The Effect of an Exercise Intervention During Early Lactation on Bone Mineral Density During the First Year Postpartum.

BACKGROUND: During lactation, women may lose up to 10% of bone mineral density (BMD) at trabecular-rich sites. Previous studies show that resistance exercise may slow BMD; however, the long-term effects of exercise on BMD during lactation have not been reported. OBJECTIVE: To evaluate the effect of two 16-week exercise interventions (4- to 20-wk postpartum) in lactating women at 1-year postpartum on lumbar spine, total body, and hip BMD. METHODS: To increase sample size at 1-year postpartum, two 16-week exercise interventions were combined for analysis. At 4-week postpartum, 55 women were randomized to intervention group (weight bearing aerobic exercise and resistance exercise) or control group (no exercise) for 16-week, with a 1-year postpartum follow-up. BMD was measured by dual-energy X-ray absorptiometry. Repeated-measures analysis of covariance was used to test for time and group differences for BMD controlling for prolactin concentration and dietary calcium at 1-year postpartum. RESULTS: Change in lumbar spine BMD was significantly different over time and between groups from 4-week to 1-year postpartum, when controlling for prolactin concentration and dietary calcium. There were no significant differences between groups in total body and hip BMD. CONCLUSION: These results suggest that resistance exercise may slow bone loss during lactation, resulting in higher BMD levels at 1-year postpartum.

Rationale, design and methods for the RIGHT Track Health Study: pathways from childhood self-regulation to cardiovascular risk in adolescence.

BACKGROUND: Cardiovascular risk factors during adolescence-including obesity, elevated lipids, altered glucose metabolism, hypertension, and elevated low-grade inflammation-is cause for serious concern and potentially impacts subsequent morbidity and mortality. Despite the importance of these cardiovascular risk factors, very little is known about their developmental origins in childhood. In addition, since adolescence is a time when individuals are navigating major life changes and gaining increasing autonomy from their parents or parental figures, it is a period when control over their own health behaviors (e.g. drug use, sleep, nutrition) also increases. The primary aim of this paper is to describe the rationale, design and methods for the RIGHT Track Health Study. This study examines self-regulation as a key factor in the development of cardiovascular risk, and further explores health behaviors as an explanatory mechanism of this association. We also examine potential moderators (e.g. psychosocial adversities such as harsh parenting) of this association. METHOD/DESIGN: RIGHT Track is a longitudinal study that investigates social and emotional development. The RIGHT Track Health Study prospectively follows participants from age 2 through young adulthood in an effort to understand how self-regulatory behavior throughout childhood alters the trajectories of various cardiovascular risk factors during late adolescence via health behaviors. Individuals from RIGHT Track were re-contacted and invited to participate in adolescent data collection (~16.5, 17.5 and 18(+) years old). Individuals completed assessments of body composition, anthropometric indicators, fitness testing (via peak oxygen consumption), heart rate variability during orthostatic challenge, 7-day accelerometry for physical activity and sleep, 24-h dietary recalls, and blood analysis for biomarkers related to metabolic syndrome, inflammatory status and various hormones and cytokines. Individuals also completed extensive self-report measures on diet and eating regulation, physical activity and sedentary behaviors, sleep, substance use, medical history, medication use and a laboratory-day checklist, which chronicled previous day activities and menstrual information for female participants. DISCUSSION: Insights emerging from this analysis can help researchers and public health policy administrators target intervention efforts in early childhood, when preventing chronic disease is most cost-effective and behavior is more malleable.

Psychosocial predictors of primiparous breastfeeding initiation and duration.

