Studies examining postpartum retained weight referenced to prepregnant body weight may mask weight gained after 6 weeks postpartum, a potential unrecognized factor contributing to weight increases after pregnancy.
Materials and Methods:
Using data from a longitudinal study, we examined three weight patterns from 6 weeks to 6 months postpartum (>2.3 kg gain; >2.3 kg loss; and ±2.3 kg as stable weight) in 302 low-income women. Predictor variables included perinatal variables, health habits, and depression risk at 3 and 6 months postpartum.
Results:
Mean weight changes were weight-gain group: 5.77 kg, standard deviation (SD) = 2.57; weight loss group: −4.79 kg, SD = 2.10; and stable group: 0.05 kg, SD = 1.24. The odds of gaining weight compared with stable weight increased with prepregnant overweight/obesity (adjusted odds ratio [aOR] = 3.22, 95% confidence interval [CI] = 1.74–6.00), and decreased with a first birth (aOR = 0.47, 95% CI = 0.24–0.93). The odds of losing weight increased with excessive gestational weight gain (aOR = 2.40, 95% CI = 1.10–5.21) and depression risk at 6 months (aOR = 2.57, 95% CI = 1.40–4.72), and decreased with prepregnant overweight/obesity (aOR = 0.49, 95% CI = 0.25–0.94). Health habits were not associated with weight gain or loss.
Conclusions:
Women with high body mass index (BMIs) may need added postpartum care to avoid gaining weight. Weight loss, although welcomed, may be secondary to depression risk. In both cases, low-cost, effective, and targeted care during the extended postpartum period could benefit women's health.
Get full access to this article
View all access options for this article.
References
1.
DietzWH.Obesity and excessive weight gain in young adults: New targets for prevention. JAMA, 2017; 318:241–242.
2.
McKinleyMC, Allen-WalkerV, McGirrC, RooneyC, WoodsideJV. Weight loss after pregnancy: Challenges and opportunities. Nutr Res Rev, 2018; 31:225–238.
3.
Centers for Disease Control and Prevention. Pediatric and Pregnancy Nutrition Surveillance System: Pregnancy data tables by health indicators, 2012:20. Available at: https://idph.iowa.gov/Portals/1/Files/WIC/2010%20National%20PNSS%20tables.pdf Accessed March2, 2019.
4.
DeputyNP, SharmaAJ, KimSY, HinkleSN. Prevalence and characteristics associated with gestational weight gain adequacy. Obstet Gynecol, 2015; 125:773–781.
5.
ParkS, SappenfieldWM, BishC, SalihuH, GoodmanD, BensylDM. Assessment of the Institute of Medicine recommendations for weight gain during pregnancy: Florida, 2004–2007. Matern Child Health J, 2011; 15:289–301.
6.
PawlakMT, AlvarezBT, JonesDM, LezotteDC. The effect of race/ethnicity on gestational weight gain. J Immigr Minor Health, 2015; 17:325–332.
7.
CollingsR, HillB, SkouterisH. The influence of psychological factors on postpartum weight retention 12 months post-birth. J Reprod Infant Psychol, 2018; 36:177–191.
8.
EndresLK, StaubH, McKinneyC, et al.Postpartum weight retention risk factors and relationship to obesity at 1 year. Obstet Gynecol, 2015; 125:144–152.
9.
HaugenM, BrantsaeterAL, WinkvistA, et al.Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: A prospective observational cohort study. BMC Pregnancy Childbirth, 2014; 14:201.
10.
Lan-PidhainyX, NohrEA, RasmussenKM. Comparison of gestational weight gain-related pregnancy outcomes in American primiparous and multiparous women. Am J Clin Nutr, 2013; 97:1100–1106.
11.
ShaoHH, HwangLC, HuangJP, HsuHY. Postpartum weight retention risk factors in a Taiwanese cohort study. Obes Facts, 2018; 11:37–45.
12.
WalkerLO, TimmermanGT, SterlingBS, KimM., DicksonP.Do low-income women attain their pre-pregnant weight by the 6th week of postpartum?. Ethn Dis, 2004; 14:119–126.
13.
SchaubergerCW, RooneyBL, BrimerLM. Factors that influence weight loss in the puerperium. Obstet Gynecol, 1992; 79:424–429.
14.
LedermanSA, AlfasiG, DeckelbaumRJ. Pregnancy-associated obesity in black women in New York City. Matern Child Health J, 2002; 6:37–42.
15.
SchneiderCR, BiggioJR, Chandler-LaneyPC. Association of early pregnancy body mass index with post-partum weight change among African-American women. Clin Obes, 2018; 8:170–175.
16.
WalkerLO, SterlingBS, KimM., ArheartKL, TimmermanGT.Trajectory of weight changes in the first 6 weeks postpartum. J Obstet Gynecol Neonatal Nurs, 2006; 35:472–481.
17.
SorbyeLM, SkjaervenR, KlungsoyrK, MorkenNH. Gestational diabetes mellitus and interpregnancy weight change: A population-based cohort study. PLoS Med, 2017; 14:e1002367.
18.
YangZ, PhungH, FreebairnL, SextonR, RaulliA, KellyP. Contribution of maternal overweight and obesity to the occurrence of adverse pregnancy outcomes. Aust N Z J Obstet Gynaecol, 2019; 59:367–374.
19.
BatemanBT, ShawKM, KuklinaEV, CallaghanWM, SeelyEW, Hernández-DíazS. Hypertension in women of reproductive age in the United States: NHANES 1999–2008. PLoS One, 2012; 7:e36171.
20.
ZhengY, MansonJE, YuanC, et al.Associations of weight gain from early to middle adulthood with major health outcomes later in life. JAMA, 2017; 318:255–269.
