Diet or exercise, or both, for weight reduction in women after childbirth.

BACKGROUND: Weight retention after pregnancy may contribute to obesity. It is known that diet and exercise are recommended components of any weight loss programme in the general population. However, strategies to achieve healthy body weight among postpartum women have not been adequately evaluated. OBJECTIVES: The objectives of this review were to evaluate the effect of diet, exercise or both for weight reduction in women after childbirth, and to assess the impact of these interventions on maternal body composition, cardiorespiratory fitness, breastfeeding performance and other child and maternal outcomes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2012) and LILACS (31 January 2012). We scanned secondary references and contacted experts in the field. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 30 April 2013 and added the results to the awaiting classification section of the review. SELECTION CRITERIA: All published and unpublished randomised controlled trials (RCTs) and quasi-randomised trials of diet or exercise or both, among women during the postpartum period. DATA COLLECTION AND ANALYSIS: Both review authors independently assessed trial quality and extracted data. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data. Data were analysed with a fixed-effect model. A random-effects model was used in the presence of heterogeneity. MAIN RESULTS: Fourteen trials were included, but only 12 trials involving 910 women contributed data to outcome analysis. Women who exercised did not lose significantly more weight than women in the usual care group (two trials; n = 53; MD -0.10 kg; 95% confidence interval (CI) -1.90 to 1.71). Women who took part in a diet (one trial; n = 45; MD -1.70 kg; 95% CI -2.08 to -1.32), or diet plus exercise programme (seven trials; n = 573; MD -1.93 kg; 95% CI -2.96 to -0.89; random-effects, T² = 1.09, I² = 71%), lost significantly more weight than women in the usual care group. There was no difference in the magnitude of weight loss between diet alone and diet plus exercise group (one trial; n = 43; MD 0.30 kg; 95% CI -0.06 to 0.66). The interventions seemed not to affect breastfeeding performance adversely. AUTHORS' CONCLUSIONS: Evidence from this review suggests that both diet and exercise together and diet alone help women to lose weight after childbirth. Nevertheless, it may be preferable to lose weight through a combination of diet and exercise as this improves maternal cardiorespiratory fitness and preserves fat-free mass, while diet alone reduces fat-free mass. This needs confirmation in large trials of high methodological quality. For women who are breastfeeding, more evidence is required to confirm whether diet or exercise, or both, is not detrimental for either mother or baby.

Correlates of soft drink and fruit juice consumption among Swedish adolescents.

The aim of the study was to investigate how soft drink and fruit juice consumption in teenagers is associated with life-style, other food choices, eating behaviour and maternal characteristics. A cross-sectional study of 16-year-old girls (n 275) and boys (n 199) and their mothers was undertaken. Questionnaires were used to assess habitual dietary intake, eating behaviour, physical activity, smoking and educational level. Weight and height were measured. It was found that eating breakfast less than five times per week was independently associated with a high soft drink consumption in both girls and boys. A low intake of cooked meals and milk and a high intake of salty snacks were associated with soft drinks in boys only, and a low intake of fruits in girls only. A high maternal juice intake, low milk and high fruit consumption were independent correlates of fruit juice intake in both girls and boys. In girls, being a smoker, having a smoking mother, a high soft drink intake, scoring low on emotional eating and high on cognitive restraint were also associated with fruit juice intake. A low intake of soft drinks and cooked meals was associated with fruit juice intake in boys only. Neither soft drinks nor fruit juice was associated with BMI. In conclusion, a high intake of both fruit juice and soft drinks were associated with a lower intake of foods such as milk and cooked meals. It might be possible to influence fruit juice intake among teenagers by aiming at their mothers, whereas the adolescents themselves should be targeted when the aim is to reduce soft drink consumption.

Association of weight gain in infancy and early childhood with metabolic risk in young adults.