BACKGROUND: Many US women fall short of meeting the recommendations on breastfeeding. Whereas prenatal demographic factors have been well researched in relation to breastfeeding, psychosocial maternal characteristics are less understood but could be important predictors of breastfeeding initiation and duration. OBJECTIVE: This study examined primiparous maternal psychosocial characteristics and temperamentally based negative infant affect as predictors of breastfeeding initiation and duration while accounting for depression and sociodemographic covariates. METHODS: Prenatally, 237 primiparous women were administered the Adult Attachment Interview and completed a measure of beliefs related to infant crying. At 6 months postpartum, negative infant affect was assessed via mother report. Breastfeeding was assessed at 6 months and 1 year postpartum via mother report. RESULTS: Results indicated that younger, low income, less educated, single, ethnic minority mothers and mothers with elevated depressive symptoms were less likely to initiate breastfeeding and breastfed for a shorter period than other women. Women who initiated breastfeeding tended to have higher adult attachment coherence scores (more secure attachment) than those who did not initiate breastfeeding (median score of 6.00 vs 4.00). An interaction was observed between negative infant affect and beliefs about crying related to spoiling, such that earlier cessation of breastfeeding was observed among mothers who reported high levels of negative infant affect and strongly endorsed the belief that responding to cries spoils infants (hazard ratio = 1.71, P < .01). CONCLUSION: Although these psychosocial variables predicted relatively little variation in breastfeeding over and above covariates, the results suggest some novel approaches to promote breastfeeding.

Diet quality of overweight and obese mothers and their preschool children.

BACKGROUND: Children of obese parents are more likely to become obese than children of normal-weight parents. However, there is little information regarding the diet intakes of children of obese parents. OBJECTIVE: Our objective was to determine the diet quality of preschoolers and their overweight/obese mothers, whether maternal and child diet quality were correlated, and predictors of child's diet quality. DESIGN: Results are from baseline measurements from a randomized controlled behavioral intervention. PARTICIPANTS: Participants were English-literate, postpartum mothers and their preschoolers (n=177 mother-child dyads) in North Carolina. Visits took place in the Triangle and Triad regions of North Carolina between September 2007 and November 2009. MAIN OUTCOME MEASURES: We measured diet quality of mothers and preschoolers using the Healthy Eating Index-2005. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, χ(2), analysis of variance, Pearson correlations, and stepwise regression models were used. RESULTS: Only 11% of children and 7% of mothers had Healthy Eating Index-2005 scores ≥80. Most children did not meet recommendations for fruits, vegetables, whole grains, meat and beans, sodium, saturated fat, and energy from solid fat and added sugars. Child diet quality was correlated with maternal diet quality (r=0.44; P<0.001). However, children and mothers differed in the proportion that met food-group recommendations: children vs mothers: total fruit (50% vs 14%), whole fruit (46% vs 28%), total vegetables (6% vs 18%), dark green and orange vegetables and legumes (7% vs 19%), total grains (57% vs 71%), milk (63% vs 22%), and meat and beans (33% vs 60%). Maternal diet quality and household income were positively correlated with child diet quality. CONCLUSIONS: The diets of children of overweight/obese mothers need improvement in several areas. Mother's diet quality and household income are important contributors to child's diet quality and should be considered in efforts to improve the diets of these children.

Parental obesity moderates the relationship between childhood appetitive traits and weight.

OBJECTIVE: In this study, the independent and combined associations between childhood appetitive traits and parental obesity on weight gain from 0 to 24 months and body mass index (BMI) z-score at 24 months in a diverse community-based sample of dual parent families (n = 213) were examined. DESIGN AND METHODS: Participants were mothers who had recently completed a randomized trial of weight loss for overweight/obese postpartum women. As measures of childhood appetitive traits, mothers completed subscales of the Children's Eating Behavior Questionnaire, including Desire to Drink (DD), Enjoyment of Food (EF), and Satiety Responsiveness (SR), and a 24-h dietary recall for their child. Heights and weights were measured for all children and mothers and self-reported for mothers' partners. The relationship between children's appetitive traits and parental obesity on toddler weight gain and BMI z-score were evaluated using multivariate linear regression models, controlling for a number of potential confounders. RESULTS: Having two obese parents was related to greater weight gain from birth to 24 months independent of childhood appetitive traits, and although significant associations were found between appetitive traits (DD and SR) and child BMI z-score at 24 months, these associations were observed only among children who had two obese parents. When both parents were obese, increasing DD and decreasing SR were associated with a higher BMI z-score. CONCLUSIONS: The results highlight the importance of considering familial risk factors when examining the relationship between childhood appetitive traits on childhood obesity.

Do high-risk preschoolers or overweight mothers meet AAP-recommended behavioral goals for reducing obesity?

