Excessive Gestational Weight Gain and Postpartum Weight Retention Among Obese Women

Vesco, Kimberly K. MD, MPH1; Dietz, Patricia M. DrPH, MPH2; Rizzo, Joanne MPA1; Stevens, Victor J. PhD1; Perrin, Nancy A. PhD1; Bachman, Donald J. MS1; Callaghan, William M. MD, MPH2; Bruce, F Carol BSN, MPH2; Hornbrook, Mark C. PhD1

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181baeacf
Original Research
Abstract

OBJECTIVE: To evaluate the incremental effect of weight gain above that recommended for term pregnancy (15 pounds) on postpartum weight retention at 1 year among obese women.

METHODS: In a retrospective cohort study, we identified 1,656 singleton gestations resulting in live births among obese women (body mass index at or above 30 kg/m2) between January 2000 and December 2005 in Kaiser Permanente Northwest. Pregnancy weight change (last available predelivery weight minus weight at pregnancy onset) was categorized as less than 0, 0–15, greater than 15 to 25, greater than 25 to 35, and greater than 35 pounds. Postpartum weight change (weight at 1 year postpartum minus weight at pregnancy onset) was defined as less than 0, 0–10, and greater than 10 pounds.

RESULTS: Total gestational weight gain was –33.2 (weight loss) to +98.0 pounds (weight gain). Nearly three fourths gained greater than 15 pounds, and they were younger and weighed less at baseline than women who gained 15 pounds or less. Pregnancy-related weight change showed a significant relationship with postpartum weight change. For each pound gained during pregnancy, there was a 0.4-pound increase above baseline weight at 1 year postpartum. In adjusted logistic regression models, the risk of a postpartum weight greater than 10 pounds over baseline was twofold higher for women gaining greater than 15 to 25 pounds compared with women gaining 0–15 pounds (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.54–3.10), fourfold higher for women gaining greater than 25 to 35 pounds (OR 3.91, 95% CI 2.75–5.56), and almost eightfold higher for women gaining greater than 35 pounds (OR 7.66, 95% CI 5.36–10.97).

CONCLUSION: Incremental increases in gestational weight gain beyond the current recommendation for obese women substantially increase the risk of weight retention at 1 year postpartum.

LEVEL OF EVIDENCE: II

In Brief

Among 1,656 obese women, gestational weight gain of more than 15 pounds is associated with an increased risk of retaining more than 10 pounds at 1 year postpartum.

Author Information

From the 1Center for Health Research, Northwest/Hawaii/Southeast, Kaiser Permanente Northwest, Portland, Oregon; and 2Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Funded by Contract # CDC 200-2006-17832, “Extent of Maternal Morbidity in a Managed Care Setting,” from the Centers for Disease Control and Prevention.

The findings and conclusions in this article are those of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or Kaiser Permanente Northwest.

Corresponding author: Kimberly K. Vesco, MD, MPH, Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, Oregon 97227; e-mail: Kimberly.k.vesco@kpchr.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.