Postpartum Weight Loss Research Articles

Targeting the postpartum period to promote weight loss: a systematic review and meta-analysis.

Many international clinical guidelines recommend that overweight and obese women lose weight prior to pregnancy to reduce the risk of adverse pregnancy outcomes. Women who have recently given birth and plan future pregnancies are an important target population for preconception weight-loss interventions. A systematic review to evaluate postpartum dietary and/or physical activity interventions to promote weight loss and improve health in a subsequent pregnancy was conducted. Five databases-the Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), Embase, the Australian New Zealand Clinical Trials Registry, and the International Clinical Trials Registry-were searched using the following terms: preconception, pregnancy, postpartum, pregnancy outcomes, body mass index, weight gain, weight loss, weight change, postpartum weight retention, dietary or lifestyle intervention, and randomiz(s)ed controlled trial. The date of last search was November 2017. Data were extracted from each identified study using a standard form. The primary outcomes were weight loss at the completion of the intervention and at follow-up assessments. Secondary endpoints included maternal and infant outcomes in a subsequent pregnancy. Mean differences (MDs) were calculated for continuous data and risk ratios for dichotomous data, both with 95%CIs. A total of 235 abstracts (193 after duplicates were excluded) were identified, from which 37 manuscripts were selected for full-text review. In total, 27 trials were identified for inclusion. Outcome data were available for approximately 75% of participants (n = 3485). A combined dietary and physical activity intervention provided post partum produced greater postpartum weight loss (MD, -2.49 kg; 95%CI, -3.34 to -1.63 kg [random-effects model]; 12 studies, 1156 women), which was maintained at 12 months post partum (MD, -2.41 kg; 95%CI, -3.89 to -0.93 kg [random-effects model]; 4 studies, 405 women), compared with no intervention. No studies reported maternal or infant health outcomes in a subsequent pregnancy. Providing a postpartum intervention is associated with weight loss after birth, but effects on maternal and infant health in a subsequent pregnancy are uncertain.

Modern dietary guidelines for healthy pregnancy; maximising maternal and foetal outcomes and limiting excessive gestational weight gain

Maternal dietary habits influence maternal and foetal health, representing a pathway for intervention to maximise pregnancy outcomes. Advice on energy intake is provided on a trimester basis, with no additional calories required in the first trimester and an additional 340 kcal d−1 and 452 kcal d−1 needed for the second and third trimesters. Energy intake depends on pre-gravid body mass index (BMI); underweight women are recommended an increase of 150, 200 and 300 kcal d−1 during the first, second and third trimester, normal weight women an increase of 0, 350 and 500 kcal d−1 and obese women an increase of 0, 450 and 350 kcal day−1. The recommendations for carbohydrate and protein intake are 175 g d−1 and 0.88–1.1 g kgBM d−1, with no change to fat intake. The number of pre-gravid obese women is rising; therefore, we need to regulate weight in women of childbearing age and limit gestational weight gain to within the recommended ranges [overweight women 6.8–11.3 kg and obese women 5.0–9.1 kg]. This can be achieved using nutritional interventions, as dietary changes have been shown to help with gestational weight management. As pregnancy has been identified as a risk factor for the development of obesity, normal weight women should gain 11.5–16.0 kg during pregnancy. While some research has shown that dietary interventions help to regulate gestational weight gain and promote postpartum weight loss to some extent, future research is needed to provide safe and effective guidelines to maximise these effects, while benefitting maternal and foetal health.

Exploring Healthy Eating and Exercise Behaviors Among Low-Income Breastfeeding Mothers.