BACKGROUND: The American Academy of Pediatrics (AAP) has issued specific behavioral recommendations to prevent obesity. It is unclear how often high-risk preschoolers and overweight mothers meet recommended behavior goals and whether meeting these goals is negatively associated with overweight/obesity. OBJECTIVE: To describe the proportion of preschoolers and mothers that meet AAP-recommended behavior goals and examine the associations of meeting goals with weight-status, and mothers meeting goals and children meeting corresponding goals. METHODS: Secondary analysis of baseline data (before an intervention) from mother-preschooler dyads in a weight-control study. Mothers were overweight or obese. Preschoolers were 2-5 years old. Dietary and feeding practices were assessed by the use of questionnaires. Activity was measured directly using accelerometry. Outcomes included preschooler overweight and maternal obesity. RESULTS: The respective proportions of children and mothers that met behavior goals were: 17% and 13% for ≥5 fruits/vegetables/day, 46% and 33% for zero sugar-sweetened beverages/day, 41% and 13% for fast-food <1×/week, and 46% and 13% for screentime ≤2 hours/day. Moderate-to-vigorous physical activity did not exceed 60 minutes/day in any participant. A total of 49% ate family meals together 7×/week. For each additional goal met, the adjusted odds for preschooler overweight was 0.9 (95% confidence interval 0.8-1.1) and for maternal obesity, 0.8 (95% confidence interval 0.6-0.9). Preschoolers had significantly greater odds of meeting each goal when mothers met the corresponding goal. CONCLUSIONS: Few high-risk preschoolers or overweight mothers meet AAP-recommended behavior goals. Meeting a greater number of behavior goals may be particularly important for maternal weight. Preschoolers have greater odds of meeting behavior goals when mothers meet behavior goals.

Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program.

BACKGROUND: Postpartum weight retention is a risk factor for long-term weight gain. Encouraging new mothers to consume a healthy diet may result in weight loss. OBJECTIVE: To assess predictors of diet quality during the early postpartum period; to determine whether diet quality, energy intake, and lactation status predicted weight change from 5 to 15 months postpartum; and to determine whether an intervention improved diet quality, reduced energy intake, and achieved greater weight loss compared with usual care. DESIGN: Randomized clinical trial (KAN-DO: Kids and Adults Now-Defeat Obesity), a family- and home-based, 10-month, behavioral intervention to prevent childhood obesity, with secondary aims to improve diet and physical activity habits of mothers to promote postpartum weight loss. PARTICIPANTS: Overweight/obese, postpartum women (n=400), recruited from 14 counties in the Piedmont region of North Carolina. INTERVENTION: Eight education kits, each mailed monthly; motivational counseling; and one group class. METHODS: Anthropometric measurements and 24-hour dietary recalls collected at baseline (approximately 5 months postpartum) and follow-up (approximately 10 months later). Diet quality was determined using the Healthy Eating Index-2005 (HEI-2005). STATISTICAL ANALYSES: Descriptive statistics, χ(2), analysis of variance, bi- and multivariate analyses were used. RESULTS: At baseline, mothers consumed a low-quality diet (HEI-2005 score=64.4 ± 11.4). Breastfeeding and income were positive, significant predictors of diet quality, whereas body mass index was a negative predictor. Diet quality did not predict weight change. However, total energy intake, not working outside of the home, and breastfeeding duration/intensity were negative predictors of weight loss. There were no significant differences in changes in diet quality, decreases in energy intake, or weight loss between the intervention (2.3 ± 5.4 kg) and control (1.5 ± 4.7 kg) arms. CONCLUSIONS: The family-based intervention did not promote postpartum weight loss. Reducing energy intake, rather than improving diet quality, should be the focus of weight-loss interventions for overweight/obese postpartum women.

Use of MyPyramid Menu Planner for Moms in a weight-loss intervention during lactation.

