1. Ethnic Differences in Weight Retention After Pregnancy in Hawai`i G. Baruffi, C. Hardy, C. Waslien, S. Uyehara, D. Krupitsky

2. Introduction Obesity in the U.S. has become an epidemic Obesity rates have increased by nearly 60% since 1991, and by 6% between 1998 and 1999 (CDC) 50% of women 25-55 yrs of age are either overweight or obese

3. Introduction (cont) Adequate weight gain during pregnancy is important for optimal pregnancy outcomes Excessive weight gain during pregnancy and retention of weight 6 months after delivery are predictors of long-term obesity

4. Introduction (cont) Weight gain during pregnancy and weight retention postpartum vary by: Prepregnancy BMI Parity, Age Breastfeeding, Smoking, Exercise Race/ethnicity

5. Purpose of the study Reported racial differences are between Black and White women Purpose of this study: to investigate weight gain during pregnancy and weight retention postpartum in a multiethnic population of women in Hawai`i

6. Methods Cross sectional study of postpartum women attending the Hawai`i WIC Program in 1997-98 Weight gain during pregnancy self reported Weight and height at postpartum visit measured by WIC staff

7. Methods (cont) Ethnicity self reported Seven ethnic groups: Asian (Japanese, Chinese, Korean) Black Caucasian (White, Puerto Rican, Spanish) Filipino Hawaiian (Hawaiian, Part-Hawaiian) Samoan Other

8. Analysis First postpartum visit 5,863 women Bivariate and multivariate analysis SAS

9. Distribution of postpartum women by ethnicity. Hawai`i WIC 1997-98 Ethnicity N % Asian Black Caucasian Filipino Hawaiian Samoan Other TOTAL 405 (6.9) 254 (4.3) 1593 (27.2) 1162 (19.8) 1751 (29.9) 236 (4.0) 456 (7.8) 5,863 (100)

10. Distribution of women by post partum duration and ethnicity. Hawai`i WIC 1997-98 EthnicityPostpartum duration (months) % 6 Asian Black Caucasian Filipino Hawaiian Samoan Other 21 25 20 21 19 26 24 42 47 40 47 48 44 41 19 15 18 19 21 19 56854345685434 14 8 14 8 12 Total %214519510

11. IOM recommendations for WT gain by prepregnancy BMI BMIWeight gain (lbs) < 19.828 – 40 19.8 – 2625 – 35 26.1 – 29.015 – 25 > 29.015

12. Distribution of women by prepregnancy BMI and WT gain. Hawai`i WIC 1997-98 BMI% WomenWT gain (lbs) <19.8 17.433.7 +12.7 19.8–26 51.734.6 +15.2 26.1–29.0 10.832.0 +16.6 >29.0 20.127.2 +20.0

13. Prepregnancy BMI and pregnancy weight gain by ethnicity. Hawai`i WIC 1997-98 Ethnicity BMI Mean SD Weight gain(lbs) Mean SD Asian Black Caucasian Filipino Hawaiian Samoan Other 22.7 +5.3 25.2 +5.0 24.5 +5.4 22.5 +4.4 26.1 +6.3 29.7 +6.9 24.6 +6.1 29.1 +12.9 32.1 +16.4 33.4 +15.9 30.0 +13.3 34.1 +17.7 37.3 +22.0 32.9 +16.7 Overall ethnic differences in prepregnancy BMI: p-value <.0001 Overall ethnic differences in mean weight gain: p-value <.0001

14. Postpartum weight loss and retention by postpartum duration. Hawai`i WIC 1997-98 PP months WT loss (lbs) Mean SD WT retention (lbs) Mean SD < 1 1 - 2 3 - 4 5 - 6 7 - 8 > 8 18.7 +11.1 20.8 +10.7 21.1 +11.9 23.4 +13.6 23.8 +15.3 23.7 +14.3 14.8 +15.7 11.8 +13.4 11.5 +14.1 9.4 +13.5 8.7 +16.0 7.4 +15.0 Overall difference in weight loss: p-value <.0001 Overall difference in weight retention: p-value <.0001

15. Postpartum weight loss and retention by ethnicity. Hawai`i WIC 1997-98 Ethnicity WT loss (lbs) Mean SD WT ret (lbs) Mean SD Asian Black Caucasian Filipino Hawaiian Samoan Other 19.5 +9.6 20.4 +12.1 22.2 +11.6 19.1 +9.2 21.8 +12.6 19.8 +16.0 19.5 +13.4 9.6 +11.2 11.7 +14.1 11.1 +13.5 11.0 +11.3 12.3 +15.7 17.5 +21.7 13.3 +16.3 Overall differences in WT loss: p-value <. 0001 Overall differences in WT retention: p-value <.0001

16. Multiple regression of WT retention by ethnicity. Hawai`i WIC 1997-98 EthnicityΒ coefficient p-value Asian Black Filipino Hawaiian Samoan Other 1.095 0.0494 0.958 0.1559 1.606 <.0001 0.363 0.2951 3.469 <.0001 2.308 <.0001 NOTE: Reference category = Caucasian. Weight retention is adjusted for weight gain during pregnancy, postpartum days, and age.

17. Conclusions 30% of women were overweight or obese before pregnancy Overweight and obese women had an excessive weight gain during pregnancy Average weight retention at 5-6 months pp was 9.4 lbs, and 7.4 lbs after 8 months pp

18. Conclusions (cont) Overall significant ethnic differences in prepregnancy BMI Samoan had the highest mean prepregnancy BMI (29.7) Filipino had the lowest mean prepregnancy BMI (22.5)

19. Conclusions (cont) Overall significant ethnic differences in weight gain during pregnancy Samoans had the highest mean weight gain (37.3 lbs) Asian had the lowest mean weight gain (29.1 lbs)

20. Conclusions (cont) Overall significant ethnic differences in weight retention Samoan had the largest average wt retention (17.5 lbs) Asian had the smallest average wt retention (9.6 lbs)

21. Conclusions (cont) Adjusting for weight gain during pregnancy, pp duration, and age, all ethnicities, except Black and Hawaiian, retained significantly more weight than Caucasian. Samoan retained the most (3.5 lbs) Asian retained the least (1.1 lbs)

22. Recommendations For each lb of weight gained during pregnancy there was almost 2/3 lb adjusted weight retention Importance of controlling weight gain during pregnancy Importance of loosing weight after delivery