Occurrence and Correlates of Postpartum Depression in Overweight and Obese Women: Results from the Active Mothers Postpartum (AMP) Study

Objective Postpartum depression (PPD) is a significant concern for new mothers and their infants, as well as the health professionals who care for them. Obesity may be a risk factor for depression, and therefore, for PPD specifically. We examined the occurrence and risk factors for PPD in a sample of overweight and obese new mothers. Methods In this cross-sectional study, 491 women who were overweight or obese prior to pregnancy completed the Edinburgh Postnatal Depression Scale (EPDS) 6 weeks postpartum, along with a number of other health- and pregnancy-related measures. Occurrence of depression was investigated, as well as bivariate and multivariate relationships between depression and demographic and health-related characteristics. Results As determined by an EPDS score of 13 or higher, the prevalence of PPD was 9.2%. Three items on the scale stood out as drivers of the total score (“blame myself unnecessarily”, “anxious or worried,” “feel overwhelmed”). Bivariate correlates of depression included education, income, marital status, and self-reported chronic illness; income remained significant in the multivariate logistic regression model. BMI was not related to postpartum depression. Discussion In this group of overweight and obese women, there was no association between BMI group and postpartum depression.     

Maternal Weight Gain During Pregnancy and Child Weight at Age 3 Years

Objectives To determine the importance of pregnancy weight gain as a predictor of overweight (Body Mass Index [BMI] >85th percentile) in offspring at age 3 years and if its influence varies by maternal BMI. Methods Chi-square and logistic regression analyses were conducted on a sample of 208 mother-child pairs from an earlier observational cohort study on postpartum weight retention. Results In the final reduced regression model, maternal early pregnancy BMI was positively and significantly associated with overweight in offspring, as were birth weight above the sample median of 3,600 g and maternal smoking during pregnancy (P ≤ 0.01). In addition, a significant interaction was found between maternal BMI and gestational weight gain (P = 0.03). The risk of offspring overweight that is associated with 5 excess pounds of net pregnancy weight gain increases with maternal BMI. Conclusions Excess pregnancy weight gain is associated with increased risk of child overweight at age 3 years and its impact is greater among high and obese BMI women than it is in normal BMI women. Reducing maternal BMI in the preconception period in overweight women and preventing excessive weight gain in pregnancy for all women appear to be appropriate strategies to address the childhood obesity epidemic.     

Association Between Gestational Weight Gain According to Body Mass Index and Postpartum Weight in a Large Cohort of Danish Women

Our aim was to investigate the association between gestational weight gain (GWG) and postpartum weight retention (PWR) in pre-pregnancy underweight, normal weight, overweight or obese women, with emphasis on the American Institute of Medicine (IOM) recommendations. We performed secondary analyses on data based on questionnaires from 1,898 women from the “Smoke-free Newborn Study” conducted 1996–1999 at Hvidovre Hospital, Denmark. Relationship between GWG and PWR was examined according to BMI as a continuous variable and in four groups. Association between PWR and GWG according to IOM recommendations was tested by linear regression analysis and the association between PWR ≥ 5 kg (11 lbs) and GWG by logistic regression analysis. Mean GWG and mean PWR were constant for all BMI units until 26–27 kg/m². After this cut-off mean GWG and mean PWR decreased with increasing BMI. Nearly 40% of normal weight, 60% of overweight and 50% of obese women gained more than recommended during pregnancy. For normal weight and overweight women with GWG above recommendations the OR of gaining ≥ 5 kg (11 lbs) 1-year postpartum was 2.8 (95% CI 2.0–4.0) and 2.8 (95% CI 1.3–6.2, respectively) compared to women with GWG within recommendations. GWG above IOM recommendations significantly increases normal weight, overweight and obese women’s risk of retaining weight 1 year after delivery. Health personnel face a challenge in prenatal counseling as 40–60% of these women gain more weight than recommended for their BMI. As GWG is potentially modifiable, our study should be followed by intervention studies focusing on GW.     