The Internet offers a valuable resource for promotion of healthy eating and Web-based communication between the dietetics practitioner and client. In a 16-week intervention examining the effects of energy restriction (500 kcal/day) and exercise on body composition in overweight/obese lactating women, MyPyramid Menu Planner for Moms was used to support dietary counseling. Random assignment occurred at 4 weeks postpartum to either an Intervention group (n=14) or Minimal Care group (n=13) from 2008 through 2010. Three 24-hour dietary recalls were obtained using the Nutrition Data System at 4 and 20 weeks postpartum. Individual MyPyramid Menu Planner accounts were created for the Intervention group and used in face-to-face dietary counseling. Repeated measures analysis of variance was used to test for differences between groups for change in dietary intake and weight. Changes in energy, saturated fat, and percent of energy from added sugars were significantly different between Intervention group and Minimal Care group (-613 [521] kcal vs -171 [435] kcal; P=0.03; -14.9 [14.0] g vs +0.9 [13.4] g; P<0.01; and -3.5% [5.3%] vs +2.2% [4.8%]; P<0.01, respectively). The Intervention group significantly increased their whole fruit servings and decreased their total grain and milk servings compared with the Minimal Care group (P<0.05). The Intervention group lost significantly more weight (-5.8 [3.5] kg) than the Minimal Care group (-1.6 [5.4] kg) (P=0.03). Although participants must have access to an Internet-based computer and possess basic food knowledge, these results suggest MyPyramid Menu Planner might prove to be an effective dietary counseling support tool for improving dietary intake and promoting weight loss during lactation.

Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study.

OBJECTIVE: The study presents the immediate post-intervention results of Kids and Adults Now - Defeat Obesity!, a randomized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler (2-5 years old) dyads in North Carolina (2007-2011). The outcomes include change from baseline in the child's diet, physical activity and weight, and in the mother's parenting behaviors, diet, physical activity, and weight. METHOD: The intervention targeted parenting through maternal emotion regulation, home environment, feeding practices, and modeling of healthy behaviors. 400 mother-child dyads were randomized. RESULTS: Mothers in the intervention arm, compared to the control arm, reduced instrumental feeding (-0.24 vs. 0.01, p<0.001) and TV snacks (-.069 vs. -0.24, p=0.001). There were also improvements in emotional feeding (p=0.03), mother's sugary beverage (p=0.03) and fruit/vegetable (p=0.04) intake, and dinners eaten in front of TV (p=0.01); these differences were not significant after adjustment for multiple comparisons. CONCLUSION: KAN-DO, designed to maximize the capacity of mothers as agents of change, improved several channels of maternal influence. There were no group differences in the primary outcomes, but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers' diets. Long-term follow-up will address whether these short-term trends ultimately improve weight status.

Effects of energy restriction and exercise on bone mineral density during lactation.

UNLABELLED: Modest energy restriction combined with resistance training (RT) has been shown in nonlactating women to protect bone during periods of weight loss. However, there is a paucity of research on dietary interventions and exercise in lactating women aimed at promoting bone health and weight loss. PURPOSE: This study aimed to investigate the effects of energy restriction and exercise on bone mineral density (BMD) and hormones during lactation. METHODS: At 4 wk postpartum, participants were randomized to either a 16-wk intervention (diet restricted by 500 kcal and RT 3 d·wk) group (IG = 14) or minimal care group (CG = 13). Measurements included BMD by DXA, three 24-h dietary recalls, and hormones. Repeated-measures ANOVA was used to test for group differences over time. RESULTS: Energy intake decreased more in IG (613 ± 521 kcal) than CG (171 ± 435 kcal) (P = 0.03). IG lost more weight (5.8 ± 3.5 kg vs CG = 1.6 ± 5.4 kg, P = 0.02). BMD decreased over time, P < 0.01, with no group differences in lumbar spine (IG = 3.4% ± 2.5%, CG = 3.7% ± 3.3%) or hip (IG and CG = 3.1 ± 1.8%). Prolactin and estradiol decreased over time in both groups, P < 0.01. Basal growth hormone remained stable; however, there was a significant increase in growth hormone response to exercise in IG. CONCLUSIONS: These results suggest that moderate energy restriction combined with RT promotes weight loss with no adverse effects on BMD during lactation.

Predictors of postpartum weight change among overweight and obese women: results from the Active Mothers Postpartum study.

