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.     

Gestational Weight Gain and Postpartum Weight Retention in a Cohort of Nova Scotian Women

Excess gestational weight gain (GWG) may predispose mothers to becoming overweight or obese. The aim of this study was to investigate the association between GWG, according to the American Institute of Medicine (IOM) guidelines, and postpartum weight retention (PPWR). A cohort of 12,875 women from Nova Scotia, Canada with at least two consecutively recorded pregnancies was identified through a population-based perinatal database between 1993 and 2010. GWG was calculated as the difference between delivery and prepregnancy weights. PPWR, analyzed as a continuous variable in linear regression models, was calculated via interpregnancy weight change. Fifty eight percent of the total study population gained in excess of the IOM guidelines. Mean PPWR, adjusted for age and prepregnancy body mass index (BMI) among women with excess GWG was 5.0 kg (95 % CI 4.9–5.2), greater than women with adequate (2.1 kg, 95 % CI 1.8–2.3) or inadequate GWG (0.3 kg, 95 % CI 0–0.7). Effect modification by prepregnancy BMI was observed; the relationship between excess GWG and increased PPWR was observed in all prepregnancy BMI categories, yet was greatest among underweight women (7.5 kg, 95 % CI 6.6–8.3). Effect modification by parity was also observed; in contrast to multiparous women, primiparous women who gained in excess of GWG guidelines retained more postpartum weight (5.3 kg, 95 % CI 5.1–5.5 vs. 4.3 kg, 95 % CI 4.0–4.7). This study demonstrates that excess GWG is associated with an increase in the amount of weight retained after pregnancy. Interventions targeted to promote optimal GWG are warranted.     

Socioeconomic Differences in Weight Retention, Weight-related Attitudes and Practices in Postpartum Women

Objective To determine if there is a socioeconomic status (SES) gradient in postpartum weight retention in women living in the UK, and examine SES differences in weight-related attitudes and practices in the postpartum period. Methods Women (n = 2745) who had full-term live births between July and December 1999 in four London hospitals were eligible to participate in this self-report postal questionnaire study. The questionnaire included items on socio-demographic characteristics, pre-pregnancy weight, postpartum height and weight, pregnancy weight gain and duration, and postpartum weight-related attitudes (body image and weight beliefs) and practices (weight control and weight monitoring). Education was used as the indicator of SES. Results Questionnaires were returned by 954 women (35%) on average eight months postpartum. Median postpartum weight retention was 2.7 kg and was significantly higher in the medium and lower SES women (3.2 kg) than higher SES women (1.8 kg) despite no difference in pregnancy weight gain. A greater proportion of higher SES women believed they would return to their pre-pregnant weight, and they engaged in more frequent weight monitoring. There were no SES differences in body dissatisfaction or the proportion of women trying to lose weight postpartum. Conclusion In the postpartum period, women of higher SES retained less weight than women of lower SES. There were also differences in weight-related attitudes and frequency of weight monitoring across SES groups.

绝经后妇女骨密度与年龄、体质量关系的分析

目的探讨绝经后妇女骨密度(BMD)与年龄、体质量的关系.方法调查142例健康的绝经后妇女的年龄、绝经年龄、绝经年限,测量身高、体质量、腰椎和股骨的骨密度,并进行统计分析.结果随着年龄的增长,腰椎及股骨的BMD值逐渐下降,骨量减少及骨质疏松的发生率呈明显上升趋势;低体质量组的BMD显著的低于正常体质量组;高风险组的年龄远大于中、低风险组;高、中风险组与低风险组比,体质量轻、腰椎及股骨的BMD小.结论年龄、体质量与骨密度有关.对绝经后女性,尤其是年龄大、绝经时间长、低体质量瘦小体型绝经后妇女,应及时监测骨密度,采取适当措施防治骨质疏松,以免发生骨折.     

Breastfeeding Initiation and Continuation Among Sexual Minority Women

Maternal and Child Health Journal - Identify disparities in breastfeeding initiation and continuation among sexual minority women (SMW) and determine if known risk factors explain any observed...     

