68 (95% CI, 1.26, 2.24)) and percentage of mothers (48.2% vs. 36.2%) at or below baseline weight at 12 months postpartum (yes/no) compared with standard care. There was no statistically significant treatment group effect on infant anthropometric outcomes at 12 months.ConclusionsCompared with standard care, lifestyle interventions initiated in pregnancy and focused on healthy eating, increased physical activity, and other behavioral strategies resulted in significantly less weight retention but similar infant anthropometric outcomes at 12 months postpartum in a large, diverse US population of women with overweight and obesity.

Association of Proinflammatory and Proinsulinemic Food Groups With Maternal Postpartum Weight Retention [18B

INTRODUCTION: Few studies have examined associations of maternal intake of proinflammatory and proinsulinemic food types with substantial postpartum weight retention (SPPWR; ≥5 kg) at 6 months. METHODS: We studied 308 mother-infant pairs enrolled in the Rise and SHINE study, a longitudinal birth cohort. Maternal diet, including consumption of foods with proinflammatory and proinsulinemic properties such as sugar-sweetened beverages (SSBs), red/processed meats, sweet snacks and fast food, and fruit/vegetables, was assessed in the third trimester and at 1-month postpartum via the NHANES Dietary Screener Questionnaire. Postpartum weight retention was calculated as the difference between pregravid and 6-month postpartum weight. RESULTS: At 6-months, 29.6% of the mothers had SPPWR. In multivariable analyses adjusted for race/ethnicity, income, maternal age, pre-pregnancy BMI and gestational weight gain, we found that each additional serving/day of SSBs was associated with higher odds of SSPWR (OR: 1.43; 95% CI: 1.11, 1.85). Intake of red/processed meats (OR: 1.97; 95% CI: 0.55, 7.13) in the third trimester, and SSBs (OR: 1.27; 95% CI: 0.94, 1.72), red/processed meats (OR: 1.96; 95% CI: 0.83, 1.12) and fast food (OR: 1.35; 95% CI: 0.17, 10.79) at 1-month postpartum were also associated with higher odds of SPPWR but confidence intervals were wide and spanned 1.0. CONCLUSION: Our results show that consumption of SSBs, and possibly other proinflammatory and proinsulinemic foods in the third trimester and 1-month postpartum is associated with SPPWR. Avoiding such beverages and foods during this window may reduce SPPWR and the risk for long term weight retention.

Association of Full Breastfeeding Duration with Postpartum Weight Retention in a Cohort of Predominantly Breastfeeding Women.

Full breastfeeding (FBF) is promoted as effective for losing pregnancy weight during the postpartum period. This study evaluated whether longer FBF is associated with lower maternal postpartum weight retention (PPWR) as compared to a shorter FBF duration. The MILK (Mothers and Infants Linked for Healthy Growth) study is an ongoing prospective cohort of 370 mother–infant dyads, all of whom fully breastfed their infants for at least 1 month. Breastfeeding status was subsequently self-reported by mothers at 3 and 6 months postpartum. Maternal PPWR was calculated as maternal weight measured at 1, 3, and 6 months postpartum minus maternal prepregnancy weight. Using linear mixed effects models, by 6 months postpartum, adjusted means ± standard errors for weight retention among mothers who fully breastfed for 1–3 (3.40 ± 1.16 kg), 3–6 (1.41 ± 0.69 kg), and ≥6 months (0.97 ± 0.32 kg) were estimated. Compared to mothers who reported FBF for 1–3 months, those who reported FBF for 3–6 months and ≥6 months both had lower PPWR over the period from 1 to 6 months postpartum (p = 0.04 and p < 0.01, respectively). However, PPWR from 3 to 6 months was not significantly different among those who reported FBF for 3–6 versus ≥6 months (p > 0.05). Interventions to promote FBF past 3 months may increase the likelihood of postpartum return to prepregnancy weight.