Postpartum weight retention is often a significant contributor to overweight and obesity. Lactation is typically not sufficient for mothers to return to pre-pregnancy weight. Modifiable health behaviors (e.g., healthy eating and exercise) are important for postpartum weight loss; however, engagement among mothers, especially those who are resource-limited, is low. A deeper understanding of low-income breastfeeding mothers' healthy-eating and exercise experience, a population that may have unique motivators for health-behavior change, may facilitate creation of effective intervention strategies for these women. To describe the healthy-eating and exercise experiences of low-income postpartum women who choose to breastfeed. Focus group discussions were conducted with low-income mothers ( N = 21) who breastfed and had a child who was 3 years old or younger. Transcript analysis employed integrated grounded analysis using both a priori codes informed by the theory of planned behavior and grounded codes. Three major themes were identified from five focus groups: (a) Mothers were unable to focus on their own diet and exercise due to preoccupation with infant needs and more perceived barriers than facilitators; (b) mothers became motivated to eat healthfully if it benefited the infant; and (c) mothers did not seek out information on maternal nutrition or exercise but used the Internet for infant-health information and health professionals for breastfeeding information. Low-income breastfeeding mothers may be more receptive to nutrition education or interventions that focus on the mother-infant dyad rather than solely on maternal health.

A randomized controlled trial to prevent excessive gestational weight gain and promote postpartum weight loss in overweight and obese women: Health In Pregnancy and Postpartum (HIPP)

BackgroundInterventions to prevent excessive gestational weight gain and promote postpartum weight loss have yielded modest results, particularly in overweight and obese women. ObjectivesTo examine the impact of a theory-based lifestyle intervention on gestational weight gain, postpartum weight loss, and related maternal and child outcomes and to examine race differences in these outcomes. DesignA randomized controlled trial (target N=400; 200 intervention, 200 standard care; 200 African American, 200 white). MethodsOverweight and obese African American and white women ≤16weeks gestation are recruited from obstetrics and gynecology clinics in South Carolina. Intervention participants receive two in-depth counseling sessions (early pregnancy and postpartum), telephone counseling, behavioral podcasts, and social media support that target weight self-monitoring and increasing physical activity and healthy dietary behavior practices, guided by Social Cognitive Theory. Standard care participants receive monthly mailings and a matched number of podcasts on non-weight related topics. All intervention activities last from ≤18weeks gestation to 6months after delivery. Gestational weight gain is the primary outcome. Secondary outcomes are meeting gestational weight gain guidelines (inadequate, adequate, excessive), weekly rate of gestational weight gain, postpartum weight retention, physical activity and dietary behaviors, health-related quality of life, and offspring adiposity. Participants are assessed at baseline (≤16weeks gestation), 32weeks gestation, and 6 and 12months postpartum, and offspring are assessed at 6 and 12months. SummaryHIPP is an innovative study that addresses significant gaps in the literature. Primary outcome results are expected in 2019.

Feasibility and Acceptability of Delivering a Postpartum Weight Loss Intervention via Facebook: A Pilot Study

ObjectiveTo evaluate the feasibility and acceptability of a Facebook-delivered postpartum weight loss intervention. MethodsOverweight and obese postpartum women received a 12-week weight loss intervention via Facebook. Feasibility outcomes were recruitment, retention, engagement, and acceptability. Weight loss was an exploratory outcome. ResultsParticipants (n = 19) were 3.5 (SD 2.2) months postpartum with a baseline body mass index of 30.1 (SD 4.2) kg/m2. Retention was 95%. Forty-two percent of participants visibly engaged on the last day of the intervention, and 100% in the last 4 weeks; 88% were likely or very likely to participate again and 82% were likely or very likely to recommend the program to a postpartum friend. Average 12-week weight loss was 4.8% (SD 4.2%); 58% lost ≥5%. Conclusions and ImplicationsFindings suggested that this Facebook-delivered intervention is feasible and acceptable and supports research to test efficacy for weight loss. Research is needed to determine how best to engage participants in social network–delivered weight loss interventions.

RELATIONSHIP BETWEEN THE DURATION OF BREASTFEEDING UNTIL THE FIRST 6 MONTHS WITH BODY COMPOSITION CHANGES ON MATERNAL POSTPARTUM

