1. Factors affecting weight retention after pregnancy
Yvonne Linné
MD, Associate Professor
Obesity unit, Karolinska Institute
Stockholm,Sweden

2. Obesity among women is increasing rapidly all over the world, and more and more women in fertile age become overweight and obese.

3. 73% of the female patients at our obesity unit reported that their weight problems started with a pregnancy and that they gained more than 10 kg after the pregnancy.

4. Stockholm Pregnancy and Weight Development study
Weight (kg)
-weight
Delivery
Check-up
Months

6. Most studies report a mean weight retention of 0. 4-3
Most studies report a mean weight retention of kg as a result of a pregnancy in studies with a range of women from 87 to 113,606 women.

7. Factors involved in the weight development after pregnancy: • Weight gain during pregnancy • Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy • Socio-economic factors

8. Factors involved in the weight development after pregnancy: • Weight gain during pregnancy • Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy • Socio-economic factors

9. The strongest factors……
Strongest factor for predicting weight development after pregnancy is
weight gain during pregnancy
weight retention at one year after delivery.
However, 50% of the high weight gainers during pregnancy lose their excess weight during the first year after delivery. Therefore, one year weight retention is a better starting point for intervention.
The strongest faktor found for weight development after pregnancy in the long term is weight gain during pregnancy and weight retention at one year. So if you treat high weight gainer during pregnancy you would proble overtreat 50% of the samle.
There are very few known strong fektors that predikt weight retentio after pregnany. Strongest factor for predicting weight development after pregnancy is 1. weight gain during pregnancy and 2. weight retention at one year after delivery. However, 50% of the high weight gainers during pregnancy lose their excess weight during the first year after delivery. Therefore, one year weight retention is a better starting point for intervention.
Weight development during and after pregnancy is probably not an effect of one single strong factor. Instead numerous factors, of which some are unknown or unmeasurable, seem to interact.

10. Factors involved in the weight development after pregnancy: • Weight gain during pregnancy • Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy • Socio-economic factors

11. Factors involved in the weight development after pregnancy: • Weight gain during pregnancy • Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy • Socio-economic factors

12. Factors involved in the weight development after pregnancy: • Weight gain during pregnancy • Smoking cessation • Changes in activity towards a more sedentary life style after pregnancy • Socio-economic factors

13. • Weight before pregnancy • Age before pregnancy • Breastfeeding
Factors not clearly involved in the weight development after pregnancy:
• Weight before pregnancy
• Age before pregnancy
• Breastfeeding

15. Weight development over time
And the anser is no Overweight women did started there pregnancy on a higher weight but did not gain more weight during pregnencu or retain more weight at one yer or 15 yers of follow upp. It is not the obese woem before pregnancy that need specal fokus during pregnancy for weight controll to avode there weght gain.
Linne Y et al. Long-term weight development in women: a 15-year follow-up of the effects of pregnancy.
Obes Res Jul;12(7):

16. • Weight before pregnancy • Age before pregnancy • Breastfeeding
Factors not clearly involved in the weight development after pregnancy:
• Weight before pregnancy
• Age before pregnancy
• Breastfeeding

17. • Weight before pregnancy • Age before pregnancy • Breastfeeding
Factors not clearly involved in the weight development after pregnancy:
• Weight before pregnancy
• Age before pregnancy
• Breastfeeding

18. Breast feeding
• Energy expenditure by full lactation
≈ 500 kcal/day
• However, no studies showing clinically important role of lactation for weight development after delivery

19. Small mean changes, but…
Small mean changes, but….. Kappel et al found in data from 2845 women that 25% of white women and 40% of the black women had gained more than 9 pounds at 8-10 weeks after delivery. Öhlin et al found in 1432 women that before pregnancy 13 % were overweight, at one year this number had increased to 21%.

20. Limitations 1. Self-reported weight before pregnancy.
2. Few studies have representative control groups.
3. Interaction with other factors such as age, socio-economic variables are hard to rule out.
4. Still unclear when to do the follow-up, 6 months, 1 year, later?

