Pregnancy and the postpartum period is a time of increased vulnerability for retention of excess body fat in women. Breastfeeding (BF) has been shown to have many health benefits for both mother and baby; however, its role in postpartum weight management is unclear. Our aim was to systematically review and critically appraise the literature published to date in relation to the impact of BF on postpartum weight change, weight retention and maternal body composition. Electronic literature searches were carried out using MEDLINE, EMBASE, PubMed, Web of Science, BIOSIS, CINAHL and British Nursing Index. The search covered publications up to 12 June 2012 and included observational studies (prospective and retrospective) carried out in BF mothers (either exclusively or as a subgroup), who were ⩽2 years postpartum and with a body mass index (BMI) >18.5 kg m–2, with an outcome measure of change in weight (including weight retention) and/or body composition. Thirty-seven prospective studies and eight retrospective studies were identified that met the selection criteria; studies were stratified according to study design and outcome measure. Overall, studies were heterogeneous, particularly in relation to sample size, measurement time points and in the classification of BF and postpartum weight change. The majority of studies reported little or no association between BF and weight change (n=27, 63%) or change in body composition (n=16, 89%), although this seemed to depend on the measurement time points and BF intensity. However, of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management.
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Health Survey for England 2007 . National Health Service Information Centre for Health and Social Care 2008, http://www.ic.nhs.uk.wedfiles/pudlications/HSE07/HSE%2007-volume%201.pdf .
Krummel DA . Postpartum weight control: a vicious cycle . J Am Diet Assoc 2007 ; 107 : 37 – 39 .
Gunderson EP, Abrams B, Selvin S . Does the pattern of postpartum weight change differ according to pregravid body size? Int J Obes 2001 ; 21 : 853 – 862 .
Williamson DF, Madams J, Pamuk E, Flegal KM, Kendrick JS, Serdula MK . A prospective study of childbearing and 10 year weight gain in US white women 25 to 45 years of age . Int J Obes Rel Metab Dis 1994 ; 18 : 561 – 569 .
Lovelady C . Balancing exercise and food intake with lactation to promote post-partum weight loss . Proc Nutr Soc 2011 ; 70 : 181 – 184 .
Gore SA, Brown DM, West DS . The role of postpartum weight retention in obesity among women: a review of the evidence . Ann Behav Med 2003 ; 26 : 149 – 159 .
Gunderson EP, Abrams B, Selvin S . The relative importance of gestational gain and maternal characteristics associated with the risk of becoming overweight after pregnancy . Int J Obes 2000 ; 24 : 1660 – 1668 .
Linné Y, Dye L, Barkeling B, Rössner S . Long-term weight development in women: a 15-year follow-up of the effects of pregnancy . Obes Res 2004 ; 12 : 1166 – 1178 .
Rooney BL, Schauberger CW . Excessive pregnancy weight gain and long term obesity: One decade later . Obstet Gynecol 2002 ; 100 : 245 – 252 .
Rooney BL, Schauberger CW, Mathiason MA . Impact of perinatal weight change on long-term obesity and obesity-related illnesses . Obstet Gynecol 2005 ; 106 : 1349 – 1356 .
Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D et al . Breastfeeding and maternal and infant health outcomes in developed countries . Evid Rep Technol Assess 2007 ; 153 : 1 – 186 .
Schwarz EB, Ray RM, Stuebe AM, Allison MA, Ness RB, Freiberg MS et al . Duration of lactation and risk factors for maternal cardiovascular disease . Obstet Gynecol 2009 ; 113 : 974 – 982 .
Stuebe AM, Rich-Edwards JW . The reset hypothesis: lactation and maternal metabolism . Am J Perinatol 2009 ; 26 : 081 .
Shrewsbury VA, Robb KA, Power C, Wardle J . Socioeconomic differences in weight retention, weight related attitudes and practices in postpartum women . Matern Child Health J 2009 ; 13 : 231 – 240 .
