Early Postpartum Period Important To Prevent Long-Term Weight Gain

MedicalResearch.com Interview with:
Laura Mullaney

School of Biological Sciences
Dublin Institute of Technology
Dublin Ireland.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are gaps in our knowledge regarding postpartum changes in weight. There continues to be a dramatic increase in adult obesity and the postpartum period is a vulnerable life-stage for weight gain in women. Maternal obesity matters because it is associated with an increase in both fetal and maternal complications, it is technically challenging, it is economically costly and it carries potential lifelong health consequences for the woman and her offspring.

Thus, our aim was to compare trajectories in maternal weight and BMI between early pregnancy and four months postpartum and nine months postpartum, and to analyse these trajectories by BMI category.

Of the 328 women who attended all appointments, mean weight at the first antenatal visit was 69.3 ±14.3 kg, mean Body Mass Index (BMI) was 25.3 ±5.0 kg/m2 and 14.4% were obese. At four months postpartum, the mean change in weight from the first antenatal visit was +1.6 ±4.2 kg, the mean change in BMI was +0.6 ±1.5 kg/m2 and 19.2% were obese. At nine months postpartum, the mean change in weight was +0.2 ±4.7 kg, the mean BMI change was -0.06 ±1.8 kg/m2 and 16.8% were obese.

Of women who had an ideal BMI in early pregnancy, 16.6% and 11.1% were overweight at four and nine months postpartum respectively. Of women who were overweight in early pregnancy, 20.3%and 14.3% had become obese at four and nine months postpartum respectively. Ninety percent of women who were obese in early pregnancy remained obese at four and nine months postpartum.

Women who had gained weight between early pregnancy and four months postpartum had a lower early pregnancy BMI and were less likely to be obese in early pregnancy. However women who gained weight between four and nine months postpartum were more likely to be obese in early pregnancy.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: This study fills a knowledge gap by assessing weight trajectories according to participants’ BMI categorisation at the first antenatal visit. Clinicians and pregnant women should be aware that maternal weight trajectories after pregnancy are not linear and that there are different trajectories in obese compared with non-obese women.

In addition there is currently a lack of data concerning the most effective time for women to initiate weight management after childbirth. Obese women in this study increased their weight between four and nine months postpartum. Women with an ideal BMI in early pregnancy however, had weight and BMI gains up to four months postpartum, with some partial reversal of these trends between four and nine months postpartum. Other studies have shown that failure to lose weight gained during pregnancy by six months postpartum, can result in long-term weight retention. Thus from our findings, the early postpartum period may be an important time to intervene to prevent long-term weight retention, particularly in obese women. Postnatal check-ups may be an opportune time for clinicians to discuss weight management with women. Additionally strategies aimed at reducing pre-pregnancy BMI may help to prevent excessive postpartum weight gain, along with other adverse maternal and fetal consequences known to be associated with entering pregnancy with a high BMI, for example, the increased risk of developing gestational diabetes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: In light of our findings, future research should focus on body composition measurements in the perinatal and postpartum periods to investigate the type of weight changes occurring in women. Additionally, lifestyle characteristics of women who are more susceptible to weight gain postpartum, for example diet, physical activity and infant feeding practices, need to be further elucidated. These findings should help to further inform intervention studies aimed at addressing postpartum weight changes.

MedicalResearch.com: Is there anything else you would like to add?

Response: Loss to follow-up continues to be a major limiting factor in postpartum research. The postpartum period is a challenging time for a woman with a new baby. Randomized control trials need to be aware of this when formulating their study design. Measures need to be taken to increase participation of women in the postpartum period. Indeed the pre-pregnancy period may be a more opportune time to intervene in terms of weight perinatal management. Women may be more accepting of weight loss interventions before pregnancy, as weight loss at this time may yield a reduced risk of adverse outcomes for their offspring. In addition, women may have more time prepregnancy to engage in a weight loss intervention than they do postpartum.

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Public Health. 2016 Apr 1. pii: S0033-3506(16)00074-3. doi: 10.1016/j.puhe.2016.02.017.

Maternal weight trajectories between early pregnancy and four and nine months postpartum.

Mullaney L1, O’Higgins AC2, Cawley S3, Daly N2, McCartney D3, Turner MJ2.

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