title: How do pregnancy-related weight changes and breastfeeding relate to maternal weight and BMI-adjusted waist circumference 7 y after delivery? Results from a path analysis.
abstract: BACKGROUND
  Reproduction has been related to long-term maternal weight gain, and changes in fat mass, with gestational weight gain, have been identified as an important contributor. However, the influence of weight changes during the whole reproductive cycle and the modifying effect of breastfeeding are unknown.
  
  
  OBJECTIVE
  The objective was to examine how prepregnancy weight, gestational weight gain, postpartum weight changes, and breastfeeding influence maternal weight and body mass index-adjusted waist circumference (WCBMI) 7 y after delivery.
  
  
  METHODS
  This was a prospective cohort study of 23,701 women participating in the Danish National Birth Cohort with singleton births and no births during follow-up. Path analysis was used to assess the total, direct, and indirect effects; the latter was mediated through weight changes on the pathways.
  
  
  RESULTS
  Postpartum weight retention at 6 mo and weight gain from 6 to 18 mo postpartum were highly positively associated with both outcomes. A 1-kg increase in weight retention at 6 mo postpartum corresponded to an average increase of 0.5 kg at 7 y. Gestational weight gain was not associated with WCBMI but was positively associated with weight at 7 y; 87% of this effect was mediated through later weight changes. For both outcomes, a small inverse association was observed for breastfeeding duration. This was strongest for WCBMI, for which 97% of the effect was direct, ie, not mediated through postpartum weight.
  
  
  CONCLUSIONS
  These findings show that postpartum weight retention at 6 mo and weight gain from 6 to 18 mo postpartum contribute equally to adverse maternal anthropometric measures 7 y after delivery. Breastfeeding duration may have a beneficial effect.
authors: Department of Public Health, Section for Epidemiology (HK), and the Department of Public Health, Biostatistics (HS), Aarhus University, Aarhus, Denmark; the Division of Nutritional Sciences, Cornell University, Ithaca, NY (KMR); the Division of Epidemiology, School of Public Health, University of California, Berkeley, CA (BA); the Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (TIAS); the Institute of Preventive Medicine, Bispebjerg and Frederiksberg University Hospital, Capital Region, Copenhagen, Denmark (TIAS); and the Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark (EAN).
authors: Helene
authors: H
authors: Kirkegaard
authors: Henrik
authors: H
authors: Stovring
authors: Kathleen M
authors: KM
authors: Rasmussen
authors: Barbara
authors: B
authors: Abrams
authors: Thorkild I A
authors: TI
authors: Sørensen
authors: Ellen A
authors: EA
authors: Nohr
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D049590:Postpartum Period / Q000502:physiology; D011247:Pregnancy; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055105:Waist Circumference; D015430:Weight Gain / Q000502:physiology*