CONTEXT: Early postnatal life has been suggested as an important window during which risks for long-term health may be influenced. OBJECTIVE: The aim of this study was to examine the independent associations between weight gain during infancy (0-6 months) and early childhood (3-6 yr) with components of the metabolic syndrome in young adults. DESIGN: This was a prospective cohort study (The Stockholm Weight Development Study). SETTING: The study was conducted in a general community. PARTICIPANTS: Subjects included 128 (54 males) singletons, followed from birth to 17 yr. MAIN OUTCOME MEASURE: None of these young adults met the full criteria for the metabolic syndrome. We therefore calculated a continuous clustered metabolic risk score by averaging the standardized values of the following components: waist circumference, blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, glucose, and insulin level. RESULTS: Clustered metabolic risk at age 17 yr was predicted by weight gain during infancy (standardized beta = 0.16; P < 0.0001) but not during early childhood (standardized beta = 0.10; P = 0.23), adjusted for birth weight, gestational age, current height, maternal fat mass, and socioeconomic status at age 17 yr. Further adjustment for current fat mass and weight gain during childhood did not alter the significant association between infancy weight gain with the metabolic risk score (standardized beta = 0.20; P = 0.007). CONCLUSIONS: Rapid weight gain during infancy (0-6 months) but not during early childhood (3-6 yr) predicted clustered metabolic risk at age 17 yr. Early interventions to moderate rapid weight gain even at very young ages may help to reduce adult cardiovascular disease risks.

Upward weight percentile crossing in infancy and early childhood independently predicts fat mass in young adults: the Stockholm Weight Development Study (SWEDES).

BACKGROUND: Rapid early postnatal weight gain predicts increased subsequent obesity and related disease risks. However, the exact timing of adverse rapid postnatal weight gain is unclear. OBJECTIVE: The objective was to examine the associations between rapid weight gain in infancy and in early childhood in relation to body composition at age 17 y. DESIGN: This prospective cohort study was conducted in 248 (103 males) singletons and their mothers. Height and weight were measured at birth, 6 mo, and 3 and 6 y. The rates of weight gain during infancy (0-6 mo) and early childhood (3-6 y) were calculated as changes in sex- and age-adjusted weight SD scores during these time periods. At 17 y, body composition was measured by air-displacement plethysmography. RESULTS: Increasing weight gain during infancy and early childhood were both independently associated with larger body mass index, fat mass, relative fat mass, fat-free mass, and waist circumference at 17 y (P < 0.005 for all; adjusted for sex, birth weight, gestational age, current height, maternal socioeconomic status, and maternal fat mass). Rapid weight gain in infancy, but not in early childhood, also predicted taller height at 17 y (P < 0.001). CONCLUSIONS: Rapid weight gain in both infancy and early childhood is a risk factor for adult adiposity and obesity. Rapid weight gain in infancy also predicted taller adult height. We hypothesize that rapid weight gains in infancy and early childhood are different processes and may allow separate opportunities for early intervention against obesity risk later in life.

Associations between physical activity and fat mass in adolescents: the Stockholm Weight Development Study.

BACKGROUND: Obesity is multifactorial. However, the accumulation of fat mass (FM) is proposed to be due to a positive energy balance, which may be caused by reduced physical activity (PA). OBJECTIVE: The objectives of the study were to describe the independent associations between PA and FM in adolescents and to describe the intergenerational association of FM between mothers and their offspring. DESIGN: We conducted a cross-sectional study in 445 (190 M, 255 F) 17-y-old adolescents and their mothers. PA was assessed with a self-reported questionnaire and validated by comparison with accelerometric data in a subsample of the cohort. Body composition was measured by using air-displacement plethysmography. RESULTS: Males were significantly more active than were females (P<0.01). PA was significantly and inversely associated with FM (beta=-3.63, P=0.005) and percentage FM (beta=-3.117, P=0.017) in males but not in females (beta=-0.576, P=0.54; beta=-0.532, P=0.59, respectively) after adjustment for birth weight and maternal FM and education level. However, FM and percentage FM in females were significantly associated with maternal FM (beta=0.159, P<0.0001; beta=0.145, P=0.002, respectively) and education level (beta=-1.048, P<0.005; beta=-1.085, P=0.006, respectively). No such associations were observed in males. CONCLUSIONS: PA was independently associated with FM in males but not in females. The data also showed an intergenerational association of FM between mothers and their daughters but not between mothers and their sons.

