BACKGROUND: Weight gained during pregnancy and not lost postpartum may contribute to obesity in women of childbearing age. OBJECTIVE: We aimed to determine whether breastfeeding reduces postpartum weight retention (PPWR) in a population among which full breastfeeding is common and breastfeeding duration is long. DESIGN: We selected women from the Danish National Birth Cohort who ever breastfed (>98%), and we conducted the interviews at 6 (n = 36 030) and 18 (n = 26 846) mo postpartum. We used regression analyses to investigate whether breastfeeding (scored to account for duration and intensity) reduced PPWR at 6 and 18 mo after adjustment for maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG). RESULTS: GWG was positively (P or=5 kg) could be reduced in all but the heaviest women. CONCLUSION: Breastfeeding was associated with lower PPWR in all categories of prepregnancy BMI. These results suggest that, when combined with GWG values of approximately 12 kg, breastfeeding as recommended could eliminate weight retention by 6 mo postpartum in many women.
Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland. Electronic address: th.sigurdardottir@gmail.com.
Source
Am J Obstet Gynecol. 2020 03; 222(3):247.e1-247.e8
Pelvic floor dysfunction, including urinary and anal incontinence, is a common postpartum complaint and likely to reduce quality of life.
To study the effects of individualized physical therapist-guided pelvic floor muscle training in the early postpartum period on urinary and anal incontinence and related bother, as well as pelvic floor muscle strength and endurance.
This was an assessor-blinded, parallel-group, randomized controlled trial evaluating effects of pelvic floor muscle training by a physical therapist on the rate of urinary and/or anal leakage (primary outcomes); related bother and muscle strength and endurance in the pelvic floor were secondary outcomes. Between 2016 and 2017, primiparous women giving birth at Landspitali University Hospital in Reykjavik, Iceland, were screened for eligibilty 6-10 weeks after childbirth. Of those identified as urinary incontinent, 95 were invited to participate, of whom 84 agreed. The intervention, starting at ~9 weeks postpartum consisted of 12 weekly sessions with a physical therapist, after which the main outcomes were assessed (endpoint, ~6 months postpartum). Additional follow-up was conducted at ~12 months postpartum. The control group received no instructions after the initial assessment. The Fisher exact test was used to test differences in the proportion of women with urinary and anal incontinence between the intervention and control groups, and independent-sample t tests were used for mean differences in muscle strength and endurance. Significance levels were set as a = 0.05.
A total of 41 and 43 women were randomized to the intervention and control groups, respectively. Three participants and 1 participant withdrew from these respective groups. Measurement variables and main delivery outcomes were not different at recruitment. At the endpoint, urinary incontinence was less frequent in the intervention group, with 21 participants (57%) still symptomatic, compared to 31 controls (82%) (P = .03), as was bladder-related bother with 10 participants (27%) in the intervention vs 23 (60%) in the control group (P = .005). Anal incontinence was not influenced by pelvic floor muscle training (P = .33), nor was bowel-related bother (P = .82). The mean differences between groups in measured pelvic floor muscle strength changes at endpoint was 5 hPa (95% confidence interval, 2-8; P = .003), and for pelvic floor muscle endurance changes, 50 hPa/s (95% confidence interval, 23-77; P = .001), both in favor of the intervention group. The mean between-group differences for anal sphincter strength changes was 10 hPa (95% confidence interval, 2-18; P = .01) and for anal sphincter endurance changes 95 hPa/s (95% confidence interval, 16-173; P = .02), both in favor of the intervention. At the follow-up visit 12 months postpartum, no differences were observed between the groups regarding rates of urinary and anal incontinence and related bother. Pelvic floor- and anal muscle strength and endurance favoring the intervention group were maintained.
Postpartum pelvic floor mucle training decreased the rate of urinary incontinence and related bother 6 months postpartum and increased muscle strength and endurance.
To examine changes in intake across food groups during a weight loss trial that produced significant and sustainable weight loss in lactating women receiving dietary treatment.