Factors associated with postpartum weight retention based on the generalized estimation equation in Kaifu Districtin Changsha

To investigate the current status of the postpartum weight retention (PPWR) in Kaifu District of Changsha, and explore the influential factors with PPWR based on the generalized estimating equation model. Methods: A cluster sampling method was applied to select women who gave birth at the health service centers of 3 street communities in Kaifu District of Changsha during 2015. According to the inclusion and exclusion criteria, 783 cases were finally included in the study. Data on PPWR were collected prospectively by using the self-made questionnaire at 1, 3, 6 and 8 months after childbirth. Analysis were performed to investigate the associations between PPWR and its potential factors with generalized estimation equation model. Results: The mean PPWR of women was gradually decreased with the increase of postpartum time, and 34.6% of them have returned to the pre-pregnancy weight in the 8 months postpartum. Our findings revealed that gestation weight gain (GWG), pre-pregnancy body mass index, feeding patterns, and delivery mode were significantly associated with maternal PPWR (P<0.05). In contrast, maternal age, educational level, per capita income of family, parity and postpartum depression were not contributed to PPWR (P>0.05). Conclusion: GWG is one of the most important predictors for PPWR. The key to reducing PPWR is to control GWG systematically. Early targeted interventions and health education should be taken to prevent women from excessive PPWR at the first-year postpartum, in particular to the women who underwent cesarean deliveries and breastfed their infants. It is conducive to reduce the risks of overweight or obesity caused by PPWR.

Effects of a lifestyle intervention during pregnancy to prevent excessive gestational weight gain in routine care \u2013 the cluster-randomised GeliS trial

BackgroundExcessive gestational weight gain (GWG) leads to obstetric complications, maternal postpartum weight retention and an increased risk of offspring obesity. The GeliS study examines the effect of a lifestyle intervention during pregnancy on the proportion of women with excessive GWG and pregnancy and obstetric complications, as well as the long-term risk of maternal and infant obesity.MethodsThe GeliS study is a cluster-randomised multicentre controlled trial including 2286 women with a pre-pregnancy BMI between 18.5 and 40.0 kg/m2 recruited from gynaecological and midwifery practices prior to the end of the 12th week of gestation in five Bavarian regions. In the intervention regions, four lifestyle counselling sessions covering a balanced healthy diet, regular physical activity and self-monitoring of weight gain were performed by trained healthcare providers alongside routine pre- and postnatal practice visits. In the control regions, leaflets with general recommendations for a healthy lifestyle during pregnancy were provided.ResultsThe intervention did not result in a significant reduction of women showing excessive GWG (adjusted OR 0.95, 95% CI 0.66–1.38, p = 0.789), with 45.1% and 45.7% of women in the intervention and control groups, respectively, gaining weight above the Institute of Medicine recommendations. Gestational diabetes mellitus was diagnosed in 10.8% and 11.1% of women in the intervention and control groups, respectively (p = 0.622). Mean birth weight and length were slightly lower in the intervention group (3313 ± 536 g vs. 3363 ± 498 g, p = 0.020; 51.1 ± 2.7 cm vs. 51.6 ± 2.5 cm, p = 0.001).ConclusionIn the setting of routine prenatal care, lifestyle advice given by trained healthcare providers was not successful in limiting GWG and pregnancy complications. Nevertheless, the potential long-term effects of the intervention remain to be assessed.Trial registrationNCT01958307, ClinicalTrials.gov, retrospectively registered October 9, 2013.

81: An intensive behavioral intervention did not reduce gestational weight gain in overweight and obese gravidas

More than half of overweight and obese women gain too much weight during pregnancy. This excessive weight gain increases risks of adverse perinatal outcomes, maternal postpartum weight retention, and childhood obesity. We aimed to evaluate the effectiveness of an antenatal intervention to target gestational weight gain (GWG) to current guidelines. We performed a prospective randomized clinical trial. Overweight and obese women with singleton gestations were recruited in the first trimester of pregnancy and randomized to usual care or a behavioral weight management intervention with financial incentives contingent upon meeting weight gain goals. The primary outcome was adherence to GWG guidelines. Group means were compared using ANOVA or ANCOVA and proportions were compared using chi-squared tests. 124 women were randomized and included in the analysis. The average BMI and % obese were similar between groups (32.3±5.7 vs 32.4±5.9 kg/m2 and 61% vs 60% intervention group vs usual care, respectively). Neither total GWG (21.4±1.6 vs 23.0±1.8 lbs; p=.52) nor GWG within/below guidelines (50.8% vs 47.7%; p=.73) differed between the intervention group and usual care. Results were unchanged when only obese women were included in the analysis. There was a trend towards fewer cases of large for gestational age neonates in the intervention group (11% vs 28%; p=.07) among obese women. An intensive behavioral intervention did not improve adherence to GWG guidelines in overweight and obese gravidas. These data suggest that antenatal modifications to GWG may be limited and highlights the importance of prepregnancy weight loss. Novel approaches are needed to optimize GWG in overweight and obese women.

