Cardiometabolic Implications of Postpartum Weight Changes in the First Year After Delivery
Article Figures & Tables
Figures
- Figure 1
Patterns of change in weight in women between prepregnancy and 3 months postpartum and between 3 and 12 months postpartum.
- Figure 2
Mean adjusted levels in each group for the following cardiometabolic risk factors at 3 and 12 months postpartum: (A) systolic blood pressure, (B) diastolic blood pressure, (C) HOMA-IR, (D) adiponectin, (E) LDL cholesterol, and (F) apoB. Each adjusted mean has been adjusted for the following covariates: age, ethnicity, family history of diabetes, parity, prepregnancy BMI, months postpartum at time of assessment, and duration of breastfeeding.
- Figure 3
Adjusted ORs for pregravid, antepartum, and postpartum factors as predictors of likelihood that a woman will gain weight between 3 and 12 months postpartum. Each OR is adjusted for the following covariates: age, ethnicity, prepregnancy BMI, and family history of diabetes.
Tables
- Table 1
Demographic, clinical, and metabolic characteristics of study population stratified into the following four groups based on changes in weight from prepregnancy to 3 months postpartum (loss or gain) and from 3 to 12 months postpartum (loss or gain): loss/loss, gain/loss, loss/gain, and gain/gain
Loss/loss (n = 25) Gain/loss (n = 202) Loss/gain (n = 33) Gain/gain (n = 45) P At OGTT in pregnancy Age, years 35.0 ± 4.1 34.7 ± 4.3 34.7 ± 4.8 35.5 ± 4.1 0.6886 Ethnicity 0.0299 Caucasian 72.0 74.8 63.6 53.3 Asian 20.0 9.4 9.1 22.2 Other 8.0 15.8 27.3 24.4 Family history of diabetes 64.0 57.9 60.6 57.8 0.9391 Parity 0.8862 Nulliparous 60.0 48.0 45.5 48.9 One 36.0 41.6 48.5 40.0 Greater than one 4.0 10.4 6.0 11.1 Smoking exposure 0.9697 Never 68.0 70.8 75.8 75.6 Remote 32.0 27.7 24.2 24.4 Current 0.0 1.5 0.0 0.0 Pregravid total physical activity 7.40 ± 1.45 7.84 ± 1.27 7.48 ± 1.06 7.43 ± 0.93 0.0651 Sport index 2.34 ± 0.76 2.36 ± 0.77 2.18 ± 0.58 2.12 ± 0.66 0.1940 Leisure-time index 3.00 ± 0.69 3.07 ± 0.63 2.88 ± 0.68 2.98 ± 0.60 0.4177 Work index 2.08 ± 0.62 2.41 ± 0.63 2.46 ± 0.56 2.33 ± 0.58 0.0801 Prepregnancy BMI, kg/m2 25.7 (22.5–28.7) 23.1 (21.1–26.6) 30.2 (26.6–32.1) 25.2 (22.7–28.8) <0.0001 Gestational weight gain to OGTT, kg/week 0.2 ± 0.1 0.4 ± 0.1 0.2 ± 0.1 0.4 ± 0.2 <0.0001 Fasting glucose on OGTT, mmol/L 4.6 ± 0.7 4.5 ± 0.5 4.8 ± 0.5 4.7 ± 0.7 0.0692 1-h glucose on OGTT, mmol/L 10.1 ± 2.0 9.2 ± 1.9 10.5 ± 1.6 9.8 ± 2.0 0.0006 2-h