Sensitivity and specificity of classification systems for fatness in adolescents.

BACKGROUND: Various body mass index (BMI) standards have been proposed for defining overweight in adolescence, but few studies have evaluated their diagnostic accuracy. OBJECTIVE: We compared the sensitivity and specificity of BMI-based classification systems for detecting excess fatness in adolescents. DESIGN: A cross-sectional analysis of 474 adolescents aged 17 y was used. Body composition was measured by using densitometry. The international BMI-based systems recommended by the International Obesity Task Force and the World Health Organization were evaluated on the basis of their sensitivity and specificity for detecting excess body fat. Receiver operating characteristic analysis was performed to derive cutoffs to maximize the sum of sensitivity and specificity. True positives were defined by using the percentage body fat cutoffs proposed by Williams et al (Am J Public Health 1992;82:358-63). RESULTS: For both classification systems, the specificity for overweight was high for both sexes (0.95-1.00). The sensitivity was fairly high for the males (0.72-0.84) but was very low for the females (0.22-0.25). For the males, a BMI cutoff equal to the 85th percentile on a Swedish BMI reference chart maximized the sum of sensitivity and specificity while having both high sensitivity (0.92) and high specificity (0.92). For the females, larger tradeoffs in specificity were needed to improve sensitivity. The mean (+/-SE) areas under the receiver operating characteristic curves for the males and the females were 0.97 +/- 0.02 and 0.85 +/- 0.02, respectively. CONCLUSIONS: Recommended international classification systems have very high specificity, which results in few cases of non-overweight adolescents being mislabeled as overweight. However, the sensitivity is very low in female adolescents. Thus, many overweight female adolescents could be missed in intervention programs that use the proposed international BMI cutoffs as selection criteria.

Pharmacotherapy of obesity.

Whereas several drugs to treat most other chronic conditions have been developed over the last 30 years, progress in pharmacologic therapy for obesity has been slow. The record of drug treatment for obesity partly explains this phenomenon and is of concern. Several compounds have been withdrawn when severe side effects have been discovered. The lack of scientifically developed safe and effective antiobesity drugs has opened the gates for an enormous number of commercial products that make vast sums of money, but have no scientific evidence backing their efficacy. This pattern is seen in both developed and developing countries. summarizes some of the presently accepted, scientifically evaluated antiobesity drugs. At present, orlistat and sibutramine are the only two major drugs used almost worldwide.

[Easy to remain overweight after pregnancy]. / Lätt bli överviktig efter graviditet.

For some women pregnancy is a trigger factor for developing overweight and obesity. 73% of patients at the Obesity Unit, Huddinge University Hospital, indicated that they had retained more than 10 kg after each of their pregnancies; for this subgroup weight development after pregnancy was of obvious importance for their future health. However, in most studies mean weight retention after pregnancy is modest: 0.5-3.5 kg up to one year after delivery. Numerous studies have analysed factors explaining weight development after pregnancy and delivery, with a wide range of subjects, but overall it has been surprisingly difficult to identify strong predictors for weight development. The strongest factor is weight gain during pregnancy, but smoking cessation, a sedentary lifestyle and socio-economic factors also play a role. Pregnancy and weight development are intertwined in a complex pattern, which includes a change in lifestyle factors, such as eating behaviour, physical activity, smoking cessation and degree of lactation, but which are still not fully understood.

Relationships between prenatal smoking cessation, gestational weight gain and maternal lifestyle characteristics.

