Severe maternal morbidity and breastfeeding outcomes in the early post‐natal period: a prospective cohort study from one English maternity unit

Previous research has identified potential issues of establishing and maintaining breastfeeding among women who experience severe maternal morbidity associated with pregnancy and birth, but evidence in the UK maternity population was scarce. We explored the association between severe maternal morbidity and breastfeeding outcomes (uptake and prevalence of partial and exclusive breastfeeding) at 6 to 8 weeks post‐partum in a UK sample. Data on breastfeeding outcomes were obtained from a large cohort study of women who gave birth in one maternity unit in England to assess the impact of women's experiences of severe maternal morbidity (defined as major obstetric haemorrhage, severe hypertensive disorder or high dependency unit/intensive care unit admission) on their post‐natal health and other important outcomes including infant feeding. Results indicated that among women who responded (n = 1824, response rate = 53%), there were no statistically significant differences in breastfeeding outcomes between women who did or did not experience severe morbidity, except for women with severe hypertensive disorder who were less likely to breastfeed either partially or exclusively at 6 to 8 weeks post‐partum. Rather, breastfeeding outcomes were related to multi‐dimensional factors including sociodemographic (age, ethnicity, living arrangement), other pregnancy outcomes (neonatal intensive care unit admission, mode of birth, women's perceived control during birth) and post‐natal psychological factors (depressive symptoms). Women who experience severe maternal morbidity can be reassured that establishing successful breastfeeding can be achieved. More studies are required to understand what support is best for women who have complex health/social needs to establish breastfeeding.     

Predictors of post‐partum weight retention in a prospective longitudinal study

Post‐partum weight retention (WR) occurs in 60–80% of women with some retaining ≥10 kg with contributing factors reported as pre‐pregnancy body mass index (BMI), gestational weight gain (GWG) and breastfeeding. A longitudinal study of pregnancy, with 12‐month post‐partum follow‐up was conducted to determine factors associated with WR. Pregnant women (n = 152) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Pre‐pregnancy weight was self‐reported; weight was measured four times during pregnancy (for GWG) and in the first 12 months post‐partum. Infant feeding data were obtained via questionnaires. Breastfeeding was categorised as exclusive, predominant, complementary or not breastfeeding. Linear mixed models tested the predictors of WR, with and without adjustment for potential confounders. Compared with pre‐pregnancy weight, 68% of women retained weight at 12 months, median (interquartile range) [4.5 kg (2.1–8.9)]. After adjustment, GWG was positively associated with WR (P < 0.01), but pre‐pregnancy weight did not predict WR. For each additional week of any breastfeeding, 0.04 kg less weight was retained. Compared with women who retained weight, those women who did retain had higher rates of exclusive breastfeeding at three months (P < 0.05), but the number of weeks of exclusive breastfeeding failed to predict WR for all women. WR following childbirth is common and associated with GWG, while the number of weeks of ‘any’ breastfeeding contributed to post‐partum weight loss. Whether these factors are modifiable strategies to optimise the weight status of women at this life stage requires further research.     

Weight‐related self‐efficacy in relation to maternal body weight from early pregnancy to 2 years post‐partum

Excessive gestational weight gain may lead to long‐term increases in maternal body weight and associated health risks. The purpose of this study was to examine the relationship between maternal body weight and weight‐related self‐efficacy from early pregnancy to 2 years post‐partum. Women with live, singleton term infants from a population‐based cohort study were included (n = 595). Healthy eating self‐efficacy and weight control self‐efficacy were assessed prenatally and at 1 year and 2 years post‐partum. Body weight was measured at early pregnancy, before delivery, and 6 weeks, 1 year and 2 years post‐partum. Behavioural (smoking, breastfeeding) and sociodemographic (age, education, marital status, income) covariates were assessed by medical record review and baseline questionnaires. Multi‐level linear regression models were used to examine the longitudinal associations of self‐efficacy measures with body weight. Approximately half of the sample (57%) returned to early pregnancy weight at some point by 2 years post‐partum, and 9% became overweight or obese at 2 years post‐partum. Body weight over time was inversely related to healthy eating (β = ?0.57, P = 0.02) and weight control (β = ?0.99, P < 0.001) self‐efficacy in the model controlling for both self‐efficacy measures as well as time and behavioural and sociodemographic covariates. Weight‐related self‐efficacy may be an important target for interventions to reduce excessive gestational weight gain and post‐partum weight gain.     