Postpartum Depression Among Somali Women in Norway

Postpartum depression (PPD) has been described as the most common complication experienced postpartum, affecting about 10–15?% of all new mothers. Factors like a history of mental illness, and experienced recent adverse life events has been associated with an increased risk for developing PPD. Immigrant women in Western countries have been found to have a marked higher prevalence of PPD compared to the general population. In Norway the prevalence of PPD in the general population has been found to be around 8–10?%, and among Pakistani immigrants a rate of 7.6?% was found. Somali people in Norway are the second largest immigrant group in Norway with a non-Western background. No study on PPD and associated factors among Somali women has been found in the literature. The aim of the study was to assess PPD and associated factors among Somali women in greater Oslo region, Norway. A cross-sectional survey was conducted; recruiting new mothers through all maternity wards in the Oslo region. Data was collected with interview-administrated questionnaires. PPD was assessed using Edinburgh Postnatal Depression Scale (EPDS), defining those scoring ≥10 to have a possible PPD. Of the 80 eligible women identified, 39 (49?%) consented to participate, and completed the study. Of the 39 respondents 3 (7.7?%) were assessed to have a possible PPD. Most important associated factors found were history of mental illness, having experienced technical assistance during delivery, self-rated health and experienced economical problems last 12 months. A low prevalence of PPD was found, and both the prevalence and its associated factors should be interpreted with caution. The associated factors do not have enough power to give any strength to the associations. However, some of the results can be used in develop new hypotheses with regard to PPD among Somali women as immigrants in a Western society.     

孕前体重指数与孕期增重及产褥期体重关系的研究

目的:了解孕前体重指数(BMI)与孕期增重、产后42天体重恢复情况及影响产后体重恢复的因素。方法:采用方便取样,对产后42天复查的产妇进行回顾性调查。结果:①不同孕前BMI妇女孕期平均增重均大于12.50kg;②不同孕前BMI者产后42天体重均存在滞留现象,平均滞留7.50kg(中位数);③影响产后体重恢复的相关因素有孕前BMI、孕期增重、喂养方式等。结论:产后体重恢复受多种因素影响,针对这些相关因素指导妇女顺利渡过孕产期,促进产后恢复。     

Preconception Stress,Birth Weight,and Birth Weight Disparities Among US Women

Objectives. We examined the impact of preconception acute and chronic stressors on offspring birth weight and racial/ethnic birth weight disparities.Methods. We included birth weights for singleton live first (n = 3512) and second (n = 1901) births to White, Mexican-origin Latina, other-origin Latina, and Black women reported at wave IV of the National Longitudinal Study of Adolescent Health (2007–2008; ages 24–32 years). We generated factor scores for preconception acute and chronic stressors from wave I (1994–1995; ages 11–19 years) or wave III (2001–2002; ages 18–26 years) for the same cohort of women.Results. Linear regression models indicated that chronic stressors, but not acute stressors, were inversely associated with birth weight for both first and second births (b = −192; 95% confidence interval = −270, −113; and b = −180; 95% confidence interval = −315, −45, respectively), and partially explained the disparities in birth weight between the minority racial/ethnic groups and Whites.Conclusions. Preconception chronic stressors contribute to restricted birth weight and to racial/ethnic birth weight disparities.Birth weight, a marker of infant health, predicts infant survival and subsequent health status. Low birth weight, defined as weight less than 2500 grams, is associated with increased risk of developing both short-term and long-term health problems.1 The prevalence of restricted birth weight has been increasing since the 1980s in the United States,2 and marked differences in birth weight persist by race/ethnicity.3,4 Limitations of prenatal care and other pregnancy interventions to address the increase over time and disparities in prevalence of adverse birth outcomes1,5 have led to a focus on preconception health, defined broadly as health before a pregnancy (although often used in public health practice to denote health during the reproductive years) and including interconception health, or health between pregnancies.6,7 Drawing on a life course framework,8–10 the concept of preconception health suggests that infants are affected not only by maternal exposures in the 9-month prenatal period, but also by maternal development before the pregnancy.One preconception exposure of interest is stress. Pearlin’s stress process model posits that social characteristics including those surrounding race/ethnicity in the United States lead to stress exposures that affect health,11–13 and has been used to understand elevated risk of adverse health outcomes among minority groups.14,15 It is worth noting that elevated stress is not inherent to persons of minority race/ethnicity, because race/ethnicity is a social construct and not a biological one. Rather, stress results from historical and societal constraints leading to differential life chances across groups.16In studies of its health consequences, stress was defined most frequently as exposure to an inventory of life events within a specified period of time.17 These acute stressors, such as a death in the family or exposure to a crime, are relatively brief in duration but may have continued ramifications.17,18 Consistent with a life course perspective, more recent studies examined chronic stressors as a risk factor for health outcomes.18,19 These stressful life conditions, including individual and neighborhood socioeconomic disadvantage, recur or accumulate throughout a respondent’s life. However, measurement of chronic stressors is less standardized across studies than that of acute stressors; validated scales of acute events19 but not chronic conditions have been developed.Physiologic mechanisms have been hypothesized to link maternal stress to maternal and infant health.20–22 For example, cumulative stress exposure may result in accelerated aging, or “weathering,” wearing down the body’s adaptive systems.21,22 Weathering in particular was proposed as a source of racial/ethnic disparities in perinatal health, such that the higher stress experienced by African American women causes their reproductive functioning to deteriorate more rapidly than that of White women.22 Other possible pathways through which stress can lead to birth outcome disparities include infection,23 nutrition,19 and pregnancy complications.24The majority of studies assessing the effects on birth outcomes of stress and related factors have relied on prenatal measurement with mixed results.19,25,26 A smaller number of studies have examined effects of acute stressors or specific chronic stressors in the reproductive period.27–30 Although several of these analyses suggested associations, this work included limitations such as small sample sizes,27 European cohorts not generalizable to the United States,29 or retrospectively reported preconception measures.30 Furthermore, none included both acute and chronic stressors or compared racial/ethnic differences for groups besides non-Hispanic Black and non-Hispanic White.To address these gaps in the literature, the objective of this study was to examine the impact of maternal preconception acute stressors (or stressful life events) and preconception chronic stressors (or stressful life conditions) on offspring birth weight and racial/ethnic birth weight disparities. Our hypotheses were as follows: (1) acute and chronic stressors will be inversely associated with birth weight, (2) the distributions of birth weight and stress will vary by maternal race/ethnicity, and (3) stress will partially explain racial/ethnic differences in birth weight where such differences exist. Our conceptual model is shown in Figure 1.Open in a separate windowFIGURE 1—Conceptual model depicting hypothesized relationships among maternal race/ethnicity, preconception stress, and offspring birth weight: National Longitudinal Study of Adolescent Health, United States, 1994–2008.     

