Breastfeeding and postpartum weight retention in a cohort of Brazilian women

BACKGROUND: The relation between postpartum weight retention and breastfeeding practices is controversial. OBJECTIVE: Defining breastfeeding as the period when a child is exclusively or predominantly breastfed, we studied the association between breastfeeding duration and postpartum weight retention. DESIGN: We followed 405 women aged 18-45 y who were assessed at 0.5, 2, 6, and 9 mo postpartum. The outcome variable, postpartum weight retention, was expressed as the difference between the observed weight at each follow-up and the reported prepregnancy weight. The main statistical procedure used was the longitudinal mixed-effects model. RESULTS: Mean postpartum weight retention at the end of the study was 3.1 kg. Single women aged > or = 30 y retained more weight than did younger single women or married women. The combined effect of breastfeeding duration and percentage of body fat at baseline was significant only for women with < 30% body fat. According to the model's prediction, when women who had 22% body fat and breastfed for 180 d were compared with those who had 22% body fat and breastfed for only 30 d, each month of breastfeeding contributed -0.44 kg to postpartum weight retention. When only the percentage of body fat was varied, the total effect was 3.0, 1.7, 1.2, and 0.04 kg in women with 18%, 25%, 28%, and 35% body fat, respectively. CONCLUSIONS: These results support the hypothesis of an association between breastfeeding and postpartum weight retention and suggest that encouraging prolonged breastfeeding might contribute to decreases in postpartum weight retention.     

孕期增重以及产后软饮料的摄入对产后体重滞留的影响

目的 研究孕期增重以及产后膳食对产后体重滞留的影响 方法 采用队列研究的方法,以在北京北方医院进行产后复查的产妇为研究对象,分别在产后1个月、6个月进行追踪随访,调查研究对象的一般信息、孕前、分娩前、产后1个月、6个月的体重;用半定量的食物频数法,收集研究对象的膳食摄入信息。利用多元线性回归模型,分析孕期增重以及膳食摄入量与产后体重滞留的关系。结果 孕期增重（β = 0.73, 95%CI: 0.52～0.71,β = 0.67, 95%CI: 0.51～0.77）、软饮料摄入量（β = 0.14, 95%CI: 0.14～1.34,β = 0.15, 95%CI: 0.05～1.53）与产后1、6个月体重滞留呈正相关关系,关联具有统计学意义;按照喂养方式分层后,孕期增重、软饮料摄入与产后1个月、6个月喂养方式之间不存在交互作用。结论 孕期增重与产后软饮料摄入与产后体重滞留有关,与软饮料摄入量相比,孕期增重是产后体重滞留更重要的预测因子。     

分娩正常出生体重儿孕妇孕期体重的变化

目的　分析分娩正常出生体重儿孕妇孕期增重的范围 ,为指导孕期营养提供科学依据。　方法　将孕妇按孕前体质指数大小分为 3组 ,计算各组孕妇孕期增重范围。　结果　低体重组、理想体重组及超重组孕妇孕期平均增重分别为 (16 .2± 4 .0 ) kg、 (15 .7± 4 .4 ) kg、 (13.2± 4 .3) kg,低体重及理想体重组妇女孕期增重大于超重妇女 ,差异有显著性 (P<0 .0 1) ,孕中期体重增长幅度大于孕晚期 ;　结论　低体重及理想体重妇女孕期平均增重大于超重组妇女     

Gestational weight gain,cesarean delivery,and cesarean delivery on maternal request: a cohort analysis of Chinese nulliparous women

PurposeTo examine the association between gestational weight gain (GWG) and cesarean delivery including cesarean delivery on maternal request (CDMR) among low-risk women.MethodsA total of 1,009,987 Chinese nulliparous women who delivered live term singletons during 1993–2010 were included. GWG, according to maternal pre-pregnancy body mass index–specified z-scores, was categorized into five groups: less than −1.2, −1.2 to less than −0.6, −0.6 to 0.6 (reference), more than 0.6 to 1.2, and more than 1.2. Multivariate log-binomial regression models were used to estimate the adjusted risk ratios and 95% confidence intervals (95% CIs).ResultsGWG was positively associated with overall cesarean and CDMR after adjusting for various confounders. Adjusted risk ratios for cesarean were 0.75 (95% CI, 0.73–0.77), 0.84 (95% CI, 0.82–0.85), 1.00, 1.16 (95% CI, 1.14–1.19), and 1.32 (95% CI, 1.29–1.35) in five ascending GWG categories, and 0.70 (95% CI, 0.67–0.73), 0.80 (95% CI, 0.78–0.82), 1.00, 1.20 (95% CI, 1.18–1.23), and 1.43 (95% CI, 1.40–1.45) for CDMR. The graded positive associations were consistent across levels of maternal pre-pregnancy body mass index, and in strata defined by southern and/or northern provinces, urban and/or rural residence, maternal age at delivery, year of delivery, and level of delivering hospital.ConclusionsEven among low-risk women, higher GWG was monotonically associated with an increased risk of cesarean delivery, indicating that limiting GWG could benefit to curb the rate of both medically necessary and unnecessary cesareans.     