Most of the mothers are very attentitve to changes in body composition, especially postpartum weight loss. One of the factors believed to facilitate the weight loss and body fat loss in postpartum mothers is breastfeeding. Factor that affect the relationship between breastfeeding with maternal postpartum body composition are food intake and physical activity. The aim of this study is to analyze the change in body composition between the mother who give exclusive breastfeeding for 6 months and the mother who don’t and also attempts to analyze the effect of breastfeeding duration to the change in body composition and the factor affecting it.This study used the panel study with longitudinal approach. 32 respondents observed for 6 months. Fat mass measurement data are collected using skinfold caliper and breastfeeding status, food intake and physical actiuvity data are collected using interview. The relationship between breastfeeding with the change in body composition is analyzed using t-test analysis. T-test analysis are also used to test the effect of food intake and physical activity to breastfeeding. Regression analysis are used to analyze the effect of food intake and physical activity to body composition.According to the result of statistical analysis, there is no significance effect of breastfeeding for 6 months to the change in maternal postpartum body composition (fat mass and free fat mass) (p = 0.743; p = 0.771) and also no significance effect of food intake and physical activity to the relation between breastfeeding with the change in body composition. There is a significance effect of breastfeeding for 4 months to the change in the body composition (p = 0.046). The average fat mass change in mother who give exclusive breastfeed is higher than the one who don’t.From 32 respondents in this study, only 4 mothers can successfully give exclusive breastfeed for 6 months. The average fat mass change in mother who give exclusive breastfeed is higher than the one who don’t. There is no significance effect of breastfeeding for 6 months to the change in maternal postpartum body composition (fat mass and free fat mass). There is a significance effect of breastfeeding for 4 months to the change in maternal postpartum body composition.Keywords: Breastfeeding, body composition, maternal postpartum

Potential of Metformin to Improve Cardiac Risk in Postpartum Women with Gestational Diabetes.

Pregnancy is associated with an increase in total cholesterol, high density lipoproteins (HDL), and low-density lipoproteins (LDL). Postpartum, HDL and LDL decrease over the first 12 weeks postpartum. Oxidized LDL (ox-LDL) is a marker of oxidative stress-related inflammation, which is associated with obesity and also with development of cardiovascular disease. Cardiovascular protection and weight loss are benefits from metformin, especially in women with diabetes. The objective of this study was to compare changes in lipid profiles and biomarkers for obesity during the initial 6 weeks postpartum between women with gestational diabetes mellitus (GDM) treated with metformin versus placebo. This was a planned ancillary study of a randomized controlled trial compares metformin versus placebo in women with GDM for postpartum weight loss. Two 3 mL blood samples were collected within 24 h of delivery and 6 weeks postpartum immediately processed after collection then stored at -20°C until completion of clinical trial prior to analysis. Change in the median plasma concentrations of total cholesterol, HDL, ox-LDL, glucose, insulin, leptin, and unacylated ghrelin were compared between study groups. Of the 77 postpartum women were included, 35 received metformin and 42 received placebo. There was less of a reduction in HDL in the metformin group compared to placebo (-2.3 versus -7.5 mg/dL, p = 0.019). In addition, there was a greater reduction in ox-LDL in those receiving metformin (-12.2 versus -3.8 mg/dL, p = 0.038). No other differences were observed in the selected biomarkers evaluated. Biomarker levels of HDL and ox-LDL were positively affected during the initial 6 weeks postpartum in GDM women treated with metformin. Additional studies with a longer duration of metformin treatment in the postpartum period are warranted to evaluate long-term potential benefits.

Associations of Maternal Weight Status Before, During, and After Pregnancy with Inflammatory Markers in Breast Milk.

ObjectiveTo examine the associations of maternal weight status before, during, and after pregnancy with breast milk C-Reactive Protein (CRP) and Interleukin-6 (IL-6), two bioactive markers of inflammation, measured at one and three months postpartum.MethodsParticipants were 134 exclusively breastfeeding mother-infant dyads taking part in the Mothers and Infants LinKed for Health (MILK) study, who provided breast milk samples. Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) were assessed by chart abstraction; postpartum weight loss was measured at the one and three month study visits. Linear regression was used to examine the associations of maternal weight status with repeated measures of breast milk CRP and IL-6 at one and three months, after adjustment for potential confounders.ResultsPre-pregnancy BMI and excessive GWG, but not total GWG or postpartum weight loss, were independently associated with breast milk CRP after adjustment (β=0.49, p<0.001 and β=0.51, p=0.011, respectively). No associations were observed for IL-6.ConclusionsHigh pre-pregnancy BMI and excessive GWG are associated with elevated levels of breast milk CRP. The consequences of infants receiving varying concentrations of breast milk inflammatory markers are unknown; however, we speculate that there are implications for the intergenerational transmission of disease risk.