Limiting Postpartum Weight Retention in Culturally and Linguistically Diverse Women: Secondary Analysis of the HeLP-her Randomized Controlled Trial

Postpartum weight retention (PPWR) contributes to maternal obesity development and is more pronounced in culturally and linguistically diverse (CALD) women. Our antenatal healthy lifestyle intervention (HeLP-her) demonstrated efficacy in reducing PPWR in non-Australian-born CALD women compared with Australian-born women. In this secondary analysis, we aimed to examine differences in the intervention effect on behavioral and psychosocial outcomes between Australian-born and non-Australian-born women and explore factors associated with the differential intervention effect on PPWR. Pregnant women at risk of gestational diabetes (Australian-born n = 86, non-Australian-born n = 142) were randomized to intervention (four lifestyle sessions) or control (standard antenatal care). PPWR was defined as the difference in measured weight between 6 weeks postpartum and baseline (12–15 weeks gestation). Behavioral (self-weighing, physical activity (pedometer), diet (fat-related dietary habits questionnaire), self-perceived behavior changes), and psychosocial (weight control confidence, exercise self-efficacy, eating self-efficacy) outcomes were examined by country of birth. Multivariable linear regression analysis was conducted to assess factors associated with PPWR. The intervention significantly increased self-weighing, eating self-efficacy, and self-perceived changes to diet and physical activity at 6 weeks postpartum in non-Australian-born women, compared with no significant changes observed among Australian-born women. Intervention allocation and decreased intake of snack foods were predictors of lower PPWR in non-Australian-born women. Results indicate that the HeLP-her intervention improved dietary behaviors, contributing to the reduction of PPWR in CALD women. Future translations could prioritize targeting diet while developing more effective strategies to increase exercise engagement during pregnancy in this population.     

Preparedness Planning for Emergencies Among Postpartum Women in Arkansas During 2009

PurposeHaving an emergency plan may reduce negative effects of disaster on the health of postpartum women and their infants. However, little is known about the prevalence of emergency plans among postpartum women. In 2009, Arkansas added a question to the Pregnancy Risk Assessment Monitoring System surveillance system about whether women who gave birth that year had an emergency plan. In this study, we first describe the sociodemographic characteristics, disaster experience, and region of residence of postpartum women in Arkansas who indicated that they had an emergency plan for their families in 2009, and second, examine associations between sociodemographic characteristics and disaster experience and the presence of an emergency plan.MethodsMultivariable logistic regression (n = 1,173) was conducted to examine associations between maternal race/ethnicity, sociodemographic characteristics, region of residence, disaster experience, and having a disaster plan. We adjusted for maternal education, federal poverty level, and family size in our final model.FindingsForty-eight percent (n = 559) of women reported having an emergency plan. Hispanic women were less likely to report having a plan compared with non-Hispanic White women (n = 102 [10%]; adjusted prevalence ratio [aPR], 0.6; 95% confidence interval [CI], 0.4–0.9). Families with five or more members were more likely to have a plan compared with smaller families (n = 123 [11%]; aPR, 1.3; 95% CI, 1.1–1.6).ConclusionsPolicymakers and public health practitioners can use these results to promote emergency planning among postpartum women in Arkansas, with special outreach to postpartum women who are Hispanic or have smaller families.     

