Postpartum Weight Management Research Articles

Lifestyle Interventions in Overweight and Obese Pregnant or Postpartum Women for Postpartum Weight Management: A Systematic Review of the Literature.

Excessive gestational weight gain (GWG) and postpartum weight retention (PPWR) may predispose women to the development of obesity. The objective of this systematic review was to evaluate the effectiveness of lifestyle interventions in overweight or obese pregnant and/or postpartum women for managing postpartum weight up to 2 years after giving birth. Eighteen randomised controlled trials were included (2559 participants) and divided into three categories according to the timing of the intervention: pregnancy only (n = 3), postpartum only (n = 12) and pregnancy and postpartum (n = 3). The intervention duration varied from 10 weeks to 10 months and included diet only (n = 5) or diet and physical activity (n = 13). Seven postpartum only interventions reported significant improvements in postpartum weight when compared to the control group. Most of these interventions were short and intensive, lasting 10–16 weeks. One pregnancy only and one pregnancy and postpartum intervention reported reduced PPWR at 6 months. Nine trials did not report an effect of the intervention on postpartum weight. However, of these, four reported associations between GWG and PPWR. This review suggests that successful postpartum weight management is achievable with intensive lifestyle interventions starting in the postpartum period; however, there is insufficient evidence to conclude whether interventions starting in pregnancy are effective. Larger trials utilising comparative methodologies in the pregnancy and postpartum periods are required to inform the development of targeted strategies preventing PPWR or reducing postpartum weight.

Implementing an Evidence-Based Outpatient Program to Reduce Postpartum Weight Retention

In 2009, the Institute of Medicine published the report Weight Gain During Pregnancy: Reexamining the Guidelines as a call to action for health care providers. The report suggests that at 6 months postpartum, approximately 50% of women still retained an excess weight of 10 pounds or more and that 25% retained 20 pounds or more. Long-term consequences of postpartum weight retention and subsequent obesity include postpartum depression, successive pregnancy complications, and chronic health conditions. This article describes Motivated Moms, an evidence-based postpartum weight management program in an outpatient clinic. Motivated Moms uses a multilevel approach including diet, social support, and self-monitoring, with the goal of reducing postpartum weight retention.

The Development of a Postpartum Weight Management Intervention for Low-Income Women: End-User Perspectives as Groundwork.

Postpartum weight retention (PPWR) leads to increased rates of maternal and childhood obesity, especially among low-income families. Literature is sparse regarding interventions to address PPWR. To gain practical insight into low-income women's preferences and opinions regarding PPWR management at a community-based organization (CBO). Mixed female focus groups composed of CBO staff and clients (n = 17) were asked open-ended questions about PPWR and potential intervention components. Systematic analysis of the discussions was performed to identify overarching themes. The tenets of community-engaged research state the necessity of developing community-based interventions with initial input and partnership with the potential end-users. In this study, low-income women were eager to share their thoughts about the postpartum period and potential solutions to correct unhealthy weight, thus completing a critical step in intervention development. The majority of women wanted to manage their weight in the postpartum setting, but needed structure, social support, assurance they would not injure themselves or their babies, and time saving strategies to do so.

Type 1 and Type 2 Diabetes Preconception and in Pregnancy: Health Impacts, Influence of Obesity and Lifestyle, and Principles of Management.

Preexisting diabetes in pregnancy results in increased risks to the mother, fetus, and neonate. Preconception care is vital to reduce risk of miscarriage, congenital malformations, and perinatal mortality. Preconception care should empower women with realistic goal setting, healthy lifestyle, and diabetes self-management skills, to ensure a positive experience of the pregnancy and to reduce diabetes-related distress. In high-risk women without known diabetes, preconception and early antenatal screening is crucial to enable prompt treatment of hyperglycemia and any complications. The prevalence of obesity in reproductive age women is rising, further increasing risk of poor pregnancy outcomes in women with diabetes. Adverse lifestyle factors should be addressed preconception and in the antenatal period, allowing opportunity to improve physical health, manage weight, and improve neonatal outcomes. Management of diabetes in pregnancy involves individualized and intensified insulin therapy, accounting for expected changes in insulin sensitivity, and minimizing glucose variability and hypoglycemia. Diabetes complications must be screened for and managed as necessary. Delivery timing will depend on fetal surveillance and obstetric considerations. It is important to maintain engagement and motivation of these women in the postpartum period, encouraging breastfeeding and postpartum weight management and supporting diabetes management.

Breast-feeding and postpartum maternal weight trajectories.