Integrating Obstetrical Care and WIC Nutritional Services to Address Maternal Obesity and Postpartum Weight Retention.

This pilot study evaluated a cost neutral, integrated Special Supplemental Nutrition Program for Women Infants and Children (WIC) and obstetrical service model designed to prevent postpartum weight retention in obese women. A sample of women who received benefits from the Johns Hopkins (JH) WIC program and prenatal care from the JH Nutrition in Pregnancy Clinic, which provides obstetrical care for women with a BMI ≥ 30kg/m2, participated in the WICNIP randomized clinical trial. Intervention participants received enhanced nutrition services and education at five visits and during one phone call between delivery and 6months postpartum. Control participants received standard WIC services. Weight data was collected for all participants at multiple time points: pre-pregnancy, delivery, and postpartum at 4, 6 weeks, 4, and 6 months. Maternal socio-demographic factors, obesity class and the number of education contacts received were also recorded. Fifty-three African-American women were randomized into the intervention and control groups. Intervention participants retained significantly less gestational weight gain than control participants (3.0 ± 11.8 vs. 12.6 ± 20.4, p < 0.05). In both groups, participants with Class III obesity retained significantly less weight than participants in Classes I and II (p = 0.02). An integrated WIC and obstetrical service model is feasible and can limit postpartum weight retention in obese women. Weight retention at 6 months postpartum between intervention and control participants was statistically significant. Further research should explore targeted interventions by obesity class to address weight retention for low-income, African American women who participate in WIC.

The INTERGROWTH-21st gestational weight gain standard and interpregnancy weight increase: A population-based study of successive pregnancies.

ObjectiveTo link the INTERGROWTH‐21st gestational weight gain standard with the risks of excess maternal postpartum weight retention, approximated by women's weight change between successive pregnancies.MethodsA population‐based retrospective cohort study of 58,534 women delivering successive pregnancies in British Columbia, Canada (2000‐2015) was conducted. Pregnancy weight gain (kg) in the index pregnancy was converted into a gestational age‐standardized z‐score using the INTERGROWTH‐21st standard. Excess interpregnancy weight gain was defined as weight increases of 5 kg, 10 kg, or obesity (≥30 kg/m2) at the next pregnancy. Weight gain z‐scores and excess interpregnancy weight change were associated using logistic regression.ResultsFor all definitions of excess interpregnancy weight gain, risks remained low and stable below a weight gain z‐score of 0 (50th percentile) but rose sharply with increasing z‐scores above zero. Compared with women gaining −1 to 0 SD (16th to 50th percentiles), women gaining > 0 to +1 SD (51st to 84th percentiles) were 55% to 84% more likely to retain excess weight between pregnancies. Risks were three‐ to sixfold higher in women gaining >+1 SD.ConclusionsA large range of the INTERGROWTH‐21st percentiles were associated with increased risks of excess interpregnancy weight gain. The standard may normalize high weight gains of women at increased risk of excess weight retention.

Modifiable risk factors of maternal postpartum weight retention: an analysis of their combined impact and potential opportunities for prevention.