Gestational weight gain and 'maternal obesity'

Summary There is an enduring belief, amongst mothers and obstetricians alike, that weight gain during pregnancy (i.e. ‘gestational weight gain’) increases the risk of permanent maternal weight gain (i.e. ‘maternal obesity’). In practice, such risks are only relevant to those mothers whose energy intake and/or energy expenditure place them in positive energy balance during pregnancy. For this reason, few studies from low‐income countries (except those amongst well‐nourished and predominantly sedentary populations) find evidence of ‘maternal obesity’. In contrast, a variety of cross‐sectional and longitudinal studies in high‐income countries suggest that pregnancy is accompanied by long‐term weight gain and an increased risk of ‘maternal’ obesity. Unfortunately, the results of all but four of these studies are compromised by the use of imprecise weight measurements, inadequate controls for potential confounding, and/or failure to account for increases in body weight with age. The four longitudinal analyses that did address these methodological concerns found that populations of women from Western European (Netherlands) and North American (United States) countries experience, on average, a net increase in body weight between conception and 1 year postpartum of 0.5 to 3.3kg (1.1 to 7.31b). These findings suggest that most well‐nourished women can expect to gain some weight in association with pregnancy, although it remains unclear whether this is wholly the result of weight gained during pregnancy (i.e. ‘gestational weight gain’) or partly reflects a pre‐pregnant and/or postpartum tendency to gain weight irrespective of pregnancy itself. In this regard, parental obesity and pre‐pregnant body weight are both associated with an increased risk of ‘maternal obesity’, as are inadequate social support, increased food intake and reduced activity during the postpartum period. Longitudinal analyses that record changes in body weight before, during and after pregnancy are therefore required to establish the role that gestational weight gain plays in ‘maternal obesity’.     

健康教育干预对妇女产后体重滞留的影响

目的:探索健康教育干预对妇女产后体重滞留的影响.方法:采取前瞻性队列研究设计方法,选择合肥市某妇幼保健站进行体检的妇女作为观察对象,并将入选对象随机分配到干预组和对照组,干预组施加3个阶段的健康教育.基线于妇女产后42天时建立,以自编式调查问卷的方式获得基线信息,随后对观察对象随访1年.产后体重恢复情况分别于42天、3个月、6个月、9个月和1年测量5次,计算各时点体重与孕前、基线体重的差值.随访期间填写知信行调查问卷,对干预效果进行评价.结果:干预组在每个随访时点上的体重减少值大于对照组,与基线比各时点体重减少值两组间差异有统计学意义(P＜0.05).随访各阶段干预组体重滞留值均小于对照组,但两组间无统计学差异.干预组在产后1年体重滞留为(2.68±4.30)kg,肥胖率是18.7％;对照组体重滞留是(3.17±4.19) kg,肥胖率为25.4％.干预有助于提高产妇健康知识水平.结论:本研究发现干预在减少产后妇女体重滞留具有一定的积极作用.建议制定更加全面的个性化健康教育方案,提高干预效应.     

High-protein diet promotes a moderate postpartum weight loss in a prospective cohort of Brazilian women

ObjectiveWhether a high-protein (HP) diet promotes body weight loss (BWL) when compared with a low-protein (LP) diet is still unclear. Therefore, we evaluated the effects of an HP diet on BWL during postpartum.MethodsA food-frequency questionnaire with 81 items was applied at 6 mo after delivery to evaluate the diet of 430 postpartum women aged 18–45 y. Body weight was measured approximately at 0.5, 2, 6, and 9 mo after delivery. Body weight loss was modeled by comparing an HP diet (≥1.2 g · kg^?1 · d^?1) with an LP diet (<1.2 g · kg^?1 · d^?1) using mixed-effects linear regression models adjusted for energy intake, percentage of body fat at baseline, stature, age, race, smoking, and schooling.ResultsUsual energy intake was higher in the HP than in the LP diet group (2623 versus 1791 kcal, P < 0.0001). Daily mean protein intakes were 1.54 ± 0.32 g · kg^?1 · d^?1 for the HP group and 0.83 ± 0.20 g · kg^?1 · d^?1 for the LP group. A multivariate model showed that women in the HP group lost 316 ± 0.062 g of body weight more per month (P < 0.01) when compared with the LP group.ConclusionA reported higher protein intake may improve moderate postpartum body weight loss. Further studies should evaluate the long-term consequences of an HP diet postpartum.     