Parker JD, Abrams B . Differences in postpartum weight retention between black and white mothers . Obstet Gynecol 1993 ; 81 : 768 – 774 .
Boardley DJ, Sargent RG, Coker AL, Hussey JR, Sharpe PA . The relationship between diet, activity, and other factors, and postpartum weight change by race . Obstet Gynecol 1995 ; 86 : 834 – 838 .
Brewer MM, Bates MR, Vannoy LP . Postpartum changes in maternal weight and body fat deposits in lactating versus non-lactating women . Am J Clin Nutr 1989 ; 49 : 259 – 265 .
Manning-Dalton C, Allen LH . The effect of lactation on energy and protein consumption, postpartum weight change and body composition of well nourished American women . Nutr Res 1983 ; 3 : 293 – 308 .
Potter S, Hannum S, McFarlin B, Essex-Sorlie D, Campbell E, Trupin S . Does infant feeding method influence maternal postpartum weight loss? J Am Diet Assoc 1991 ; 91 : 441 – 446 .
Rooney BL, Schauberger CW . Excess pregnancy weight gain and long-term obesity: one decade later . Obstet Gynecol 2002 ; 100 : 245 – 252 .
Oken E, Taveras EM, Popoola FA, Rich-Edwards JW, Gillman MW . Television, walking and diet. Associations with postpartum weight retention . Am J Prev Med 2007 ; 32 : 305 – 311 .
Walker LO, Timmerman GM, Sterling BS, Kim M, Dickson P . Do low-income women attain their pre-pregnancy weight by the 6th week postpartum? Ethn Dis 2004 ; 14 : 119 – 126 .
National Institute for Health and Clinical Excellence . 2010 . NICE Clinical Guideline 93, www.nice.org.uk/cg93 .
Baker JL, Gamborg M, Heitmann BL, Lissner L, Sorensen TI, Rasmussen KM . Breastfeeding reduces postpartum weight retention . Am J Clin Nutr 2008 ; 88 : 1543 – 1551 .
Gould Rothberg B, Magriples U, Kershaw T, Rising SS, Ickovics JR . Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women . Am J Obstet Gynecol 2011 ; 204 : e1 – e11 .
Gunderson EP, Rifas-Shiman SL, Oken E, Rich-Edwards JW, Kleinman KP, Taveras EM et al . Associations of fewer hours of sleep at 6 months postpartum with substantial weight retention at 1 year postpartum . Am J Epidemiol 2008 ; 167 : 178 – 187 .
Haiek LM, Kramer MS, Ciampi A, Tirado R . Postpartum weight loss and infant feeding . J Am Board Fam Pract 2001 ; 14 : 85 – 94 .
Janney CA, Zhang D, Sowers MF . Lactation and weight retention . Am J Clin Nutr 1997 ; 66 : 1116 – 1124 .
Laskey MA, Prentice A, Hanratty LA, Jarjou LM, Dibba B, Beavan SR . Bone changes after 3 months of lactation: influence of calcium intake, breast-milk output, and vitamin D-receptor genotype . Am J Clin Nutr 1998 ; 67 : 685 – 692 .
Lyu LC, Lo CC, Chen HF, Wang CY, Liu DM . A prospective study of dietary intakes and influential factors from pregnancy to postpartum on maternal weight retention in Taipei, Taiwan . Br J Nutr 2009 ; 102 : 1828 – 1837 .
Martin JE, Hure AJ, Macdonald-Wicks L, Smith R, Collins CE . Predictors of post-partum weight retention in a prospective longitudinal study . Matern Child Nutr; e-pub ahead of print 13 September 2012 ; doi: 10.1111/j.1740-8709.2012.00437.x .
Nuss H, Clarke K, Klohe-Lehman D, Freeland-Graves J . Influence of nutrition attitudes and motivators of eating on postpartum weight status in low-income new mothers . J Am Diet Assoc 2006 ; 106 : 1774 – 1782 .
Öhlin A, Rössner S . Maternal body weight development after pregnancy . Int J Obes Disord 1990 ; 14 : 159 – 173 .
