Postpartum Weight Change Research Articles

576 The association of perinatal housing instability with postpartum care utilization in a diverse US cohort

Care in the postpartum period is often suboptimal in the US, and the role of housing as a potential social determinant of postpartum care utilization is poorly understood. Our objective was to evaluate whether housing instability is associated with differences in postpartum care utilization and health outcomes. In this cohort study of housing instability in pregnancy, postpartum patients completed surveys regarding housing instability during pregnancy. Patients were considered housing unstable if they answered affirmatively to at least one of six screening items concerning moving, financial constraints, foreclosures, and homelessness. The primary outcome was attendance at a comprehensive postpartum care visit. Secondary outcomes included emergency department visit, hospital readmission, blood pressure or mood-specific visits (when indicated), postpartum vaccination status, postpartum weight change, breastfeeding, postpartum depression, and contraception uptake. Logistic and linear regression models were adjusted for age, race, and insurance status. In this cohort (N = 488), 11% (N=54) of participants experienced housing instability during pregnancy. Patients with housing instability were more likely to be minority race, have less than a college education, be single, and unemployed. Although the frequency of the primary outcome was lower for individuals with unstable housing (80% v. 91%, p = 0.01), there was no difference in the odds of the postpartum visit attendance after adjusting for age, race, and insurance status (0.69, 95% CI 0.28-1.65) (Table). No secondary outcomes differed by housing status. Housing instability may not be an independent risk factor for postpartum care utilization and postpartum health outcomes. However, given the overlap of housing instability with other social determinants, further work is required to understand how best to support postpartum individuals who experience housing instability.

Productivity and Haematology of Semi-intensively Raised Nulliparous Nigerian Goats Following Estrus Synchronization in the Humid Tropical Environment

ABSTRACT Most Nigerian indigenous breeds of goat are raised under free range traditional system in rural communities, where their embedded genetic potentials are underexploited due to poor management practices. This study compared the productivity of phenotypically identified primigravid does belonging to three different breed types; West African Dwarf (WAD) n=17, Red Sokoto (RS) n=13 and crossbreed of WAD & RS n= 12. Synchronization was done using gonadotropin-releasing hormone (Gn-RH) (Receptal®) at 100µg per animal, and Prostaglandin F2 alpha (PGF2α) Dinoprost thromethamine (LutalyseR) at 5mg per animal. The animals were mated naturally, fed supplemented diet and allowed access into established paddocks for 190 days. The weight and the haematology of the does were monitored during the pregnancy. The gestation length (GL), litter size, weight of kids, weight distribution by sex and post-partum offspring weight changes and survival were evaluated. Data were tested for significant differences between groups using analysis of variance (ANOVA). P

Predictors of patterns of weight change 1 year after delivery in a cohort of Mexican women.

To evaluate the associations of pregestational BMI, gestational weight gain (GWG) and breast-feeding at 1 month postpartum with four patterns of weight change during the first year after delivery: postpartum weight retention (PPWR), postpartum weight gain (PPWG), postpartum weight retention + gain (PPWR + WG) and return to pregestational weight. In this secondary analysis of a prospective study, we categorised postpartum weight change into four patterns using pregestational weight and weights at 1, 6 and 12 months postpartum. We evaluated their associations with pregestational BMI, GWG and breast-feeding using multinomial logistic regression. Results are presented as relative risk ratios (RRR) and 95 % CI. Mexico City. Women participating in the Programming Research in Obesity, Growth, Environment and Social Stressors pregnancy cohort. Five hundred women were included (53 % of the cohort). Most women returned to their pregestational weight by 1 year postpartum (57 %); 8 % experienced PPWR, 14 % PPWG and 21 % PPWR + WG. Compared with normal weight, pregestational overweight (RRR 2·5, 95 % CI 1·3, 4·8) and obesity (RRR 2·2, 95 % CI 1·0, 4·7) were associated with a higher risk of PPWG. Exclusive breast-feeding, compared with no breast-feeding, was associated with a lower risk of PPWR (RRR 0·3, 95 % CI 0·1, 0·9). Excessive GWG, compared with adequate, was associated with a higher risk of PPWR (RRR 3·3, 95 % CI 1·6, 6·9) and PPWR + WG (RRR 2·4, 95 % CI 1·4, 4·2). Targeting women with pregestational overweight or obesity and excessive GWG, as well as promoting breast-feeding, may impact the pattern of weight change after delivery and long-term women's health.