OBJECTIVES: To describe maternal characteristics and lifestyle factors associated with prenatal smoking habits and to appraise the effect of quitting smoking in early gestation on maternal weight gain during pregnancy. METHODS: This is a follow-up study of 1753 women who gave birth in 1984/1985 in Stockholm, Sweden. Multivariate logistic models were used to evaluate the association between smoking cessation and weight gain above the American Institute of Medicine (IOM) recommendations, based on pre-pregnancy BMI. RESULTS: About 22% of all participants identified themselves as current smokers and 11.6% reported smoking cessation during pregnancy. Smokers were more likely to be single mothers and reported low quality of breakfast (e.g. eating only 1 food group at breakfast). Non-smokers were older, more likely to be married and have a healthier lifestyle. Quitters also adopted healthier eating habits (e.g. improvement in their breakfast quality). Women who quit smoking gained, on average, 15.3 kg (SD 4.4) during pregnancy, non-smokers gained 14.1 kg (SD 4.0) and smokers gained 13.8 kg (SD 4.3). Quitters gained significantly more weight than both non-smokers and smokers (p<0.001). Smoking cessation was significantly associated with gaining weight above IOM recommendations, even after controlling for potential confounders (OR: 2.0; 95%CI: 1.4-3.0; p

Characteristics of high and low energy reporting teenagers and their relationship to low energy reporting mothers.

OBJECTIVE: To describe the differences in socio-economic characteristics and body measurements between low, adequate and high energy reporting (LER, AER and HER) teenagers; furthermore, to investigate the relationship to misreporting mothers. DESIGN: Cross-sectional study. Habitual dietary intake was reported in a questionnaire. Classification into LER, AER and HER using the Goldberg equation within three activity groups based on physical activity questionnaire and calculated BMR. SETTING: Stockholm, Sweden. SUBJECTS: Four hundred and forty-one 16-17-year-old teenagers (57 % girls) and their mothers. RESULT: Of the teenagers, 17-19 % were classified as HER, while 13-16 % as LER. There was a highly significant trend from HER to LER in BMI (P < 0.001) and body fat % (P < 0.001). There was also a trend in number of working hours of mother (P = 0.01), family income (P = 0.008) and number of siblings (among boys only) (P = 0.02), but not in educational level of either father or mother. HER teenagers were lean, had mothers working fewer hours with lower income and had siblings. It was more likely that an LER girl had an LER mother than an AER mother (OR = 3.32; P = 0.002). CONCLUSIONS: The reasons for the high number of over-reporters could be many: misclassification due to growth, lacking established eating pattern due to young age or method-specific. Nevertheless, the inverted characteristic of HER compared to LER indicates that this is a specific group, worth further investigation.

Older members perform better in an internet-based behavioral weight loss program compared to younger members.

BACKGROUND: New technology offers increased opportunities for weight control. However, it is not clear whether older people with less computer training can make use of this tool. Our objective was to examine how members above the age of 65 years performed in an internet-based behavioral weight loss program, compared to younger members. METHODS: Data from members (n = 23,233) of an internet-based behavioral weight loss program were analyzed. We restricted our study to active participants accessing the weight club, during a 6-month period (n = 4,440). The number of logins, food intake, and weight records were examined. Participants were divided into age tertiles separately for men and women. The oldest tertile was further subdivided into two groups: above and below the age of 65 years. RESULTS: Participants aged 65 or older were more likely to remain active in the weight club for at least 6 months compared to younger age groups. They had the highest frequency of recordings of food intake and current weight. Among women, those older than 65 years had on average the highest percentage of weight loss (5.6 kg, 6.8%). Men above 65 years of age had the highest number of logins, on average 161 times during the 6-month period. CONCLUSION: Older participants are performing equally well or even better in an internet-based behavioral weight loss program than younger participants. Internet-based programs could be a promising and attractive option for older adults requiring assistance in losing weight.