Olson CM, Strawderman MS, Hinton PS, Pearson TA . Gestational weight gain and postpartum behaviours associated with weight change from early pregnancy to 1 y postpartum . Int J Obes 2003 ; 27 : 117 – 127 .
Østbye T, Peterson BL, Krause KM, Swamy GK, Lovelady CA . Predictors of postpartum weight change among overweight and obese women: results from the Active Mothers’ Postpartum Study . J Womens Health 2012 ; 21 : 2 .
Schauberger CW, Rooney BL, Brimer LM . Factors that influence weight loss in the puerperium . Obstet Gynecol 1992 ; 79 : 424 – 429 .
Scholl TO, Hediger ML, Schall JI, Ances IG, Smith WK . Gestational weight gain, pregnancy outcome and postpartum weight retention . Obstet Gynecol 1995 ; 86 : 423 – 427 .
Sheikh GN . Observations of maternal weight behaviour during the puerperium . Am J Obstet Gynecol 1971 ; 111 : 2 .
Walker LO . Predictors of weight gain at 6 and 18 months after childbirth: A pilot study . J Obstet Gynecol Neonatal Nurs 1996 ; 25 : 39 – 48 .
Walker LO, Sterling BS, Kim M, Arheart KL, Timmerman GM . Trajectory of weight changes in the first 6 weeks postpartum . J Obstet Gynecol Neonatal Nurs 2006 ; 35 : 472 – 481 .
Bradshaw MK, Pfeiffer S . Feeding mode and anthropometric changes in primiparas . Hum Biol 1988 ; 60 : 251 – 261 .
Butte NF, Hopkinson JM, Mehta N, Moon JK, Smith EO . Adjustments in energy expenditure and substrate utilization during late pregnancy and lactation . Am J Clin Nutr 1999 ; 69 : 299 – 307 .
Butte NF, Ellis KJ, Wong WW, Hopkinson JM, Smith EO . Composition of gestational weight gain impacts maternal fat retention and infant birth weight . Am J Obstet Gynecol 2003 ; 189 : 1423 – 1432 .
Chou TW, Chan GM, Moyer-Mileur L . Postpartum body composition changes in lactating and non-lactating primiparas . Nutrition 1999 ; 15 : 481 – 484 .
Dewey KG, Heinig MJ, Nommsen LA . Maternal weight loss pattern during prolonged lactation . Am J Clin Nutr 1993 ; 58 : 162 – 166 .
Dugdale AE, Eaton-Evans J . The effect of lactation and other factors on post-partum changes in body-weight and triceps skinfold thickness . Br J Nutr 1989 ; 61 : 149 – 153 .
Hatsu IE, McDougald DM, Anderson AK . Effect of infant feeding on maternal body composition . Int Breastfeed J 2008 ; 3 : 18 .
Kramer FM, Stunkard AJ, Marshall KA, McKinney S, Liebschutz J . Breast-feeding reduces maternal lower-body fat . J Am Diet Assoc 1993 ; 93 : 429 – 433 .
Motil KJ, Sheng HP, Kertz BL, Montandon CM, Ellis KJ . Lean body mass of well-nourished women is preserved during lactation . Am J Clin Nutr 1998 ; 67 : 292 – 300 .
Ota E, Haruna M, Matsuzaki M, Honda Y, Sasaki S, Yeo S et al . Comparison of body fat mass changes during the third trimester and at one month postpartum between lactating and nonlactating Japanese women . Biosci Trends 2008 ; 2 : 200 – 205 .
Sidebottom AC, Brown JE, Jacobs Jr DR . Pregnancy-related changes in body fat . Eur J Obstet Gynecol Reprod Biol 2001 ; 94 : 216 – 223 .
