The Association between Weight-related Variables and Postpartum Depressive Symptoms

Objectives: Postpartum depressive symptoms (PPDS) are common, and weight-related variables may be risk factors. In this study, we examined associations between weight-related variables and PPDS in postpartum women. Methods: Participants who gave birth within the past 12 months completed an online survey assessing various weight-related variables and PPDS. We examined associations between weight-related variables and PPDS using regression models. Results: Participants (N=315) were 30.1±3.9 years of age and 5.6±3.7 months postpartum. A majority were white (96.2%), married (87.9%), and had a bachelor's degree or higher (70.5%). Having a higher pre-pregnancy body mass index (BMI) and current BMI, lower weight loss at 6 months postpartum, and substantial postpartum weight retention were associated with higher PPDS. There was no relationship between total gestational weight gain, IOM weight gain category, excess weight gain, postpartum weight retention, and pre-pregnancy-to-postpartum change in BMI, and postpartum depressive symptoms. Conclusions: Understanding factors associated with postpartum depressive symptoms can help to develop and implement appropriate screenings/follow-ups and interventions among those at greatest risk. Given the potential connection to PPDS, there is a need for interventions aimed at promoting healthy pre-conception weight and helping women to lose excess pregnancy weight during the postpartum period.

1463Impact of missing outcome data in meta-analyses of lifestyle interventions during pregnancy to reduce postpartum-weight-retention

Background High risk of bias associated with missing outcome data (MOD) in meta-analyses (MAs) of the effects of lifestyle interventions during pregnancy on postpartum weight retention (PPWR), casts doubt on whether such interventions can be relied upon as truly effective, since estimates are deemed valid only if MOD was missing at random (MAR). Methods We conducted a systematic overview of MAs to examine the impact of MOD on the estimation of meta-analytic summary intervention effects and conducted sensitivity analyses using pattern mixture models and informative missingness parameters (describing how the outcome in the missing participants may be related to the outcome in the completers), to ascertain the robustness of the estimates to reasonable deviations from the MAR assumption. Results Three relevant MAs were identified, all with high MOD rates in the RCTs included (median>30%), and all reporting beneficial intervention effects on PPWR (in kg) estimated based on complete case analyses: [-0.78 (95%CI: -1.39,-0.16), -0.81 (-1.57,-0.06), and -0.94 (-1.52,-0.37)] in MAs of any lifestyle, exercise, or diet + exercise interventions, respectively. In plausible scenarios where the outcome for the intervention group in participants with vs without MOD was worse (by 0.5kg), effect estimates were attenuated in all and no longer significant in 2 of the MAs [-0.58 (-1.29,0.13), -0.70 (-1.50,0.10) and -0.88 (-1.73,-0.02)]. Conclusions Statistical significance was retained when all 19 RCTs identified across MAs were meta-analysed: -0.63 (-0.17,-0.08). Key messages The clinical relevancy of effects of this magnitude remains unclear.

Adherence to the Mediterranean diet during pregnancy is associated with lower odds of excessive gestational weight gain and postpartum weight retention: results of the MISC cohort

During the first 1000 days of life, gestational weight gain (GWG) and postpartum weight retention (PPWR) are considered critical determinants of nutritional status. This study examined the effect of adherence to the Mediterranean Diet (MD) during pregnancy on GWG and PPWR at 2 and 6 months among women in the United Arab Emirates (UAE), using data from the Mother-Infant Study Cohort (MISC). The latter is a prospective study, for which pregnant women were recruited (n=243) during their 3rd trimester and were followed up for 18 months. Data on sociodemographic characteristics and anthropometric measurements were obtained. An 86-item food frequency questionnaire was used to examine dietary intake during pregnancy. Adherence to the MD was assessed using the alternate MD (aMED) and the Lebanese MD (LMD). Adherence to the MD, PPWR2 (2 months), and PPWR6 (6 months) were considered high if participants belonged to the third tertile of the respective measures. Results indicated that 57.5% of participants had excessive GWG while 50.7% and 45% retained ≥ 5Kg at 2 and 6 months postpartum, respectively. After adjustment, adherence to both MD scores was associated with lower odds of excessive GWG (aMED, OR:0.41, 95%CI:0.18-0.93; LMD, OR:0.40, 95%CI: 0.16-0.98). Adherence to MD was also associated with PPWR2 (aMED: OR: 0.23, 95%CI: 0.06-0.88) and PPWR6 (aMED OR:0.26; 95%CI:0.08-0.86; LMD, OR:0.32; 95%CI: 0.1-0.98). The findings of this study showed that adherence to the MD may reduce GWG and PPWR and, hence, underscored the importance of promoting the MD for better health of the mother and infant.