glucose on OGTT, mmol/L 9.3 ± 2.1 8.2 ± 1.9 9.1 ± 1.5 8.0 ± 1.9 0.0020 3-h glucose on OGTT, mmol/L 7.5 ± 2.0 6.9 ± 4.2 7.1 ± 1.9 6.6 ± 1.7 0.8252 AUCgluc on OGTT, mmol/L × h 25.4 ± 4.8 23.1 ± 4.4 25.5 ± 3.3 23.4 ± 4.4 0.0032 GDM 56.0 24.8 54.6 31.1 0.0002 Matsuda index of insulin sensitivity 4.4 (2.6–6.5) 5.0 (3.3–7.2) 2.8 (2.1–3.6) 4.1 (2.6–5.3) <0.0001 HOMA-IR 1.8 (1.1–2.5) 1.5 (1.0–2.2) 2.8 (1.7–3.6) 1.9 (1.4–3.0) <0.0001 Adiponectin, µg/mL 8.1 ± 2.6 8.3 ± 3.0 7.0 ± 2.5 7.1 ± 1.9 0.0255 CRP, mg/L 5.98 (2.90–8.62) 4.19 (2.27–7.27) 6.73 (4.50–11.80) 5.68 (2.83–9.85) 0.0013 Total cholesterol, mmol/L 6.09 ± 1.31 6.38 ± 1.24 6.37 ± 1.28 6.33 ± 1.15 0.7549 LDL cholesterol, mmol/L 3.24 ± 1.24 3.65 ± 1.15 3.62 ± 1.18 3.52 ± 0.88 0.4250 HDL cholesterol, mmol/L 1.63 ± 0.28 1.70 ± 0.39 1.53 ± 0.42 1.69 ± 0.36 0.1569 Triglycerides, mmol/L 2.47 (1.88–2.91) 2.31 (1.87–2.87) 2.57 (2.21–3.00) 2.06 (1.81–2.89) 0.2883 apoB, g/L 1.31 ± 0.32 1.26 ± 0.31 1.31 ± 0.32 1.26 ± 0.26 0.7416 apoA1, mmol/L 2.03 ± 0.33 2.09 ± 0.31 2.03 ± 0.33 2.11 ± 0.31 0.4599 At 3 months postpartum Months postpartum 3.1 (2.8–4.0) 3.1 (2.9–3.4) 3.1 (3.0–3.4) 3.50 (3.0–3.9) 0.0267 BMI, kg/m2 24.5 (21.9–28.0) 25.2 (23.0–29.0) 28.0 (25.1–31.0) 26.7 (23.3–31.0) 0.0168 Waist circumference, cm 87.7 ± 10.9 88.6 ± 10.5 92.5 ± 12.2 91.9 ± 15.3 0.1332 Duration of breastfeeding, months 3.0 (3.0–4.0) 3.0 (3.0–3.0) 3.0 (2.5–4.0) 3.0 (3.0–4.0) 0.1277 Current smoking 8.0 2.5 0.0 0.0 0.1807 Total physical activity 4.76 ± 0.84 4.94 ± 1.08 4.65 ± 1.00 4.71 ± 0.87 0.2999 Sport index 1.95 ± 0.45 2.06 ± 0.71 1.87 ± 0.52 1.90 ± 0.57 0.2702 Leisure-time index 2.83 ± 0.61 2.89 ± 0.59 2.81 ± 0.63 2.82 ± 0.56 0.8090 Fasting glucose on OGTT, mmol/L 4.5 ± 0.4 4.6 ± 0.5 4.5 ± 0.4 4.6 ± 0.4 0.5988 2-h glucose on OGTT, mmol/L 6.5 ± 2.1 6.6 ± 1.9 6.2 ± 1.7 6.2 ± 1.6 0.5451 Prediabetes/diabetes on OGTT 16.0 22.6 15.6 10.3 0.3102 Matsuda index of insulin sensitivity 10.7 (8.4–14.2) 10.8 (7.2–16.5) 7.5 (4.8–12.1) 9.7 (6.0–14.0) 0.0092 HOMA-IR 0.6 (0.5–1.1) 0.8 (0.6–1.3) 1.2 (0.7–1.9) 1.0 (0.6–1.8) 0.0278 Adiponectin, µg/mL 9.2 ± 2.8 8.8 ± 3.2 8.0 ± 2.1 7.6 ± 2.6 0.1068 CRP, mg/L 1.49 (1.24–3.28) 2.32 (0.89–4.07) 2.16 (1.48–5.28) 2.19 (0.96–3.87) 0.5375 Total cholesterol, mmol/L 4.55 ± 0.95 5.18 ± 0.99 5.06 ± 1.13 5.60 ± 0.95 0.0064 LDL cholesterol, mmol/L 2.63 ± 0.80 3.24 ± 0.92 3.14 ± 1.06 3.55 ± 0.80 0.0110 HDL cholesterol, mmol/L 1.51 ± 0.35 1.43 ± 0.30 1.40 ± 0.19 1.49 ± 0.36 0.5275 Triglycerides, mmol/L 