To W, Wong M . Body fat composition and weight changes during pregnancy and 6 to 8 months postpartum in primiparous and multiparous women . Aust New Z J Obstet Gynecol 2009 ; 49 : 34 – 38 .
van Raaij JM, Schonk CM, Veramaat-Miedema SH, Peek ME, Hautvast JG . Energy cost of lactation, and energy balances of well-nourished Dutch lactating women: reappraisal of the extra energy requirements of lactation . Am J Clin Nutr 1991 ; 53 : 612 – 619 .
Wosje K, Kalkwarf H . Lactation, weaning and calcium supplementation: effects on body composition in the postpartum period . Am J Clin Nutr 2004 ; 80 : 423 – 429 .
Butte NF, Hopkinson JM, Ellis KJ, Wong WW, Smith EO . Changes in fat-free mass and fat mass in postpartum women: a comparison of body composition models . Int J Obes 1997 ; 21 : 874 – 880 .
Moller UK, Streym SV, Mosekilde L, Rejnmark L . Changes in bone mineral density and body composition during pregnancy and postpartum. A controlled cohort study . Osteoporos Int 2012 ; 23 : 1213 – 1223 .
Fowles ER, Walker LO . Correlates of dietary quality and weight retention in postpartum women . J Commun Health Nurs 2006 ; 23 : 183 – 197 .
Krause K, Lovelady C, Peterson BL, Chowdhury N, Ostbye T . Effect of breastfeeding on weight retention at 3 and 6 months postpartum: data from the North Carolina WIC Programme . Pub Health Nutr 2010 ; 13 : 2019 – 2026 .
Olsen L, Mundt M . Postpartum weight loss in a nurse-midwifery practice . J Nurse Midwifery 1986 ; 31 : 177 – 181 .
Slotkin E, Herbold N . Influences on weight status of female adults at 6 months postpartum . Topics Clin Nutr 2010 ; 25 : 256 – 263 .
Walker LO, Freeland-Graves J . Lifestyle factors related to postpartum weight gain and body image in bottle and breastfeeding women . J Obstet Gynecol Neonatal Nurs 1998 ; 27 : 151 – 160 .
World Health Organisation . ed. Indicators for Assessing Breast Feeding Practices . World Health Organisation: Geneva, 1991 .
National Health Service . Infant Feeding Survey, UK 2010. The Information Centre for Health and Social Care. Published 20 November 2012 http://www.ic.nhs.uk/searchcatalogue?topics=1/Publichealth/Maternal, infantandchild health&sort=Date&size=10&page=1#top .
Butte NF, Hopkinson JM . Body composition changes during lactation are highly variable among women . J Nutr 1998 ; 128 : 381S – 385S .
Gunderson EP, Abrams B . Epidemiology of gestational weight gain and body weight changes after pregnancy . Epidemiol Rev 2000 ; 22 : 261 – 274 .
Gunderson EP, Jacobs DR, Chiang V, Lewis CE, Feng J, Quesenberry CP et al . Duration of lactation and incidence of the metabolic syndrome in women of reproductive age according to gestational diabetes mellitus status: a 20-year prospective study in CARDIA—The Coronary Artery Risk Development in Young Adults Study . Diabetes 2010 ; 59 : 495 – 504 .
Lederman SA . The effect of pregnancy weight gain on later obesity . Obstet Gynecol 1993 ; 82 : 148 – 155 .
We acknowledge Ohaka Ugomma Chijioke who assisted with the literature searches and data extraction. This work was supported by a grant from the Department of Employment and Learning Northern Ireland.
CEN conducted the literature searches, extracted the data and wrote the first draft of the manuscript. JVW assisted in study selection and data extraction. All of the authors contributed to the writing, editing and reading of the manuscript. CEN had final responsibility for the final content of the paper.
The authors declare no conflict of interest.
Supplementary Information accompanies this paper on International Journal of Obesity website
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Neville, C., McKinley, M., Holmes, V. et al. The relationship between breastfeeding and postpartum weight change—a systematic review and critical evaluation. Int J Obes 38, 577–590 (2014). https://doi.org/10.1038/ijo.2013.132
- weight management
- body composition
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