Pregnancy triggers a physiological change in weight status. Postpartum weight retention in the childbearing years can substantially alter a woman's weight gain trajectory, with several potential contributing factors identified. Most research has relied on women's recall of pre-pregnancy weight during pregnancy or later, and not considered risk factors in combination. Using measured pre-pregnancy weight, this study aimed to examine the associations of maternal postpartum weight retention with parity, pre-pregnancy BMI, excessive gestational weight gain (GWG), maternal serum vitamin D concentration and dietary Glycaemic Index in early and late pregnancy, and breastfeeding duration, including analysis of the combined impact of potentially modifiable risk factors. Prospective cohort study of 12 583 non-pregnant women aged 20-34 years in Southampton (UK) who were assessed prior to pregnancy, with those who subsequently became pregnant followed up in early and late gestation, and after delivery (n=2559 in the final sample). Linear regression models examined potential predictors of weight retention in adjusted individual and multivariate analyses, and as a risk factor score. Compared with pre-pregnancy weight, 73% of women retained some weight at 6 months postpartum (mean (s.d.): 3.5 (6.2) kg). In the adjusted multivariate model, women who were primiparous, had a lower pre-pregnancy BMI, excessive GWG, a lower early pregnancy vitamin D concentration and breastfed for <6 months had greater weight retention 6 months postpartum (P<0.05 for all variables). For each additional modifiable risk factor (excessive GWG, low vitamin D concentration in early pregnancy and short breastfeeding duration; scale 0-3), women retained an additional 2.49 kg (95% CI: 2.16, 2.82; P<0.001). Having a greater number of modifiable risk factors was associated with greater weight retention 6 months postpartum. Initiatives supporting women to target these risk factors in the years prior to, during and after pregnancy could impact on their weight gain trajectory and later risk of adverse weight-related outcomes.

A genetic link between prepregnancy body mass index, postpartum weight retention, and offspring weight in early childhood.

The effects of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) on maternal and offspring obesity traits, as well as the maternal and offspring genetic contribution to GWG and postpartum weight retention, were examined. Blood samples from mothers (n = 608) and offspring (n = 541) were genotyped for 83 BMI-associated SNPs and 47 waist-to-hip ratio (WHR)-associated SNPs. Linear regression and mixed-effects regression models were performed to examine clinical epidemiological and genetic associations with unweighted and weighted BMI and WHR genetic risk scores (GRS). Prepregnancy BMI was positively associated with offspring weight and BMI Z-score from birth to 5 years. GWG was positively associated with maternal postpartum weight retention at 1 and 5 years and with offspring weight Z-score from birth to 5 years old. The maternal unweighted BMI GRS was associated with prepregnancy BMI, postpartum weight retention at 5 years, and offspring weight Z-score from birth to 5 years old, but not associated with GWG. Both maternal and offspring unweighted WHR GRSs were negatively associated with GWG. Maternal BMI-associated SNPs may contribute to the genetic link between prepregnancy BMI variation, long-term postpartum weight retention, and offspring birth weight and longitudinal weight. Maternal and offspring WHR-associated SNPs may contribute to GWG variation.

Breastfeeding Pattern and Duration and Post-Partum Maternal Weight Retention

Background/Aim: The aims were to investigate the association of breastfeeding (BF) duration with maternal postpartum weight retention (PPWR) at 12 months after delivery. Methods: In this prospective cohort study, mothers were interviewed at birth, and at 3, and 12 months after delivery to gather information on socio-demographic and reproductive maternal characteristics, BF initiation, BF pattern at 3 months and BF duration, as well as to measure maternal anthropometric indicators. Results: A negative association between BF intensity at 3-months and maternal PPWR was found at 3-months and 12-months after delivery. In adjusted multivariable linear regression, for each month of EBF increase between birth and 3-months postpartum, there was a mean decrease of 0.21 kg in maternal long-term PPWR; and for each month of any BF increase between birth and 12 months postpartum, there was a mean decrease of 0.11 kg in maternal long-term PPWR. Maternal younger ages weakened the negative long-term effect of BF on PPWR and the greater levels of maternal pre-gestational body mass index annulled the effect of any BF on PPWR. Conclusion: This study supports the evidence that BF improves the reduction of PPWR and suggests that encouraging prolonged EBF and any BF may contribute to decrease PPWR.

Routine weighing of women during pregnancy is of limited value and should be abandoned: AGAINST: Routine weighing in pregnancy is the first step to preventing adverse birth outcomes.