We examined whether breast-feeding, and in particular exclusive breast-feeding, was associated with maternal weight and body composition changes at 4 months postpartum independently of other maternal variables. Prospective longitudinal study. Women were recruited in the first trimester after an ultrasound examination confirmed an ongoing singleton pregnancy. Weight and body composition were measured using advanced bio-electrical impedance analysis at the first antenatal visit and 4 months postpartum. Detailed questionnaires were completed on breast-feeding, socio-economic status, diet and exercise in addition to routine clinical and sociodemographic details. Large Irish university maternity hospital. Women who delivered a baby weighing ≥500 g between November 2012 and March 2014. At the postpartum visit, the mean weight was 70·9 (sd 14·2) kg (n 470) and the mean BMI was 25·9 (sd 5·0) kg/m2. 'Any breast-feeding' was reported by 65·1 % of women (n 306). Irish nativity (OR=0·085, P<0·001), current smoking (OR=0·385, P=0·01), relative income poverty (OR=0·421, P=0·04) and deprivation (OR=0·458, P=0·02) were negatively associated with exclusive breast-feeding. At 4 months postpartum there was no difference in maternal weight change between women who exclusively breast-fed and those who formula-fed (+2·0 v. +1·1 kg, P=0·13). Women who exclusively breast-fed had a greater increase in percentage body fat at 4 months postpartum compared with women who formula-fed (+1·0 v. -0·03 %, P=0·02), even though their dietary quality was better. Exclusive breast-feeding was not associated with postpartum maternal weight or body fat percentage change after adjusting for other maternal variables. There are many reasons why breast-feeding should be strongly promoted but we found no evidence to support postpartum weight management as an advantage of breast-feeding.

Genetic Predisposition to Polycystic Ovary Syndrome, Postpartum Weight Reduction, and Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes.

Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women and a major female-specific risk factor of obesity, impaired glucose tolerance, and diabetes. We examined whether the genetic variation predisposing to PCOS affected glycemic changes in women with prior gestational diabetes mellitus (GDM) and whether such an effect was modified by changes in body adiposity, especially during and after pregnancy. This is a longitudinal study in Tianjin, China. We genotyped 7 genome-wide association study-identified PCOS single nucleotide polymorphisms and assessed gestational weight gain and changes in glycemic traits and weight at 1 to 5 years postpartum in 1133 women with prior GDM. The main outcome measure was postpartum glycemic changes. The PCOS genetic risk score significantly interacted with postpartum weight reduction on changes in fasting glucose and 2-h glucose (P for interaction = .032 and .007; respectively) after multivariable adjustment. In women with postpartum weight reduction of ≥ 5 kg/y, the genetic risk score was associated with decreased fasting and 2-h glucose, whereas an opposite genetic effect was found in women who lost less weight. The association between postpartum weight reduction and glycemic improvement was more significant among women with a higher genetic risk score. In a large cohort of Chinese women with a history of GDM, our data for the first time indicate that the genetic predisposition to PCOS may interact with postpartum weight reduction on long-term glycemic changes, emphasizing the importance of postpartum weight management in prevention of diabetes in this subgroup of women.

Associations of mood symptoms with ante- and postnatal weight change in obese pregnancy are not mediated by cortisol

Both maternal obesity and disordered mood have adverse effects on pregnancy outcome. We hypothesized that maternal very severe obesity (SO) is associated with increased anxiety and depression (A&D) symptoms during pregnancy, with adverse effects on gestational weight gain (GWG), postpartum mood and postpartum weight retention (PPWR) and explored any mediation by circulating glucocorticoids. We measured A&D symptoms with validated questionnaires at weeks 17 and 28 of pregnancy and 3 months postpartum in 135 lean [body mass index (BMI) ⩽25 kg/m2] and 222 SO (BMI ⩾40 kg/m2) pregnant women. Fasting serum cortisol was measured by radioimmunoassay; GWG and PPWR were recorded. A&D symptoms were higher in the SO group during pregnancy and postpartum despite adjusting for multiple confounders including previous mental health diagnosis (p < 0.05), and were non-linearly correlated with total GWG (anxiety R 2 = 0.06, p = 0.037; depression R 2 = 0.09, p = 0.001). In the SO group only, increased maternal anxiety (β = 0.33, p = 0.03) and depression (β = 0.19, p = 0.04) symptoms at week 17 of pregnancy were associated with increased PPWR, independent of total GWG and breastfeeding. Anxiety symptoms at week 28 of pregnancy, but not depression, were non-linearly correlated with serum cortisol level at week 36 of pregnancy (R 2 = 0.06, p = 0.02). Cortisol did not mediate the link between A&D symptoms and GWG. Maternal SO was associated with increased A&D symptoms, and with adverse effects on GWG and PPWR independent of circulating glucocorticoids. Strategies to optimize GWG and postpartum weight management in SO women should include assessment and management of maternal mood in early pregnancy.