Satiety Responsiveness and the Relationship Between Breastfeeding and Weight Status of Toddlers of Overweight and Obese Women

Numerous studies indicate an association between breastfeeding and decreased toddler adiposity. The mechanism behind this association is still unknown. One possibility is that children who are breastfed may have increased responsiveness to internal satiety cues. This study assessed the effect of satiety responsiveness on the association between breastfeeding and weight status among toddlers. We conducted a secondary analysis of data from 428 toddlers aged 2 years. Mothers’ body mass index (BMI) and children’s BMI z score were calculated from measured height and weight. Mothers completed a detailed breastfeeding survey and the satiety responsiveness subscale of the Child Eating Behaviour Questionnaire. Multiple linear regression and logistic regression were used to determine if satiety responsiveness mediated the effect of breastfeeding on BMI z score or overweight/obesity (BMI ≥ 85th percentile). Establishment of breastfeeding was associated with decreased BMI z score (0.40 vs. 0.60; p = 0.04), and increased breastfeeding intensity was associated with lower odds of overweight/obesity (OR 0.97, p = 0.04). Satiety responsiveness was not associated with either breastfeeding measures, suggesting it does not play a meditational role in the relationship between breastfeeding and toddler weight status. Furthermore, a relationship between satiety responsiveness and obesity does not exist after controlling for well-known confounders. This study did not find a mediation effect of satiety responsiveness on the association between breastfeeding and weight status in toddlers. More research is needed to characterize satiety responsiveness and its influence on the relationship between breastfeeding and childhood obesity.     

Weight, Diet, and Physical Activity-Related Beliefs and Practices Among Pregnant and Postpartum Latino Women: The Role of Social Support

Objectives: Eating and physical activity patterns may contribute to excessive pregnancy weight gain and postpartum retention that increase the risks of obesity and diabetes for both Latino mothers and their children. Social support is an important health determinant and may affect health-related beliefs and behaviors. The objective of this study was to investigate the influence of social support on weight, diet, and physical activity-related beliefs and behaviors among pregnant and postpartum Latinas. Methods: A community-based participatory project, Promoting Healthy Lifestyles among Women, was conducted in southwest Detroit to plan interventions aimed at reducing risks of obesity and type 2 diabetes. Qualitative analyses of in-depth semistructured interviews with dyads of 10 pregnant and postpartum Latinas, and 10 people who influenced them were conducted. Results: Husbands and some female relatives were primary sources of emotional, instrumental, and informational support for weight, diet, and physical activity-related beliefs and behaviors for Latina participants. Holistic health beliefs and the opinions of others consistently influenced Latinas' motivation and beliefs about the need to remain healthy and the links between behavior and health. Absence of mothers, other female relatives, and friends to provide childcare, companionship for exercise, and advice about food were prominent barriers that limited women's ability to maintain healthy practices during and after pregnancy. Conclusion: The findings support evidence that low-income, recently immigrated pregnant and postpartum Latinas could benefit from community-based, family-oriented interventions that provide social support necessary to promote and sustain healthy lifestyles.     

Prevalence and Risk Factors for Postpartum Depressive Symptoms Among Women Enrolled in WIC

The objectives of this study were to determine the prevalence and correlates of postpartum depressive symptoms (PDS) among women with a recent live birth and specifically among women participating in and eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pregnancy Risk Assessment and Monitoring System data from 22 states in 2006–2008 (n = 75,234) were used to estimate the prevalence of PDS using a two-question screener. Associations between PDS and respondent demographics, risk factors and behaviors, and WIC program eligibility and participation were assessed using logistic regression. Overall prevalence of PDS was 13.8 %:19.8 % among WIC participants, 16.3 % among non-participants eligible for WIC, and 6.8 % of women not eligible for the program. PDS prevalence was higher among younger, less educated, and poorer women, as well as those engaging in risky behaviors during pregnancy (smoking and binge drinking), and those with an unintended pregnancy and who experienced intimate partner violence during pregnancy. Controlling for these factors, the odds of PDS were no different between WIC participants and women eligible but not participating in the program (aOR 1.08, 95 % CI 0.97–1.22), but WIC enrollees were significantly more likely than ineligible women to report PDS (aOR 1.65, 95 % CI 1.39–1.95). WIC serves more than 1 million pregnant women each year, one-fifth of whom may experience PDS. WIC has a unique opportunity to screen and provide referrals to new mothers receiving postpartum WIC benefits.     

