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  • Print publication year: 2012
  • Online publication date: August 2012

8 - Long-term consequences of obesity in pregnancy for the mother

from Section 3 - Long-term consequences

Summary

Introduction

Current knowledge argues that pregnancy serves as a preview of a woman’s long-term health. The numerous physiological changes during pregnancy, which stress the metabolic system [1], can reveal subclinical disease states as well as identify new ones [2,3]. Evidence for this assertion exists in studies that have examined the association between gestational diabetes mellitus (GDM) and subsequent type 2 diabetes mellitus (T2DM) [4], as well as hypertensive disorders during pregnancy and subsequent cardiovascular disease risk factors [5]. Whether pregnancy is on the causal pathway or simply a time period that allows these chronic diseases to be unmasked remains yet to be determined. Obese women are more likely to be at higher risk of developing complications such as GDM, hypertensive disorders, and pre-eclampsia during pregnancy [6–9]. In this chapter we will focus on the evidence for the association between gestational weight gain and postpartum weight retention among obese women, as well as the association between obesity and lack of breastfeeding, and how these associations are potentially interrelated to cause further disease in obese women.

Postpartum weight retention

Pregnancy and its associated weight gain may be potential “triggers” for the development of obesity in women [10,11]. Pooled estimates of average absolute postpartum weight retention in units of body mass index (BMI) (kg/m2) are 2.42 (95% CI: 2.32–2.52) at six weeks, 1.14 (95% CI: 1.04–1.25) at six months, and 0.46 (95% CI: 0.38–0.54) at twelve months postpartum [12]. These estimates suggest that most women will lose the majority of weight that is associated with pregnancy within one year postpartum. However, many studies have observed a wide range of variation in postpartum weight retention [13,14], with as many as 20% of women having substantial postpartum weight retention ranging over 5kg (11lbs) [13].

