Nutrition Surveillance System Research Articles

Food and Nutrition Surveillance System (SISVAN) coverage, nutritional status of older adults and its relationship with social inequalities in Brazil, 2008-2019: an ecological time-series study.

to analyze the temporal trend of Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar e Nutricional - SISVAN) coverage and the nutritional status of older adults, and its correlation with indicators of social inequality in Brazil between 2008-2019. this was an ecological study using records from SISVAN, related to the population aged 60 years and older; the temporal trend of coverage and the correlation between indicators of social inequality and increment rate of nutritional status were analyzed; slope index of inequality and concentration index were used to measure absolute and relative inequalities. 11,587,933 records were identified; national coverage increased from 0.1% (2008) to 2.9% (2019), with a statistically significant upward trend; a moderate inverse correlation with an annual increment rate of overweight between human development index and gross domestic product per capita, was found. there was an increasing trend in SISVAN coverage; the increase in overweight was associated with social inequality.

Contributions of the Food and Nutrition Surveillance System (SISVAN) to the analysis of the nutritional profile of the Brazilian population: potentials and limitations

Contributions of the Food and Nutrition Surveillance System (SISVAN) to the analysis of the nutritional profile of the Brazilian population: potentials and limitations

Estado nutricional e tendência temporal da cobertura de adolescentes brasileiros acompanhados no Sistema de Vigilância Alimentar e Nutricional, 2008 a 2019

Abstract Objectives: to analyze the nutritional status and temporal trend of the coverage of Brazilian adolescents monitored in the Food and Nutritional Surveillance System in the period 2008-2019. Methods: ecological study of temporal series with SISVAN data collected from 2008 to 2019 with 45,869.266 registration. Body mass index data were collected and the registration coverage of adolescents monitored by the system was calculated. The percentage of annual variation in coverage and nutritional status was estimated using Prais-Winsten regression, with a significance level of 5%. Results: an increase in the prevalence of obesity was observed between 2008 and 2019, during this period thinness remained stable in Brazil. National coverage evolved from 9.3% in 2008 to 19.6% in 2019, with an annual variation of 9% and a statistically significant increase trend. In Brazil, obesity in this age group increased between 2008 and 2019, with an annual variation of 8.7% (CI95% = 7.8-9.6). Conclusion: modifications were observed in nutritional status suggest the occurrence of nutritional transition in the adolescents’ population. The percentage of coverage available in the system has growth potential, however, the current scenario impacts on a possible insufficient analysis to support the elaboration and reorientation of public policies.

Racial and regional inequality in the temporal trend of stunting and excess weight in Brazilian children under five years of age.

To analyze the occurrence of racial and regional inequality in the temporal trend of the prevalence of stunting and overweight in Brazilian children under five years of age over the years 2008-2018. An ecological time-series study with data from the Food and Nutrition Surveillance System on the prevalence of stunting and overweight in children under five years old according to race/skin color, region, and year. To assess differences between median prevalence per year of outcomes, the Kruskal-Wallis test was performed. Linear regression analyses were proposed to assess trends in the prevalence of outcomes over the years. In Brazil, black children tended to be overweight (β=4.611; p=0.042). Among black children, there was an increase over the years in stunting in the Southeast (β=3.960; p=0.014) and a decrease in the South (β=-4.654; p=0.022). In Brazil and in most regions, the median prevalence of stunting was higher in black children than in white ones (12.86 vs. 11.54%, p<0.001). In the Southeast and South, black children also had the highest prevalence of overweight (15.48 and 15.99%, respectively). Children from less developed regions of Brazil and of black skin color/race were more vulnerable to a double burden of malnutrition.

Tendência e correlação de obesidade e aleitamento materno continuado em crianças de seis a 23 meses

