Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women

Abstract

Objective: Document weight change trajectories that lead to gestational weight gain or postpartum weight loss outside clinical recommendations established by the Institute of Medicine.

Study design: Women aged 14-25 receiving prenatal care and delivering singleton infants at term (n = 427). Medical record review and 4 structured interviews conducted: second and third trimester, 6- and 12-months postpartum. Longitudinal mixed modeling to evaluate weight change trajectories.

Results: Only 22% of participants gained gestational weight within Institute of Medicine guidelines. There were 62% that exceeded maximum recommendations-more common among those overweight/obese (body mass index ≥25.0; P < .0001). 52% retained ≥10 lb 1-year postpartum. Increased weight gain and retention documented among smokers and women with pregnancy-induced hypertension; breastfeeding promoted postpartum weight loss (all P < .02). Body mass index by race interaction suggested healthier outcomes for Latinas (P = .02).

Conclusion: Excessive pregnancy weight gain and inadequate postpartum weight loss are highly prevalent among young low-income ethnic minority women. Pregnancy and postpartum are critical junctures for weight management interventions.

Figure 1

Mean predicted weight changes according to race within each of: (A) normal weight women (baseline BMI 18.5-24.9 kg/m²), (B) overweight women (baseline BMI 25.0-29.9 kg/m2) and, (C) obese women (baseline BMI ≥30.0). Within each graph, curves correspond to the weight change trajectories for the respective race categories as follows: Black = black curves, Hispanic=blue curves, all other ethnicities=red curves. The upper and lower solid horizontal lines represent the BMI-based upper-limit of the IOM recommendations for pregnancy-related weight gain and the suggested minimal 1-year post-partum weight loss, respectively.