Per- and Polyfluoroalkyl Substance Exposure, Gestational Weight Gain, and Postpartum Weight Changes in Project Viva.

The purpose of this study was to test the extent to which pregnancy per- and polyfluoroalkyl substance (PFAS) concentrations were associated with gestational weight gain and postpartum weight changes. This study was composed of 1,614 women recruited between 1999 and 2002 via the Project Viva cohort with pregnancy plasma concentrations of six PFAS, including perfluorooctanesulfonic acid, perfluorooctanoic acid (PFOA), and 2-(N-ethyl-perfluorooctane sulfonamido) acetic acid. Gestational weight gain was defined as the difference between last pregnancy weight and prepregnancy weight, 1-year postpartum weight retention as the difference between 1-year postpartum weight and prepregnancy weight, and 3-year postpartum weight change as the difference between 3-year postpartum weight and prepregnancy weight. During pregnancy, women gained 0.37 kg (95% CI: 0.11-0.62) more weight per doubling of 2-(N-ethyl-perfluorooctane sulfonamido) acetic acid. At 1 year post partum, women retained 0.55 kg (95% CI: 0.07-1.04) more weight per doubling of PFOA. At 3 years post partum, women gained 0.91 kg (95% CI: 0.25-1.56) more weight per doubling in PFOA. Findings were similar after adjustment for all PFAS. Other PFAS were not associated with weight changes. Postpartum associations were stronger among women with higher prepregnancy BMI. Models were adjusted for demographics. Pregnancy PFAS were associated with greater gestational weight gain, weight retention, and weight gain years after pregnancy.

Reward-related eating, self-regulation, and weight change in pregnancy and postpartum: the Pregnancy Eating Attributes Study (PEAS).

Background/Objectives.Reward-related eating is hypothesized to underlie risk for weight gain in obesogenic environments, but its role is unknown during pregnancy and postpartum when weight change is normative, but excess weight gain and weight retention are common. This study examined associations of self-reported reward-related eating, self-regulation, and the home food environment with excessive gestational weight gain (GWG) and postpartum weight change.Subjects/Methods.Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks pregnancy and followed through one-year postpartum (458 recruited; 367 retained through delivery). Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale, Power of Food Scale, Multiple Choice Procedure, and a Reinforcing Value of Food Questionnaire; two measures of self-regulation – Barratt Impulsiveness Scale and Delay of Gratification Inventory; and a Home Food Inventory. Measured weight and skinfolds were obtained. Multinomial logistic and multiple linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with excessive GWG, gestational fat gain, postpartum weight change, and percent of GWG retained.Results.Excessive GWG was associated with food reinforcement intensity, but not with any other measure of reward-related eating, self-regulation, or home food environment. Greater gestational fat gain was associated only with higher Multiple Choice Procedure. Postpartum weight change and percent of GWG retained were associated with greater Delay of Gratification and obesogenic home food environment, but not with any measure of reward-related eating or with impulsivity.Conclusions.Findings do not support the hypothesis that self-reported reward-related eating is associated with weight outcomes in pregnancy and postpartum but indicate a relation of Delay of Gratification with postpartum weight retention. Further research using both surveys and objective measures of reward-related eating is needed to advance our understanding of the relation of reward-related eating with weight changes during this critical period of a woman’s life.