The Association of Maternal Pre-pregnancy Body Mass Index with Breastfeeding Initiation

Recent evidence extends the health benefits of breastfeeding to include reduction of maternal body mass index (BMI) and childhood obesity. Since most women decide if they will breastfeed prior to pregnancy, it is important to understand, given the high population prevalence of obesity, if maternal underweight, overweight or obese status is associated with breastfeeding initiation. Population-based study. Florida resident birth certificate records. All live singleton births (2004–2009), excluding observations that lacked the primary outcomes of maternal pre-pregnancy BMI and breastfeeding initiation (final sample of 1,161,949 unique observations). Odds of initiating breastfeeding, adjusted by maternal and infant factors, stratified by pre-pregnancy BMI, categorized as underweight, normal, overweight and obese. Adjusting for the known maternal factors associated with breastfeeding initiation, underweight and obese women were significantly less likely to initiate breastfeeding than women with normal BMI, (adjusted odds ratio 0.87, 95 % confidence interval 0.85–0.89 for underweight women; 0.84, 95 % CI 0.83–0.85 for obese women). The magnitude of these findings did not significantly vary by race or ethnicity. Medicaid status and adherence to the Institute of Medicine’s 2009 pregnancy weight gain recommendations had only minor influences on breastfeeding initiation. Among adolescents, only underweight status predicted breastfeeding initiation; obesity did not. Underweight and obese women have significantly lower rates of breastfeeding initiation compared to women with normal pre-pregnancy BMI. Future studies need to address the health care, social, and physical barriers that interfere with breastfeeding initiation, especially in underweight and obese women, regardless of race, ethnicity or income.     

Maternal Body Mass Index and Self-Reported Postpartum Depressive Symptoms

Objectives: The association between extremes of body mass index (BMI) and depression in women has been documented, yet little is known about the relationship between obesity and postpartum depression (PPD). This study seeks to characterize the association between BMI and PPD. Methods: The 2000–2001 Utah data from Pregnancy Risk Assessment Monitoring System (PRAMS) were used to determine the proportion of women, stratified by prepregnancy body mass index, reporting postpartum depressed mood and stressors during pregnancy. Results: The prevalence of self-reported moderate or greater depressive symptoms was 27.7% (S.E. ±2.2) in underweight, 22.8% (±1.2) in normal weight, 24.8% (±2.9) in overweight and 30.8% (±2.5) in obese women. After controlling for marital status and income, normal BMI (19.8–25.9) was associated with the lowest rate of self-reported postpartum depressive symptoms. There was a two-fold increase in self-reported depressive symptoms requiring assistance among overweight and obese women compared to normal weight women (1.53% normal, 2.99% overweight, and 3.10% obese [p < 0.001]). Obese women were significantly more likely to report emotional and traumatic stressors during pregnancy than normal weight women. Conclusion: This population-based survey suggests a potential association between prepregnancy body mass index and self-reported postpartum depressive symptoms. Prospective studies of association between obesity and PPD, with improved diagnostic precision are warranted.     

Effects of breastfeeding on postpartum weight loss among U.S. women

ObjectiveThe aim of this study is to evaluate the effects of breastfeeding on maternal weight loss in the 12 months postpartum among U.S. women.MethodsUsing data from a national cohort of U.S. women conducted in 2005–2007 (N = 2102), we employed propensity scores to match women who breastfed exclusively and non-exclusive for at least three months to comparison women who had not breastfed or breastfed for less than three months. Outcomes included postpartum weight loss at 3, 6, 9, and 12 months postpartum; and the probability of returning to pre-pregnancy body mass index (BMI) category and the probability of returning to pre-pregnancy weight.ResultsCompared to women who did not breastfeed or breastfed non-exclusively, exclusive breastfeeding for at least 3 months resulted in 3.2 pound (95% CI: 1.4,4.7) greater weight loss at 12 months postpartum, a 6.0-percentage-point increase (95% CI: 2.3,9.7) in the probability of returning to the same or lower BMI category postpartum; and a 6.1-percentage-point increase (95% CI: 1.0,11.3) in the probability of returning to pre-pregnancy weight or lower postpartum. Non-exclusive breastfeeding did not significantly affect any outcomes.ConclusionOur study provides evidence that exclusive breastfeeding for at least three months has a small effect on postpartum weight loss among U.S. women.     