Risk Factors for Sub-Clinical and Major Postpartum Depression Among a Community Cohort of Canadian Women

Objectives To identify prenatal and perinatal factors that predict women at risk of sub-clinical and major postpartum depression among a cohort of low medical risk pregnant women in Canada. Methods Data from 1,403 women who completed a randomized controlled trial of supplementary support during pregnancy was analyzed to identify risk factors for sub-clinical and major postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS), completed at eight weeks postpartum, was used to classify each woman’s depression symptom severity. Demographic, obstetric, behavioral risk, mental health and psychosocial factors were considered. Multiple logistic regression analyses were used to identify risk factors most predictive of sub-clinical and major postpartum depression. Results After adjustment for other covariates, variables that increased the risk of sub-clinical postpartum depression included a history of depression (OR = 2.27, CI = 1.42–3.63), anxiety symptoms during pregnancy (OR = 2.12, CI = 1.09–4.11), being born outside Canada (OR = 1.87, CI = 1.17–3.00), and low parenting self-efficacy (OR = 1.65, CI = 1.06–2.55). Variables that increased the risk of major postpartum depression included a history of depression (OR = 2.78, CI = 1.56–4.97), being born outside Canada (OR = 2.97, CI = 1.70–5.17), depressive symptoms during pregnancy (OR = 2.83, CI = 1.29–6.19) and not breastfeeding at eight weeks postpartum (OR = 2.12, CI = 1.21–3.70). Conclusions A history of depression and being born outside Canada predicted women who were at an increased risk of sub-clinical and major postpartum depression. The remaining risk factors specific to sub-clinical and major postpartum depression suggest some differences between women vulnerable to sub-clinical compared to major depressive symptoms in the postpartum period, which may have implications for targeted screening and intervention strategies.     

孕期体重变化与胎盘重量和新生儿出生体重间的关系研究

目的探讨孕期体重变化、胎盘重量与新生儿出生体重间的关系,从而进一步探讨影响新生儿出生体重的相关因素,为孕期体重管理提供科学有效的参考依据,推进我市孕期合理体重增加模式的构建,降低低体重儿、巨大儿及妊娠期、分娩期并发症的发生率,提高母婴健康水平。方法收集2016年5月—12月间在高安市中医院住院分娩单胎活产且保健手册记录完整的产妇120例,通过卡方检验、方差分析等,分析不同孕前BMI组,孕期体重增加、新生儿出生体重及胎盘的差异及关系。结果按美国医学研究所推荐的体重控制自身体重的孕妇占54.16%,体重增加不足的孕妇占18.33%,体重增加超标的孕妇占27.5%。随着孕前BMI指数增加,孕妇体重增加逐渐降低,新生儿体重、胎盘重量均逐渐升高,差异均有统计学意义。新生儿出生体重与胎盘重量存在显著正相关,差异有显著统计学意义。胎盘重量大的孕妇分娩的新生儿体重高于胎盘重量低的孕妇。结论孕前BMI指数越低孕期增重越容易增长不足,孕前BMI指数越高孕期体重增长越容易超标。孕前BMI指数与新生儿出生体重呈正相关,故控制好孕前BMI指数可减低巨大儿的发生率。     

The Associations of Maternal Weight Change with Breastfeeding,Diet and Physical Activity During the Postpartum Period

Objective To determine the association between breastfeeding practices, diet and physical activity and maternal postpartum weight. Methods This was a secondary data analysis of a randomized community trial on beneficiaries of the Programa de Desarrollo Humano Oportunidades, recently renamed Prospera (n = 314 pregnant women), without any diseases that could affect body weight. Generalized estimating equations were used to determine the association between postpartum weight change and changes in diet, physical activity and type of breastfeeding. Results The mean postpartum weight change from the first to the third month was 0.6 ± 2.2 kg. Women who breastfed exclusively for 3 months had a 4.1 (SE = 1.9) kg weight reduction in comparison with women who did not provide exclusive breastfeeding or who discontinued breastfeeding before 3 months (p = 0.04). There was no association between postpartum weight change and physical activity (p = 0.24) or energy intake (p = 0.06). Conclusions Exclusive breastfeeding was associated with maternal postpartum weight reduction. These results reinforce the World Health Organization recommendation of exclusive breastfeeding during the first 6 months of life in order to reduce the risk of weight retention or weight gain in postpartum women. It has been well established that exclusive breastfeeding is beneficial for both infants and mothers, but promoting breastfeeding as a strategy to promote postpartum weight loss is of paramount importance, especially in countries like Mexico where excessive weight in women of reproductive age is a public health problem.