Associations between salivary bacteria and reported sugar intake and their relationship with body mass index in women and their adolescent children.

OBJECTIVE: To study associations between reported sugar intake and salivary bacteria (mutans streptococci, MS and lactobacilli, LB), and sugar intake in relation to body mass index (BMI), in women and adolescents. DESIGN: Cross-sectional study. Habitual dietary intake was reported in a questionnaire and whole saliva samples were collected and cultivated. SETTING: Stockholm, Sweden. SUBJECTS: Four hundred and fourteen mothers and their 16-year-old children (57% girls). RESULTS: Reported total sugar intake was significantly associated with LB in mothers (P = 0.001), but not in daughters and sons (P = 0.03 for mother-son interaction). When excluding lactose, the associations with LB and MS were significant in daughters (P = 0.032 and 0.005, respectively). High BMI and sugar intake from milk were independently associated with MS counts in mothers in a multiple regression model (R2 = 0.053). In daughters, sugar from beverages, candies/chocolates and fruits were all independently associated with MS counts (R2 = 0.074), whereas in sons, only mothers' MS counts were associated (R2 = 0.084). High BMI, low intake from cooked meals and high intake of candies/chocolates were all independently associated with LB in mothers (R2 = 0.076), while, except for candies/chocolates in daughters, no significant associations were found in children. BMI was significantly associated with bacteria counts in both mothers and children, whereas reported sugar intake was not. CONCLUSION: The associations between reported sugar intake and bacteria were generally weak. In mothers and daughters, some significant associations were found, but not in sons. Bacteria counts, but not reported sugar intake, were positively associated with BMI.

Assessment of weight changes during and after pregnancy: practical approaches.

The usefulness of routine prenatal weight measurements in predicting pregnancy outcomes is still a controversial issue. Comparisons among studies and the interpretation of research findings are complicated due to the variety of indicators applied to express maternal weight changes during and after pregnancy. A review of literature was conducted to clarify the definitions and examine the strengths and limitations of methods for measuring gestational weight gain (WG) and postpartum weight changes. The reasons for weak correlations or non-significant associations between gestational WG and maternal and neonatal outcomes were probably owing to poor quality of obstetrics records and selection of wrong indicators to compute gestational WG. The choice of an indicator depends on clinical and research purpose, availability and reliability of data and cost. Considering the health implication of gestational WG, it is necessary to take into account the measurements used as initial and final weight, accuracy of gestational age estimation and the inclusion of fetal weight as part of maternal WG. Regardless of the indicators used to compute the weight changes after delivery, attention is drawn to the approach for designating prepregnancy weight, the time frame of postpartum weight measurements and the use of overlapping variables, which results in bias (part-whole correlation). It is necessary to address criticisms on the accuracy of prenatal weight measurements and the way of expressing the maternal weight changes during and after pregnancy in order to have reliable results from research.

Maternal predictors of birthweight: The importance of weight gain during pregnancy.

OBJECTIVE: To investigate the importance of maternal weight gain during pregnancy as a predictor of birthweight. SUBJECTS: Two thousand and forty-six mother-infant pairs were recruited in 1984-1985 from 14 maternity units from the Stockholm Pregnancy and Weight Development Study. METHODS: Weight gain during pregnancy (WGP), smoking, pre-pregnancy BMI, gestational diabetes, hypertension, parity, marital status, age, and sex of the child were investigated as predictors of birthweight by multiple regression analysis. WGP was analysed as a continuous and categorical variable, with the latter defined according to the Institute of Medicine (IOM) recommendations as inadequate (n = 501), adequate (n = 860) or excessive (n = 535). RESULTS: The predictors studied explained 25% of the variance in birthweight. After adjustment for gestational age, WGP (both categorical and continuous) was an important independent predictor of birthweight. Infants of mothers with excessive weight gain had higher birthweight (139 g; 95%CI 83, 196) than infants to mothers with adequate weight gain. In contrast, birthweight was lower for infants of mothers with inadequate weight gain (-148 g; 95%CI -202, -93). Measured as a continuous variable the infants became 26 g heavier for each kilogram the mother gained in weight. In addition, smoking, parity, sex and BMI also showed a positive association to birthweight. Hypertension contributed only marginally and the impact of marital status and maternal age did not reach statistical significance. CONCLUSION: As WGP is both an important and modifiable risk factor for abnormal birthweight, and recommendations exist for different BMI groups, it seems natural to put further emphasis on advising pregnant women to stay within the recommended ranges.

Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI?

OBJECTIVE: The objective was to assess the relevance of the recommendations of the Institute of Medicine (IOM), regarding gestational weight gain (GWG) for long-term BMI development. RESEARCH METHODS AND PROCEDURES: The Stockholm Pregnancy and Women's Nutrition is a follow-up study of 483 women who delivered children in 1984 to 1985. ANOVA was used to examine the change in body weight before pregnancy, at 6 months, and 1 year postpartum and 15 years after childbirth. Multiple linear regression was used to assess the predictors of BMI at 15-year follow-up. RESULTS: The weight increase from baseline to 15-year follow-up was 6.2 kg for IOM-insufficient, 6.7 kg for IOM-recommended, and 10.0 kg for IOM-excessive weight gain (p < 0.01). ANOVA showed a main effect of time, group and group by time interaction. The weight of the women who had excessive GWG was significantly greater at each time-point of follow-up than the weight of those who gained within or below recommendations. GWG was related to BMI at 15-year follow-up even after accounting for several confounders. Women who gained excessive weight during pregnancy had an increase of 0.72 kg/m(2) in long-term BMI compared with women who gained within recommendations. DISCUSSION: The findings support the adequateness of IOM guidelines, not only for the pregnancy-related health matters, but also for preventing long-term weight retention after delivery. Healthcare providers should give women appropriate advice for controlling GWG and motivate them to lose pregnancy-related weight during postpartum to prevent future overweight.

Gender differences in associations of eating pathology between mothers and their adolescent offspring.

OBJECTIVE: To study the association of eating pathology between mothers and their adolescent offspring in a population sample. RESEARCH METHODS AND PROCEDURES: The participants were 481 women (mean age, 47+/-SD 5 years; BMI, 25+/-4 kg/m2) and their 481 adolescent children 16 to 17 years old (BMI, 21+/-3 kg/m2) of the Stockholm Weight Development Study. Assessment methods were the Three-Factor Eating Questionnaire Revised 18 and the Eating Disorder Inventory 2. RESULTS: A higher body weight was most related to cognitive restraint for adolescents and to emotional eating for adult women. A mother-daughter link could be identified for eating pathology, with the strongest link found for emotional eating. No mother-son link could be identified. Age subgroup analyses revealed a stronger mother-daughter link for body attitudes in younger mothers and for cognitive restraint in older mothers. DISCUSSION: Gender differences revealed that eating pathology was shared by mothers and daughters but not by mothers and sons. A psychological strategy such as eating as a response to negative emotions was most interrelated between mothers and daughters. Younger mothers shared more attitudes toward the body with their daughters, whereas older mothers shared more restrictive eating behaviors with their daughters. The mother-daughter links found may be due to gender-specific genetic and psychological family transmission and gender-specific environmental influences. The sons' eating behaviors seem to be more independent and would be formed by other factors than for the girls.

Interrelationships between weight development and weight retention in subsequent pregnancies: the SPAWN study.

