**4. Postpartum effects of excessive pregnancy weight gain**

Excessive PWG in women of all prepregnancy BMI categories exerts negative effects on the mother and her infant. Women with excessive gain are at greater risk for cesarean delivery [14–16] and more likely to have pregnancy complications [15]. Infants of women with excessive PWG are more likely to be overweight by 7 years of age [22] and to be obese by adolescence [25]. If this adolescent is female, then she begins pregnancy in a high BMI and is already at greater risk for excessive PWG. After delivery, women with excessive PWG are more prone to postpartum weight retention [11, 17] and more likely to become overweight or obese by the next pregnancy [19, 112, 113].

**3.3. Parity**

50 Selected Topics in Midwifery Care

Even one pregnancy changes the fatness of a woman's body. One arm of the CARDIA study showed that White and Black women with a single pregnancy had pregnancy-related increased adiposity as compared to women who remained nulliparous [98]. Parity has a significant relationship to PWG independent of other known influences. In women from England, parity contributed most greatly to PWG followed by birth weight and BMI [85]. Adolescent primiparas gained 5.28 pounds more than multiparas [99]; had twice the likelihood of excessive PWG than multiparas [96]; and large multiethnic studies have also reported

A relationship between hypertension in pregnancy and excessive PWG has been observed in women of diverse ethnicities [3, 99, 101, 102]. Midwives and health workers must be aware of both modifiable and non-modifiable factors associated with pregnancy-related hypertension. Compared to White women, Black women consistently have more pregnancy-related hypertension independent of other factors [103–105]. In Hispanics, findings are less consistent: from reports of lower risk [106] to differential risk, higher risk for certain types of hypertension (e.g., preeclampsia but not gestational hypertension) [107]. In all ethnicities, pregnancy-related hypertension is more common in primiparas [102] and in women with a

High prepregnancy BMI and excessive PWG are modifiable factors that appear to have independent as well as synergistic influences on hypertension in pregnancy. Women with excessive PWG had a three-fold risk of hypertension and four-fold risk of preeclampsia compared to women who gained appropriately [109], and women with obese BMI had 2.5-fold higher odds of having pregnancy-related hypertension with excessive PWG compared to those who

Increased risk for gestational diabetes mellitus is associated with excessive PWG in early pregnancy [111]. However, once diagnosed with gestational diabetes, women may be more likely to gain inadequately [92, 93] or adequately [90] overall due to dietary and exercise modifications. Therefore, the diagnosis of gestational diabetes is really an opportunity to optimize pregnancy health through monitoring dietary intake and being more intentional to add

Excessive PWG in women of all prepregnancy BMI categories exerts negative effects on the mother and her infant. Women with excessive gain are at greater risk for cesarean delivery [14–16] and more likely to have pregnancy complications [15]. Infants of women with excessive PWG are more likely to be overweight by 7 years of age [22] and to be obese by adolescence [25]. If this adolescent is female, then she begins pregnancy in a high BMI and is already

physical activity as a means of controlling blood-sugar levels.

**4. Postpartum effects of excessive pregnancy weight gain**

primiparity versus subsequent births as a covariate for excessive PWG [2, 3, 100].

**3.4. Hypertension and gestational diabetes**

family history of hypertension [108].

gained adequately [110].

Postpartum weight retention is defined as the weight change from preconception to the first year postpartum. Postpartum weight retention includes PWG, the early postpartum weight loss (from delivery to 6 weeks of postpartum), and late postpartum loss (subsequent weight changes in the postpartum year [114]. Early postpartum weight loss is from the combined weight of the infant, placenta, amniotic fluid, and water accumulated during pregnancy. Depending on the size of the infant and amount of water accumulated, the loss will be about 7 kg (15 lb). However, with an average PWG of 12–14 kg, 4–6 kg is the maternal fat gain, often referred to as "baby fat." Therefore, late postpartum weight loss requires loss of maternal fat that was acquired to support the pregnancy. With excessive PWG, there is even greater fat deposition and the mother has yet more weight to lose.

The pattern of postpartum weight changes was examined in multi-ethnic women (n = 985) aged 18–41 years with 2 consecutive births between 1980 and 1990 [18]. Early postpartum weight change (6 weeks of postpartum) was similar in all four groups. However, the underweight and normal-weight groups lost more late postpartum weight even though their average PWG was greater. The higher (overweight and obese) BMI groups gained less during pregnancy but had diminished weight loss in the later postpartum period. This demonstrated that early postpartum loss is simply a reversal of physiological processes of pregnancy but late postpartum loss requires an alteration in maternal fat stores.

Another multi-ethnic study of young women aged 14–25 years (n = 427) reported that nearly two-thirds had excessive PWG. Of those, 33% of the young women moved to a higher BMI category in the first-year postpartum resulting in 68% being overweight or obese [97].

Excessive PWG is the single greatest contributor to postpartum weight retention and subsequent life-long obesity and related co-morbidities [19, 113]. However, this is further compounded by acculturation/globalization, for example, acquisition of Western patterns of eating and more sedentary work [68, 69, 115]; ethnicity, as women of color are less likely to lose postpartum weight or to gain weight in the postpartum period [116, 117]; short interpregnancy interval [118]; and lower socioeconomic status [119].

Obviously, diminishing postpartum weight retention is greatly dependent on gaining appropriately during pregnancy and not "eating for two." Health workers and midwives should prepare pregnant women for exclusive breastfeeding for at least 6 months not only for the well-known health benefits to the baby but for the increased metabolic expenditure needed for lactation [120]. In women who exclusively breastfed for even 6 months, postpartum weight retention was eliminated in women with average PWG and any weight gain was reduced in all but women with BMI ≥35 kg/m<sup>2</sup> [121]. Each additional week of breastfeeding resulted in an additional postpartum loss or 1.5 lb [97]. In the longer term, breastfeeding has effects on the mother's health beyond postpartum. Middle-aged women who never breastfed were compared to those who breastfed for even 3 months and had waist circumferences of 6.5 cm greater, 28% more central obesity, and therefore greater risk for cardiovascular disease [122]. Therefore, beyond the direct positive effect on postpartum weight retention, and the benefits to the infant, breastfeeding positively influences the mother's trajectory of cardiovascular risk.

**Notes/thanks/other declarations**

**A. Appendix**

your joy in this wonderful work that we are blessed to do!

I must recognize the army of doctors, midwives and health workers who strive to make birth safer for the women and babies of the world. Thank you for doing much with little and for

Pregnancy Weight Gain: The Short Term and the Long Term

http://dx.doi.org/10.5772/intechopen.79066

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