Elsevier

Public Health

Volume 135, June 2016, Pages 144-146
Public Health

Short Communication
Maternal weight trajectories between early pregnancy and four and nine months postpartum

https://doi.org/10.1016/j.puhe.2016.02.017Get rights and content

Highlights

  • Weight and BMI changes after pregnancy are not linear.

  • Weight changes after pregnancy is different in obese compared with non-obese women.

  • 16.6% normal BMI women in early pregnancy were overweight at four months postpartum.

  • 11.1% normal BMI women in early pregnancy were overweight at nine months postpartum.

  • 90% of those who were obese in early pregnancy were obese at four and nine months postpartum.

Introduction

Over a generation there has been a dramatic increase in adult obesity levels in well-resourced countries. Maternal weight retention after pregnancy is variable.1 However, optimising weight management following childbirth may potentially reduce the long-term risks of obesity-related disorders such as diabetes, heart disease and cancer among women of childbearing age; as well as reducing their risk of obesity-related obstetric complications in future pregnancies.

The National Institute for Health and Care Excellence (NICE) Guidelines identified the postpartum period as a vulnerable life stage for weight gain.2, 3 It has been suggested that more knowledge about weight management during the postpartum period is required.4 The Institute of Medicine (IoM) has also stated that there are gaps in the surveillance of postpartum weight retention (PPWR), and that findings should be reported by Body Mass Index (BMI) category.5 NICE identified the need for a population-based approach in relation to weight management before, during and after pregnancy in order to reach all women of childbearing age as many pregnancies are unplanned. NICE have also highlighted that information describing the most effective time for women to start managing their weight after childbirth, and the optimal rate of weight loss during this postpartum period is lacking.3

The aim of this prospective longitudinal study was to address these knowledge deficits by comparing 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.

The Coombe Women and Infants University Hospital (CWIUH) is one of the largest maternity hospitals in the EU and cares for women from all socio-economic groups and from across the urban-rural divide. Women were recruited to our study at their convenience between February and August 2013 after an ultrasound examination confirmed an ongoing singleton pregnancy. The woman's clinical and sociodemographic details were computerized routinely at the first antenatal visit and updated immediately after delivery.

Height was measured to the nearest centimetre using a Seca wall-mounted digital height measure with the woman standing in her bare feet. Weight was measured in a standardized way before 18 weeks gestation. We have previously reported in a cross-sectional study that there is no significant change in mean maternal weight before this stage of gestation.6, 7 BMI was calculated and categorized according to the World Health Organization BMI classification.8 Written informed consent was obtained. Women received no dietary or lifestyle interventions as part of the research either during or after pregnancy.

Women were invited back to the hospital at approximately four and nine months postpartum. The woman's weight and BMI were re-measured and socio-economic and infant feeding data were collected using standardized questionnaires. The study was approved by the hospital's Research Ethics Committee on the 16th May 2012.

The number of women initially enrolled in the first trimester was 1035. Of the 1035 women, 98% (n = 1018) delivered a live-born baby in the hospital. Women returned for their four month postpartum appointment (n = 494) at 18.0 ± 2.2 weeks postpartum and their nine month postpartum appointment (n = 328) at 39.8 ± 3.6 weeks postpartum. Of the 328 women who attended all appointments, mean weight at the 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.

Section snippets

Longitudinal changes in weight and BMI

Wilcoxin signed rank tests, conducted with a Bonferroni correction, were used to assess longitudinal changes in maternal weight and BMI which occurred from early pregnancy to four and nine months postpartum (n = 328). Increases in weight (r = 0.46; z = −8.5 (P ≤ 0.001)) and BMI (r = 0.47; z = −8.43 (P ≤ 0.001)) occurred between early pregnancy and four months postpartum. Conversely, decreases in weight (r = 0.43; z = −7.9 (P ≤ 0.001)) and BMI (r = 0.40; z = −7.4 (P ≤ 0.001)) were observed

Acknowledgements

We acknowledge the commitment of the pregnant women who took part in this study.

Ethical approval

This study was approved by the hospital's Research Ethics Committee on the 16th May 2012.

Funding

This project was supported by the UCD Centre for Human Reproduction and was partially funded by an unlimited educational grant from Danone Nutricia Early Life Nutrition for the first author. Danone Nutricia Early Life Nutrition had no role in the study design, data analysis, data interpretation or writing of this article.

Competing interests

The

First page preview

First page preview
Click to open first page preview

References (10)

  • S.A. Gore et al.

    The role of postpartum weight retention in obesity among women: a review of the evidence

    Ann Behav Med

    (2003)
  • Centre for Public Health Excellence at NICE (UK)

    Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children

    (2006)
  • National Institute for Health and Clinical Excellence

    NICE public health guidance 27: weight management before, during and after pregnancy

    (2010)
  • J. Messina et al.

    Systematic review of weight management interventions after childbirth

    (2009)
  • Institute of Medicine

    Weight gain during pregnancy: reexamining the guidelines

    (2009)
There are more references available in the full text version of this article.

Cited by (0)

View full text