Abstract Objectives: to analyze the trend and correlation of obesity and the increase in continued breastfeeding in children aged six to 23 months in Brazil, from 2015-2019. Methods: ecological time series study with data from the Sistema de Vigilância Alimentar e Nutricional (Food and Nutritional Surveillance System). The dependent variable was the prevalence of obesity. Prais-Winsten linear regression was used to verify the trend. Spearman’s correlation was used to verify the relationship between the prevalence of obesity and the increase in continued breastfeeding. Results: there was a trend towards a reduction in the prevalence of obesity in all regions in Brazil (Annual Percentage Variation [APV]: -4.14; CI95%=-4.50; -3.79). The prevalence of continued breastfeeding showed an upward trend in the North (APV=4.89; CI95%=2.92; 6.90), Southeast (APV=3.36; CI95%=2.32; 4 .41) and South (APV=2.67; CI95%=0.98; 4.38). There was a negative and significant correlation between obesity and continued breastfeeding in the North, Northeast, Southeast and South regions. Conclusion: the reduction in the prevalence of obesity and the increase in continued breastfeeding occurred only in some regions, requiring the implementation of effective strategies to be present throughout the country. Actions to promote, protect and support continued breastfeeding and healthy eating should be more prioritized to promote the child’s healthy growth.

Desigualdade racial e regional na tendência temporal do déficit de estatura e excesso de peso de crianças brasileiras menores de cinco anos

ABSTRACT Objective: To analyze the occurrence of racial and regional inequality in the temporal trend of the prevalence of stunting and overweight in Brazilian children under five years of age over the years 2008–2018. Methods: An ecological time-series study with data from the Food and Nutrition Surveillance System on the prevalence of stunting and overweight in children under five years old according to race/skin color, region, and year. To assess differences between median prevalence per year of outcomes, the Kruskal-Wallis test was performed. Linear regression analyses were proposed to assess trends in the prevalence of outcomes over the years. Results: In Brazil, black children tended to be overweight (β=4.611; p=0.042). Among black children, there was an increase over the years in stunting in the Southeast (β=3.960; p=0.014) and a decrease in the South (β=-4.654; p=0.022). In Brazil and in most regions, the median prevalence of stunting was higher in black children than in white ones (12.86 vs. 11.54%, p&lt;0.001). In the Southeast and South, black children also had the highest prevalence of overweight (15.48 and 15.99%, respectively). Conclusion: Children from less developed regions of Brazil and of black skin color/race were more vulnerable to a double burden of malnutrition.

Prevalência do aleitamento materno entre povos Indígenas da Tríplice Fronteira: Brasil, Argentina e Paraguai

Abstract Objectives: to verify the prevalence of breastfeeding and the children’s nutritional status of indigenous origin up to two years of age in the triple frontier region: Brazil, Argentina and Paraguay. Methods: data from the Sistema de Vigilância Nutricional e Alimentar Indígena (Indigenous Food and Nutrition Surveillance System) were analyzed, being a cross-sectional and descriptive study. The survey was carried out in 2018, with data referring to 2017. Registrations of indigenous children of both sexes,aged zero to two years old were included. Data were extracted from the indigenous children’s follow-up map. The prevalence of breastfeeding and complementary feeding was evaluated. Results: the prevalence of exclusive breastfeeding in children under six months of age was 93.4% and complementary breastfeeding was 6.5%. The prevalence of complementary breastfeeding after six months was 71.6% and exclusive breastfeeding after six months was 28.3%. Regarding social benefits, 30.3% of the families accumulated two types of social benefits. Conclusions: the prevalence of exclusive breastfeeding was high and surpassed the national prevalence in the first semester of life, there was no early weaning.

Anthropometric indicators in traditional peoples and communities in Brazil: analysis of individual records from the Food and Nutrition Surveillance System, 2019

Resumo Objetivo: Descrever a prevalência de indicadores de baixo peso e de obesidade entre os indivíduos registrados como povos e comunidades tradicionais no Sistema de Vigilância Alimentar e Nutricional, de todo o Brasil, em 2019. Métodos: Estudo descritivo, com dados individualizados secundários de participantes atendidos na Atenção Básica do Sistema Único de Saúde. Resultados: Na população estudada (N = 13.944), houve maior prevalência de altura baixa entre crianças e adolescentes do sexo masculino (14,2%), quando comparados aos do sexo feminino (11,8%); na população adulta do sexo feminino, observou-se maior prevalência de obesidade (23,0%), quando comparada à do sexo masculino (11,3%); destacou-se a prevalência de altura baixa para a idade nas comunidades ribeirinhas (18,5%), e de obesidade na população adulta faxinalense (75,1%). Conclusões: As heterogeneidades antropométricas entre as comunidades exigem respostas adaptadas, com ênfase na atenção primária à saúde e na garantia da segurança alimentar e nutricional.

