Awareness,Beliefs and Perspectives Regarding Weight Retention and Weight Gain among Postpartum Women in India: A Thematic Analysis of Focus Group Discussions and In-Depth Interviews

Background and AimsThe pregnancy weight is usually retained in the form of abdominal fat during the postpartum period. The willingness to lose weight is influenced by knowledge, attitude, beliefs and practices. This study aims to comprehend the awareness, beliefs and perspectives of postpartum women regarding their perceived factors, barriers and facilitators associated with post-pregnancy weight status.MethodsOverweight and obese postpartum women aged between 20 and 40 years and had delivered an infant in the last 2 years were recruited via convenience and purposive sampling techniques. The final sample comprised 27 participants with a mean age of 29.96 ± 4.50 years. Four focus group discussions and eight in-depth interviews carried out were audio-recorded and transcribed verbatim. Codes, sub-themes and themes were generated using Atlas.ti 9 software.ResultsMajor themes identified were perceived factors causing postpartum weight retention/weight gain including social and cultural beliefs related to diet and exercise specifically associated with this period, perceived motivators and deterrents of weight loss including eagerness to lose weight and perceived facilitators and barriers to weight loss including intrinsic and extrinsic factors such as time, energy, evidence-based knowledge about diet and physical activity, family support and obligation to family’s advice.ConclusionThe unique challenges and barriers associated with postpartum weight loss efforts should be taken into consideration by healthcare professionals and public health policy-makers to design strategies specific to postpartum women.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13224-022-01644-9.     

Efficacy of an intervention to prevent excessive gestational weight gain

OBJECTIVE: This study was undertaken to evaluate the efficacy of an intervention directed at preventing excessive gestational weight gain. STUDY DESIGN: Healthy pregnant women with normal and overweight early pregnancy body mass index were monitored from early pregnancy until 1-year postpartum. One hundred seventy-nine women in the intervention group had their gestational weight gains monitored by health care providers and also received by-mail patient education. Three hundred eighty-one women formed an historical control group. The proportions in each group gaining more weight in pregnancy than is recommended and retaining more than 2.27 kg at 1-year postpartum were compared using logistic regression analysis. RESULTS: Low-income women who received the intervention had a significantly reduced risk of excessive gestational weight gain (odds ratio [OR]=0.41, 95% CI=0.20-0.81). Overweight women within this income subgroup were at significantly reduced risk of retaining more than 2.27 kg (OR=0.24, 95% CI=0.07-0.89). CONCLUSION: The intervention appeared to reduce the risk of excessive gestational weight gain only in the low-income subgroup.     

Offspring birth weight and maternal fasting lipids in women screened for gestational diabetes mellitus (GDM)

Objectives

Maternal lipid metabolism is altered during pregnancy but little is known about the influence of these alterations on either intrauterine fetal development or maternal wellbeing. The purpose of this study was to examine the relationship between both fasting cholesterol and triglycerides and offspring birth weight in women screened selectively for gestational diabetes mellitus (GDM).

Study design

In a prospective observational study in a University Maternity Hospital, women were recruited at their convenience when they were screened for GDM with a diagnostic 75 g oral glucose tolerance test (OGTT). An additional sample was taken for a lipid profile at the time the fasting glucose was obtained. Clinical and socio-demographic details were recorded.

Results

Of the 189 women recruited, the mean age was 32 years, 35.4% (n = 67) were primigravidas, 44.1% (n = 82) were obese and 11.6% (n = 22) had an abnormal OGTT. On univariate analysis, increasing birth weight was correlated positively with multiparity, first trimester body mass index (BMI), GDM and hypertriglyceridaemia but not with cholesterol levels. On multivariate analysis, increased birth weight correlated positively only with hypertriglyceridaemia.

Conclusions

This study provides further evidence that maternal hypertriglyceridaemia is important in programming intrauterine fetal growth and raises questions about whether women should be screened selectively for dyslipidaemia before, during and after pregnancy.     

Postpartum maternal adipokines and infant weight for length at 1 year in women with gestational diabetes

Background: Maternal, cord blood and childhood adipokines have been associated with childhood obesity. We investigated whether postpartum maternal adipokines are associated with increased weight at 1 year of age in children of women with gestational diabetes (GDM).

Methods: Plasma leptin and adiponectin concentrations were measured in 160 women at approximately 12 weeks following pregnancy with GDM and compared with infant weight for length z-score at 1 year of age after adjustment for maternal and infant demographic variables.

Results: No association was demonstrated between maternal postpartum leptin and adiponectin concentrations and infant weight for length z-score at 1 year of age.     

Patterns of gestational weight gain in healthy,low-risk pregnant women without co-morbidities

Background

little is known of the impact of gestational weight gain (GWG) in relation to Body Mass Index (BMI) classification on perinatal outcomes in healthy pregnant women without co-morbidities. As a first step, the prevalence of obesity and the distribution of GWG in relation to the Institute of Medicine (IOM) 2009 guidelines for GWG were examined.