Two-year follow-up of a postpartum weight loss intervention: Results from a randomized controlled trial.

We recently reported that a 12-week diet intervention among postpartum women produced a weight loss of 12% after 1year, compared to 5% in controls. Here, we present 2-year results after 1year of unsupervised follow-up. In total, 110 women with a self-reported body mass index of ≥27kg/m2 at 6-15-week postpartum were randomized to diet group (D-group) or control group (C-group). D-group received a 12-week diet intervention by a dietitian followed by monthly e-mails up to the 1-year follow-up. C-group received a brochure on healthy eating. No contact was provided from 1 to 2years to either group. Eighty-nine women (81%) completed the 2-year follow-up. Median (1st; 3rd quartile) weight change from 0 to 2years was -6.9 (-11.0; -2.2) kg in D-group and -4.3 (-8.7; -0.2) kg in C-group. There was no group by time interaction at 2years (p=.082); however, when women with a new pregnancy between 1 and 2years were excluded, the interaction became significant (-8.2 vs. -4.6kg, p=.038). From 1 to 2years, women in D- and C-group gained 2.5±5.0kg and 1.1±4.4kg, respectively (p=.186). Women who gained weight from 1 to 2years reported a decrease in self-weighing frequency compared to women who maintained or lost weight (p=.008). Both groups achieved clinically relevant 2-year weight loss, but the significant between-group-difference observed at 1year was not maintained at 2years in the main analysis. However, when women with a new pregnancy between 1 and 2years were excluded, a significant weight loss effect was observed also at 2years.

Maternal Outcomes of Breastfeeding in King Abdulaziz University Hospital, Saudi Arabia

Breastfeeding has a great efficacy on the growing infant, as well as the mother. It has been suggested that breastfeeding promotes postpartum weight loss. Furthermore, it may alter the risk of developing postpartum depression. The aim of this study is to further understand the adherence and the effect of breast milk feeding on developing a postpartum depression and calculating the postpartum weight reduction percentage in comparison to pre-pregnancy weight. A cross-sectional study was conducted in King Abdulaziz University Hospital among 153 mothers, whose infants are less than two years of age. Data were collected by interviewing the mothers using a standard questionnaire designed for the study and the HAMD depression scale with anthropometric measures. 85.62% of the study sample had breastfed, 43.38% breastfed for 1 to 2 months, and 24.18% for 6 months or more. However, the relationship of postpartum depression and breastfeeding was not significant with a P-value &gt; 0.05. 84.97% of the included mothers had the same or greater weight than before pregnancy. In conclusion, mothers in King Abdulaziz University Hospital are well adherent to breast milk feeding. The association of breastfeeding to weight loss was not observed as suggested. Mothers with postpartum depression were less adherent to the practice of breastfeeding.

Postpartum Weight Loss on the Web

Postpartum weight retention and continued weight gain challenge over a quarter of women delivering in the U.S. To test whether an Internet-based weight loss program designed for low-income postpartum women could result in greater weight loss than the Special Supplemental Nutrition Program for Women, Infants, and …

The Challenge of Postpartum Weight Loss in Low-Income Mothers.

The Challenge of Postpartum Weight Loss in Low-Income Mothers.

Intervening during and after pregnancy to prevent weight retention among African American women