Reducing Postpartum Weight Retention and Improving Breastfeeding Outcomes in Overweight Women: A Pilot Randomised Controlled Trial

Overweight and obesity is prevalent among women of reproductive age (42% BMI > 25 kg/m²) and parity is associated with risk of weight gain. Weight gain greater than that recommended by the Institute of Medicine (IOM )is also associated with lower rates of breastfeeding initiation and duration in women. The aim of this pilot randomised controlled trial is to examine the feasibility of recruiting and maintaining a cohort of pregnant women with the view of reducing postpartum weight retention and improving breastfeeding outcomes. Women (BMI of 25–35 kg/m² (n = 36)) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Participants were stratified by BMI and randomised to one of three groups with follow-up to six months postpartum. Women received a dietary intervention with or without breastfeeding support from a lactation consultant, or were assigned to a wait-list control group where the dietary intervention was issued at three months postpartum. Feasibility and acceptability was assessed by participation rates and questionnaire. Analysis of variance and covariance was conducted to determine any differences between groups. Sixty-nine per cent of the participants were still enrolled at six months postpartum. This pilot demonstrated some difficulties in recruiting women from antenatal clinics and retaining them in the trial. Although underpowered; the results on weight; biomarkers and breastfeeding outcomes indicated improved metabolic health.     

Who is Counseled to Lose Weight? Survey Results and Anthropometric Data from 3,149 Lower Socioeconomic Women

Because obesity is a grave public health concern, this study examined the percentage of disadvantaged women who recalled ever having received weight loss advice from a healthcare provider and factors associated with such advice. This study was part of a 5-clinic, cervical cancer prevention trial. Patients not immediately post-partum completed a Spanish/English survey; height and weight were also obtained. Of the 3,149 respondents (response rate 83%), 2,138 (68%) were overweight or obese (body mass index (BMI) ≥ 25); 94% reported a household income of <$35,000/year; 69% were Hispanic; 10% non-Hispanic black; and 40% completed the survey in Spanish. Only one-third reported ever having been told to lose weight. Based on BMI, these rates were 15% in the 25–29.9 range (overweight); 34% within 30–34.9; 57% within 35–39.9; and 73% ≥ 40. In univariate analyses, among overweight women, diabetes or English-speaking was associated with weight loss advice. In multivariate analyses, being older, more educated, and diabetic were associated with such advice. 48% of non-Hispanic whites, 31% of non-Hispanic blacks, and 29% of Hispanic had a home scale. Among disadvantaged women, obesity alone does not determine who recalls weight loss advice. Language barriers and lack of a home scale merit further study to address obesity.     

Prevalence of Overweight and Obesity Among Women of Childbearing Age: Results from the 2002 National Survey of Family Growth

Objective To estimate the prevalence of overweight and obesity among U.S. women of childbearing age. Methods Our study population was drawn from the 2002 National Survey of Family Growth (NSFG) and consisted of non-pregnant female respondents aged 20–44 years with a valid body mass index (BMI) (N = 5,958). Univariate and bivariate analyses were conducted to document variations in the prevalence of overweight and obesity by age, race and Hispanic origin, and socioeconomic status. Results Overall, 24.5% of women 20–44 years of age were overweight (BMI 25.0–29.9 kg/m²) and 23.0% were obese (BMI ≥ 30.0 kg/m²). Among those who were obese, 10.3% met the criteria for class II or III obesity (BMI ≥ 35.0 kg/m²). Non-Hispanic black and women were 2.25 times more likely to be overweight or obese compared to non-Hispanic white women (95% CI: 1.87–2.69). This disparity in risk between non-Hispanic black and non-Hispanic white women declined and no longer achieved statistical significance after adjustment for education, household income, and health insurance coverage. Conclusions Nearly one in two U.S. women of childbearing age are either overweight or obese. The racial/ethnic disparity in prevalence rates may be due in part to variability in educational attainment, household income, and stability of health insurance coverage.     