A Prospective Study of Relations Among Infant, Maternal, and Paternal Adiposity Indicators

Abstract Objectives This study examines relations of infant birth size and growth with maternal early pregnancy BMI, gestational weight gain (GWG), postpartum weight change and paternal body size. Methods Infant birth size (small for gestational age- SGA, <10th percentile and large for gestational age- LGA, >90th percentile) and weight-for-length z-scores (WFLz) were calculated from anthropometrics obtained at birth (n = 331), 6 weeks, 6 months and 12 months of age. Maternal early pregnancy BMI, GWG, % of GWG lost (%GWGL), and return to early pregnancy weight (EPW) were derived from height and weight measured from early pregnancy (mean ± SD = 9.9 ± 1.7 weeks gestation) through 12 months postpartum. Mothers reported father's baseline body size via Stunkard figure ratings. Logistic regressions and linear mixed models estimated relations of SGA, LGA and WFLz with parent weight indicators. Multiplicative interaction terms tested interactions of maternal BMI with pregnancy and postpartum weight change, and of paternal with maternal weight indicators. Analyses controlled for maternal height, demographics, child sex, gestational age at delivery, and delivery mode. Results LGA was positively associated with maternal BMI (OR = 1.10, 95%CI:1.05–1.16, P < 0.001) but not GWG. SGA was associated with lower odds of excessive GWG (OR = 0.24, 95%CI:0.07–0.79, P = 0.02) but was not associated with maternal BMI. Paternal body size was not associated with LGA or SGA. WFLz was positively associated with maternal BMI (β ± SE = 0.03 ± 0.09 P = 0.001), but not GWG, %GWGL, EPW, or paternal body size. However, WFLz was positively associated with GWG in mothers with low (<25) but not high (≥25) early pregnancy BMI (β ± SE interaction term = −0.004 ± 0.002, P = 0.04). Paternal body size did not modify associations of maternal with infant weight indicators. Conclusions Maternal BMI was consistently associated with birth size and infant adiposity development, and associations were not modified by paternal body size. Whether pre-pregnancy interventions are more effective than pregnancy interventions for reducing offspring overweight in women with high BMI is an important area of future investigation. Funding Sources This research was supported by the NICHD Intramural Research Program.

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

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.

Interventions including a nutrition component aimed at managing gestational weight gain or postpartum weight retention: a systematic review and meta-analysis.

The objective of this systematic review was to evaluate the effectiveness of interventions that include a nutrition component aimed at improving gestational weight gain and/or postpartum weight retention. Excessive gestational weight gain and postpartum weight retention increase the risk of adverse maternal and neonatal outcomes. Current evidence comprises many interventions targeting gestational weight gain and postpartum weight retention that incorporate a nutrition component. To date, no review has synthesized evidence from pregnancy through the postpartum period or described the intervention approaches in detail. The review included women (≥18 years) during pregnancy and/or up to 12 months postpartum. Studies were included if they involved a weight management intervention with a nutrition component and had the primary objective of determining the impact of gestational weight gain and/or postpartum weight change. Interventions were compared to usual care (i.e. control conditions with no intervention or wait-list control or standard pregnancy or postpartum care) or "other" (alternative intervention). The review considered randomized controlled trials published between 1980 and January 21, 2016. Studies that included a weight related primary outcome measured during pregnancy and/or postpartum were included. Seven databases were searched and the reference lists of included studies were searched for additional studies not previously identified. Two independent reviewers assessed the methodological quality of studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used to extract data. A narrative synthesis was undertaken to qualitatively synthesize included studies, with meta-analyses used to pool weight outcome data from studies conducted separately for pregnancy and postpartum. Effect sizes for meta-analyses have been expressed as weighted mean differences (95% confidence intervals). The search yielded 4063 articles of which 48 articles from 39 studies were included. Eleven of 20 studies during pregnancy reported significant reductions in gestational weight gain with the intervention when compared to control groups. One of five studies where the intervention was conducted during both pregnancy and postpartum reported statistically significant reductions in gestational weight gain, and postpartum weight retention between intervention and control groups. Nine of 14 studies conducted after childbirth reported statistically significant intervention effects, indicating lesser postpartum weight retention. Random effects meta-analyses indicated that despite considerable heterogeneity, interventions conducted during pregnancy (-1.25 kg; 95% CI: -2.10 kg, -0.40 kg; p = 0.004), and postpartum (-3.25 kg; 95% CI: -4.69 kg, -1.82 kg; p < 0.001) were significantly more effective at improving weight outcomes compared to usual care or other interventions. Most studies were of moderate quality due to lack of clarity in describing study details required for appraising methodological quality. Few interventions were conducted from pregnancy through the postpartum period (n = 5). Limited interventions adopted online modalities in intervention delivery (n = 4). Intention-to-treat analysis was used in only 12 studies. The pregnancy and postpartum period presents a unique opportunity to engage women in interventions to help optimize lifestyle behaviors for weight management, however the optimal approach is unclear. Improving consistency in intervention implementation and reporting will improve future evidence synthesis.

