Factors affecting weight retention after pregnancy

1. Factors affecting weight retention after pregnancy Yvonne Linné MD, Associate Professor Obesity unit, Karolinska Institute Stockholm,Sweden

2. Obesity among women is increasing rapidly all over the world, and more and more women in fertile age become overweight and obese.

3. 73% of the female patients at our obesity unit reported that their weight problems started with a pregnancy and that they gained more than 10 kg after the pregnancy.

4. Stockholm Pregnancy and Weight Development study Weight (kg) -weight Delivery Check-up Months

6. Most studies report a mean weight retention of 0.4-3.8 kg as a result of a pregnancy in studies with a range of women from 87 to 113,606 women.

7. Factors involved in the weight development after pregnancy:• Weight gain during pregnancy • Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy• Socio-economic factors

8. Factors involved in the weight development after pregnancy:• Weight gain during pregnancy• Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy• Socio-economic factors

9. The strongest factors…… • Strongest factor for predicting weight development after pregnancy is • weight gain during pregnancy • weight retention at one year after delivery. • However, 50% of the high weight gainers during pregnancy lose their excess weight during the first year after delivery. Therefore, one year weight retention is a better starting point for intervention.

10. Factors involved in the weight development after pregnancy:• Weight gain during pregnancy• Smoking cessation• Changes in activity towards a more sedentary life style after pregnancy• Socio-economic factors

11. Factors involved in the weight development after pregnancy:• Weight gain during pregnancy • Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy• Socio-economic factors

12. Factors involved in the weight development after pregnancy:• Weight gain during pregnancy • Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy• Socio-economic factors

13. Factors not clearly involved in the weight development after pregnancy: • Weight before pregnancy • Age before pregnancy • Breastfeeding

15. Weight development over time Linne Y et al. Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res. 2004 Jul;12(7):1166-78.

16. Factors not clearly involved in the weight development after pregnancy: • Weight before pregnancy • Age before pregnancy • Breastfeeding

17. Factors not clearly involved in the weight development after pregnancy: • Weight before pregnancy • Age before pregnancy • Breastfeeding

18. Breast feeding • Energy expenditure by full lactation ≈ 500 kcal/day • However, no studies showing clinically important role of lactation for weight development after delivery

19. Small mean changes, but…..Kappel et al found in data from 2845 women that 25% of white women and 40% of the black women had gained more than 9 pounds at 8-10 weeks after delivery.Öhlin et al found in 1432 women that before pregnancy 13 % were overweight, at one year this number had increased to 21%.

20. Limitations 1. Self-reported weight before pregnancy. 2. Few studies have representative control groups. 3. Interaction with other factors such as age, socio-economic variables are hard to rule out. 4. Still unclear when to do the follow-up, 6 months, 1 year, later?

22. Limitations 1. Self-reported weight before pregnancy. 2. Few studies have representative control groups. 3. Interaction with other factors such as age, socio-economic variables are hard to rule out. 4. Still unclear when to do the follow-up, 6 months, 1 year, later?

23. Limitations 1. Self-reported weight before pregnancy. 2. Few studies have representative control groups. 3. Interaction with other factors such as age, socio-economic variables are hard to rule out. 4. Still unclear when to do the follow-up, 6 months, 1 year, later?

24. 1 .maternal age 2. marital status 3 maternal height 4. heterozygosity (monozygotic twins) 5. education 6. occupation, social class and employment status 7. urbanization 8. religion and church attendance 9. ethnicity 10 size and housing 11. husband’s age 12 income 13. capacity for work 14 smoking status 15. fertility 16. husband’s BMI17 obesity during adolescence and adult life18. age at menopause and/or menopausal problems19. birthweight of previous child20. body weight during first pregnancy21. household size22. age at menarche23. contraceptive and/or HRT use24. alcohol use25. physical activity26. medical history and health status27. family history of breast and/or endometrial cancer28. menstrual cycle rhythmicity29. dieting and weight cycling30. lactation31. interbirth interval Confounders identified by Harris et al.

25. 1 .maternal age 2. marital status 3 maternal height 4. heterozygosity (monozygotic twins) 5. education 6. occupation, social class and employment status 7. urbanization 8. religion and church attendance 9. ethnicity 10 size and housing 11. husband’s age 12 income 13. capacity for work 14 smoking status 15. fertility 16. husband’s BMI17 obesity during adolescence and adult life18. age at menopause and/or menopausal problems19. birthweight of previous child20. body weight during first pregnancy21. household size22. age at menarche23. contraceptive and/or HRT use24. alcohol use25. physical activity26. medical history and health status27. family history of breast and/or endometrial cancer28. menstrual cycle rhythmicity29. dieting and weight cycling30. lactation31. interbirth interval Confounders identified by Harris et al.

26. 1 .maternal age 2. marital status 3 maternal height 4. heterozygosity (monozygotic twins) 5. education 6. occupation, social class and employment status 7. urbanization 8. religion and church attendance 9. ethnicity 10 size and housing 11. husband’s age 12 income 13. capacity for work 14 smoking status 15. fertility 16. husband’s BMI17 obesity during adolescence and adult life18. age at menopause and/or menopausal problems19. birthweight of previous child20. body weight during first pregnancy21. household size22. age at menarche23. contraceptive and/or HRT use24. alcohol use25. physical activity26. medical history and health status27. family history of breast and/or endometrial cancer28. menstrual cycle rhythmicity29. dieting and weight cycling30. lactation31. interbirth interval Confounders identified by Harris et al.

27. 1 .maternal age 2. marital status 3 maternal height 4. heterozygosity (monozygotic twins) 5. education 6. occupation, social class and employment status 7. urbanization 8. religion and church attendance 9. ethnicity 10 size and housing 11. husband’s age 12 income 13. capacity for work 14 smoking status 15. fertility 16. husband’s BMI17 obesity during adolescence and adult life18. age at menopause and/or menopausal problems19. birthweight of previous child20. body weight during first pregnancy21. household size22. age at menarche23. contraceptive and/or HRT use24. alcohol use25. physical activity26. medical history and health status27. family history of breast and/or endometrial cancer28. menstrual cycle rhythmicity29. dieting and weight cycling30. lactation31. interbirth interval Confounders identified by Harris et al.

28. Limitations 1. Self-reported weight before pregnancy. 2. Few studies have representative control groups. 3. Interaction with other factors such as age, socio-economic variables are hard to rule out. 4. Still unclear when to do the follow-up, 6 months, 1 year, later?

29. Summary For the average woman pregnancy does not cause major weight retention, but in a subgroup of women pregnancy is associated with obesity. Weight development during and after pregnancy is probably not an effect of one single strong factor. Instead numerous factors, of which some are unknown or unmeasurable, seem to interact.

31. Thank you for your attention!