Maternal prepregnant body mass index, duration of breastfeeding, and timing of complementary food introduction are associated with infant weight gain

BACKGROUND: Women who are overweight or obese before pregnancy breastfeed for shorter durations than do normal-weight women. These shorter durations may place infants of overweight and obese women at risk of not receiving the benefits of breastfeeding, which may include a reduced risk of overweight later in life. OBJECTIVE: We examined how maternal prepregnant body mass index (BMI; in kg/m2) and infant feeding pattern are associated with infant weight gain. DESIGN: In this prospective, observational study, we used multiple regression analyses adjusted for potential confounding factors to examine these associations among 3768 mother-infant dyads from the Danish National Birth Cohort. RESULTS: In multiple regression analyses, increasing maternal prepregnant BMI, decreasing durations of breastfeeding, and earlier complementary food introduction were associated with increased infant weight gain. An interaction was identified for short durations of breastfeeding (<20 wk). Earlier complementary food introduction (<16 wk) was associated with greater infant weight gain; however, the timing of complementary food introduction did not increase infant weight gain at longer durations of breastfeeding (> or =20 wk). In this sample, prepregnant obesity (BMI > or = 30.0), short durations of breastfeeding, and earlier introduction of complementary food were associated with 0.7 kg of additional weight gain during infancy. CONCLUSIONS: Infant weight gain is associated with maternal prepregnant BMI and with an interaction between the duration of breastfeeding and the timing of complementary food introduction. Future investigations of the effects of breastfeeding on infant weight gain should account for all of these factors.     

High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women

BACKGROUND: An association between high prepregnant body mass index (BMI) and early termination of breastfeeding has been observed, but this finding may have depended on the sociocultural context. OBJECTIVE: The objective was to determine whether this association was stronger with increasing maternal obesity, was modified by gestational weight gain, and still existed when there was greater social support for breastfeeding. DESIGN: Study participants (37 459 women) were drawn from the Danish National Birth Cohort. The association of prepregnant BMI and gestational weight gain with the termination of full or any breastfeeding by 1, 16, or 20 wk postpartum was assessed with logistic regression analyses, and the risk of early termination of full and any breastfeeding during the first 18 mo postpartum was assessed with Poisson regression analyses. RESULTS: The risk of early termination of any (with similar results for full) breastfeeding rose progressively with increasing prepregnant BMI values (in kg/m(2)), from 1.12 (95% CI: 1.09, 1.16) for overweight (BMI = 25.0-29.9) women to 1.39 (95% CI: 1.19, 1.63) for obese class III women (BMI >or= 40) compared with normal-BMI women. Gestational weight gain did not add to or modify the association between prepregnant BMI and breastfeeding. CONCLUSIONS: These findings extend the observation to a broader range of BMIs that the greater the prepregnant BMI, the earlier the termination of breastfeeding. Together with the fact that this association was evident in a more supportive social context for breastfeeding, these findings suggest a biological basis for the association.     

The association between gestational weight gain and risk of stillbirth: a population-based cohort study

PurposeTo estimate the risk of stillbirth associated with excessive and inadequate weight gain during pregnancy.MethodsRetrospective cohort study using the Texas vital records database between 2006 and 2011, with 2,230,310 births (5502 stillbirths) was included for analysis. Pregnancies were categorized as adequate weight gain, excessive weight gain, inadequate weight gain, or weight loss based on the Institute of Medicine 2009 recommendations. Hazard ratios (HRs) for stillbirth were estimated for each gestational weight-gain stratum using adequate weight gain as the comparison group. The analysis was performed separately for each body mass index (BMI) class.ResultsBoth inadequate weight gain and weight loss were associated with an increased risk of stillbirth for all BMI classes except the morbidly obese group. Highest risk was seen in weight-loss groups after 36 completed weeks (normal weight: HR = 18.85 [8.25–43.09]; overweight: HR = 5.87 [2.99–11.55]; obese: HR = 3.44 [2.34–5.05]). Weight loss was associated with reduced stillbirth risk in morbidly obese women between 24 and 28 weeks (HR = 0.56 [0.34–0.95]). Excess weight gain was associated with an increased risk of stillbirth among obese and morbidly obese women, with highest risk after 36 completed weeks (obese: HR = 2.00 [1.55–2.58]; morbidly obese: HR = 3.16 [2.17–4.62]). In contrast, excess weight gain was associated with reduced risk of stillbirth in normal-weight women between 24 and 28 weeks (HR = 0.57 [0.44–0.70]) and in overweight women between 29 and 33 weeks (HR = 0.62 [0.45–0.85]). Analysis for the underweight group was limited by sample size. Both excessive weight gain and inadequate weight gain were not associated with stillbirth in this group.ConclusionsStillbirth risk increased with inadequate weight gain and weight loss in all BMI classes except the morbidly obese group, where weight demonstrated a protective effect. Conversely, excessive weight gain was associated with higher risk of stillbirth among obese and morbidly obese women but was protective against stillbirth in lower weight women.     