High-intensity breastfeeding improves insulin sensitivity during early post-partum period in obese women with gestational diabetes.

To investigate whether high-intensity breastfeeding (HIB) reduces insulin resistance during early post-partum period in women with gestational diabetes (GDM), independent of post-partum weight change (PWC). In this multicentre prospective study, we included Japanese women with GDM who underwent a 75-g oral glucose tolerance test (OGTT) during early post-partum. We measured plasma insulin during OGTT to obtain a homeostasis model of assessment of insulin resistance (HOMA-IR). We defined the condition in which infants were fed by breastfeeding alone or greater than or equal to 80% of the volume as HIB, and other statuses, including partial and nonbreastfeeding, as non-HIB. We investigated the association between post-partum HOMA-IR and the breastfeeding status after adjusting for confounders including PWC. Among 222 women with GDM who underwent the OGTT at 7.9±2.3weeks post-partum with a PWC of -7.8±3.4kg, although the rate of abnormal glucose tolerance (prediabetes and diabetes) did not differ between the groups (33% vs 32%), the HOMA-IR in the HIB women (n=166) was significantly lower than that in the non-HIB women (n=56) (1.12±0.85 vs 1.72±1.43, P=0.0002). The effect of the HIB was independently associated with lower HOMA-IR after adjusting for confounders including PMC. However, the subgroup analysis according to their pre-pregnancy obesity states showed that the effect was seen only in the obese subjects (BMI≥25). In obese Japanese women with GDM, HIB has a significant effect in reducing insulin resistance during early post-partum, independent of the post-partum weight loss.

Influence of Sleep Duration on Postpartum Weight Change in Black and Hispanic Women

Objective:To examine associations of objectively-measured sleep duration with weight changes in black and Hispanic mothers over the first postpartum year.Methods:Data were from 159 mothers (69% black, 32% Hispanic). We assessed nocturnal sleep duration using wrist actigraphy at 6 weeks and 5 months postpartum, examined as a continuous variable and in categories (<7 versus ≥7 hours/night, consistent with American Academy of Sleep Medicine recommendations). Body weights were abstracted from medical records in pregnancy and measured at 6 weeks, 5 months, and 12 months postpartum. Outcomes included early postpartum (6 weeks to 5 months) and late postpartum (5 to 12 months) weight changes.Results:The majority of participants slept <7 hours/night at 6 weeks (75%) and 5 months (63%) postpartum. Early postpartum weight change did not differ by 6 week sleep duration category. By contrast, adjusted average late postpartum weight gain (SE) was 1.8 (0.7) kg higher in participants sleeping <7 hours at 5 months postpartum compared to those sleeping ≥7 hours (p=0.02). We did not detect statistically significant associations of continuous measures of sleep duration, nor measures of sleep quality, with postpartum weight changes.Conclusions:Sleeping <7 hours/night was associated with late postpartum weight gain in minority mothers.

Health effects of breastfeeding on the mother

We evaluated the effect of breastfeeding on maternal health outcomes. We distinguished between long-term effects (breast carcinoma, ovarian carcinoma, endometrial carcinoma, osteoporosis, and type2 diabetes mellitus) and short-term effects (lactational amenorrhea, postpartum depression, and postpartum weight change).Predominant breastfeeding increases the duration of lactational amenorrhea, which has ashort-term effect on the reduction of fertility. There are many studies that show that breastfeeding is protective against breast, ovarian carcinoma, and endometrial carcinoma. The effects depend on the duration of breastfeeding. There is evidence that breastfeeding reduces the risk of type2 diabetes and metabolic syndrome and cardiac diseases. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not clearly evident.