A Gap Analysis of Effective Interventions for Postpartum Weight Loss in Obese New Mothers [163

INTRODUCTION: In Los Angeles County, 46% of postpartum women are overweight or obese. Unhealthy preconception weight increases the likelihood of retaining weight postpartum, but little is known about weight management interventions immediately postpartum. Choose Health LA Moms aims to provide education, resources, and support for postpartum weight management. This study highlights areas of focus needed in development of the program. METHODS: The 2012 Los Angeles Mommy and Baby Survey assessed 6,843 women before, during, and shortly after their most recent pregnancy. Data collected included demographics, geographic region, prepregnancy body mass index, breastfeeding status, and exercise during pregnancy. RESULTS: In Los Angeles County, 45.7% of women were overweight or obese preconception, 91.2% breastfed, and 79.1% exercised during pregnancy. Of eight total regions, region 6 and region 1 had the highest rates of being overweight or obese preconception (58.4% and 55.4%, respectively), the lowest rates of breastfeeding (84.4% and 88.2%), and among the lowest rates of exercising during pregnancy (75.5% and 73.2%). Latina and African American mothers had the highest overall rates of preconception obesity (57.4% and 56.8%, respectively) and the lowest rates of breastfeeding (89.3% and 84.2%). African American women had the lowest rate of exercising during pregnancy (72.1%). CONCLUSION: There is an inverse correlation between maternal obesity and breastfeeding as well as between maternal obesity and exercising during pregnancy. Postpartum obese women may require a targeted program that uses evidence-based interventions for weight loss such as breastfeeding and walking.

Predictors of engagement in postpartum weight self-management behaviours in the first 12weeks after birth.

To explore factors that influence postpartum weight self-management behaviours. Transitions Theory and the Integrated Theory of Health Behaviour Change guided selection of variables. Transition conditions, level of patient activation and social facilitation were examined for association with postpartum weight self-management behaviours. Retention of pregnancy weight increases risk of overweight and obesity later in life. Little is known about what women do to self-manage return to pre-pregnant weight and how providers can influence their behaviours. Prospective, longitudinal, correlational. Data collection occurred from March through October, 2013. One hundred and twenty-four women completed surveys during postpartum hospitalization; telephone interviews were completed by 91 women at 6weeks and 66 women at 12weeks. Standard and hierarchical multiple regression methods were used for analyses. Transition difficulty was negatively associated with patient activation and immediate postbirth patient activation was positively associated with eating behaviours at 6weeks, eating behaviours at 12weeks and physical activity at 12weeks. Social support and social influence were not significant predictors in the regression models. Patients experiencing a difficult postpartum transition have lower activation levels; those less activated are less probably to engage in weight self-management behaviours in the 12weeks following their baby's birth. Patient activation level should be considered in tailoring promotion of healthy postpartum weight management.

The effectiveness of weight management interventions in breastfeeding women--a systematic review and critical evaluation.

The postpartum period is a vulnerable time for excess weight retention, particularly for the increasing number of women who are overweight at the start of their pregnancy and subsequently find it difficult to lose additional weight gained during pregnancy. Although postpartum weight management interventions play an important role in breaking this potentially vicious cycle of weight gain, the effectiveness of such interventions in breastfeeding women remains unclear. Our aim was to systematically review the literature about the effectiveness of weight management interventions in breastfeeding women. Seven electronic databases were searched for eligible papers. Intervention studies included were carried out exclusively in breastfeeding mothers, ≤2years postpartum and with a body mass index greater than 18.5kg/m(2) , with an outcome measure of change in weight and/or body composition. Six studies met the selection criteria, and were stratified according to the type of intervention and outcome measures. Despite considerable heterogeneity among studies, the dietary-based intervention studies appeared to be the most efficacious in promoting weight loss; however, few studies were tailored toward the needs of breastfeeding women. Weight management interventions which include an energy-restricted diet may play a key role in successful postpartum weight loss for breastfeeding mothers.

Trial for Reducing Weight Retention in New Mums: a randomised controlled trial evaluating a low intensity, postpartum weight management programme

Failure to return to pregnancy weight by 6 months postpartum is associated with long-term obesity, as well as adverse health outcomes. This research evaluated a postpartum weight management programme for women with a body mass index (BMI) > 25 kg m(-2) that combined behaviour change principles and a low-intensity delivery format with postpartum nutrition information. Women were randomised at 24-28 weeks to control (supported care; SC) or intervention (enhanced care; EC) groups, stratified by BMI cohort. At 36 weeks of gestation, SC women received a 'nutrition for breastfeeding' resource and EC women received a nutrition assessment and goal-setting session about post-natal nutrition, plus a 6-month correspondence intervention requiring return of self-monitoring sheets. Weight change, anthropometry, diet, physical activity, breastfeeding, fasting glucose and insulin measures were assessed at 6 weeks and 6 months postpartum. Seventy-seven percent (40 EC and 41 SC) of the 105 women approached were recruited; 36 EC and 35 SC women received a programme and 66.7% and 48.6% completed the study, respectively. No significant differences were observed between any outcomes. Median [interquartile range (IQR)] weight change was EC: -1.1 (9.5) kg versus SC: -1.1 (7.5) kg (6 weeks to 6 months) and EC: +1.0 (8.7) kg versus SC: +2.3 (9) kg (prepregnancy to 6 months). Intervention women breastfed for half a month longer than control women (180 versus 164 days; P = 0.10). An average of 2.3 out of six activity sheets per participant was returned. Despite low intervention engagement, the high retention rate suggests this remains an area of interest to women. Future strategies must facilitate women's engagement, be individually tailored, and include features that support behaviour change to decrease women's risk of chronic health issues.