Population-Based Assessment of the Risk of Primary Cesarean Delivery Due to Excess Prepregnancy Weight Among Nulliparous Women Delivering Term Infants

Objective: To estimate the risk of cesarean delivery due to excess prepregnancy body mass index (BMI) in a multistate, US population-based sample. Methods: We analyzed data from the population-based Pregnancy Risk Assessment Monitoring System (PRAMS) on 24,423 nulliparous women with single, term infants delivered between 1998 and 2000 in 19 states. We calculated BMI from self-reported weight and height. We assessed interactions between prepregnancy BMI and other risk factors. We estimated weighted relative risks and 95% confidence intervals for the association between prepregnancy BMI and cesarean section from multiple logistic regression models adjusting for demographic and medical risk factors from the PRAMS questionnaire or birth certificates. Results: The incidence of cesarean delivery increased with increased prepregnancy BMI, from 14.3% (0.8 standard error (SE)) for lean women (BMI < 19.8) to 42.6% (2.0 SE) for very obese women (BMI ≥ 35). The risk of cesarean section differed by presence of any medical, labor and/or delivery complication. Among women with any complication, the estimated adjusted RR for cesarean delivery was 1.1 (95% confidence interval (CI) 1.0–1.2) among overweight women, 1.3 (95% CI 1.1–1.4) among obese women, and 1.4 (95% CI 1.2–1.6) among very obese women compared with normal weight women. Among women without any complications, the estimated adjusted RR was 1.4 (95% CI 1.0–1.8) among overweight women, 1.5 (95% CI 1.1–2.1) among obese women, and 3.1 (95% CI 2.3–4.8) among very obese women. Conclusion: Excess prepregnancy weight increases the risk of cesarean delivery among nulliparous women giving birth to single, term infants, especially among very obese women without any complications.     

Pregnancy-Associated Obesity in Black Women in New York City

Objective: To determine weight gain during pregnancy and weight changes postpartum in first-time mothers delivering at or near term. Methods: At about 2 weeks after delivery, 47 adult, Black and Hispanic women provided information on their prepregnancy weight and height and maximum pregnancy weight. Women reinterviewed at 2 and 6 months after delivery reported their most recent weight measurement and the date of that measurement. This information was used to compute each woman's prepregnancy body mass index, pregnancy weight gain, and weight loss postpartum. Information on infant feeding was also collected at each postpartum visit. Results: About 2/3 of the women and 100% of the overweight and obese women gained excessive weight during pregnancy. Weight gain was most marked in women who started pregnancy overweight or obese. At 2 months postpartum, women were on average almost 18 lb above their prepregnancy weight. No additional maternal weight was lost by 6 months postpartum. Most infants were started on formula by 2 weeks of age. At 2 months of age, 85% were fed formula only and 91% of the infants were on WIC. Conclusions: Our results demonstrate a need for interventions to help women avoid obesity by regulating their pregnancy weight gain, losing weight for a longer period postpartum, and initiating and maintaining exclusive breast-feeding.     