Iodine status during pregnancy and at 6 weeks, 6, 12 and 18 months post‐partum

Iodine deficiency during pregnancy and in the post‐partum period may lead to impaired child development. Our aim is to describe iodine status longitudinally in women from pregnancy until 18 months post‐partum. Furthermore, we explore whether iodine status is associated with dietary intake, iodine‐containing supplement use and breastfeeding status from pregnancy until 18 months post‐partum. We also assess the correlation between maternal iodine status 18 months post‐partum and child iodine status at 18 months of age. Iodine status was measured by urinary iodine concentration (UIC) during pregnancy (n = 1,004), 6 weeks post‐partum (n = 915), 6 months post‐partum (n = 849), 12 months post‐partum (n = 733) and 18 months post‐partum (n = 714). The toddlers' UIC was assessed at 18 months of age (n = 416). Demographic variables and dietary data (food frequency questionnaire) were collected during pregnancy, and dietary data and breastfeeding practices were collected at all time points post‐partum. We found that iodine status was insufficient in both pregnant and post‐partum women. The UIC was at its lowermost 6 weeks post‐partum and gradually improved with increasing time post‐partum. Intake of milk and use of iodine‐containing supplements significantly increased the odds of having a UIC above 100 μg/L. Neither the mothers' UIC, vegetarian practice, nor exclusion of milk and dairy products were associated with the toddlers UIC 18 months post‐partum. Women who exclude milk and dairy products from their diets and/or do not use iodine‐containing supplements may be at risk of iodine deficiency. The women possibly also have an increased risk of thyroid dysfunction and for conceiving children with nonoptimal developmental status.     

Effect of a low glycaemic index diet in gestational diabetes mellitus on post‐natal outcomes after 3 months of birth: a pilot follow‐up study

A low glycaemic index (LGI) diet during pregnancy complicated by gestational diabetes mellitus (GDM) may offer benefits to the mother and infant pair beyond those during pregnancy. We aimed to investigate the effect of an LGI diet during pregnancy complicated with GDM on early post‐natal outcomes. Fifty‐eight women (age: 23–41 years; mean ± SD pre‐pregnancy body mass index: 24.5 ± 5.6 kg m^?2) who had GDM and followed either an LGI diet (n = 33) or a conventional high‐fibre diet (HF; n = 25) during pregnancy had a 75‐g oral glucose tolerance test and blood lipid tests at 3 months post‐partum. Anthropometric assessments were conducted for 55 mother–infant pairs. The glycaemic index of the antenatal diets differed modestly (mean ± SD: 46.8 ± 5.4 vs. 52.4 ± 4.4; P < 0.001), but there were no significant differences in any of the post‐natal outcomes. In conclusion, an LGI diet during pregnancy complicated by GDM has outcomes similar to those of a conventional healthy diet. Adequately powered studies should explore the potential beneficial effects of LGI diet on risk factors for chronic disease.     

Recruiting and retaining postpartum women from areas of social disadvantage in a weight‐loss trial – an assessment of strategies employed in the WeighWell feasibility study

Little is known about the response of post‐partum women from deprived backgrounds to weight management interventions, however behavioural intervention trials in disadvantaged communities are often characterised by recruitment difficulties. Recruitment and retention is key to the robust conduct of an effective trial, and exploratory work is essential prior to a definitive randomised controlled trial. This paper describes strategies used to recruit to the WeighWell feasibility study, which aimed to recruit 60 overweight or obese post‐partum women living in areas of deprivation to a trial of a weight‐loss intervention. Recruitment strategies included the following: (1) distribution of posters and ‘business cards’; (2) newspaper advertisements; (3) visits to community groups; and (4) personalised letters of invitation sent via the National Health Service (NHS). Potential participants were screened for eligibility following response to a Freephone number. Body mass index was calculated using self‐reported body weight and height. Over 6 months, 142 women responded of whom 65 (46%) met the eligibility criteria. The most effective methods for recruiting eligible women and those who went on to complete the study (n = 36) were visits to community groups (37% and 42%, respectively), personalised letters (26% and 17%, respectively) and posters and ‘business cards’ (22% and 31%, respectively). These results emphasise the need to utilise a range of strategies beyond traditional NHS settings. Current approaches might be enhanced by sending personal contact letters via their General Practitioner to women identified as eligible at post‐natal discharge. Under‐reporting of body weight by self‐report suggests that a threshold lower than 25 kg/m² should be utilised for screening purposes.     