References
Kaaja, R J Greer, I A Manifestations of chronic disease during pregnancy JAMA 2005 294 2751
Rich-Edwards, J W McElrath, T F Karumanchi, S A Seely, E W Breathing life into the lifecourse approach: pregnancy history and cardiovascular disease in women Hypertension 2010 56 331
Sattar, N Greer, I A Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening? BMJ 2002 325 157
Bellamy, L Casas, J P Hingorani, A D Williams, D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis Lancet 2009 373 1773
Bellamy, L Casas, J P Hingorani, A D Williams, D J Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis BMJ 2007 335 974
Saldana, T M Siega-Riz, A M Adair, L S Suchindran, C. The relationship between pregnancy weight gain and glucose tolerance status among black and white women in central North Carolina Am J Obstet Gynecol 2006 195 1629
Thadhani, R Stampfer, M J Hunter, D J High body mass index and hypercholesterolemia: risk of hypertensive disorders of pregnancy Obstet Gynecol 1999 94 543
Chu, S Y Callaghan, W M Kim, S Y Maternal obesity and risk of gestational diabetes mellitus Diabetes Care 2007 30 2070
Bodnar, L M Catov, J M Klebanoff, M A Ness, R B Roberts, J M Prepregnancy body mass index and the occurrence of severe hypertensive disorders of pregnancy Epidemiology 2007 18 234
Linne, Y Barkeling, B Rossner, S. Long-term weight development after pregnancy Obes Rev 2002 3 75
Hunt, S C Daines, M M Adams, T D Heath, E M Williams, R R Pregnancy weight retention in morbid obesity Obes Res 1995 3 121
Schmitt, N M Nicholson, W K Schmitt, J. The association of pregnancy and the development of obesity – results of a systematic review and meta-analysis on the natural history of postpartum weight retention Int J Obes 2007 31 1642
Gunderson, E P Abrams, B. Epidemiology of gestational weight gain and body weight changes after pregnancy Epidemiol Rev 2000 22 261
Nohr, E A Vaeth, M Baker, J L Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy Am J Clin Nutr 2008 88 1705
Siega-Riz, A M Herring, A H Carrier, K Sociodemographic, perinatal, behavioral, and psychosocial predictors of weight retention at 3 and 12 months postpartum Obesity (Silver Spring) 2010 18 1996
Rasmussen, K M Abrams, B Bodnar, L M Recommendations for weight gain during pregnancy in the context of the obesity epidemic Obstet Gynecol 2010 116 1191
Mamun, A A Kinarivala, M O’Callaghan, M J Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: evidence from 21y postpartum follow-up Am J Clin Nutr 2010 91 1336
Amorim, A R Rossner, S Neovius, M Lourenco, P M Linne, Y. Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI? Obesity (Silver Spring) 2007 15 1287
Institute of Medicine, Subcommittee on Nutrition Status and Weight Gain during Pregnancy Nutrition during Pregnancy Washington, DC: National Academy of Sciences 1990
International Obesity Task Force: World Health Organization 1998
Institute of Medicine Weight Gain During Pregnancy: Reexamining the Guidelines Washington, DC National Academies Press 2009
Vesco, K K Dietz, P M Rizzo, J Excessive gestational weight gain and postpartum weight retention among obese women Obstet Gynecol 2009 114 1069
Rooney, B L Schauberger, C W Mathiason, M A Impact of perinatal weight change on long-term obesity and obesity-related illnesses Obstet Gynecol 2005 106 1349
Boardley, D J Sargent, R G Coker, A L Hussey, J R Sharpe, P A The relationship between diet, activity, and other factors, and postpartum weight change by race Obstet Gynecol 1995 86 834
Joseph, N P Hunkali, K B Wilson, B Pre-pregnancy body mass index among pregnant adolescents: gestational weight gain and long-term postpartum weight retention J Pediatr Adolesc Gynecol 2008 21 195
Ostbye, T Krause, K M Swamy, G K Lovelady, C A Effect of breastfeeding on weight retention from one pregnancy to the next: results from the North Carolina WIC program Prev Med 2010 51 368
Villamor, E Cnattingius, S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study Lancet 2006 368 1164
Mostello, D Chang, J J Allen, J Recurrent preeclampsia: the effect of weight change between pregnancies Obstet Gynecol 2010 116 667
Durnwald, C P Ehrenberg, H M Mercer, B M The impact of maternal obesity and weight gain on vaginal birth after cesarean section success Obstet Gynecol 2004 191 954
Juhasz, G Gyamfi, C Gyamfi, P Tocce, K Stone, J L Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery Obstet Gynecol 2005 106 741
Harris, H E Ellison G, T Do the changes in energy balance that occur during pregnancy predispose parous women to obesity? Nutr Res Rev 1997 10 57
Gunderson, E P Abrams, B Selvin, S. Does the pattern of postpartum weight change differ according to pregravid body size? Int J Obes 2001 25 853
Walker, L O Sterling, B S Timmerman, G M Retention of pregnancy-related weight in the early postpartum period: implications for women’s health services JOGNN 2005 34 418
Gunderson, E P Murtaugh, M A Lewis, C E Excess gains in weight and waist circumference associated with childbearing: the Coronary Artery Risk Development in Young Adults Study (CARDIA) Int J Obes 2004 28 525
Rooney, B L Schauberger, C W Excess pregnancy weight gain and long term obesity: one decade later Obstet Gynecol 2002 100 245
Lederman, S A Paxton, A Heymsfield, S B Body fat and water changes during pregnancy in women with different body weight and weight gain Obstet Gynecol 1997 90 483
Butte, N F Ellis, K J Wong, W W Hopkinson, J M Smith, E O Composition of gestational weight gain impacts maternal fat retention and infant birth weight Am J Obstet Gynecol 2003 189 1423
Soltani, H Fraser, R B A longitudinal study of maternal anthropometric changes in normal weight, overweight, and obese women during pregnancy and postpartum Br J Nutr 2000 84 95
Berg, A H Scherer, P E Adipose tissue, inflammation, and cardiovascular disease Circ Res 2005 96 939
Bartha, J L Marin-Segura, P Gonzalez-Gonzalez, N L Ultrasound evaluation of visceral fat and metabolic risk factors during early pregnancy Obesity 2007 15 2233
Amir, L H Donath, S. A systematic review of maternal obesity and breastfeeding intention, initiation, and duration BMC Pregnancy Childbirth 2007 7 9
Baker, J L Michaelsen, K F Thorkild I, A Rasmussen, K M High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women Am J Clin Nutr 2007 86 404
Mehta, U J Siega-Riz, A M Herring, A H Effect of body image on pregnancy weight gain Matern Child Health J 2011 15 324
Stuebe, A M Rich-Edwards, J W Willett, W C Manson, J E Michels, K B Duration of lactation and incidence of type 2 diabetes JAMA 2005 294 2601
Schwarz, E B Brown, J S Creasman, J M Lactation and maternal risk of type 2 diabetes: a population-based study Am J Med 2010 123 863
Ram, K T Bobby, P Hailpern, S M Duration of lactation is associated with lower prevalence of the metabolic syndrome in midlife – SWAN, the Study of Women’s Health Across the Nation Am J Obstet Gynecol 2008 198 268.e1
Gunderson, E P Jacobs, D R Chiang, V Duration of lactation and incidence of the metabolic syndrome in women of reproductive age according to gestational diabetes mellitus status: a 20-Year prospective study in CARDIA (Coronary Artery Risk Development in Young Adults) Diabetes 2010 59 495
Stuebe, A M Michels, K B Willett, W C Duration of lactation and incidence of myocardial infarction in middle to late adulthood Am J Obstet Gynecol 2009 200 138.e1
Schwarz, E B Ray, R M Stuebe, A M Duration of lactation and risk factors for maternal cardiovascular disease Obstet Gynecol 2009 113 974
Stuebe, A M Rich-Edwards, J W The reset hypothesis: lactation and maternal metabolism Am J Perinatol 2009 26 81
Kac, G Benicio, M Velasquez-Melendez, G Valente, J G Struchiner, C. Breastfeeding and postpartum weight retention in a cohort of Brazilian women Am J Clin Nutr 2004 79 487
Janney, C A Zhang, D Sowers, M. Lactation and weight retention Am J Clin Nutr 1997 66 1116
Kramer, M S Kakuma, R. Optimal duration of exclusive breastfeeding Cochrane Database Syst Rev 2002 1 CD003517
Fewtrell, M Wilson, D C Booth, I Lucas, A. Six months of exclusive breast feeding: how good is the evidence? BMJ 2010 342 c5955
Cope, M B Allison, D B Critical review of the World Health Organization’s (WHO) 2007 report on “evidence of the long-term effects of breastfeeding: systematic reviews and meta-analysis” with respect to obesity Obes Rev 2008 9 594