Association of early pregnancy body mass index with post-partum weight change among African-American women.

Post-partum weight retention is relatively common and increases the risk for future obesity. Women who are overweight or obese prior to pregnancy, or who gain excessively during pregnancy, are more likely to retain weight post-partum. Much of the existing research is limited by a single post-partum body-weight measure and therefore cannot distinguish post-partum weight retention from post-partum weight accrual. This study tested the hypothesis that early pregnancy body mass index (BMI) is positively associated with post-partum weight change, independent of gestational weight gain (GWG) and breastfeeding (BF) among African-American women, a demographic group with greater risk for obesity. Healthy African-American women (n = 32) were weighed at 2 weeks and 3 months post-partum to derive post-partum weight change. Data from prenatal care records were retrieved to calculate BMI at the first prenatal care visit and GWG. BF status at 2 weeks post-partum was self-reported. Early pregnancy BMI was positively associated with post-partum weight change (partial r = 0.53, P < 0.005), independent of GWG and BF status at 2 weeks post-partum. These results extend the literature by suggesting that the association between early pregnancy BMI and post-partum weight retention may be at least partially attributable to the accrual of new weight during the post-partum period. Future research in a larger and more diverse cohort is warranted and should explore potential mechanisms contributing to post-partum weight change.

724: Interpregnancy BMI changes and offspring mortality following second pregnancy

Obesity in pregnancy is associated with increased risk of neonatal mortality, however the effect of interpregnancy weight change is less understood. We sought to understand the impact of maternal interpregnancy body mass index (BMI) change on second offspring mortality risk. We included 266,971 women with first and second singleton deliveries between 1989 and 2015 from the Utah Population Database. Our exposure was defined as interpregnancy BMI change from date of first delivery to conception date of second pregnancy, derived from best clinical gestational dating of second pregnancy. We categorized exposure as: <-1, [-1, 0], [0, <1 reference], [1, 2], [2-4], ≥4 BMI units (kg/m2). Our outcomes were all-cause age-specific mortality: neonatal (≤ 28 days), infant (≤1 year old) childhood (≤5 years old), and late childhood (5-<18 years old). Analyses were based on Cox proportional hazards stratified by full term (>37 weeks) and preterm (< 37 weeks) deliveries. We assessed all-cause mortality and death from congenital anomalies and early infancy. Cox regression was used to estimate hazard ratios of childhood mortality and all models were adjusted for maternal age, race/ethnicity, maternal education, smoking during pregnancy, diabetes, hypertension, assisted reproduction, interpregnancy interval, maternal BMI prior to first pregnancy, infant sex, gestational age (term or not) and small for gestational age. Among full term deliveries, women with BMI change of 4+ had increased risk of neonatal mortality in their second child (hazard ratio 1.63, 95% confidence interval 1.15, 2.31). There were no differences in infant, early or late childhood mortality by interpregnancy BMI change. Maternal interpregnancy BMI changes of 2 to 3.99 and ≥4 had increased risk of all-cause mortality and mortality associated with congenital anomalies or conditions originating in the perinatal period (ICD10 760-779) in their second child (Table 1). In a large U.S. population study, women with large interpregnancy BMI changes have a significant risk of mortality in their second term offspring. Further studies are needed to assess if maternal post-partum weight change are a modifiable risk factor for adverse childhood outcomes.

The effect of high-intensity breastfeeding on postpartum glucose tolerance in women with recent gestational diabetes