Barriers to weight‐related health behaviours: a qualitative comparison of the socioecological conditions between pregnant and post‐partum low‐income women

The association between socioecological factors and poor health outcomes for low‐income women and their children has been the focus of disparities research for several decades. This research compares the socioecological conditions among low‐income women from pregnancy to post‐partum and highlights the factors that make weight management increasingly difficult after delivery. As part of the formative research for an online health intervention, group and individual interviews were conducted with low‐income pregnant and post‐partum women. Five pregnancy group interviews (n = 15 women), five post‐partum group interviews (n = 23 women) and seven individual interviews with a total of 45 participants were conducted in Rochester, New York. All interviews were audio‐recorded. The constant comparative method was used to code interview notes and identify emergent themes. Subjects faced many challenges that affected their attitudes, beliefs and their ability to maintain or improve healthy weight behaviours. These included unemployment, relationship issues, minimal social support, lack of education, limited health care access, pre‐existing medical conditions and neighbourhood disadvantage. Compared with pregnant women, post‐partum women faced additional difficulties, such as child illnesses and custody issues. The most striking differences between pregnancy and post‐partum related to the family's medical problems and greater environmental constraints. Many factors detracted from women's capacity to engage in healthy weight behaviours post‐partum, including challenges present prior to delivery, challenges present prior to delivery that worsen after delivery, and new challenges that begin after delivery. These additional post‐partum challenges need to be considered in designing programmes, policies and interventions that promote healthy weight.     

The impact of intrapartum and immediate post‐partum complications and newborn care practices on breastfeeding initiation in Ethiopia: A prospective cohort study

This study aimed to investigate the impact of intrapartum and post‐partum complications and newborn care practices on early initiation of breastfeeding (EIBF). Data for the study came from a prospective cohort study in Ethiopia that recruited and followed pregnant and post‐partum women from 2019 to 2021. Resident enumerators conducted interviews at enrolment in 2019 and follow‐ups at 6 weeks, 6 months and 1 year post‐partum. The present analysis is based on data from the baseline survey and 6 weeks follow‐up. Multivariable logistic regression was used to estimate the effects of newborn care practices and intrapartum and post‐ partum complications on EIBF (the proportion of newborns who initiated breastfeeding within the first hour of birth). Overall, 2660 mother–infant pairs were included in this analysis. After adjustment, EIBF was less likely among women who experienced intrapartum haemorrhage (adjusted odds ratio [AOR]: 0.76, 95% confidence interval [CI]: 0.59–0.97), malpresentation (AOR: 0.46, 95% CI: 0.30–0.72) and convulsions (AOR: 0.48, 95% CI: 0.34–0.66) during childbirth. Mother–newborn skin‐to‐skin contact increased the likelihood of EIBF (AOR: 1.47, 95% CI: 1.11–1.94). Women who experienced post‐partum haemorrhage (AOR: 0.63, 95% CI: 0.47–0.84), retained placenta for more than 30 min (AOR: 0.36, 95% CI: 0.24–0.52) and convulsions after delivery (AOR: 0.57, 95% CI: 0.41–0.79) were less likely to initiate breastfeeding early. Also, women who had a caesarean birth (AOR: 0.28, 95% CI: 0.18–0.41), delivered outside of a healthcare facility (AOR: 0.70, 95% CI: 0.50–0.99) or had twin birth (AOR: 0.43, 95% CI: 0.22–0.85) were less likely to initiate breastfeeding early. Skin‐to‐skin contact should be encouraged whenever possible, and women with obstetric complications should be encouraged and supported to initiate breastfeeding early.     