Nutritional status and temporal trend of coverage of Brazilian adolescents monitored in the Food and Nutritional Surveillance System, 2008 to 2019

Resumo Objetivos: analisar o estado nutricional e a tendência temporal da cobertura de adolescentes brasileiros acompanhados no Sistema de Vigilância Alimentar e Nutricional no período de 2008-2019. Métodos: estudo ecológico de séries temporais com dados do SISVAN coletados no período de 2008 a 2019 com 45.869.266 de registos. Foram coletados dados de índice de massa corporal e calculadas as coberturas dos registros dos adolescentes acompanhados pelo sistema. Estimou-se a percentagem da variação anual da cobertura e estado nutricional pela regressão de Prais-Winsten, com nível de significância de 5%. Resultados: observa-se crescimento da prevalência de obesidade entre 2008 a 2019, nesse período a magreza manteve-se estável no Brasil. A cobertura nacional evoluiu de 9,3% em 2008 para 19,6% em 2019, com variação anual de 9% e tendência de aumento estatisticamente significativa. No Brasil, a obesidade nessa faixa etária apresentou um aumento entre os anos de 2008 e 2019, com uma variação anual de 8,7% (IC95%= 7,8-9,6). Conclusão: modificações observadas no estado nutricional sugerem a ocorrência da transição nutricional na população de adolescentes. O percentual de cobertura disponível no sistema tem potencial de crescimento, entretanto, o atual cenário impacta em possível análise insuficiente para subsidiar a elaboração e reorientação de políticas públicas.

Perfil nutricional de crianças indígenas menores de cinco anos de idade no Alto Rio Solimões, Amazonas, Brasil (2013)

Abstract Objectives: to characterize the nutritional status of indigenous children underfive years of age living in rural communities in the Upper Solimões River region, inhabited by seven ethnic groups, based on data of december 2013. Methods: weight and height data extracted from SISVAN-I (Indigenous Food and Nutritional Surveillance System) forms filled in 2013 for 7,520 children (86.0% of the estimated children in this age group). The indices height-for-age (H/A), weight-for-age (W/A), weight-for-height(W/H), and body mass index-for-age (BMI/A) were calculated. Growth reference curves proposed by the World Health Organization were used to calculate z-scores. Results: the height-for-age (H/A) index presented the lowest mean z-score values, reaching -1.95 among children between 36 and 60 months. Mean z-score values for the weight-for-age (W/A) index also remained below zero. Mean z-score values for the indices weight-for-height (W/H) and body mass index-for-age (BMI/A) remained slightly above zero, reaching a maximum value of 0.5. Of all children, 45.7% presented low H/A, 9.6% presented low W/A, 4.5% presented low W/H, and 10.7% presented overweight based on BMI/A. Conclusion: our analysis show that in 2013 poor nutritional status persisted as an important health issue among these rural indigenous children.

Cobertura do Sistema de Vigilância Alimentar e Nutricional (SISVAN), estado nutricional de idosos e sua relação com desigualdades sociais no Brasil, 2008-2019: estudo ecológico de série temporal

Abstract Objective: to analyze the temporal trend of Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar e Nutricional - SISVAN) coverage and the nutritional status of older adults, and its correlation with indicators of social inequality in Brazil between 2008-2019. Methods: this was an ecological study using records from SISVAN, related to the population aged 60 years and older; the temporal trend of coverage and the correlation between indicators of social inequality and increment rate of nutritional status were analyzed; slope index of inequality and concentration index were used to measure absolute and relative inequalities. Results: 11,587,933 records were identified; national coverage increased from 0.1% (2008) to 2.9% (2019), with a statistically significant upward trend; a moderate inverse correlation with an annual increment rate of overweight between human development index and gross domestic product per capita, was found. Conclusion: there was an increasing trend in SISVAN coverage; the increase in overweight was associated with social inequality.

Development of a growth monitoring and promotion index to improve child health in Zimbabwe

In Zimbabwe, growth monitoring and promotion as conducted by community health workers are part of the nutritional surveillance system. This study seeks to develop a new index which will combine both caregiver behaviours, attitudes and CHW growth monitoring and promotion activities. An explanatory sequential mixed method design will be conducted in three phases. Phase one will comprise a scoping literature review. The second phase will comprise a needs analysis through quantitative data collection using two surveys of community health workers and caregivers of children under five years. Thereafter, qualitative data will be collected from caregivers of children under five years. The quantitative data will be analysed using SPSS while qualitative data will be collected and analysed using Atlas-ti. Phase three will be the development phase for the growth monitoring and promotion Index. The growth monitoring and promotion Index will be used to classify the GMP performance of districts through the DHIS2 thus strengthening the quality of growth monitoring and promotion. Recommendations on the findings and the adoption of the Index will be shared with the Ministry of Health and Child Care and key stakeholders implementing maternal, newborn and child health programmes in Zimbabwe for adoption and use in growth monitoring and promotion programming.