Methods

data from a prospective cohort study of – a priori – low risk, pregnant women from five midwife-led practices (n=1449) were analysed. Weight was measured at 12, 24 and 36 weeks.

Findings

at 12 weeks, 1.4% of the women were underweight, 53.8% had a normal weight, 29.6% were overweight, and 15.1% were obese according to the WHO classification of BMI. In our study population, 60% of the women did not meet the IOM recommendations: 33.4% had insufficient GWG and 26.7% gained too much weight. Although BMI was negatively correlated to total GWG (p<.001), overweight and obese women class I had a significant higher risk of exceeding the IOM guidelines. Normal weight women had a significantly higher risk of gaining less weight than recommended. Obese women classes II and III were at risk in both over- and undergaining.

Conclusions

our data showed that the majority of women were unable to stay within recommended GWG ranges without additional interventions. The effects on pregnancy and health outcomes of falling out the IOM guidelines remain unclear for – a priori – low risk women. Since interventions to control GWG would have considerable impact on women and caregivers, harms and benefits should be well-considered before implementation.     

Obesity and nutrition in women throughout adulthood

Nutritional challenges are particularly relevant to women. Almost 62% of women are overweight; of these women, 33% are obese. The incidence of obesity is even greater in non-Hispanic Black and Mexican American women. Women who are overweight or obese experience a greater number of adverse health outcomes, including an increased incidence of cardiovascular disease and breast and colon cancer. Dietary patterns influence health outcomes, with a heart-healthy pattern having the most positive health outcomes. Health care providers should encourage women to consume a diet high in fruits and vegetables and low in total and saturated fats.     

Weight retention from early pregnancy to three years postpartum: a study in Iranian women

Objectives

to examine weight retention from early pregnancy to three years postpartum in Iranian women.

Design

a prospective cohort study.

Setting

12 health centres selected at random in urban and rural areas in Guilan.

Participants

1315 pregnant women (705 in urban areas and 610 in rural areas) who regularly attended health centres for antenatal care and growth monitoring of their babies.

Measurements

details of weight, height, pregnancy weight gain, body weight at one to three years postpartum, mother's age, parity, duration of any breast feeding, education and employment status of women who carried singleton fetuses and delivered at term were collected at the first antenatal visit. The women were categorised based on their pre-pregnancy body mass index, weight retention at one to three years postpartum, employment status and educational levels.

Findings

women who gained more weight than recommended during pregnancy tended to be heavier at three years postpartum than women who gained weight within the recommended ranges during pregnancy (7.0±5.3 versus 4.8±6.7 kg; p<0.0001). Less-educated women were at greater risk for inadequate pregnancy weight gain than other educational groups, and they had less weight retention at three years postpartum than other educational groups. Also, weight retention for primiparous women was higher than that for multiparous women (5.4±6.6 versus 3.8±6.3 kg; p<0.0001). The results of logistic regression analysis revealed that only total pregnancy weight gain was independently related to major weight retention (?4 kg) at three years postpartum (odds ratio 1.34, 95% confidence intervals 1.03–1.74; p=0.02).

Conclusion

a high body mass index before pregnancy is not associated with increased risk of retaining more weight after pregnancy. On the other hand, total pregnancy weight gain was the most important determinant of weight retention at three years postpartum in this population of Iranian women.     

Postpartum fatigue in the active-duty military woman

OBJECTIVE: (a) To describe fatigue levels in military active-duty women, (b) to describe the relationship among selected predictor variables of fatigue, and (c) to examine the relationship between predictor variables, fatigue levels, and performance (as measured by functional status) after childbirth. DESIGN: Based on the Theory of Unpleasant Symptoms, a longitudinal, prospective design. SETTING: A large military medical facility in the southwest United States. PATIENTS/PARTICIPANTS: A convenience sample of 109 military active-duty women. MAIN OUTCOME MEASURE: Postpartum fatigue. RESULTS: Women were found to be moderately fatigued across time, with no change in fatigue levels from 2 to 6 weeks after delivery. All variables correlated with fatigue during hospitalization and at 2 weeks after delivery, and depression, anxiety, maternal sleep, and functional status correlated with fatigue at 6 weeks after delivery. Regression analyses indicated that maternal anxiety predicted fatigue at 6 weeks after delivery. Over half the women had not regained full functional status when they returned to work, and 40% still displayed symptoms of postpartum depression and anxiety. CONCLUSIONS: Military women continue to experiencing postpartum fatigue when they return to the workplace. Future research is needed to examine issues surrounding fatigue and its associated variables during the first year after delivery.     