Efforts to prevent postpartum weight retention in extant clinical trials of African American women have proven exceedingly challenging. The primary purpose of this pilot study was to determine whether a behavioral intervention implemented in early pregnancy through 6 months postpartum could increase the proportion of African American women who were at or below their early pregnancy weights by 6 months postpartum. We additionally evaluated whether mothers' postpartum weight loss could be maintained at 12 months postpartum. Participants were 66 socioeconomically disadvantaged African American women (36% overweight, 64% obese) randomly assigned to a behavioral intervention or usual care group. The intervention, implemented from early pregnancy to 6 months postpartum, promoted weight control through: (1) empirically supported behavior change goals; (2) interactive self-monitoring text messages; (3) weekly to monthly health coach calls; and (4) skills training and support through Facebook. In modified intent-to-treat analyses, participants assigned to the intervention were significantly more likely to be at or below their early pregnancy weights by 6 months postpartum compared to usual care (56% vs. 29%, p = 0.04). At 12 months postpartum, the maternal weight difference between intervention and usual care groups was not maintained (41% vs. 38% respectively at or below early pregnancy weights, p = 0.83). Findings suggest that a combined pregnancy and postpartum weight control intervention improves 6 month weight outcomes in socioeconomically disadvantaged African American women with obesity. Longer interventions may be needed to overcome late postpartum weight gain among this high risk group.Clinical trial registration number: ClinicalTrials.gov identifier NCT01530776

Family Support and Family Negativity as Mediators of the Relation between Acculturation and Postpartum Weight in Low-Income Mexican-Origin Women.

Obesity presents a significant health concern among low-income, ethnic minority women of childbearing age. The study investigated the influence of maternal acculturation, family negativity, and family support on postpartum weight loss among low-income Mexican-origin women. Low-income Mexican-origin women (N=322; 14% born in the U.S.) were recruited from a prenatal clinic in an urban area of the Southwest U.S. Acculturation was assessed during a prenatal home visit (26-38 weeks gestation), and post-birth family support and general family negativity were assessed at 6 weeks postpartum. Objective maternal weight measures were obtained at five time points across the first postpartum year. Higher acculturation predicted higher family support and family negativity. Higher family support predicted decreasing weight across the first postpartum year, and higher family negativity predicted higher weight at 6 weeks postpartum and increasing weight across the first postpartum year. In combination, family negativity and support mediated the impact of acculturation on postpartum weight gain. Cultural and family-related factors play a significant role in postpartum weight gain and loss for low-income Mexican-origin women.

The Relationship Between Intuitive Eating and Postpartum Weight Loss.

Objective Postpartum weight loss is challenging for new mothers who report limited time and difficulties following traditional weight loss methods. Intuitive eating (IE) is a behavior that includes eating based on physical hunger and fullness and may have a role in encouraging weight loss. The purpose of this study was to examine the relationship between IE and postpartum weight loss. Methods Women 12-18months postpartum completed a questionnaire regarding weight changes surrounding pregnancy, exercise, breastfeeding and intuitive eating using the Intuitive Eating Scale. Latent growth curve modeling was utilized to determine the relationship between IE, breastfeeding, weight gain during pregnancy, and postpartum weight trajectories. Results Participants (n = 50) were 28.5 ± 4.9years old, had an average pre-pregnancy BMI of 26.4 ± 6.8 and the majority were married, and non-Hispanic white. The conditional model revealed that more intuitive eating practices predicted greater postpartum BMI decreases (Est. = -0.10, p < .05) when controlling for breastfeeding duration, exercise duration, and initial BMI and pregnancy BMI changes. Greater pregnancy BMI increases were associated with more rapid postpartum BMI decreases (Est. = -0.34, p < .001) while breastfeeding duration, exercise and initial BMI were not related. Conclusions for Practice Postpartum weight retention is a challenge for many women. Following a more intuitive eating approach to food consumption may encourage postpartum weight loss without the required weighing, measuring, recording and assessing dietary intake that is required of traditional weight loss programs. IE could offer an alternative approach that may be less arduous for new mothers.

Women's Perceived Reasons for Their Excessive Postpartum Weight Retention: A Qualitative Interview Study

