Influence of Pregnancy Weight on Maternal and Child Health Workshop Report (2007) / Chapter Skim
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4 Maternal Weight, Gestational Weight Gain, and Maternal Health
4 Maternal Weight, Gestational Weight Gain, and Maternal Health
Pages 33-49
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From page 33... ...
Understanding the effects of different weight patterns and gestational weight gain on maternal health outcomes requires close examination of the mechanisms that link gestational weight to later health conditions as well as consideration of risk and protective factors that contribute to or inhibit these effects. As discussed in Chapter 3, the relationship between prepregnancy weight and gestational weight gain is complex; their influence on maternal health outcomes is not easily distinguished, and this is reflected in this summary.
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From page 34... ...
A substantial interaction between prepregnant BMI and gestational weight gain arises when considering impaired glucose tolerance. In this study, women who were classified overweight before pregnancy and who also had excessive gestational weight gain were at a highly increased risk for impaired glucose tolerance when compared with women who had lower gestational weight gain and prepregnancy BMI.
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From page 35... ...
Inasmuch as the biological mechanism for this association could be the accumulation of fat it is possible that gestational weight gain may also play a role. Data from PRAMS have not demonstrated an interaction between prepregnant BMI and gestational weight gain on the duration of any breastfeeding, but Rasmussen's recent study of 2,700 women in Cooperstown, New York, reported such an interaction for the duration of exclusive breastfeeding (Hilson et al., 2006)
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From page 36... ...
In multivariate analysis, Olson et al. demonstrated that a variety of factors predicted postpartum weight retention, including high levels of exercise, low food intake, still breastfeeding at a year postpartum, low gestational weight gain, and extremes of maternal age.
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From page 37... ...
and Gestational Weight Gain Prepregnant Gestational Outcome BMI Weight Gain Interaction Preeclampsia Yes Yes Unknown Gestational diabetes Yes No Unknown Cesarean delivery Yes Yes Conflicting Failure to initiate/sustain breastfeeding Yes Yes No/conflicting Postpartum weight retention at 1 year No Yes Conflicting NOTES: "Yes" indicates an association has been found in the literature between prepregnancy BMI or gestational weight gain to a maternal health outcome. "No" indicates an association has not been found in the literature between prepregnancy BMI or gestational weight gain to a maternal health outcome.
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From page 38... ...
The available data, however, consistently show associations between increasing prepregnant BMI, more specifically being overweight or underweight, and a range of negative maternal health outcomes -- preeclampsia, gestational diabetes, cesarean delivery, failure to initiate and sustain breastfeeding, and postpartum weight retention at 1 year. The data that demonstrate relationships between gestational weight gain and these same negative outcomes are also consistent: excessive weight gain is associated with these same negative maternal health outcomes.
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From page 39... ...
. The key risk factors for the excess weight gain after pregnancy, which were fairly consistent across these studies, were high prepregnancy weight, high prepregnancy BMI, high gestational weight gain, and parity.
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From page 40... ...
The study indicates a potential pattern of postpartum maternal weight loss and suggests a point at which there is a change from a loss to a gain. As mentioned earlier, work done in the pregnancy cohort looked at whether pregnancy gain varied by prepregnancy BMI (Gunderson et al., 2001)
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From page 41... ...
Of those who became overweight, 69 percent had excessive gestational weight gain. A higher propor
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From page 42... ...
. These studies include only white women and have high attrition rates, but overall their results suggest that high prepregnancy BMI, weight retention at 6 months postpartum, gestational weight gain, and short breastfeeding duration are associated with greater weight gain later in life.
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From page 43... ...
that primiparous women gained more net weight than nulliparous ones, and excess net weight gain associated with one birth was about 7 lbs. for overweight women, who also had some increase in BMI with gestational weight gain (Rosenberg et al., 2003)
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From page 44... ...
. Chronic Diseases In terms of pregnancy and future risk of chronic disease, a study using a pregnancy cohort found that a high BMI and excess weight gain over 15 years were associated with increased risk of future chronic disease although the researchers did not report a direct association between gestational weight gain and chronic disease (Rooney et al., 2005)
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From page 45... ...
by prepregnancy weight or gestational weight gain and the impact of these factors on not only weight but also abdominal adiposity, body composition, and other risk factors for cardiovascular disease. Third, the field needs more information about preconception measures of the risk factors, gestational weight gain, postpartum weight patterns, whether postpartum weight gain is really retention or secular trends, and what point in time is the most important to intervene.
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From page 46... ...
including preeclampsia, gestational diabetes, cesarean delivery, failure to initiate and sustain breastfeeding, and postpartum weight retention at 1 year. Studies that show a relationship between gestational weight gain and these same immediate and short-term maternal health outcomes are also consistent.
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From page 47... ...
The high rates of obesity among women of reproductive age suggest that guidelines that are directed solely at changing gestational weight gain should be viewed as only one component of a comprehensive strategy to limit the long-term maternal effects of chronic obesity. Since the ability to predict gestational weight gain is limited and the consequences of inappropriate gestational weight gain are poorly understood, more research is necessary to inform the knowledge base that could guide policy and professional guidance.
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From page 48... ...
2003 Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 yr postpartum. International Journal of Obesity Related Metabolic Disorders 27(1)
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From page 49... ...
2006 Gestational Weight Gain: Short-term Maternal Health Outcomes. Presentation at the Workshop on the Impact of Pregnancy Weight on Maternal and Child Health, May 30, Washington, DC.
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