Social and Racial Disparities in Food Consumption Among Brazilian College Students: a Nationwide Study.

This study aims to assess the association between economic class, race/skin color, and food consumption among Brazilian college students. A cross-sectional web-based survey was conducted with college students from all over Brazil. Demographic data, economic class, self-reported race/skin color, anthropometry, and food consumption markers from the Brazilian Food and Nutrition Surveillance System were collected. The final sample comprised 5843 participants with a mean age of 24.1 (SD: 6.3) years, 4292 (73.5%) were female, and 810 (13.9%) in the highest economic stratum. We observed a progressive decrease in the frequency of fresh fruits and vegetables consumption from higher to lower economic classes (p < 0.01 for both). Contrarily, there was a progressive increase in the frequency of consumption of beans from higher to lower economic classes (p < 0.01). The frequency consumption of vegetables was also associated with race/skin color (p < 0.01), being lower in brown (PR: 0.94; CI 95%: 0.90; 0.98), and black (PR: 0.91; 95% CI: 0.85; 0.98) individuals, compared to white individuals. Brown individuals showed higher frequency consumption of beans (PR: 1.10; 95% CI: 1.05; 1.15) than whites. When compared to individuals of white race/skin color, brown (PR: 1.07; 95% CI: 1.01; 1.13) and black (PR: 1.15; 95% CI: 1.07; 1.23) individuals showed higher frequency consumption of sweetened beverages. Economic class and race/skin color were independent factors associated with the food consumption of Brazilian college students.

Temporal trend of child stunting prevalence and Food and Nutritional Surveillance System

Temporal trend of child stunting prevalence and Food and Nutritional Surveillance System

The tendency of stunting among children under five in the Northern Region of Brazil, according to the Food and Nutrition Surveillance System, 2008-2017

ObjectiveTo analyze the temporal tendency of stunting prevalence among children under five years of age registered in the Food and Nutritional Surveillance System (SISVAN) in the Brazilian Northern Region, from 2008 to 2017. MethodsEcological time-series study with data from SISVAN. The annual variation rate for the prevalence of undernutrition, measured by the presence of stunting (low height-for-age index), was estimated for the Northern Region and for each of its states using the Prais-Winsten regression model with and without variable adjustment for SISVAN coverage to explore the relationship between these variables. ResultsThe Northern Region showed a tendency toward the reduction of chronic child stunting, with an annual variation of -5.30% (95%CI -9.64; -0.77) in the period studied. The states of Acre (-7.19%; 95%CI -12.31; -1.77), Pará (-4.86%; 95%CI -9.44; -0.03), and Tocantins (-6.22%; 95%CI -9.88; -2.41) showed a tendency to reduce the prevalence of stunting, while the other four states showed stability during the period. A strong negative correlation was found between SISVAN coverage and the prevalence of stunting in the states of Acre (beta: -0.725), Amazonas (beta: -0.874), Pará (beta: -0.841), and Tocantins (beta: -0.871), indicating that the increase in system coverage is associated with a reduction of stunting. ConclusionsThere is a tendency toward a reduction in the prevalence of stunting particularly in three states and in the North Region as a whole, from 2008 to 2017. The coverage by the system was associated with a reduction in the prevalence of child stunting in four states.