IntroductionObesity in Sweden has doubled to 14% over the last 20 years. New strategies for treatment and prevention are needed. Excessive gestational weight gain has been found to contribute substantially to obesity, and there is a consistent association between postpartum weight retention and obesity later in life. We aimed to explore what factors women perceive as reasons for having substantial postpartum weight retention, to identify areas for new and improved interventions.MethodsQualitative interview study (semi-structured) using an emergent design. Fifteen women, with a postpartum weight retention ≥ 10 kg, were interviewed by a trained cognitive therapist. Eight women had pre-pregnancy BMI below 30 kg/m2. Interviews were transcribed verbatim and data analysed using inductive manifest content analysis. Salient text passages were extracted, shortened, coded and clustered into categories.ResultsParticipants reported no knowledge of current gestational weight gain recommendations or of risks for adverse pregnancy outcomes with excessive weight gain or postpartum weight retention. Excessive eating emerged as a common strategy to provide relief of psychological, emotional and physical discomfort, such as depression and morning sickness. Women perceived medical staff as being unconcerned about weight, and postpartum weight loss support was scarce or absent. Some women reported eating more due to a belief that breastfeeding would automatically lead to weight loss.ConclusionThere is a need to raise awareness about risks with unhealthy gestational weight development and postpartum weight retention in women of childbearing age. The common strategy to cope with psychological, emotional or physical discomfort by eating is an important factor to target with intervention. The postpartum year is a neglected period where additional follow-up on weight and weight loss support is strongly indicated.

Exploring the need for interventions to manage weight and stress during interconception.

Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers' understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.

It’s not all about the baby: Post-partum weight loss as a motivator for breastfeeding initiation and continuation

This paper was published in the journal Appetite and the definitive published version is available at https://doi.org/10.1016/j.appet.2016.08.095. This paper was also presented at the British Feeding and Drinking Group, London, UK, 7th-8th April 2016.

Fresh Start, a postpartum weight loss intervention for diverse low-income women: design and methods for a randomized clinical trial.

BackgroundOverweight and obesity are prevalent among young women and are greater among minority and low-income women. The postpartum period is critical in women’s weight trajectories as many women do not lose their pregnancy weight, and others lose some and then plateau or experience weight gain. Excess weight puts women at greater risk of chronic disease and thus weight loss in the postpartum period may be key to the long-term health of young women. This paper describes the design and methods of a randomized clinical trial of Fresh Start, an innovative narrative-based group intervention aimed at promoting postpartum weight loss among low-income, diverse women.Methods/designStudy participants were recruited from the five sites of the Women, Infants and Children (WIC) program in central Massachusetts. Participants were English-speaking, age ≥ 18 years, 6 weeks to 6 months postpartum, with a body mass index (BMI) ≥ 27 kg/m2. The Fresh Start postpartum weight loss intervention, adapted from the Diabetes Prevention Program (DPP) in collaboration with WIC staff and clients, consisted of an 8-week group-based curriculum followed by nine monthly telephone calls. It included a narrative component (i.e., storytelling), group discussions, print materials and access to exercise facilities. The study is a two-arm randomized controlled trial. The control condition included print materials and access to exercise facilities. In-person assessments were conducted at baseline and at 6 and 12 months following the eight-week intervention phase.DiscussionThe Fresh Start intervention translated key elements of an evidence-based weight loss protocol into a format that is hypothesized to be relevant, acceptable and effective for the target audience of low-SES postpartum women. This novel intervention was developed in collaboration with WIC to be sustainable within the context of its clinics, which reach approximately 9 million individuals per year across the U.S. via 10,000 clinics.Trial registrationclinicaltrials.gov NCT02176915. Registered 25 June 2014.

Incidental Anterior Abdominal Hernias During Abdominoplasty

Anterior abdominal wall hernias, especially umbilical, are a relatively common finding among patients undergoing abdominoplasty. These individuals are usually postpartum or massive weight loss patients seeking abdominal contouring surgery. Incidentally discovered hernias include umbilical, periumbilical, epigastric, and incisional hernias. There is a plethora of literature discussing the repair of these hernias, alone, using general surgical standards of care. However, the literature is lacking as to the discussion of these hernia repairs when combined with abdominoplasty. Many times, these hernias may be repaired without the use of reinforcing mesh, especially when performing simultaneous rectus diastasis plication. By using an algorithmic approach to incidental hernias found at the time of abdominoplasty, repair can be performed to allow the best results of cosmesis and function with a recurrence rate on par with standard techniques. We will concentrate on umbilical, epigastric, and some incisional hernias. Large ventral and/or incisional hernias will not be covered here, as those generally need abdominal wall reconstruction or very large pieces of mesh.