At 10-14 wk postpartum, 61 overweight and obese lactating Swedish women were randomized to a 12-wk dietary (D), exercise (E), combined (DE), or control (C) treatment. Food intake was assessed by 4-d weighed diet records which were used to examine changes in intake across seven food groups from baseline to 12 wk and 1 y after randomization. Differences in changes in food choice between women receiving dietary treatment (D+DE) and no dietary treatment (E+C) were examined using multivariate linear regression.
At baseline, sweets and salty snacks contributed to 21±10 percent of total energy intake (E%). During the intervention period, women receiving dietary treatment reduced their E% from sweets and salty snacks and caloric drinks and increased their E% from vegetables more than did women not receiving dietary treatment (all P?
To review the existing literature on the physiology of exercise in pregnancy as a basis for clinical practice guidelines for prenatal exercise prescription.
MEDLINE search for English language abstracts and articles published between 1966 and 2003 related to physiological adaptations to pregnancy, effects of pregnancy on responses to acute exercise and aerobic conditioning, effects of acute maternal exercise on indexes of fetal well-being, impact of physical conditioning on birth weight and other pregnancy outcomes, and use of exercise to prevent or treat gestational diabetes mellitus and preeclampsia.
Maximal aerobic power (VO(2)max, L/min) is well-preserved in pregnant women who remain physically active, but anaerobic working capacity may be reduced in late gestation. The increase in resting heart rate, reduction in maximal heart rate, and resulting smaller heart rate reserve render heart rate a less precise way of estimating exercise intensity. As rating of perceived exertion (RPE) is not altered by pregnancy, the use of revised pulse rate target zones along with Borg's RPE scale is recommended to prescribe exercise intensity during pregnancy. Responses to prolonged submaximal exercise (>30 min) in late gestation include a moderate reduction in maternal blood glucose concentration, which may transiently reduce fetal glucose availability. The normal response to sustained submaximal exercise is an increase in fetal heart rate (FHR) baseline. Transient reductions in FHR reactivity, fetal breathing movements, and FHR variability may also occur in association with more strenuous exercise. Controlled prospective studies have demonstrated that moderate prenatal exercise during the second and third trimesters is useful to improve aerobic fitness and maternal-fetal physiological reserve without affecting fetal growth.
The Physical Activity Readiness Medical Examination for Pregnancy is recommended for use by physicians and midwives to provide medical clearance for prenatal exercise. Evidence-based prenatal exercise guidelines are needed to counsel healthy and fit pregnant women on the safety of involvement in more strenuous physical conditioning. Future study is also recommended to determine the usefulness of prenatal exercise in the prevention and treatment of gestational diabetes mellitus and preeclampsia.
Coital incontinence and vaginal symptoms and the relationship to pelvic floor muscle function in primiparous women at 12 months postpartum: a cross-sectional study.
Symptoms related to sexual dysfunction postpartum are scarcely addressed in the literature, and the relationship to pelvic floor muscle (PFM) function is largely unknown.
The aim of this study was to investigate primiparous women 12 months postpartum and study: (i) prevalence and bother of coital incontinence, vaginal symptoms, and sexual matters; and (ii) whether coital incontinence and vaginal symptoms were associated with vaginal resting pressure (VRP), PFM strength, and endurance.
International Consultation on Incontinence Modular Questionnaire (ICIQ) sexual matters module and ICIQ-Vaginal Symptoms Questionnaire were used for questions on coital incontinence, vaginal symptoms, and sexual matters, respectively. PFM function was assessed by manometer (Camtech AS, Sandvika, Norway).
Coital incontinence, vaginal symptoms, and PFM function were the main outcome measures.
One hundred seventy-seven primiparous women, mean age 28.7 (standard deviation [SD] 4.3) participated. Of the 94% of women having sexual intercourse, coital incontinence was found for 1.2% whereas 34.5% reported at least one vaginal symptom interfering with the sexual life of primiparous women. Of the symptoms investigated, "vagina feels dry," "vagina feels sore," and "vagina feels loose or lax" were most prevalent, but the overall impact on the woman's sexual life was minimally bothersome, mean 1.4 out of 10 (SD 2.5). Women reporting "vagina feels loose or lax" had lower VRP, PFM strength, and endurance when compared with women without the symptom.
