Weight development over time in parous women—The SPAWN study—15 years follow-up

Abstract

BACKGROUND: Weight gain is common after pregnancy. Most studies suggest that weight gain associated with a pregnancy is between 0.5 and 3.8 kg up to 2.5 y of follow-up. However, 73% of the female patients at our obesity clinic identified pregnancy as an important trigger for marked weight retention. The majority retained more than 10 kg after each pregnancy. The aim of this study was to examine long-term weight development after pregnancy in a 15 y follow-up of women who took part in the Stockholm Pregnancy And Women's Nutrition (SPAWN) study. METHOD AND SUBJECTS:The SPAWN study is a long-term follow-up study of women who delivered children in 1984-85 in Stockholm (n ¼ 2342). A total of 1423 participants (response rate ¼ 61%) completed questionnaires, which covered eating behaviour and exercise, demographic information including social situation and status and details of the pregnancy before, during and up to 1 y after pregnancy. After 15 y, these women were invited to take part in the follow-up study. Anthropometric measurements and the same questionnaire data were collected from the 563 women who participated (response rate ¼ 40%). The sample was divided into two main groups: those who were normal weight before pregnancy and remained normal weight, and those who were normal weight before pregnancy and had become overweight at 15 y follow-up. RESULTS: Those women who became overweight had a higher pre-pregnant body mass index (BMI) (22.371.5 vs 20.571.6 kg/m 2 , Po0.001), gained more weight during pregnancy (16.374.3 vs 13.673.7 kg, Po0.001) and had retained more at 1 y follow-up. The women who became overweight had a steeper weight trajectory gaining more from 1 y follow-up to 15 y follow-up (11.176.5 vs 4.576.5 kg, Po0.001), with a higher BMI at 15 y follow-up of 27.572.6 vs 22.572.3 5 kg/m 2 (Po0.001). However, differences between those who became overweight and those who did not could not be explained by age, number of children and various socioeconomic factors. Features of pregnancy that did differ between the two groups were breastfeeding and smoking cessation. However, women who became overweight had lower lactation scores than women who remained normal weight. Relatively more subjects of the group that became overweight stopped smoking during pregnancy. DISCUSSION: Pregnancy is a vulnerability factor for some women to become overweight. This study attempted to identify those factors that place initially normal weight women on a steeper weight trajectory as a result of pregnancy. Demographic, behavioural, physical and psychological characteristics only partly explain the weight gain observed at 15 y follow-up. Further research is required to investigate the relative role of these characteristics in predicting postpregnancy weight development.

Country development and the association between parity and overweight

“…8,9,38,39 Excess gestational weight gain has consistently been shown to increase postpartum weight retention in the short term, 38,[40][41][42] and has also been associated with increased weight gain in the long term. 5,9 Because of the changes occurring in many developing countries due to the nutrition transition (described below), these same mechanisms may now be operating in some developing countries. For example, a recent Brazilian study found that women who had gestational weight gain above recommendations had significantly higher postpartum weight retention at 9 months than women who gained within or below the guidelines, independent of prepregnant BMI.…”

“…[4][5][6][7] Excessive gestational weight gain and the inability to lose this weight in the postpartum period are thought to be two of the main ways in which reproduction contributes to overweight. 4,5,[8][9][10] In developing countries, frequent reproductive cycles (especially when accompanied by short or absent recuperative intervals, that is periods free from pregnancy or breastfeeding) have been suggested as a risk factor for maternal depletion. 11 Poor dietary intake and heavy activity patterns further exacerbate the nutritional and energetic stress of frequent reproductive cycles, such that nutritional status deteriorates over time.…”

New Mothers' Views of Weight and Exercise

“…If women gain weight during pregnancy according to the Institute of Medicine (IOM) recommendations, but fail to lose the extra weight by 6 months postpartum, they experience long term weight increases (Rooney & Schauberger, 2002). In addition, pre-pregnant body mass index (BMI) has also been shown to contribute to long term obesity, because women who start pregnancy heavier retain more weight following childbirth (Gunderson et al, 2004;Linne, Dye, Barkeling, & Rossner, 2003).…”

Identification of women at risk of adverse weight development following pregnancy

“…11,27 Few strong predictive factors before and during pregnancy have been identified, although weight retention at 1 year after delivery has been identified previously as a good point of predicting further weight development. 28 Clinically there is a need for reference values for high weight gain during pregnancy in order to identify women at risk of subsequent adverse weight development. Such reference values could enable targeted intervention during and after this major life event to prevent pregnancy to become a trigger of obesity.…”

“…34 To analyse the implications of drop-outs, we have made several drop-out analyses to determine if our material is representative. 28 It is known from previous studies that the subjects who drop out usually are people with low income and low socio-economic status. 39 These variables also correlate with higher body weight.…”