BACKGROUND: The postpartum period may be critical for the development of midlife obesity. Identifying factors associated with postpartum weight change could aid in targeting women for healthy lifestyle interventions. METHODS: Data from Active Mothers Postpartum (AMP), a study of overweight and obese postpartum women (n=450), were analyzed to determine the effect of baseline characteristics, breastfeeding, diet, physical activity, and contraception on weight change from 6 weeks to 12, 18, and 24 months postpartum. The repeated measures mixed model was used to test the association of these effects with weight change. RESULTS: Although mean weight loss was modest (0.49 kg by 24 months), the range of weight change was striking (+21.5 kg to -24.5 kg, standard deviation [SD] 7.4). Controlling only for baseline weight, weight loss was associated with breastfeeding, hormonal contraception, lower junk food and greater healthy food intake, and greater physical activity. Only junk food intake and physical activity were significant after controlling for all other predictors. CONCLUSIONS: Eating less healthy foods and being less physically active put overweight and obese women at risk of gaining more weight after a pregnancy.

Postpartum physical activity in overweight and obese women.

BACKGROUND: Low physical activity (PA) during the postpartum period is associated with weight retention. While patterns of PA have been examined in normal weight women during this period, little is known about PA among overweight and obese women. The aim of this cross-sectional study was to investigate PA and determine the proportion of women meeting recommendations for PA. METHODS: Women (n = 491), with a body mass index (BMI) ≥ 25 kg/m² were enrolled in a behavioral intervention. PA was assessed at six weeks postpartum using the Seven-Day PA Recall. RESULTS: Women averaged 923 ± 100 minutes/day of sedentary/ light and 33 ± 56 minutes/day of combined moderate, hard, and very hard daily activity. Women with a BMI ≥ 40 kg/m² reported more time in sedentary/light activities and less hours of sleep than those with a lower BMI. Only 34% met national PA guidelines; this proportion was significantly lower among blacks (OR 0.5, CI 0.3-0.9). CONCLUSIONS: These overweight and obese postpartum women reported a large percentage of time spent in sedentary/light activity, and a high proportion failed to meet minimal guidelines for PA. Promotion of PA in the postpartum period should focus on reducing sedentary behaviors and increasing moderate PA.

Effects of a dairy supplement and resistance training on lean mass and insulin-like growth factor in women.

PURPOSE: To examine the effect of yogurt supplementation pre- and postexercise on changes in body composition in overweight women engaged in a resistance-training program. METHODS: Participants (age = 36.8 ± 4.8 yr) with a body-mass index of 29.1 ± 2.1 kg/m2 were randomized to yogurt supplement (YOG; n = 15) or isoenergetic sucrose beverage (CONT; n = 14) consumed before and after exercise for 16 wk. Participants were also instructed to reduce energy intake daily (-1,046 kJ) during the study. Body composition was assessed by dual-energy X-ray absorptiometry, waist circumference, and sagittal diameter. Strength was measured with 1-repetition maximum. Dietary recalls were obtained by a multipass approach using Nutrition Data System software. Insulin-like growth factor-1 and insulin-like growth-factor-binding protein-3 were measured with ELISA. RESULTS: Significant weight losses of 2.6 ± 4.5 kg (YOG) and 1.2 ± 2.5 kg (CONT) were observed. Total lean weight increased significantly over time in both YOG (0.8 ± 1.2 kg) and CONT (1.1 ± 0.9 kg). Significant reductions in total fat (YOG = 3.4 ± 4.1 kg vs. CONT = 2.3 ± 2.4 kg) were observed over time. Waist circumference, sagittal diameter, and trunk fat decreased significantly over time without group differences. Both groups significantly decreased energy intake while maintaining protein intake. Strength significantly increased over time in both groups. No changes over time or between groups were observed in hormone levels. CONCLUSIONS: These data suggest that yogurt supplementation offered no added benefit for increasing lean mass when combined with resistance training and modest energy restriction.

Kids and adults now! Defeat Obesity (KAN-DO): rationale, design and baseline characteristics.