Análise da prevalência do consumo de açúcar em consultas de puericultura

Abstract Objectives: to analyze the prevalence of sugar consumption and associated factors in childcare consultations. Methods: cross-sectional study with 599 children &gt; six months to &lt; 24 months of age, assisted by the Family Health Units. Outcomes: daily consumption of sweetened beverages, sweets/candies, recorded in the Food and Nutrition Surveillance System; independent variables: sociodemographic data. Multiple logistic regression test was applied. Results: 62.10% of the children consume sugary drinks and 42.23%, sweets/candies. Consuming sugary drinks was associated with the age of 12-17 months and 29 days (OR=2.525; CI95%=1.68-3.78) and 18-17 months and 29 days (OR=2.90; CI95%=1.90-4.43); children living with more than four people at home (OR=1.59; CI95%=1.11-2.26), aged 12-17 months and 29 days (OR=2.05; CI95%=1.34-3.13) and 18-23 months and 29 days (OR=2.51; CI95%=1.62-3.87) were more likely to consume sweets/candies than younger children. Maternal aspects, such as age (OR=0.66; CI95%=0.46-0.93), marital status (OR=1.67; CI95%=1.06-2.6), schooling (OR=2.14; CI95%=1.12-4.08), and presence of government assistance (OR=2.03; CI95%=1.41-2.93), were conditions associated with the consumption of sweets. Conclusions: the prevalence of sugar in children’s diet was high and was associated with sociodemographic aspects. Health education actions should be carried out in childcare, in order to promote healthy food, minimizing the consumption of sugar.

Accuracy of a handheld 3D imaging system for child anthropometric measurements in population-based household surveys and surveillance platforms: an effectiveness validation study in Guatemala, Kenya, and China

An efficacy evaluation of the AutoAnthro system to measure child (0-59 months) anthropometry in the United States found 3D imaging performed as well as gold-standard manual measurements for biological plausibility and precision. We conducted an effectiveness evaluation of the accuracy of the AutoAnthro system to measure 0- to 59-month-old children's anthropometry in population-based surveys and surveillance systems in households in Guatemala and Kenya and in hospitals in China. The evaluation was done using health or nutrition surveillance system platforms among 600 children aged 0-59 months (Guatemala and Kenya) and 300 children aged 0-23 months (China). Field team anthropometrists and their assistants collected manual and scan anthropometric measurements, including length or height, midupper arm circumference (MUAC), and head circumference (HC; China only), from each child. An anthropometry expert and assistant later collected both manual and scan anthropometric measurements on the same child. The expert manual measurements were considered the standard compared to field team scans. Overall, in Guatemala, Kenya, and China, for interrater accuracy, the average biases for length or height were -0.3cm, -1.9cm, and -6.2cm, respectively; for MUAC were 0.9cm, 1.2cm, and -0.8cm, respectively; and for HC was 2.4cm in China. The inter-technical errors of measurement (inter-TEMs) for length or height were 2.8cm, 3.4cm, 5.5cm, respectively; for MUAC were 1.1cm, 1.5cm, and 1.0cm, respectively; and for HC was 2.8cm in China. For intrarater precision, the absolute mean difference and intra-TEM (interrater, intramethod TEM) were 0.1cm for all countries for all manual measurements. For scans, overall, absolute mean differences for length or height were 0.4-0.6cm; for MUAC were 0.1-0.1cm; and for HC was 0.4cm. For the intra-TEM, length or height was 0.5cm in Guatemala and China and 0.7cm in Kenya, and other measurements were≤0.3cm. Understanding the factors that cause the many poor scan results and how to correct them will be needed prior to using this instrument in routine, population-based survey and surveillance systems.

Trends of stunting, underweight and overweight among children aged < 5 years in Kuwait: findings from Kuwait Nutritional Surveillance System (2007-2019).

There is a paucity of data on the secular trends of stunting and overweight among children aged < 5 years in oil-rich countries in the Middle East. To examine the secular trends of stunting, underweight and overweight in children aged < 5 years in Kuwait between 2007 and 2019. We used large individual data records (n=48 108) from the Kuwait Nutritional Surveillance System (KNSS) to calculate height/length-for-age z score (HAZ), weight-for-age z score and body mass index (BMI)-for-age z score using World Health Organization growth references. Stunting and underweight were defined as < -2 standard deviation (SD) and overweight (including obesity) as ≥ +2 SD. Trends of stunting, underweight and overweight were investigated using logistic regression models. The prevalence of stunting, underweight and overweight was 5.15%, 2.33% and 10.78%, respectively. Stunting increased during the study period, among children aged < 2 years. There was no increasing trend in overweight during the study period. These findings were corroborated by the distribution of HAZ and BMI-for-age z scores. Current prevalence of combined stunting and overweight was 1.53% in boys and 1.98% in girls. Current prevalence of stunting and underweight is low in Kuwait indicating that undernutrition is no longer a major public health issue. There is a tendency for stunting to increase in children aged < 2 years, highlighting the need to investigate early causes of stunting such as maternal and pregnancy-related factors.