Breastfeeding and obesity at 14 years: a cohort study

AIM: To determine the influence of breastfeeding on overweight and obesity in early adolescence. METHODS: Data about breastfeeding duration, BMI of children at 14 years, and confounding variables, were collected from an ongoing longitudinal study of a birth cohort of 7776 children in Brisbane. Prevalence of overweight and obesity at 14 years was assessed according to duration of breastfeeding, with logistic regression being used to adjust for the influence of confounders. RESULTS: Data were available for 3698 children, and those not included were significantly different in age, educational level, income, race, birthweight, and small-for-gestational-age status. Breastfeeding for longer than six months was protective of obesity (OR 0.6, 95% CI 0.4, 0.96) though not of overweight. When confounding variables were considered the effect size diminished and lost statistical significance OR 0.8 (95% CI 0.5, 1.3). Breastfeeding for less than 6 months had no effect on either obesity or overweight though a trend was found for increased prevalence of overweight at 14 years with shorter periods of breastfeeding. CONCLUSION: This investigation contributes to the gathering body of evidence that breastfeeding for longer than 6 months has a modest protective effect against obesity in adolescence.     

Post-partum weight change patterns in the WHO Multicentre Growth Reference Study

The interplay of factors that affect post‐partum loss or retention of weight gained during pregnancy is not fully understood. The objective of this paper is to describe patterns of weight change in the six sites of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) and explore variables that explain variation in weight change within and between sites. Mothers of 1743 breastfed children enrolled in the MGRS had weights measured at days 7, 14, 28 and 42 post‐partum, monthly from 2 to 12 months and bimonthly thereafter until 24 months post‐partum. Height, maternal age, parity and employment status were recorded and breastfeeding was monitored throughout the follow‐up. Weight change patterns varied significantly among sites. Ghanaian and Omani mothers lost little or gained weight post‐partum. In Brazil, India, Norway and USA, mothers on average lost weight during the first year followed by stabilization in the second year. Lactation intensity and duration explained little of the variation in weight change patterns. In most sites, obese mothers tended to lose less weight than normal‐weight mothers. In Brazil and Oman, primiparous mothers lost about 1 kg more than multiparous mothers in the first 6 months. In India and Ghana, multiparous mothers lost about 0.6 kg more than primiparas in the second 6 months. Culturally defined mother‐care practices probably play a role in weight change patterns among lactating women. This hypothesis should stimulate investigation into gestational weight gain and post‐partum losses in different ethnocultural contexts.     

Transformative Lifestyle Change: key to sustainable weight loss among women in a post‐partum diet and exercise intervention

The increase in overweight and obesity among women is a growing concern, and reproduction is associated with persistent weight gain. We have shown that dietary behavioural modification treatment, with or without exercise, results in weight loss and maintenance of weight loss. The aim of this study was to provide an explanatory model of how overweight and obese women achieve weight loss during, and after, participating in a post‐partum diet and/or exercise intervention. Using Grounded Theory, we performed and analysed 29 interviews with 21 women in a 12‐week Swedish post‐partum lifestyle intervention with a 9‐month follow‐up. Interviews were made after the intervention and at the 9‐month follow‐up. To overcome initial barriers to weight loss, the women needed a ‘Catalytic Interaction’ (CI) from the care provider. It depended on individualised, concrete, specific and useful information, and an emotional bond through joint commitment, trust and accountability. Weight loss was underpinned by gradual introduction of conventional health behaviours. However, the implementation depended on the experience of the core category process ‘Transformative Lifestyle Change’ (TLC). This developed through a transformative process of reciprocal changes in cognitions, emotions, body, environment, behaviours and perceived self. Women accomplishing the stages of the TLC process were successful in weight loss, in contrast to those who did not. The TLC process, dependent on initiation through CI, led to implementation and integration of recognised health behaviours, resulting in sustainable weight loss. The TLC model, including the CI construct and definition of barriers, facilitators and strategies provides an explanatory model of this process.     

