title: Maternal prepregnancy waist circumference and BMI in relation to gestational weight gain and breastfeeding behavior: the CARDIA study.
abstract: BACKGROUND
  Studies suggest that gestational weight gain (GWG) and breastfeeding behavior may influence long-term maternal abdominal fat mass. However, this could be confounded by abdominal fat mass before pregnancy because it is unknown whether abdominal fat mass, independently of body size, affects GWG and breastfeeding behavior.
  
  
  OBJECTIVE
  We investigated how maternal prepregnancy fat distribution, described by waist circumference (WC) and body mass index (BMI), is associated with GWG and breastfeeding behavior.
  
  
  METHODS
  We analyzed 1371 live births to 1024 women after enrollment in the Coronary Artery Risk Development in Young Adults study (1985-1996). For each birth, maternal prepregnancy BMI and WC were measured at year 0 (baseline), 2, 5, or 7 examinations. Recalled GWG and breastfeeding behavior were collected at years 7 and 10. GWG was analyzed by using linear regression and breastfeeding behavior by using logistic regression and discrete-time logistic regression.
  
  
  RESULTS
  Adjusted for potential confounders, a 1-cm larger WC adjusted for BMI was associated with a 0.19-kg (95% CI: -0.29-, -0.10-kg) lower GWG. In contrast, a 1-unit higher BMI adjusted for WC was associated with a 0.27-kg (95% CI: 0.06-, 0.47-kg) higher GWG. The OR for ever breastfeeding compared with never breastfeeding was 0.93 (95% CI: 0.90, 0.97) per 1-cm larger WC after adjustment for BMI, whereas it was 1.10 (95% CI: 1.02, 1.19) per 1-unit higher BMI adjusted for WC.
  
  
  CONCLUSIONS
  Maternal prepregnancy body size was differently associated with GWG and breastfeeding behavior depending on the location of the fat mass. Thus, maternal fat distribution may be a more important determinant of GWG and breastfeeding behavior than BMI alone.
authors.affiliation: Department of Public Health, Section for Epidemiology and hkie@ph.au.dk.
authors.forename: Helene
authors.initials: H
authors.lastname: Kirkegaard
authors.affiliation: Research Unit of Obstetrics and Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark;
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Nohr
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY;
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Rasmussen
authors.affiliation: Biostatistics, Aarhus University, Aarhus, Denmark;
authors.forename: Henrik
authors.initials: H
authors.lastname: Stovring
authors.affiliation: Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Preventive Medicine, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark;
authors.forename: Thorkild I A
authors.initials: TI
authors.lastname: Sørensen
authors.affiliation: Division of Preventive Medicine and the UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, AL; and.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Division of Research, Cardiovascular and Metabolic Conditions Section, Kaiser Permanente, Northern California, Oakland, CA.
authors.forename: Erica P
authors.initials: EP
authors.lastname: Gunderson
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D039382:Maternal Nutritional Physiological Phenomena; D009765:Obesity / Q000503:physiopathology*; D056128:Obesity, Abdominal / Q000503:physiopathology*; D050177:Overweight / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D015430:Weight Gain; D055815:Young Adult
keywords: breastfeeding; fat distribution; gestational weight gain; maternal; prepregnancy