Evolution of Postpartum Weight and Body Composition after Excessive Gestational Weight Gain: The Role of Lifestyle Behaviors—Data from the INTER-ACT Control Group

Women with excessive gestational weight gain are at increased risk of postpartum weight retention and potentially also unfavorable body composition. Insight into the lifestyle behaviors that play a role in the evolution of postpartum weight and body composition among these women could aid identification of those at highest risk of long-term adverse outcomes. This secondary analysis of the INTER-ACT randomized controlled trial investigates control group data only (n = 524). The evolution of weight retention, percentage loss of gestational weight gain, fat percentage, waist circumference, and associated lifestyle behaviors between 6 weeks and 12 months postpartum were assessed using mixed model analyses. At six weeks postpartum, every sedentary hour was associated with 0.1% higher fat percentage (P = 0.01), and a higher emotional eating score was associated with 0.2% higher fat percentage (P < 0.001) and 0.3 cm higher waist circumference (P < 0.001). Increase in emotional eating score between 6 weeks and 6 months postpartum was associated with a 0.4 kg (P = 0.003) increase in postpartum weight retention from six months onwards. Among women with overweight, an increase in the uncontrolled eating score between 6 weeks and 6 months postpartum was associated with a 0.3 kg higher postpartum weight retention (P = 0.04), and 0.3% higher fat percentage (P = 0.006) from six months onwards. In conclusion, sedentary and eating behaviors play important roles in postpartum weight and body composition of women with excessive gestational weight gain and should therefore be incorporated as focal points in lifestyle interventions for this population.

Characterizing the Impact of Breastfeeding and Socioeconomic Status on Maternal Weight Change From Pregnancy to Ten Years Postpartum

Objectives Breastfeeding is a potentially modifiable factor associated with less postpartum weight retention; however, in the United States women with lower socioeconomic status (SES) are less likely to initiate breastfeeding and, therefore, may be at higher risk for long-term weight retention. We sought to describe associations between duration of breastfeeding with postpartum weight retention and later BMI, and to determine whether associations varied by SES. Methods Maternal and infant data (n = 2144 dyads) are from the Geographic Research on Wellbeing survey (GROW), a follow-up study of California's annual statewide-representative Maternal and Infant Health Assessment. Pre-pregnancy BMI was obtained from self-report; at 4–10y postpartum, breastfeeding history and self-reported body weight were collected. Multivariable linear regression was used to examine associations between breastfeeding and long-term maternal body size. SES was calculated as a composite score of % federal poverty threshold plus education and was dichotomized. Results Overall, mean prepregnancy BMI was 24.9 kg/m,2 while long-term weight retention 4–10 y postpartum was 4.0 kg. The sample average breastfeeding duration was 8.5 months with 61% meeting the World Health Organization (WHO) recommendations for 6 months of breastfeeding. In adjusted models, compared to women who did not meet recommendations, women who met WHO recommendations had slightly lower long-term postpartum weight retention (b = −1.06 kg, CI: −1.93, −0.25, p = 0.01) and a small reduction in BMI (b = −0.4 kg/m,2 95% CI −0.74, −0.08; p = 0.02). Compared to higher SES women, fewer lower SES women ever breastfed (89% vs 74%, p &lt; .0001) or met WHO recommendations (70% vs 51%, p &lt; .0001). Lower SES women had higher prepregnancy BMI (25.9kg/m2 vs 23.5, p &lt; .0001), and had greater long-term weight retention 4–10 y postpartum (5.68kg vs. 1.83, p &lt; .0001). In SES stratified adjusted models, there were no differences in associations between breastfeeding with long-term weight retention or BMI. Conclusions Breastfeeding was associated with long term maternal postpartum weight status. Six months of breastfeeding was associated with lower long-term postpartum weight retention and lower BMI at 4–10 years postpartum, and effects did not vary by socioeconomic status. Funding Sources CDPH, UCSF.