BackgroundAlthough breastfeeding is expected to reduce the incidence of diabetes in women with gestational diabetes, the effect has not been clearly confirmed. We examined whether or not high-intensity breastfeeding reduces the incidence of abnormal glucose tolerance and investigated the effect of high-intensity breastfeeding on insulin resistance during the first year postpartum in Japanese women with current gestational diabetes.MethodsIn this retrospective study, we included women with gestational diabetes who underwent postpartum 75 g oral glucose tolerance test during the first year (12-14 months) postpartum from 2009 to 2011 at a single tertiary perinatal care center in Japan. High-intensity breastfeeding was defined as the condition in which infants were fed by breastfeeding alone or 80% or more of the volume. We investigated the effect of high-intensity breastfeeding on the prevalence of postpartum abnormal glucose tolerance and the postpartum homeostasis model of assessment of insulin resistance (HOMA-IR), after controlling for confounders, including prepregnancy obesity and weight changes during pregnancy and postpartum.ResultsAmong 88 women with gestational diabetes, 46 (52%) had abnormal glucose tolerance during the postpartum period. High-intensity breastfeeding women (n = 70) were significantly less likely to have abnormal glucose tolerance than non-high-intensity breastfeeding women (n = 18) (46% vs. 78%, p = 0.015). High-intensity breastfeeding was also associated with a lower HOMA-IR at 12-14 months postpartum than non-high-intensity breastfeeding (1.41 ± 1.02 vs. 2.28 ± 1.05, p = 0.035). Those associations remained significant after controlling for confounders. At least six months of high-intensity breastfeeding had a significant effect on lowering both the abnormal glucose tolerance prevalence and HOMA-IR compared with non-high-intensity breastfeeding.ConclusionsIn Japanese women with gestational diabetes, high-intensity breastfeeding ≥6 months had a protective effect against the development of abnormal glucose tolerance during the first year postpartum through improving insulin resistance, independent of obesity and postpartum weight change.

Influence of supplemental canola or soybean oil on milk yield, fatty acid profile and postpartum weight changes in grazing dairy goats.

ObjectiveThis experiment was designed to evaluate the effect of supplementation with soybean or canola oil on milk production and the composition of long chain fatty acids as well as weight changes in the goats and their kids.MethodsThirty nine mulitparous crossed Alpine×Nubian goats (initial body weight [BW] 43.5±1.7 kg) from the day of parturition were assigned to the treatments: grazing control (n = 15); grazing plus 20 mL/goat/d of supplemental soybean oil (n = 12); and grazing plus 20 mL/goat/d of supplemental canola oil (n = 12) from November 26, 2014 to March 7, 2015. The planned contrasts were: CI (control vs supplemented with oils); CII (soybean vs canola oil) to compare the treatment effects.ResultsThe vegetable oil supplementation reduced weight losses in lactating goats (CI: −0.060 vs 0.090 kg/d; p = 0.03) but did not improve milk production or affect kids’ growth. The content of C4, C6, C8, C10, C11, C14, and C18:1n9t in the milk was increased (p<0.05) with respect to control. However, C12, C14, C16, C18, C18:1n9c, C18:2n6c, and C18:3n3 were reduced (p<0.05) in supplemented goats. Conjugated linoleic acid (CLA) was increased (p<0.05) in goats supplemented with oils compared to the control group.ConclusionSupplementation with 20 mL/d of soybean or canola oil did not affect milk production or kids’ performance; however, it increased CLA concentration and reduced the reduced weight losses in lactating goats.

Impact of Normal Postpartum Glucose Tolerance on Postpartum Weight Change in Women with Recent Gestational Diabetes Mellitus

Objective: Although women with gestational diabetes mellitus (GDM) are at increased risk for type 2 diabetes, most revert to normal glucose tolerance after delivery. Awareness of normal glucose tolerance may mislead women regarding their risk of diabetes and decrease motivation for lifestyle changes. The objective was to investigate whether women with GDM who reported normal postpartum glucose tolerance had higher weight and body mass index (BMI) in the second year after delivery.

Breastfeeding and maternal health outcomes: a systematic review and meta-analysis.