BACKGROUND: Pregnancy is frequently associated with post-delivery weight retention in women. Most studies suggest weight retention associated with pregnancy of between 0.5 to 3.8 kg with up to 2.5 years of follow-up. However, 73% of the female patients at our obesity clinic report that their pregnancies have been important trigger factors for marked weight gain and that they had gained more than 10 kg after each pregnancy. The aim of this study was to examine correlations in weight gain and weight retention after pregnancy in the long-term perspective. METHOD AND SUBJECTS: The SPAWN (Stockholm Pregnancy and Women's Nutrition) study is a long-term follow-up study of women who delivered children in 1984-85 in Stockholm (n = 2342). The participants filled out questionnaires about their eating and exercise habits, social condition, etc. before, during and up to 1 year after pregnancy. Antropometric data were also sampled. One thousand four hundred and twenty-three women completed the study and filled out all questionnaires up to 1 year after pregnancy. Fifteen years later, these 1423 women were invited to the follow-up study. Five hundred and sixty-three women participated and filled out extended questionnaires, and antropometric data were also sampled. Data from the Swedish Medical Birth Register (MBR) about weight before and weight gain during pregnancy were collected. The sample was divided into groups regarding four critical time periods: (1) Time interval between first and second pregnancy, less and more than 2 years. (2) Overweight and normal weights before first pregnancy based on initial body mass index (BMI). (3) Low and high weight gainers during pregnancy by mean split. (4) Low and high weight retainers at 1 year after first pregnancy by mean split. RESULTS: 1) There were no differences between those women who have more than 2 years between their pregnancies regarding weight gain during and weight retention after the first and second pregnancy. (2) Overweight women did not gain more weight during pregnancy or retain more weight at 1 year of follow-up after the first and second pregnancy. (3) High weight gainers retained more weight at 1 year after both the first and second pregnancy. (4) High weight retainers had gained more during pregnancy and retained it into the second pregnancy, and also gained more during and retained more after the second pregnancy. DISCUSSION: To our knowledge, the SPAWN study is the longest follow-up study of factors affecting weight development after pregnancy. Women overweight before pregnancy did not have any higher risks of postpartum weight retention than normal weight women. Weight gain during pregnancy and weight retention up to 1 year after delivery is of predictive value for the weight development in the second pregnancy. Obviously the environmental variation is an important determinant of the differences in weight increase, which follow a pregnancy. Pregnancies time interval does not seem to be of any importance. There are practical implications of these findings: Women who plan their later pregnancy several years after the first pregnancy have no reason to assume that the weight development during subsequent pregnancies will be worse than before. On the other hand, women who have increased considerably in weight during the first pregnancy or retained weight after delivery have a higher risk of doing so in the subsequent pregnancies and should receive appropriate advise and support.

Natural course of gestational diabetes mellitus: long term follow up of women in the SPAWN study.

OBJECTIVES: Long term follow up women with gestational diabetes mellitus (GDM). DESIGN: Case-control study. SETTING: Academic obesity unit. POPULATION: Women earlier identified as having gestational diabetes mellitus. METHOD: Twenty-eight women diagnosed with GDM in 1984-1985, and a control group (n = 52) who gave birth at the same time performed a 2-h oral glucose tolerance test 15 years later. Basic anthropometry and questions about various aspects of eating and exercise habits were furthermore obtained. RESULTS: Ten women (35%) in the GDM group were diagnosed with type 2 diabetes mellitus and none in the control group (P < 0.001). Mean BMI in the diabetic group was 27.4 kg/m2 and in the non-diabetic GDM group 24.6 kg/m2 (P < 0.05). The mean weight gain since the first child was 8A kg in all GDM versus 8.1 kg in controls (ns). The women who developed type 2 diabetes mellitus, however, gained 15.1 kg since the birth of their first child (P < 0.05). CONCLUSIONS: Women who are diagnosed with GDM have a considerably higher risk of developing type 2 diabetes mellitus later in life. Despite a close medical monitoring during pregnancy, the further follow up within the health care system and information about long term consequences of GDM for later type 2 diabetes mellitus development seems to be generally lacking. More active strategies for future weight control and lifestyle advice after delivery might therefore be indicated for women with GDM.