Midwives' experiences of referring obese women to either a community or home-based antenatal weight management service: Implications for service providers and midwifery practice

Objectivea variety of services to support women to undertake weight management behaviours during pregnancy have recently been implemented as a means to reduce the risks to mother and infant. In the UK, midwives lead the care of the majority of pregnant women and are seen as the ideal source of referral into antenatal services. However, midwives have reported concerns regarding raising the topic of weight with obese women and negative referral experiences have been cited as a reason not to engage with a service. This study explored midwives’ experiences of referring women to one of two antenatal weight management services.Designqualitative, cross-sectional interview and focus group study, with data analysed thematically.Settingmidwifery teams in the West Midlands, England.Participantsmidwives responsible for referring to either a home-based, one to one service (N=12), or a community-based, group service (N=11).Findingsfour themes emerged from the data. Participants generally had a positive View of the service, but their Information needs were not fully met, as they wanted more detail about the service and feedback regarding the women they had referred. Approaches to referral differed, with some participants referring all women who met the eligibility criteria, and some offering women a choice to be referred or not. Occasionally the topic was not raised at all when a negative reception was anticipated. Reasons for poor uptake of the services included pragmatic barriers, and their perception of women's lack of interest in weight management.Key conclusionsmidwives’ differing views on choice and gaining agreement to refer means referral practices vary, which could increase the risk that obese women have inequitable access to weight management services. However, midwives’ confidence in the services on offer may be increased with more detailed information about the service and feedback on referrals, which would additionally act as prompts to refer.Implications for practiceweight management services need to improve communication with their referral agents and try to overcome practical and psychosocial barriers to uptake. It would be beneficial to develop a shared understanding of the concept of ‘informed choice’ specifically regarding referral to health promotion services among midwives. Training which demonstrates effective methods of sensitively introducing a weight management service to obese women may increase midwives’ confidence to consistently include this in their practice. These measures may improve women's engagement with services which have the potential to reduce the risks associated with maternal obesity.     

Maternal weight gain ranges for optimal fetal growth in Japanese women.

OBJECTIVE: To identify adequate weight gain ranges during pregnancy in Japanese women. METHOD: Obstetric records from 2001 to 2002 for 46,659 term, singleton, vaginally delivered live births was used to estimate IUGR and macrosomia risk. Total maternal weight gain was grouped according to gestational age-specific percentile values of weight gain as follows: "very low" (under the 25th), "low" (25th to 49th), "moderate" (50th to 74th), "high" (75th to 89th), and "very high" (90th and over). RESULTS: About 6% of infants were identified as having IUGR and 0.9% as macrosomia. IUGR risk was elevated with low weight gains. Macrosomia risk was related to high weight gains and previous spontaneous abortions. CONCLUSION: Achieving weight gains between the 50th and 75th percentiles for gestational age was considered adequate for optimal fetal growth in Japanese pregnant women.     

Attitudes and awareness towards weight gain among normal weight and overweight pregnant women

Objectives: (1) To evaluate the proportion who correctly classify- or misclassify maternal weight gain; (2) to investigate weight gain attitudes, and (3) to compare weight gain attitudes with weight gain recommendations by the Institute of Medicine (IOM), as well as background and lifestyle factors.

Methods: This is secondary analysis of cohort data collected as part of a prospective study of determinants of macrosomic infants in Norway (the STORKproject). The participants (n?=?467) answered a self-administered questionnaire, including report on maternal weight gain and attitudes towards weight gain, in mean gestation week 36.4 (SD?=?1.7). The women were also weighted (kg) at the hospital using a digital beam scale.

Results: A significant discrepancy was found between self-reported and measured maternal weight gain. About 76% reported to be satisfied with maternal weight gain while 24% were dissatisfied. Women reporting to be dissatisfied were significantly more likely to be sedentary, sick-listed, reporting poor eating habits and to be multiparous.

Conclusions: Most women reported to be satisfied with their maternal weight gain, but had gained excessively according to recommended weight gain ranges issued by IOM. Pregnant women may need targeted advice on their specific weight gain and impact of increased weight gain on health variables for mother and child.     

Trajectory of weight changes in the first 6 weeks postpartum

OBJECTIVE: To determine the trajectory of postpartum weight changes and to examine associations between weight change in the first 6 weeks postpartum and demographic, clinical, psychosocial, and behavioral variables. DESIGN: Prospective, longitudinal design. SETTING: Community hospital and university research setting. PARTICIPANTS: 26 low-income women (9 White, 8 Black, and 9 Hispanic) with uncomplicated term pregnancies. MAIN OUTCOME MEASURE: Body mass index measured weekly. RESULTS: Among White women, body mass index decreased significantly for the first 3 weeks of the postpartum period. Black women experienced a significant reduction in body mass index for only the first 2 postpartum weeks. Similarly, the postpartum body mass index decreased for the first 2 weeks for Hispanic women. Prepregnancy body mass index and gestational weight gain each had a significant positive effect on postpartum body mass index. Perception of social support at 4 weeks had a significant positive effect on postpartum body mass index in Black women. CONCLUSIONS: The trajectory of weight change was nonlinear with large initial weight losses during the first 2 to 3 weeks postpartum followed by weight plateaus for the remainder of the first 6 weeks postpartum.