The impact of maternal post‐partum depressive symptoms on child diet at 18 months

Post‐partum depression (PPD) is a serious mental health problem, which can impair maternal behaviours and adversely affect the cognitive, emotional and behavioural development of children. This study aims to explore the impact of maternal depressive symptoms at 3 months post‐partum (baseline) on child diet at 18 months of age (follow‐up). This study used longitudinal data from 263 first‐time mothers from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Extend. Women self‐reported depressive symptoms (10‐item Center for Epidemiological Studies Depression Scale [CES‐D]) and child diet (fruits, vegetables and discretionary foods). Multiple linear regression analyses were used to explore the relationship between maternal depressive symptoms at baseline and child fruit and vegetable intake and discretionary food intake (g day⁻¹) at follow‐up. Baseline maternal depressive symptoms were associated with higher childhood consumption of discretionary foods at 18 months of age (β = 0.45, 95% confidence interval [CI] 0.03 to 0.87, P = 0.034 [adjusted]). There was no evidence of association for maternal depressive symptoms and child intake of fruits and vegetables. Further longitudinal studies are warranted to confirm these findings, with the hope of translating this knowledge into optimal clinic care and improved physical and mental health for mother and child.     

Associations of maternal nutrition during pregnancy and post‐partum with maternal cognition and caregiving

Pregnant and post‐partum women require increased nutrient intake and optimal cognition, which depends on adequate nutrition, to enable reasoning and learning for caregiving. We aimed to assess (a) differences in maternal cognition and caregiving between women in Malawi who received different nutritional supplements, (b) 14 effect modifiers, and (c) associations of cognition and caregiving with biomarkers of iron, Vitamin A, B‐vitamin, and fatty acid status. In a randomized controlled trial (n = 869), pregnant women daily received either multiple micronutrients (MMN), 20 g/day lipid‐based nutrient supplements (LNS), or a control iron/folic acid (IFA) tablet. After delivery, supplementation continued in the MMN and LNS arms, and the IFA control group received placebo until 6 months post‐partum, when cognition (n = 712), caregiving behaviour (n = 669), and biomarkers of nutritional status (n = 283) were assessed. In the full group, only one difference was significant: the IFA arm scored 0.22 SD (95% CI [0.01, 0.39], p = .03) higher than the LNS arm in mental rotation. Among subgroups of women with baseline low hemoglobin, poor iron status, or malaria, those who received LNS scored 0.4 to 0.7 SD higher than the IFA arm in verbal fluency. Breastmilk docosahexaenoic acid and Vitamin B12 concentrations were positively associated with verbal fluency and digit span forward (adjusting for covariates ps < .05). In this population in Malawi, maternal supplementation with MMN or LNS did not positively affect maternal cognition or caregiving. Maternal docosahexaenoic acid and B12 status may be important for post‐partum attention and executive function.     

Antenatal dietary patterns and depressive symptoms during pregnancy and early post‐partum

Perinatal depression is a debilitating disorder experienced during pregnancy and/or the first year post‐partum. Recently, maternal dietary intake during pregnancy has emerged as a possible area of intervention for the prevention of mental disorders in women and their offspring. However, the relationship between antenatal diet quality and perinatal depressive symptoms remains poorly understood. The current study explored the predictive role of antenatal diet quality for antenatal and post‐natal depressive symptoms. Pregnant women (n = 167) were recruited between February 2010 and December 2011. Women completed the Edinburgh Postnatal Depression Scale at time 1 [T1, mean weeks gestation = 16.70, standard deviation (SD) = 0.91], time 2 (T2, mean weeks gestation = 32.89, SD = 0.89) and time 3 (T3, mean weeks post‐partum = 13.51, SD = 1.97) and a food frequency questionnaire at T1 and T2. Diet quality was determined by extracting dietary patterns via principal components analysis. Two dietary patterns were identified: ‘healthy’ (including fruit, vegetables, fish and whole grains) and ‘unhealthy’ (including sweets, refined grains, high‐energy drinks and fast foods). Associations between dietary patterns and depressive symptoms were investigated by path analyses. While both ‘healthy’ and ‘unhealthy’ path models showed good fit, only one significant association consistent with study hypotheses was found, an ‘unhealthy’ diet was associated with increased depressive symptoms at 32 weeks gestation. Given that this association was cross‐sectional, it was not possible to make any firm conclusions about the predictive nature of either dietary patterns or depressive symptoms. Dietary intervention studies or larger prospective studies are therefore recommended.     