The relationship between breastfeeding and postpartum weight change—a systematic review and critical evaluation

Pregnancy and the postpartum period is a time of increased vulnerability for retention of excess body fat in women. Breastfeeding (BF) has been shown to have many health benefits for both mother and baby; however, its role in postpartum weight management is unclear. Our aim was to systematically review and critically appraise the literature published to date in relation to the impact of BF on postpartum weight change, weight retention and maternal body composition. Electronic literature searches were carried out using MEDLINE, EMBASE, PubMed, Web of Science, BIOSIS, CINAHL and British Nursing Index. The search covered publications up to 12 June 2012 and included observational studies (prospective and retrospective) carried out in BF mothers (either exclusively or as a subgroup), who were ≤ 2 years postpartum and with a body mass index (BMI) >18.5 kg m(-2), with an outcome measure of change in weight (including weight retention) and/or body composition. Thirty-seven prospective studies and eight retrospective studies were identified that met the selection criteria; studies were stratified according to study design and outcome measure. Overall, studies were heterogeneous, particularly in relation to sample size, measurement time points and in the classification of BF and postpartum weight change. The majority of studies reported little or no association between BF and weight change (n=27, 63%) or change in body composition (n=16, 89%), although this seemed to depend on the measurement time points and BF intensity. However, of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management.

StartSmart: a randomized intervention to promote maternal weight control and reduce childhood obesity in the Mississippi Delta

Excessive gestational weight gain (GWG) can complicate a woman's pregnancy and put her and her child at risk for poor delivery and birth outcomes and chronic conditions such as obesity. Further, feeding and activity habits established early in life can significantly impact the development of obesity in children. Thus, interventions designed to optimize GWG and promote postpartum and early childhood weight management have the potential to significantly impact the health of moms and their babies. We developed StartSmart, an 18 month culturally‐tailored maternal weight management and early childhood obesity prevention program for first time African American (AA) moms‐to‐ be in the Mississippi Delta. The program was designed using foundational components from the Diabetes Prevention Program and the Australian INFANT trial. 150 women, in their early 2nd trimester, will be randomized to a child development home visiting program or child development home visiting program + StartSmart. Both interventions will be implemented by trained lay parent educators. The comparative impact of the programs on weight status, dietary intake, and health behaviors of mom and baby will be assessed. Results will determine if a novel, scalable lifestyle intervention can improve the health of AA women and their children at high risk for obesity and chronic disease. Funding was provided by the USDA Agricultural Research Service.

Testing the integrated theory of health behaviour change for postpartum weight management.

This is a report of a correlational study to test the Integrated Theory of Health Behaviour Change within the context of postpartum weight self-management including the impact of race/ethnicity and weight classification. Women experiencing childbirth face increasing challenges to manage their weight postpartum. Little is known about women's weight self-management during the complex physiological and psychosocial transition of the postpartum period. Data were collected during the birth hospitalization and 4 months postbirth during 2005 and 2006. A quota sample of 250 postpartum women using two strata, race/ethnicity and prepregnant weight classification, were enrolled; 179 women completed the follow-up survey. A survey questionnaire measured concepts from the Integrated Theory of Health Behaviour Change concepts, including knowledge and beliefs (self-efficacy, outcome expectancy and goal congruence), self-regulation skills and abilities, and social facilitation (social support and social influence) and the proximal outcome of weight retention. Factor analysis identified 5 factors consistent with the theoretical concepts that accounted for 47·1% of total survey variance. Model testing using path analysis explored the relationship among factors. The final model explained 25·7% of the variance in self regulation at 4 months, but did not explain weight retention. The contribution of select concepts to total variance was different for Caucasian and African American women, but not by weight classification. Findings support use of theoretical concepts and relationships to understand postpartum weight self-management. The different relationships among concepts in Caucasian and African American women should be considered in planning targeted postpartum weight self-management interventions.

The Role of Diet and Exercise in Postpartum Weight Management

The Role of Diet and Exercise in Postpartum Weight Management