0.74 (0.65–0.95) 0.97 (0.66–1.33) 1.22 (0.75–1.36) 0.96 (0.65–1.45) 0.1706 apoB, g/L 0.76 ± 0.23 0.93 ± 0.24 0.91 ± 0.25 0.99 ± 0.20 0.0164 apoA1, mmol/L 1.59 ± 0.20 1.57 ± 0.21 1.62 ± 0.17 1.65 ± 0.26 0.2022 At 12 months postpartum Months postpartum 11.8 (11.4–12.3) 12.1 (11.6–12.7) 12.2 (11.6–13.0) 12.6 (11.7–13.8) 0.0689 BMI, kg/m2 23.4 (21.5–26.8) 23.8 (21.2–27.8) 30.3 (26.6–32.5) 27.8 (23.8–32.4) <0.0001 Waist circumference, cm 83.4 ± 9.1 84.7 ± 9.8 97.1 ± 13.8 94.5 ± 16.5 <0.0001 Duration of breastfeeding, months 11.0 (5.0–12.0) 10.0 (4.0–12.0) 10.0 (6.0–12.0) 11.5 (5.5–12.0) 0.5369 Current smoking 4.0 4.0 0.0 4.6 0.7844 Total physical activity 8.09 ± 1.50 8.42 ± 1.43 7.70 ± 1.43 7.70 ± 1.09 0.0052 Sport index 2.29 ± 0.85 2.38 ± 0.79 2.05 ± 0.72 1.98 ± 0.61 0.0209 Leisure-time index 3.06 ± 0.57 3.07 ± 0.62 2.83 ± 0.65 2.99 ± 0.45 0.1965 Work index 2.78 ± 0.62 2.95 ± 0.61 2.84 ± 0.66 2.74 ± 0.60 0.1029 Fasting glucose on OGTT, mmol/L 4.6 ± 0.3 4.7 ± 0.5 4.8 ± 0.3 4.9 ± 0.5 0.0308 2-h glucose on OGTT, mmol/L 5.9 ± 1.5 6.2 ± 1.8 6.5 ± 1.7 6.6 ± 1.7 0.2859 Prediabetes/diabetes on OGTT 8.0 14.4 24.2 28.9 0.0464 Matsuda index of insulin sensitivity 11.0 (9.3–13.8) 10.4 (6.7–15.7) 5.7 (3.4–7.7) 5.9 (4.3–11.5) <0.0001 HOMA-IR 0.9 (0.7–1.3) 1.0 (0.6–1.5) 2.0 (1.5–2.8) 1.6 (0.9–2.2) <0.0001 Adiponectin, µg/mL 11.0 ± 4.2 9.4 ± 3.6 7.6 ± 2.9 7.6 ± 2.5 <0.0001 CRP, mg/L 0.89 (0.57–2.05) 0.99 (0.47–2.45) 2.73 (0.87–4.25) 1.96 (0.66–4.41) 0.0045 Total cholesterol, mmol/L 4.29 ± 0.54 4.62 ± 0.80 4.98 ± 0.92 5.05 ± 0.97 <0.0001 LDL cholesterol, mmol/L 2.35 ± 0.54 2.72 ± 0.73 3.07 ± 0.91 3.06 ± 0.80 <0.0001 HDL cholesterol, mmol/L 1.53 ± 0.32 1.45 ± 0.34 1.36 ± 0.31 1.45 ± 0.37 0.3134 Triglycerides, mmol/L 0.73 (0.64–1.03) 0.81 (0.65–1.18) 1.05 (0.86–1.53) 0.94 (0.79–1.35) 0.0010 apoB, g/L 0.69 ± 0.12 0.80 ± 0.20 0.91 ± 0.19 0.90 ± 0.21 <0.0001 apoA1, mmol/L 1.53 ± 0.23 1.49 ± 0.23 1.50 ± 0.24 1.54 ± 0.24 0.4797 Data for continuous variables are mean ± SD, except for prepregnancy BMI, Matsuda index, HOMA-IR, CRP, triglycerides, months postpartum, BMI and duration of breastfeeding, which are median (interquartile range). Categorical variables are presented as percentages. P values refer to the overall difference across groups as derived from ANOVA for normally distributed variables and Kruskal–Wallis test for skewed variables and either χ2 test or Fisher exact test for categorical variables.
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