Skin color and marital status influence postpartum weight retention among Brazilian adolescents

We identify epidemiological predictors of postpartum weight retention, including skin color and marital status, among Brazilian adolescents. A cohort study with 4 follow-up time points at 0.5, 2, 6, and 9 months postpartum was conducted in a primary health care center located at the municipality of Rio de Janeiro, Brazil. One hundred five adolescents aged 15 to 19 years participated in the study. Postpartum weight retention was calculated as the difference between the weight measured at each visit and the prepregnancy weight. We estimate the statistical associations between the outcome variable and potential explanatory covariates of interest by fitting a multivariate longitudinal mixed-effects model. Most adolescents live with a partner (53.3%); 37.1% are single, and 9.6% are married. The adolescents are predominantly of mixed (48.6%) and white (28.6%) color. Postpartum weight retention decreased from 4.9 to 2.8 kg. Single and mixed skin color women return faster to their previous prepregnancy weight. Only marital status (married/single, coefficient = −2.0547 [SE, 0.7505]; P = .0074) (married/with partner, coefficient = −0.9403 [SE, 0.3425]; P = .0072) and skin color (black/mixed, coefficient = −1.3378 [SE, 0.5179]; P = .0113) achieved statistical significance to remain in the final longitudinal regression model. In conclusion, the results have shown that younger, married, and black adolescents are at higher risk of developing maternal obesity as a consequence of increasing postpartum weight retention. The results presented herein provide empirical evidence supporting the need to put in practice health policies aimed at preventing postpartum weight retention among adolescents and the associated side effects.     

Prenatal weight gain and postpartum weight loss patterns in adolescents

The standard weight gain curve for pregnant females is used for all ages but its suitability for pregnant adolescents has not been satisfactorily examined. The purpose of this project was to compare prenatal weight gain patterns of 80 adolescents (13-17 yr old) with those of the standard curve. Girls who were chronologically and physiologically younger tended to gain less weight prenatally then older girls. Girls who were underweight prior to pregnancy gained more weight prenatally than other girls. Term weight gain averaged 37 lb. Increase in height was not recorded during the course of the investigation. The development of standard curves for adolescents must be based on a larger study population, but the curves presented here are an important initial step toward achieving this goal.     

Predictors of postpartum weight retention among urban Malaysian mothers: A prospective cohort study

BackgroundWomen of childbearing age are predisposed to becoming overweight or obese. This study determines the mean, prevalence and factors associated with 6 months postpartum weight retention among urban Malaysian mothers.MethodsA prospective cohort study was conducted at baseline (after delivery), 2, 4 and 6 months postpartum. From 638 eligible mothers initially recruited, 420 completed until 6 months. Dependent variable was weight retention, defined as difference between weight at 6 months postpartum and pre-pregnancy weight, and weight retention ≥5 kg was considered excessive. Independent variables included socio-demographic, history of pregnancy and delivery, lifestyle, practices and traditional postpartum practices.ResultsAverage age was 29.61 ± 4.71 years, majority (83.3%) were Malays, 58.8% (low education), 70.0% (employed), 65.2% (middle income family), 33.8% (primiparous) and 66.7% (normal/instrumental delivery). Average gestational weight gain was 12.90 ± 5.18 kg. Mean postpartum weight retention was 3.12 ± 4.76 kg, 33.8% retaining ≥5 kg. Bivariable analysis showed low income, primiparity, gestational weight gain ≥12 kg, less active physically, higher energy, protein, carbohydrate and fat intake in diet, never using hot stone compression and not continuing breastfeeding were significantly associated with higher 6 months postpartum weight retention. From multivariable linear regression analysis, less active physically, higher energy intake in diet, gestational weight gain ≥12 kg, not continuing breastfeeding 6 months postpartum and never using hot stone compression could explain 55.1% variation in 6 months postpartum weight retention.ConclusionWomen need to control gestational weight gain, remain physically active, reduce energy intake, breastfeed for at least 6 months and use hot stone compression to prevent high postpartum weight retention.