Characterization of the prevalence of excess weight in Brazil

Introduction/BackgroundThis work aims to analyse the prevalence of excess weight in Brazil to demonstrate the nutritional transition that is occurring. The data mobilized in the research are from the Food and Nutritional Surveillance System (FNSS).Materials and methodsThis study employed a quantitative approach from the FNSS online secondary data survey through reports of nutritional status in different phases of life (child, adolescent, adult, elderly and pregnant), in different macroregions of the country (South, Southeast, Midwest, Northeast and North) and with a 12-year historical series (2008 to 2019).ResultsIn the adult life stage, there was a time trend of increasing excess weight in all regions of this historical series. The southern region of Brazil and the adult life stage had the highest national percentage of excess weight (69,1%) in 2019 and had the lowest percentage of eutrophy (29.3%) in the region in 2019. In the elderly life phase, in the South, Southeast and Midwest regions, excess weight was higher than the other outcomes in the time series, with the highest annual prevalence in the South region (58,6%) in 2019. In the adolescent life stage, there was a time trend of increasing excess weight in all regions, and excess weight had the highest prevalence in 2019 in the South (35,8%). The lowest prevalence rates of excess weight were in the following age groups: children aged 0 to < 2 years old and children aged 2 to < 5 years old. Additionally, it was in Group 5 to < 10 years old that the most critical prevalence of excess weight (35,07%) was found in 2018. However, malnutrition (low weight) persists, especially in the elderly and children. In the pregnancy life stage, there was a temporal trend of increase in excess weight in all regions, with higher percentages in 2019 in the South (53.5%) and Southeast (50.8%).ConclusionExcess weight has shown increasing time trends in the adolescent, adult, elderly and pregnant life stages in all regions of Brazil, suggesting that public FNS policymakers should be more assertive in the planning and management of programs and actions to reduce the percentages of diseases.

Association Between Gestational Weight Gain in Each Trimester and Weight Retention at 6 and 12 Months Postpartum: Results From a National Administrative Dataset in Brazil

ObjectivesTo estimate the association between gestational weight gain (GWG) in the first, second, and third pregnancy trimesters and weight retention at 6 and 12 mo postpartum.MethodsIndividual data from the Brazilian National Food and Nutrition Surveillance System from 2008–2020 were used. Cumulative GWG was calculated as the difference between the last weight measured in each trimester and self-reported pre-pregnancy weight, standardized for gestational age and pre-pregnancy body mass index (BMI) into z-scores using the Brazilian charts. Postpartum weight retention (PWR) was calculated as the difference between weight measured close to (±1 month) 6 and 12 months postpartum and self-reported pre-pregnancy weight and categorized as < 5 or ≥ 5 kg. Median, interquartile ranges (IQR), frequencies, and proportions were calculated. Maternal age (y), participation in the Bolsa Familia conditional cash transfer program (yes/no), and pre-pregnancy BMI (kg/m2) were used to adjust linear regression models.ResultsAmong the 31,846 women included, 88.5% were < 35 y old; 77.2% participated in the Bolsa Familia program, and 52.7% were classified as normal weight before pregnancy. The median (IQR) cumulative GWG was 1.2 (0–2.8), 4.0 (1.2–7.0), and 9.0 (5.3–12.7) kg in the first, second, and third pregnancy trimesters, respectively. At 6 and 12 mo postpartum, 32.7% and 31.4% of the women had PWR ≥ 5 kg, respectively. The prevalence of PWR ≥ 5 kg at 6 and 12 mo was higher among women who gained weight > 90th percentile of the Brazilian charts than those who gained below those values (73.2 v. 29.6% for 6; 63.9 v. 28.7% for 12 mo, respectively). Each 1 z-score increase in the cumulative GWG in the first, second, and third trimesters was associated with an increase of 2.0, 2.3, and 2.4 kg, respectively, in the PWR at 6 mo. Similar trends were observed for PWR at 12 mo (P < 0.001 for all cases).ConclusionsGWG in all pregnancy trimesters was associated with PWR at 6 and 12 mo postpartum. The association between GWG in the first trimester and PWR highlights the importance of monitoring weight gain since the beginning of pregnancy to prevent the occurrence of adverse outcomes, such as maternal obesity, during the postpartum period.Funding SourcesBill & Melinda Gates Foundation.