Gestational Weight Gain and Body Composition Changes during Pregnancy and Early Postpartum.

摘要

Gestational weight gain (GWG) is associated with short-and long-term maternal and infant health outcomes. The purpose of this research was to describe longitudinal changes in weight and body composition during pregnancy and early postpartum according to pre-pregnancy body mass index (BMI) categories. The contributions of sociodemographic and lifestyle factors and resting energy expenditure (REE) on these changes were examined, and the effects of gaining within and outside the recommended GWG on maternal and infant anthropometrics were studied. Overall, 56% of women exceeded total GWG recommendations; higher rates of weight gain above recommendations were observed among overweight and obese women. GWG was significantly associated with higher postpartum weight retention irrespective of pre-pregnancy BMI; however, overweight and obese women retained a larger quantity of fat mass, particularly in the truncal and abdominal regions, at postpartum. Excessive GWG was positively associated with higher weight at birth and 3 months, and rapid postnatal growth in infants. Other covariates associated with changes in weight and adiposity, were as follows: being nulliparous and having a smoking history were associated with excessive GWG and with a faster rate of fat accumulation in late pregnancy; ethnicity contributed to significant differences in GWG and adiposity; and belonging to a low-income family was associated with higher postpartum weight and fat retention and low birth weight. The sports activity score was a significant predictor of lower fat mass and higher fat-free mass accretion during pregnancy, while REE was positively associated with fat mass, fat free mass and excessive GWG during pregnancy. Longer duration of breast feeding was associated with greater loss of fat mass at postpartum. There was no significant difference in macronutrient intake irrespective of BMI; however, overweight and obese women’s energy intake at trimesters 2 and 3 were significantly less than their estimated energy intake requirements. In sum, this research has shown that excessive GWG plays a significant role in postpartum weight retention and could be a risk factor for incremental weight gain in mother-infants. Effective intervention programs promoting optimal GWG should account for variation in an individual woman’s energy expenditure, dietary intake and the presence of risk factors.