22. Limitations 1. Self-reported weight before pregnancy.
2. Few studies have representative control groups.
3. Interaction with other factors such as age, socio-economic variables are hard to rule out.
4. Still unclear when to do the follow-up, 6 months, 1 year, later?

23. Limitations 1. Self-reported weight before pregnancy.
2. Few studies have representative control groups.
3. Interaction with other factors such as age, socio-economic variables are hard to rule out.
4. Still unclear when to do the follow-up, 6 months, 1 year, later?

24. Confounders identified by Harris et al.
1 .maternal age 2. marital status 3 maternal height 4. heterozygosity
(monozygotic twins) 5. education 6. occupation, social class and
employment status 7. urbanization 8. religion and church attendance 9. ethnicity 10 size and housing 11. husband’s age 12 income 13. capacity for work 14 smoking status 15. fertility
16. husband’s BMI 17 obesity during adolescence and adult life 18. age at menopause and/or menopausal problems 19. birthweight of previous child 20. body weight during first pregnancy 21. household size 22. age at menarche 23. contraceptive and/or HRT use 24. alcohol use 25. physical activity 26. medical history and health status 27. family history of breast and/or endometrial cancer 28. menstrual cycle rhythmicity 29. dieting and weight cycling 30. lactation 31. interbirth interval

25. Confounders identified by Harris et al.
1 .maternal age 2. marital status 3 maternal height 4. heterozygosity
(monozygotic twins) 5. education 6. occupation, social class and
employment status 7. urbanization 8. religion and church attendance 9. ethnicity 10 size and housing 11. husband’s age 12 income 13. capacity for work 14 smoking status 15. fertility
16. husband’s BMI 17 obesity during adolescence and adult life 18. age at menopause and/or menopausal problems 19. birthweight of previous child 20. body weight during first pregnancy 21. household size 22. age at menarche 23. contraceptive and/or HRT use 24. alcohol use 25. physical activity 26. medical history and health status 27. family history of breast and/or endometrial cancer 28. menstrual cycle rhythmicity 29. dieting and weight cycling 30. lactation 31. interbirth interval

26. Confounders identified by Harris et al.
1 .maternal age 2. marital status 3 maternal height 4. heterozygosity
(monozygotic twins) 5. education 6. occupation, social class and
employment status 7. urbanization 8. religion and church attendance 9. ethnicity 10 size and housing 11. husband’s age 12 income 13. capacity for work 14 smoking status 15. fertility
16. husband’s BMI 17 obesity during adolescence and adult life 18. age at menopause and/or menopausal problems 19. birthweight of previous child 20. body weight during first pregnancy 21. household size 22. age at menarche 23. contraceptive and/or HRT use 24. alcohol use 25. physical activity 26. medical history and health status 27. family history of breast and/or endometrial cancer 28. menstrual cycle rhythmicity 29. dieting and weight cycling 30. lactation 31. interbirth interval

27. Confounders identified by Harris et al.
1 .maternal age 2. marital status 3 maternal height 4. heterozygosity
(monozygotic twins) 5. education 6. occupation, social class and
employment status 7. urbanization 8. religion and church attendance 9. ethnicity 10 size and housing 11. husband’s age 12 income 13. capacity for work 14 smoking status 15. fertility
16. husband’s BMI 17 obesity during adolescence and adult life 18. age at menopause and/or menopausal problems 19. birthweight of previous child 20. body weight during first pregnancy 21. household size 22. age at menarche 23. contraceptive and/or HRT use 24. alcohol use 25. physical activity 26. medical history and health status 27. family history of breast and/or endometrial cancer 28. menstrual cycle rhythmicity 29. dieting and weight cycling 30. lactation 31. interbirth interval

28. Limitations 1. Self-reported weight before pregnancy.
2. Few studies have representative control groups.
3. Interaction with other factors such as age, socio-economic variables are hard to rule out.
4. Still unclear when to do the follow-up, 6 months, 1 year, later?

29. Summary
For the average woman pregnancy does not cause major weight retention, but in a subgroup of women pregnancy is associated with obesity.
Weight development during and after pregnancy is probably not an effect of one single strong factor. Instead numerous factors, of which some are unknown or unmeasurable, seem to interact.

31. Thank you for
your attention!