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 1 year, compared to 5% in controls. Here, we present 2‐year results after 1 year of unsupervised follow‐up. In total, 110 women with a self‐reported body mass index of ≥27 kg/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 2 years to either group. Eighty‐nine women (81%) completed the 2‐year follow‐up. Median (1st; 3rd quartile) weight change from 0 to 2 years 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 2 years (p = .082); however, when women with a new pregnancy between 1 and 2 years were excluded, the interaction became significant (?8.2 vs. ?4.6 kg, p = .038). From 1 to 2 years, women in D‐ and C‐group gained 2.5 ± 5.0 kg and 1.1 ± 4.4 kg, respectively (p = .186). Women who gained weight from 1 to 2 years 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 1 year was not maintained at 2 years in the main analysis. However, when women with a new pregnancy between 1 and 2 years were excluded, a significant weight loss effect was observed also at 2 years.     

Serum retinol in post‐partum mothers and newborns from an impoverished South African community where liver is frequently eaten and vitamin A deficiency is absent

Serum retinol was assessed in mothers and newborns from an impoverished South African community where liver is frequently eaten and vitamin A deficiency known to be absent. Paired cord and maternal blood (n = 201) were collected after delivery and analysed for serum retinol and C‐reactive protein (CRP). Liver intake during pregnancy and intention to breastfeed were also assessed. Mean serum retinol was 1.03 µmol/L ± 0.40 in mothers and 0.73 ± 0.24 µmol/L in newborns, with 21.4% and 49.3% having serum retinol <0.70 µmol/L (<20 µg/dL), respectively. Raised CRP was found in 59.9% of mothers, with a significant negative correlation between serum retinol and CRP (r = ?0.273; p < 0.0001). Liver was eaten by 87.6% of mothers, and 99% indicated their intention to breastfeed. Despite consumption of liver, serum retinol was low in both the mother and the newborn. The conventional cut‐off for serum retinol, i.e. <0.70 µmol/L may therefore not apply for the mother and newborn in the period immediately after delivery. Serum retinol may be influenced by factors other than vitamin A status, e.g. the haemodilution of pregnancy, as well as the acute phase response induced by the birth process, as suggested by raised CRP in 60% of mothers. In the newborns, the low serum retinol is likely to increase rapidly, as liver is frequently eaten by mothers and practically all of them intended to breastfeed. Our results confirm the need for better indicators of vitamin A status or alternative cut‐off values during this period.     

Breastfeeding and childhood obesity: A 12‐country study

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (P_trend = .020) and 1.00, 0.64, 047, and 0.64 for high body fat (P_trend = .012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries.     

Validity of birth certificate‐derived maternal weight data in twin pregnancies

Birth certificates are an important source of pre‐pregnancy body mass index (BMI) and gestational weight gain (GWG) data for surveillance and aetiologic studies, but little is known about their validity in twin pregnancies. Twins experience high rates of adverse perinatal outcomes that have been associated with BMI and GWG in singletons. Our objective was to evaluate the accuracy of birth certificate‐derived pre‐pregnancy BMI and GWG compared with medical record‐derived data in a sample of 186 twin pregnancies at a teaching hospital in Pennsylvania (2003–2010). Twelve strata were created by simultaneous stratification on pre‐pregnancy BMI (underweight, normal weight/overweight, obese class 1, obese classes 2 and 3) and GWG (<20th, 20–80th, >80th percentile). The agreement of birth certificate‐derived pre‐pregnancy BMI category with medical record BMI category was lowest among underweight mothers [75% (95% confidence interval 51–91%) ] and highest among normal/overweight [97% (90–99%) ] and obese classes 2 and 3 mothers [97% (85–99%) ]. Agreement for GWG category from the birth certificate varied from 57% (41–70%) for GWG >80th percentile to 80% (65–91%) and 82% (72–89%) for GWG <20th and 20th–80th percentiles, respectively. The misclassification of BMI and GWG was primarily due to error in pre‐pregnancy weight rather than weight at delivery or height. Agreement proportions for twins were not meaningfully different from the proportions in a comparable sample of singleton pregnancies. These data suggest that birth certificate‐based BMI and GWG data are prone to error in twin pregnancies. Those who use these data should conduct internal validation studies and adjust their results using bias analyses.     

Breastfeeding experiences and support for women who are overweight or obese: A mixed‐methods systematic review

Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence‐based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.