Twelve-month postpartum coital incontinence was rare, whereas the prevalence of vaginal symptoms interfering with sexual life was more common. The large majority of primiparous women in our study had sexual intercourse at 12 months postpartum and the reported overall bother on sexual life was low. Women reporting "vagina feels loose or lax" had lower VRP, PFM strength, and endurance when compared with women without the symptom.
Comparison of National Diabetes Data Group and American Diabetes Association diagnostic criteria for gestational diabetes in their identification of postpartum risk of glucose intolerance.
Gestational diabetes mellitus (GDM) is associated with adverse obstetrical outcomes and postpartum pre-diabetes/diabetes. As the American Diabetes Association (ADA) criteria for GDM may capture obstetrical risk better than the National Diabetes Data Group (NDDG) criteria, we compared these criteria in their detection of postpartum risk of glucose intolerance.
487 Women underwent oral glucose tolerance test in pregnancy and at 3-month postpartum. Participants were stratified into the following 5 groups: normal glucose tolerance (NGT) by both ADA and NDDG; gestational impaired glucose tolerance (GIGT) by ADA only; GIGT by both ADA and NDDG; GDM by ADA only; and GDM by both ADA and NDDG.
The prevalence of postpartum glucose intolerance (pre-diabetes/diabetes) varied across the groups (NGT by both ADA and NDDG: 5.9%; GIGT by ADA only: 14.3%; GIGT by both ADA and NDDG: 10.6%; GDM by ADA only: 21.6%; GDM by both ADA and NDDG: 32.8%; overall p
OBJECTIVE: The objective was to assess the relevance of the recommendations of the Institute of Medicine (IOM), regarding gestational weight gain (GWG) for long-term BMI development. RESEARCH METHODS AND PROCEDURES: The Stockholm Pregnancy and Women's Nutrition is a follow-up study of 483 women who delivered children in 1984 to 1985. ANOVA was used to examine the change in body weight before pregnancy, at 6 months, and 1 year postpartum and 15 years after childbirth. Multiple linear regression was used to assess the predictors of BMI at 15-year follow-up. RESULTS: The weight increase from baseline to 15-year follow-up was 6.2 kg for IOM-insufficient, 6.7 kg for IOM-recommended, and 10.0 kg for IOM-excessive weight gain (p
To report on the relationship between delivery method (cesarean vs. vaginal) and type (planned vs. unplanned) and breastfeeding initiation in hospital and continuation to 6 weeks postpartum as self-reported by study participants.
Quantitative sequential mixed methods design.
Women were recruited from 11 hospital sites in Ontario, Canada.
Participants included 2,560 women age 16 years or older who delivered live, full-term, singleton infants.
Data were collected from an in-hospital questionnaire, hospital records, and a 6-week postpartum interview.
Ninety-two percent of women reported initiating breastfeeding, and 74% continued to 6 weeks. The method of delivery, when defined as cesarean versus vaginal, was not a determining factor in breastfeeding initiation in hospital or in the early postdischarge period. An unexpected delivery method (i.e., unplanned cesarean or instrument-assisted vaginal deliveries) was associated, at a statistically significant level, with an increased likelihood of initiating breastfeeding and continuation to 6 weeks postdischarge.
Breastfeeding can be considered a coping strategy that serves to normalize an abnormal experience and allows the individual to once again assume control. These unexpected results warrant further investigation to understand why women make the decision to initiate breastfeeding, why they choose to continue breastfeeding, and how they can be supported to achieve exclusive breastfeeding as recommended for infants in the first 6 months.
The objective of this article is to assess in a hypertensive pregnant population the role of ethnic background on the development of small for gestational age (SGA) infants. A cohort population of 366 pregnant women who developed new hypertension in their pregnancy were interviewed and their ethnic groups defined. We then compared the outcomes of the pregnancies with regard to the development of SGA infants among the various ethnic groups. Preeclamptic women were more likely to deliver a SGA infant than gestational hypertensive women. Women of East Indian descent delivered the highest incidence of SGA infants when they developed preeclampsia (50%) compared to an incidence in the White population of 13.8%. Only the ethnocultural group, mean third-trimester blood pressure and third-trimester hematocrit, significantly correlated with the development of a SGA infant. Chinese and East Indian women who develop preeclampsia are at the highest risk of having a growth-restricted infant.