Gestational weight gain (GWG) outside of recommended ranges is a common and growing public health challenge. Since 2000, the percent of US women gaining weight during pregnancy in excess of current guidelines increased 3% – from an already high 42.5% in 2000–1 to 45.5% in 2008–9. (Johnson JL et al. Am J Obstet Gynecol. Jan 28 2015). In combination with the ~20% of women with inadequate gain, almost 2/3 of women are now gaining outside of recommended ranges. Strong and consistent evidence links appropriate GWG to lower risks for adverse pregnancy outcomes, including small or large for gestational age, preterm birth, cesarean delivery, maternal postpartum weight retention, and child obesity (Oken E, et al. Am J Epidemiol 2009;170(2):173–180). Out of range GWG carries not only large relative risks, but also impressive population attributable risks. For example, a recent Canadian analysis found that 18.2% (95% CI: 17.8, 18.7) of all preterm births could be attributed to excessive GWG and another 4.7% (4.4, 9.0) to inadequate gain, compared with 2.6% from maternal underweight and 3.2% from prenatal smoking (Dzakpasu S, et al. BMC Preg Child 2015;15(1):21) Thus, there should be no debate about the importance of appropriate gestational weight gain for maternal and child health. The question at hand is whether routine weighing of pregnant women is an appropriate screening test. Almost all standard principles for screening programs are easily met. Routine weighing is inexpensive, widely available in multiple settings, and broadly acceptable. Guidelines for appropriate GWG published by the US Institute of Medicine in 2009 have been rapidly adopted, even internationally. Gestational weight gain temporally precedes most outcomes of interest, such as preterm birth, infant mortality, and excess postpartum maternal and child weight, although the timing of its relationship with fetal growth is likely more complex. Evidence is more limited regarding which interventions are likely to be successful. While additional high-quality adequately-powered trials are certainly needed, existing data suggest that lifestyle interventions that incorporate nutrition and exercise programs can succeed at lowering rates of excessive GWG (Siega-Riz AM, et al. Nutr Rev 2013;71 (S1):S26–30). Some interventions were also effective at decreasing risk for poor obstetric outcomes including large for gestational age, with no increased risk for small for gestational age or low birth weight. Furthermore, no great alternative to routine weighing exists. While ultrasound can more directly measure fetal growth, it is expensive, not available in many settings, and does not necessarily predict other outcomes such as cesarean delivery or preterm. Furthermore, ultrasound measurements tend to be least accurate in the heaviest women who are at high risk for both poor and excessive fetal growth. The path to appropriate gain matters, as we learned in the middle 20th century when some women (in some cases encouraged by their obstetricians) smoked as a way to limit their weight gain. Achieving energy balance by healthful diet and regular physical activity remains essential. Routine weighing of pregnant women is not by itself a solution to preventing adverse birth outcomes, but it’s a start.

Diet matters, particularly in pregnancy – Results from MoBa studies of maternal diet and pregnancy outcomes

Awareness that maternal diet may influence the outcome of pregnancy as well as the long-term health of mother and child has increased in recent years. A new food frequency questionnaire (FFQ) was developed and validated specifically for the Norwegian Mother and Child Cohort Study (MoBa). The MoBa FFQ is a semi-quantitative tool which covers the average intake of food, beverages and dietary supplements during the first 4 to 5 months of pregnancy. It includes questions about intakes of 255 foods and dishes and was used from 2002 onwards. Data assessed by the MoBa FFQ is available for 87,700 pregnancies. Numerous sub-studies have examined associations between dietary factors and health outcomes in MoBa. The aim of this paper is to summarize the results from 19 studies of maternal diet and pregnancy outcomes, which is the complete collection of studies based on the MoBa FFQ and published before September 2014. The overall research question is whether maternal diet – from single substances to dietary patterns – matters for pregnancy outcome. The pregnancy outcomes studied till now include birth size measures, infants being small and large for gestational age, pregnancy duration, preterm delivery, preeclampsia, as well as maternal gestational weight gain and postpartum weight retention. As a whole, the results from these studies corroborate that the current dietary recommendations to pregnant women are sound and that maternal diet during pregnancy is likely to contribute to reduce the risk of pregnancy complications including preterm birth, preeclampsia, and reduced foetal growth. The results provide supporting evidence for recommending pregnant women to consume vegetables, fruit, whole grain, fish, dairy, and water regularly and lower the intake of sugar sweetened beverages, processed meat products and salty snacks. The results showing negative impact of even low levels of environmental contaminants support the precautionary advice on consumption of foods containing these. New findings are that particularly lean fish explained the positive association between seafood intake and foetal growth, and the indications of a protective effect of probiotic and antimicrobial foods on pregnancy outcomes. This points to the importance of diet composition for a healthy gut flora and the body’s immune response. Although these studies are observational and cannot infer causality, the results identify diet as an important modifiable lifestyle factor, suggesting that healthy eating, defined as following the official recommendations, is particularly important in pregnancy.