BACKGROUND: Prevention of childhood obesity is a public health priority. Parents influence a child's weight by modeling healthy behaviors, controlling food availability and activity opportunities, and appropriate feeding practices. Thus interventions should target education and behavioral change in the parent, and positive, mutually reinforcing behaviors within the family. METHODS: This paper presents the design, rationale and baseline characteristics of Kids and Adults Now! - Defeat Obesity (KAN-DO), a randomized controlled behavioral intervention trial targeting weight maintenance in children of healthy weight, and weight reduction in overweight children. 400 children aged 2-5 and their overweight or obese mothers in the Triangle and Triad regions of North Carolina are randomized equally to control or the KAN-DO intervention, consisting of mailed family kits encouraging healthy lifestyle change. Eight (monthly) kits are supported by motivational counseling calls and a single group session. Mothers are targeted during a hypothesized "teachable moment" for health behavior change (the birth of a new baby), and intervention content addresses: parenting skills ((e.g., emotional regulation, authoritative parenting), healthy eating, and physical activity. RESULTS: The 400 mother-child dyads randomized to trial are 75% white and 22% black; 19% have a household income of $30,000 or below. At baseline, 15% of children are overweight (85th-95th percentile for body mass index) and 9% are obese (≥ 95th percentile). CONCLUSION: This intervention addresses childhood obesity prevention by using a family-based, synergistic approach, targeting at-risk children and their mothers during key transitional periods, and enhancing maternal self-regulation and responsive parenting as a foundation for health behavior change.

Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding.

BACKGROUND: Weight gain in the postpartum period is a risk factor for long-term obesity. Investigations of dietary intake among lactating and nonlactating overweight women might identify nutritional concerns specific to this population. OBJECTIVE: To compare nutrient, meal, and snack intakes, food-group servings and prevalence of dieting among fully breastfeeding (BF), mixed breast and formula feeding (MF), and formula feeding (FF) overweight and obese women. The second aim was to compare nutrient intakes and food-group servings to the Dietary Reference Intake and MyPyramid recommendations, respectively. DESIGN: Data were collected from September 2004 through April 2006 in Durham, NC. Infant feeding practices and dietary information were collected on 450 women between 6 and 9 weeks postpartum. Two 24-hour dietary recalls were completed by phone, using Nutrition Data Systems for Research. Analysis of covariance was used to compare infant feeding groups in dietary quality (nutrient intake per 1,000 kcal) and food-group servings, controlling for prepregnancy body mass index, race, age, education, income, and marital status. χ² analysis was performed to determine differences in meal and snack intake and dieting among infant feeding groups. RESULTS: BF women consumed more energy (2,107 ± 50 kcal) than MF (1,866 ± 56 kcal) or FF (1,657 ± 50 kcal) women (P < 0.001). Adjusted nutrient intake did not differ between groups. All groups were at risk for inadequate intakes of vitamins A, E, C, and folate and did not meet recommended servings of all food groups. BF women consumed lunch and snacks more frequently, were less likely to diet, and reported higher intakes of grains and desserts than MF and FF women. CONCLUSIONS: To help increase intakes of nutrients lacking in the diet and prevent postpartum weight gain, overweight women should be encouraged to increase fruits, vegetables, low-fat dairy, whole grains, legumes, and healthy types of fat, while decreasing refined grains, regular soda, sweetened beverages, and desserts.

Predictors of breastfeeding in overweight and obese women: data from Active Mothers Postpartum (AMP).

Excess maternal weight has been negatively associated with breastfeeding. We examined correlates of breastfeeding initiation and intensity in a racially diverse sample of overweight and obese women. This paper presents a secondary analysis of data from 450 women enrolled in a postpartum weight loss intervention (Active Mothers Postpartum [AMP]). Sociodemographic measures and body mass index (BMI), collected at 6 weeks postpartum, were examined for associations with breastfeeding initiation and lactation score (a measure combining duration and exclusivity of breastfeeding until 12 months postpartum). Data were collected September 2004-April 2007. In multivariable analyses, BMI was negatively associated with both initiation of breastfeeding (OR: .96; CI: .92-.99) and lactation score (ß -0.22; P = 0.01). Education and infant gestational age were additional correlates of initiation, while race, working full-time, smoking, parity, and gestational age were additional correlates of lactation score. Some racial differences in these correlates were noted, but were not statistically significant. Belief that breastfeeding could aid postpartum weight loss was initially high, but unrelated to breastfeeding initiation or intensity. Maintenance of this belief over time, however, was associated with lower lactation scores. BMI was negatively correlated with breastfeeding initiation and intensity. Among overweight and obese women, unrealistic expectations regarding the effect of breastfeeding on weight loss may negatively impact breastfeeding duration. In general, overweight and obese women may need additional encouragement to initiate breastfeeding and to continue breastfeeding during the infant's first year.

