title: Evidence for a Complex Relationship Among Weight Retention, Cortisol and Breastfeeding in Postpartum Women.
abstract: Objective To assess the relationship between cortisol slope, a biologic marker of stress, and postpartum weight retention. Methods We included 696 women in a secondary analysis from a multi-site study conducted using principles of community-based participatory research to study multi-level sources of stress on pregnancy outcomes. As a stress marker, we included salivary cortisol slope; the rate of cortisol decline across the day. Pre-pregnancy weight and demographic data were obtained from the medical records. At 6 months postpartum, patients were weighed and returned saliva samples. We built stepwise regression models to assess the effect of demographic variables, cortisol slope and cortisol covariates (wake time, tobacco use and breastfeeding) on postpartum weight retention. Results 45.5 % of participants were African American, 29.2 % White, and 25.3 % Hispanic. Of the Hispanic women 62.5 % were Spanish speaking and 37.5 % were English speaking. In general, participants were young, multiparous, and overweight. Postpartum, almost half (47.6 %) of women studied retained >10 lbs. In multivariable analysis including age, pre-pregnancy BMI and public insurance, cortisol slope was significantly associated with weight retention (β = -1.90, 95 % CI = 0.22-3.58). However, when the model was adjusted for the cortisol covariates, breastfeeding (β = -0.63, 95 % CI = -1.01 to -0.24) and public insurance (β = 0.62, 95 % CI = 0.20-1.04) were the two strongest correlates of weight retention. Conclusions for Practice The association between cortisol slope and postpartum weight retention appears to be influenced breastfeeding status.
authors.affiliation: Department of Obstetrics and Gynecology, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA. HeatherStraubMD@gmail.com.|MultiCare Regional Maternal-Fetal Medicine, MS: 1105-2-MFM, 1105 Division Ave, Suite 201, Tacoma, WA, 98403, USA. HeatherStraubMD@gmail.com.
authors.forename: Heather
authors.initials: H
authors.lastname: Straub
authors.affiliation: Institute for Policy Research, Northwestern University, Evanston, IL, USA.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Simon
authors.affiliation: Department of Obstetrics and Gynecology, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Plunkett
authors.affiliation: Department of Obstetrics and Gynecology, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Loraine
authors.initials: L
authors.lastname: Endres
authors.affiliation: Institute for Policy Research, Northwestern University, Evanston, IL, USA.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Adam
authors.affiliation: Research Institute, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Mckinney
authors.affiliation: Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA.
authors.forename: Calvin J
authors.initials: CJ
authors.lastname: Hobel
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
authors.forename: Tonse
authors.initials: T
authors.lastname: Raju
authors.affiliation: Research Institute, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Shalowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology; D055812:Community-Based Participatory Research; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D049590:Postpartum Period / Q000378:metabolism* / Q000523:psychology; D011247:Pregnancy / Q000502:physiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012424:Rural Population; D012463:Saliva / Q000378:metabolism; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D013383:Suburban Population; D014505:Urban Population; D015430:Weight Gain; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: Breast feeding; Cortisol slope; Postpartum weight retention; Stress