The Association Between Pre-pregnancy BMI and Preterm Delivery in a Diverse Southern California Population of Working Women

Whereas preterm birth has consistently been associated with low maternal pre-pregnancy weight, the relationship with high pre-pregnancy weight has been inconsistent. We quantified the pre-pregnancy BMI—preterm delivery (PTD) relationship using traditional BMI categories (underweight, normal weight, overweight and obese) as well as continuous BMI. Eligible women participated in California’s statewide prenatal screening program, worked during pregnancy, and delivered a live singleton birth in Southern California in 2002–2003. The final analytic sample included 354 cases delivering at <37 weeks, as identified by clinical estimate of gestational age from screening records, and 710 term normal-birthweight controls. Multivariable logistic regression models using categorical BMI levels and continuous BMI were compared. In categorical analyses, PTD was significantly associated with pre-pregnancy underweight only. Nonparametric local regression revealed a V-shaped relationship between continuous BMI and PTD, with minimum risk at the high end of normal, around 24 kg/m². The odds ratio (OR) for PTD associated with low BMI within the normal range (19 kg/m²) was 2.84 (95%CI = 1.61–5.01); ORs for higher BMI in the overweight (29 kg/m²) and obese (34 kg/m²) ranges were 1.42 (95%CI = 1.10–1.84) and 2.01 (95% CI = 1.20–3.39) respectively, relative to 24 kg/m²). BMI categories obscured the preterm delivery risk associated with low-normal, overweight, and obese BMI. We found that higher BMI up to around 24 kg/m² is increasingly protective of preterm delivery, beyond which a higher body mass index becomes detrimental. Current NHLBI/WHO BMI categories may be inadequate for identifying women at higher risk for PTD.     

Maternal obesity is negatively associated with breastfeeding success among Hispanic but not Black women

Prepregnant overweight and obesity have been associated with failure to initiate and to sustain breastfeeding (BF) among Caucasian women; however, this relationship has not been studied among either Black or Hispanic women. Information extracted from medical records was used to examine the relationship between prepregnant overweight (BMI = 26.1-29.0 kg/m(2)) and obesity (BMI > 29.0 kg/m(2)) and the initiation and duration of BF among Black and Hispanic women living in an urban area. Among 587 Hispanic women, those who were obese were more likely than normal-weight women to feed formula and breast milk rather than to feed breast milk alone before discharge [odds ratio (OR): 1.9; 95% CI: 1.2-3.1]. Obese Hispanic women also had higher rates of discontinuation of exclusive BF [relative risk (RR): 1.5; 95% CI: 1.1-2.0]) and higher rates of discontinuation of BF to any extent (RR: 1.5; 95% CI: 1.1-2.1) during the first 6 mo postpartum. Among 640 Black women, prepregnant BMI was neither associated with differences in feeding pattern before discharge nor with differences in rates of discontinuation of exclusive or any BF. We concluded that among healthy women who attempt to breastfeed in the hospital, maternal prepregnant obesity was negatively associated with initiation and duration of BF in Hispanic women. In contrast, prepregnant BMI did not have the same association among Black women who attempted to breastfeed. We speculate that obesity may have a different biological meaning for BF success in Black women than it does in those who are Caucasian or Hispanic.     

Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight

In this study, we investigate how three alternative measures of maternal body mass index (BMI) relate to youth overweight. We contrast the typical cross-sectional measure of maternal BMI with a longitudinal mean and a standard deviation in maternal BMI. Using National Longitudinal Survey of Youth data, we estimate logistic regressions that relate maternal BMI to the risk of a youth being overweight while controlling for other familial characteristics. Participants in this study are 918 males and 841 females who were age 16–21 and either healthy weight or overweight in 2006. To be eligible for inclusion, teens were 15 years old by December 2006. After comparing several measures of maternal weight, we find that higher mean maternal BMI measured over the life of the adolescent has the strongest relationship with the odds of youth overweight for both male and female adolescents. For boys, a one unit increase in mother’s mean BMI increases the odds of being overweight by 16% (OR = 1.16, 95% CI 1.11–1.20) while for girls the increase in the odds of being overweight is 13% (OR = 1.13, 95% CI 1.09–1.18). Our findings suggest that researchers should move beyond static measures of maternal weight when examining the correlates of youth BMI. Maternal weight histories offer additional insights about the youth’s home environment that are associated with the risk of a youth being overweight.     

Comparison and correlates of three preference-based health-related quality-of-life measures among overweight and obese women with urinary incontinence

Purpose  

To compare three preference-based health-related quality-of-life (HRQL) measures and examine independent correlates of HRQL among overweight and obese women with urinary incontinence (UI) enrolled in a weight loss intervention trial.