Gestational weight gain in consecutive pregnancies.

OBJECTIVE: The purpose of this study was to examine the association between gestational weight gain (GWG) in a woman's first and second pregnancies. STUDY DESIGN: We conducted a retrospective observational cohort study of 27,771 women with their first and second births in North Carolina's Pregnancy Nutrition Surveillance System database from 1996-2004. GWG was categorized as inadequate, appropriate, or excessive, according to 2009 Institute of Medicine guidelines. Covariate adjusted polytomous logistic regression was used to test the association between GWG category in the first and second pregnancy. RESULTS: Compared with women with appropriate GWG in their first pregnancy, women with excessive GWG in their first pregnancy had an odds ratio of 2.6 (95% confidence interval, 2.4-2.7) for excessive GWG in their second pregnancy. Women with inadequate GWG in their first pregnancy were similarly likely to repeat this category in their subsequent pregnancy. CONCLUSION: GWG category in a woman's first pregnancy is a significant predictor of GWG category in her subsequent pregnancy.

Effect of breastfeeding on weight retention from one pregnancy to the next: results from the North Carolina WIC program.

OBJECTIVES: Pregnancy-related weight retention can contribute to obesity, and breastfeeding may facilitate postpartum weight loss. We investigated the effect of breastfeeding on long-term postpartum weight retention. METHODS: Using data from the North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC; 1996-2004), weight retention was assessed in women aged 18 years or older who had more than one pregnancy available for analysis (n=32,920). Using multivariable linear regression, the relationship between duration of breastfeeding after the first pregnancy and change in pre-pregnancy weight from the first pregnancy to the second pregnancy was estimated, controlling for demographic and weight-related covariates. RESULTS: Mean time between pregnancies was 2.8 years (standard deviation (SD) 1.5), and mean weight retention from the first to the second pregnancy was 4.9kg (SD 8.7). In covariate-adjusted analyses, breastfeeding for 20 weeks or more resulted in 0.39kg (standard error (SE) 0.18) less weight retention at the beginning of the second pregnancy relative to no breastfeeding (p=0.025). CONCLUSION: In this large, racially diverse sample of low-income women, long-term weight retention was lower among those who breastfed for at least 20 weeks.

Effect of breast-feeding on weight retention at 3 and 6 months postpartum: data from the North Carolina WIC Programme.

OBJECTIVE: Pregnancy-related weight retention can contribute to obesity, and breast-feeding may facilitate postpartum weight loss. We investigated the effect of breast-feeding on postpartum weight retention. DESIGN: A retrospective follow-up study of weight retention, compared in women who were fully breast-feeding, combining breast-feeding with formula-feeding (mixed feeding), or formula-feeding at 3 months (n 14 330) or 6 months (n 4922) postpartum, controlling for demographic and weight-related covariates using multiple linear regression. SETTING: The North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). SUBJECTS: Participants in the North Carolina WIC Programme who delivered a baby between 1996 and 2004. RESULTS: In covariate-adjusted analyses, there was no association between breast-feeding and weight retention at 3 months postpartum. At 6 months postpartum, as compared to formula-feeders, mean weight retention was 0·84 kg lower in mixed feeders (95 % CI 0·39, 1·29; P = 0·0002) and 1·38 kg lower in full breast-feeders (95 % CI 0·89, 1·87; P ≤ 0·0001). CONCLUSIONS: Breast-feeding was inversely associated with weight retention at 6 months postpartum in this large, racially diverse sample of low-income women. Further, full breast-feeding had a larger protective effect than did breast-feeding combined with formula-feeding.