Editorials

Preventing Postpartum Weight Retention

Am Fam Physician. 2002 Aug 1;66(3):380-384.

Weight change in the postpartum period is a dominant concern of new mothers.1 Post-partum weight retention has important public health implications as well, because retention of gestational weight can be a significant contributor to long-term obesity and associated health risks.2 Family physicians should be aware of normal postpartum weight loss patterns, as well as risk factors for weight retention, so they can assist their patients in achieving a healthy postpartum weight.

Normal Postpartum Weight Loss Patterns

The greatest amount of weight loss occurs in the first three months postpartum and then continues at a slow and steady rate until six months postpartum.35 Studies relating lactation to postpartum weight loss have revealed inconsistent results, although most studies do not support the notion that breastfeeding accelerates postpartum weight loss or leads to less weight retention.3,59

Some investigators suggest that breastfeeding mothers may not lose as much weight as expected because the Recommended Daily Allowance (RDA) for lactating women of 2,500 kcal per day is too high and does not take into account the fact that most women who lactate are relatively sedentary. Recent research suggests that lactating women may more easily lose weight without diminishing their milk supply if their kcal intake per day is between 2,000 and 2,300.4,5

A recent prospective trial10 of 21 overweight, exclusively breastfeeding women found that caloric restriction by 500 kcal per day and 45 minutes of exercise per day, four days a week, resulting in a weight loss of approximately 0.5 kg per week between four and 14 weeks postpartum, did not affect the growth of their infants when they were compared with a control group who neither restricted calories nor exercised more than once a week.

Risk Factors for Weight Retention

Besides lactation, factors such as pre-gravid weight, gestational weight gain, age, parity, race, smoking status, exercise history, marital status, and employment have been investigated for a relationship to postpartum weight loss.3,79 Of these factors, weight gain during pregnancy is the one that has proved in multiple studies to be the most relevant.2,4,69,1113

The Institute of Medicine (IOM)14 recommends that women with a normal pre-gravid body mass index (BMI) of 19.8 to 26 should gain 11.5 to 16 kg during pregnancy; underweight women (BMI of less than 19.8) should gain 12.5 to 18 kg; overweight women (BMI of 26 to 29) should gain 7 to 11.5 kg; and obese women (BMI of greater than 29) should gain 6 kg.

In a 1995 prospective study11 of 274 patients with a normal pre-gravid BMI, 28 percent had excessive gestational weight gain (more than 0.68 kg per week at 20 to 36 weeks, or 20 kg total), retaining about 40 percent of the gestational weight at six months postpartum. This yielded an odds ratio of 2.9 for being overweight (BMI greater than 26) at six months postpartum.

Adolescent and black patients are at higher risk for postpartum weight retention. It is common for growing adolescent mothers to gain an excessive amount during pregnancy and to retain more of the weight into the early postpartum period than nongrowing adolescents.12

A study2 examining the implications of the IOM recommendations for 1,592 patients found that black women retained significantly more weight than white women with comparable weight gain during pregnancy. The higher rate of excessive weight gain in pregnancy and failure to return to pre-gravid weight postpartum may partially explain the higher prevalence of obesity and obesity-related illnesses in women of these two patient populations.11,15

Achieving a Healthy Postpartum Weight

Family physicians should counsel their patients during pregnancy about the risks of excessive weight gain and subsequent obesity. Gestational weight gain in excess of current IOM recommendations (even in patients with a normal pre-gravid BMI) can lead to significant postpartum weight retention, especially in growing adolescents, minorities, and low-income patients.

Family physicians can help patients develop realistic weight loss goals in the postpartum period and beyond, emphasizing that post-partum weight loss normally proceeds slowly and steadily. Lactation may not facilitate weight loss, especially if the patient consumes a high-calorie diet and does not routinely exercise for an adequate amount of time.

Nicole P. Somvanshi, M.D., is a faculty member in the department of family medicine at Franklin Square Hospital, Baltimore.

Address correspondence to Nicole P. Somvanshi, M.D., Department of Family Medicine, Franklin Square Hospital, 9101 Franklin Square Dr., Suite 205, Baltimore, MD 21237 (e-mail: nicoleso@helix.org).

REFERENCES

1. Kline CR, Martin DP, Deyo RA. Health consequences of pregnancy and childbirth as perceived by women and clinicians. Obstet Gynecol. 1998;92:842–8.

2. Keppel KG, Taffel SM. Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine Guidelines. Am J Public Health. 1993;83:1100–3.

3. Kramer FM, Stunkard AJ, Marshall KA, McKinney S, Liebschutz J. Breast-feeding reduces maternal lower-body fat. J Am Diet Assoc. 1993;93:429–33.

4. Crowell DT. Weight change in the postpartum period: a review of the literature. J Nurse Midwifery. 1995;40:418–23.

5. Brewer MM, Bates MR, Vannoy LP. Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating women. Am J Clin Nutr. 1989;49:259–65.

6. Haiek LN, Kramer MS, Ciampi A, Tirado R. Postpartum weight loss and infant feeding. J Am Board Fam Pract. 2001;14:85–94.

7. Janney CA, Zhang D, Sowers M. Lactation and weight retention. Am J Clin Nutr. 1997;66:1116–24.

8. Butte NF, Hopkinson JM. Body composition changes during lactation are highly variable among women. J Nutr. 1998;1282 suppl:381S–385S.

9. Lederman SA. The effect of pregnancy weight gain on later obesity. Obstet Gynecol. 1993;82:148–55.

10. Lovelady CA, Garner KE, Moreno KL, Williams JP. The effect of weight loss in overweight, lactating women on the growth of their infants. N Engl J Med. 2000;342:449–53.

11. Scholl TO, Hediger ML, Schall JI, Ances IG, Smith WK. Gestational weight gain, pregnancy outcome, and postpartum weight retention. Obstet Gynecol. 1995;86:423–7.

12. Scholl TO, Hediger ML, Schall JI, Khoo CS, Fischer RL. Maternal growth during pregnancy and the competition for nutrients. Am J Clin Nutr. 1994;60:183–8.

13. Greene GW, Smiciklas-Wright HS, Scholl TO, Karp RJ. Postpartum weight change: how much of the weight gained in pregnancy will be lost after delivery/. Obstet Gynecol. 1988;71:701–7.

14. Subcommittee on Nutritional Status and Weight Gain during Pregnancy; Subcommittee on Dietary Intake and Nutrient Supplements during Pregnancy; Committee on Nutritional Status during Pregnancy and Lactation; Food and Nutrition Board; Institute of Medicine (U.S.). Nutrition during pregnancy: summary. Washington D.C.: National Academy Press, 1990:1–23.

15. Kuczmarski RJ. Prevalence of overweight and weight gain in the United States. Am J Clin Nutr. 1992;552 suppl:495S–502S.


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