21.
GundersonEP, AbramsB. Epidemiology of gestational weight gain and body weight changes after Pregnancy. Epidemiol Rev, 1999; 21:261–275.
22.
GundersonEP, AbramsB, SelvinS. Does the pattern of postpartum weight change differ according to pregravid body size?. Int J Obes Relat Metab Disord, 2001; 25:853–862.
23.
National Research Council and the Institute of Medicine. Influence of pregnancy weight on maternal and child health. Washington, DC: National Academies Press, 2007.
24.
HalesCM, CarrollMD, FryarCD, OgdenCL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief, 2017;(288):1–8.
25.
FowlesER, WalkerLO. Correlates of dietary quality and weight retention in postpartum women. J Community Health Nurs, 2006; 23:183–197.
26.
OstbyeT, PetersonBL, KrauseKM, SwamyGK, LoveladyCA. Predictors of postpartum weight change among overweight and obese women: Results from the Active Mothers Postpartum study. J Womens Health, 2012; 21:215–222.
27.
ÖhlinA, RössnerS. Trends in eating patterns, physical activity and socio-demographic factors in relation to postpartum body weight development. Br J Nutr, 1994; 71:457–470.
28.
WalkerLO, KangS, SterlingBS. Weight-loss resilience among low-income postpartum women: Association with health habits. West J Nurs Res, 2019:41:1709–1723.
29.
GoldsteinND, RogersS, EhrenthalDB. The impact of psychosocial stressors on postpartum weight retention. Arch Womens Ment Health, 2016; 19:691–694.
30.
HerringSJ, Rich-EdwardsJW, OkenE, Rifas-ShimanSL, KleinmanKP, GillmanMW. Association of postpartum depression with weight retention 1 year after childbirth. Obesity, 2008; 16:1296–1301.
OlsonCM, StrawdermanMS, HintonPS, PearsonTA. Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. Int J Obes Relat Metab Disord, 2003; 27:117–127.
33.
MacMillan UribeAL, OlsonBH. Exploring healthy eating and exercise behaviors among low-income breastfeeding mothers. J Hum Lact, 2019; 35:59–70.
34.
WalkerLO, Freeland-GravesJH, MilaniT, et al.Weight and behavioral and psychosocial factors among ethnically diverse, low income women after childbirth. I. methods and context. Women Health, 2004; 40:1–17.
35.
SorensenTIA, RissanenA, KorkeilaM, KaprioJ. Intention to lose weight, weight changes, and 18-y mortality in overweight individuals without co-morbidities. PLoS Med, 2005; 2:e171.
36.
WingRR, PhelanS. Long-term weight loss maintenance. Am J Clin Nutr, 2005; 82(Suppl):222S–225S.
37.
AbebeDS, Von SoestT, Von HolleA, ZerwasSC, TorgensenL, BulkCM. Developmental trajectories of postpartum weight 3 years after birth: Norwegian Mother and Child Cohort study. Matern Child Health J, 2015; 19:917–925.
38.
KacG, BenicioMH, Velasquez-MenendezG, ValenteJG, StruchinerCJ. Gestational weight gain and prepregnancy weight influence postpartum weight retention in a cohort of Brazilian women. J Nutr, 2004; 134:661–666.
39.
KrauseKM, LoveladyCA, PetersonBL, ChowdhuryN, OstbyeT. Effect of breast-feeding on weight retention at 3 and 6 months postpartum: Data from the North Carolina WIC programme. Public Health Nutr, 2010; 13:2019–2026.
40.
RooneyBL, SchaubergerCW. Excess pregnancy weight gain and long-term obesity: One decade later. Obstet Gynecol, 2002; 100:245–252.
41.
RooneyBL, SchaubergerCW, MathiasonMA. Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstet Gynecol, 2005; 106:1349–1356.
42.
Institute of Medicine. Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: National Academy Press, 2009.
43.
RadloffLS.The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas, 1977; 1:385–401.
44.
VilagutG, ForeroCG, BarbagliaG, AlonsoJ. Screening for depression in the general population with the Center for Epidemiologic Studies Depression (CES-D): A systematic review with meta-analysis. PLoS One, 2016; 11:e0155431.
45.
BrawarskyP, StotlandNE, JacksonRA, et al.Pre-pregnancy and pregnancy-related factors and the risk of excessive or inadequate gestational weight gain. Int J Gynecol Obstet, 2005; 91:125–131.
46.
Chasan-TaberL, SchmidtMD, PekowP, SternfeldB, SolomonCG, MarkensonG. Predictors of excessive and inadequate gestational weight gain in Hispanic women. Obesity, 2008; 16:1657–1666.
47.
WellsCS, SchwalbergR, NoonanG, GaborV. Factors influencing inadequate and excessive weight gain in pregnancy: Colorado, 2000–2002. Matern Child Health J, 2006; 10:55–62.
48.
HillB, McPhieS, SkouterisH. The role of parity in gestational gain and postpartum weight retention. Women's Health Issues, 2016; 26:123–129.
49.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: American Psychiatric Association, 2013.
50.
BergeJM, LarsonN, BauerKW, Neumark-SztainerD. Are parents of young children practicing healthy nutrition and physical activity behaviors?. Pediatrics, 2011; 127:881–887.
51.
HullEE, RofeyDL, RobertsonRJ, NagleEF, OttoAD, AaronDJ. Influence of marriage and parenthood on physical activity: A 2-year prospective analysis. J Phys Act Health, 2010; 7:577–583.
52.
NasutiG, BlanchardC, NaylorPJ, et al.Comparison of the dietary intakes of new parents, second-time parents, and nonparents: A longitudinal cohort study. J Acad Nutr Diet, 2014; 114:450–456.