AimTo evaluate the effect of breastfeeding on long-term (breast carcinoma, ovarian carcinoma, osteoporosis and type 2 diabetes mellitus) and short-term (lactational amenorrhoea, postpartum depression, postpartum weight change) maternal health outcomes.MethodsA systematic literature search was conducted in PubMed, Cochrane Library and CABI databases. Outcome estimates of odds ratios or relative risks or standardised mean differences were pooled. In cases of heterogeneity, subgroup analysis and meta-regression were explored.ResultsBreastfeeding >12 months was associated with reduced risk of breast and ovarian carcinoma by 26% and 37%, respectively. No conclusive evidence of an association between breastfeeding and bone mineral density was found. Breastfeeding was associated with 32% lower risk of type 2 diabetes. Exclusive breastfeeding and predominant breastfeeding were associated with longer duration of amenorrhoea. Shorter duration of breastfeeding was associated with higher risk of postpartum depression. Evidence suggesting an association of breastfeeding with postpartum weight change was lacking.ConclusionThis review supports the hypothesis that breastfeeding is protective against breast and ovarian carcinoma, and exclusive breastfeeding and predominant breastfeeding increase the duration of lactational amenorrhoea. There is evidence that breastfeeding reduces the risk of type 2 diabetes. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not evident.

The Associations of Maternal Weight Change with Breastfeeding, Diet and Physical Activity During the Postpartum Period.

To determine the association between breastfeeding practices, diet and physical activity and maternal postpartum weight. This was a secondary data analysis of a randomized community trial on beneficiaries of the Programa de Desarrollo Humano Oportunidades, recently renamed Prospera (n = 314 pregnant women), without any diseases that could affect body weight. Generalized estimating equations were used to determine the association between postpartum weight change and changes in diet, physical activity and type of breastfeeding. The mean postpartum weight change from the first to the third month was 0.6 ± 2.2 kg. Women who breastfed exclusively for 3 months had a 4.1 (SE = 1.9) kg weight reduction in comparison with women who did not provide exclusive breastfeeding or who discontinued breastfeeding before 3 months (p = 0.04). There was no association between postpartum weight change and physical activity (p = 0.24) or energy intake (p = 0.06). Exclusive breastfeeding was associated with maternal postpartum weight reduction. These results reinforce the World Health Organization recommendation of exclusive breastfeeding during the first 6 months of life in order to reduce the risk of weight retention or weight gain in postpartum women. It has been well established that exclusive breastfeeding is beneficial for both infants and mothers, but promoting breastfeeding as a strategy to promote postpartum weight loss is of paramount importance, especially in countries like Mexico where excessive weight in women of reproductive age is a public health problem.

The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes' Effects on Moms (GEM) Cluster Randomized Controlled Trial.

To compare the effectiveness of diabetes prevention strategies addressing postpartum weight retention for women with gestational diabetes mellitus (GDM) delivered at the health system level: mailed recommendations (usual care) versus usual care plus a Diabetes Prevention Program (DPP)-derived lifestyle intervention. This study was a cluster randomized controlled trial of 44 medical facilities (including 2,280 women with GDM) randomized to intervention or usual care. The intervention included mailed gestational weight gain recommendations plus 13 telephone sessions between 6 weeks and 6 months postpartum. Primary outcomes included the following: proportion meeting the postpartum goals of 1) reaching pregravid weight if pregravid BMI <25.0 kg/m(2) or 2) losing 5% of pregravid weight if BMI ≥25.0 kg/m(2); and pregravid to postpartum weight change. On average, over the 12-month postpartum period, women in the intervention had significantly higher odds of meeting weight goals than women in usual care (odds ratio [OR] 1.28 [95% CI 1.10, 1.47]). The proportion meeting weight goals was significantly higher in the intervention than usual care at 6 weeks (25.5 vs. 22.4%; OR 1.17 [1.01, 1.36]) and 6 months (30.6 vs. 23.9%; OR 1.45 [1.14, 1.83]). Condition differences were reduced at 12 months (33.0 vs. 28.0%; OR 1.25 [0.96, 1.62]). At 6 months, women in the intervention retained significantly less weight than women in usual care (mean 0.39 kg [SD 5.5] vs. 0.95 kg [5.5]; mean condition difference -0.64 kg [95% CI -1.13, -0.14]) and had greater increases in vigorous-intensity physical activity (mean condition difference 15.4 min/week [4.9, 25.8]). A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity.

Lactation, Weight Retention and Body Composition at 3 Months Postpartum: Is There a Link?

Postpartum weight retention (PPWR) can contribute to obesity development in women of reproductive age. However, little is known about the trajectory of postpartum weight and regional fat patterning change.