Assessing Readiness in Military Women The Relationship of Body, Composition, Nutrition, and Health (1998) / Chapter Skim
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6 Pregnancy and Lactation and Postpartum Return-To-Duty Fitness
6 Pregnancy and Lactation and Postpartum Return-To-Duty Fitness
Pages 127-156
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From page 127... ...
. Prior to the twentieth week, pregnant women are allowed to remain on sea duty if, in an emergency situation, medical treatment can be obtained within 6 hours (Navy and Marine Corps)
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~ The Air Force does not have personnel classified as warrant officers. SOURCE: Defense Manpower Data Center (Rosslyn, Va., 1996~.
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a variety of factors that pose a risk to successful pregnancy outcome in active-duty women. These factors include the profile of the military woman herself, dietary habits, pressures to meet body weight standards, and service work environments.
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There was some evidence that pregnant women would be transferred off ships before 20 weeks. Frequently mentioned hazards included toxic chemicals, fuels, fumes from paints, and other products.
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, arid pregnant women constituted 1.4 percent of enlisted forces. Pregnancy rates were highest among women in pay grades E-4 and below and among women in their first enlistment.
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Army According to the Army Sample Survey of Military Personnel, g percent of enlisted females, 4 percent of warrant officers, and 6 percent of officers reported giving birth during fiscal year 1996 (Table 6-51. Air Force Prevalence rates of pregnancy among Air Force servicewomen were obtained from the Air Force Office of Medical Logistics.
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Pregnancy Course and Outcome Although DoD service-wide statistics are not available, studies suggest that pregnancy complications and preterm delivery may be more prevalent in military women than in their civilian counterparts. A survey compared deliveries within the DoD military health care system in 1980 (N= 100,351)
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African American enlisted women in the Aridly had a cumulative probability of preterm delivery (13.5%) that was higher than that for Caucasian enlisted women (10.5%)
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preterm deliveries occur, nor for spontaneous rupture of membranes or idiopathic preterm labor, the most common causes of preterm delivery. African American-Caucasian hazard ratios were greatest and significantly different for all deliveries before 33 weeks and for medically indicated preterm deliveries that were required because of severe preeclampsia, fetal growth restriction, or fetal compromise.
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The proportions diagnosed with pregnancy-induced hypertension were similar in African American and Caucasian women in the Navy and Marine Corps (Irwin et al., 1 994)
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Pregnancy complication rates were not associated with MOS or marital status, but were associated with high gestational weight gain. Studies of pregnancy outcome among active-duty Air Force women have shown that African American women were at increased risk of preecIampsia and of giving birth to smaller preterm infants, but that rates of pregnancy-induced hypertension and infant mortality were unaffected by ethnic origin.
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From page 140... ...
Consultation with a physician is encouraged. Lower gestational weight gain and birth weight among women who exercise through pregnancy have been demonstrated in some (Bell et al., 1995; Clapp, 1990; Clapp and Dickstein, 1984; Clapp and Little, 1995)
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In contrast to the above studies, when four levels of exercise, from vigorous walking at least three times per week for at least 20 minutes to aerobic exercise less than once a week in 388 women, were monitored from 16.5 weeks through delivery (Sternfeld et al., 1995) , birth weight, gestational age, and gestational weight gain were unrelated to the level of exercise.
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POSTPARTUM CHANGES IN WEIGHT AND PHYSICAL FITNESS No data were found on the percentage of military women who attain weight, body fat, and fitness standards by 6 months postpartum. Gestational weight gain is the major determinant of postpartum weight retention, but unfortunately, representative statistics on gestational weight gain are not available on military servicewomen.
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Very young adolescents and African Americar~ women should aim for upper limit of range arid short women should aim for the lower limit of range. Since the release of the TOM recommendations on gestational weight gain, a number of reports have validated the recommendations in terms of infarct outcome arid postpartum weight retention (Cogswell et al., 1995; Edwards et al., 1996; Hickey et al., 1993; Muscati et al., 1996; Parker and Abrams, 1992; Siega-Riz et al., 1994)
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gained less than recommended as compared with other groups. Since African American women in each pregravid BMI category delivered increasingly larger infants as they met or exceeded recommended gestational weight gain, it was concluded that African American women should strive for the upper end of the recommended range for pregravid BMI.
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Moreover, African American women appear less likely to lose weight postpartum. Postpartum Weight Loss Postpartum weight retention increases with gestational weight gain (Abrams, 1994; Parker and Abrams, 1992)
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. Predictors of postpartum weight loss included ethnicity, gestational weight gain, prepregnancy weight, parity, and prenatal exercise (Boardley et al., 1995; Schauberger et al., 1992)
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Postpartum weight retention is higher at every level of gestational weight gain for African American women. Many women do not return to prepregnancy weight by 6 months postpartum.
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Lactation and Postpartum Weight Loss Research on the rate of weight loss during lactation (IOM, 1991) tends to show an average weight loss between 0 and 6 months postpartum of I.3 to I.8 lb/mo (0.6-0.8 kg/mo)
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Effects of rapid weight loss are unknown the first month postpartum when the milk supply is being established. Physical Activity and Lactation , particularly during No adverse effect of vigorous exercise on lactation performance was observed in a group of exercising women (N = 8)
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To reduce attrition and enhance military readiness, all supervisory staff need increased training and education regarding pregnancy policy and treatment of pregnant personnel. Few data are available on pregnancy outcome or the rate of gestational weight gain and postpartum weight loss for active-duty women.
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1996. Determinants of gestational weight gain outside the recommended ranges among black and white women.
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1996. Pregnancy complications and birth outcome in obese and normal-weight women: Effects of gestational weight change.
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1983. The effects of lactation on energy and protein consumption, postpartum weight change and body composition of well-nourished North American women.
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1994. Institute of Medicine maternal weight gain recommendations and pregnancy outcome in a predominantly Hispanic population.
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1992. Impact of pregnant women and single parents upon Navy personnel systems.
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