Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Identification of women at risk of adverse weight development following pregnancy

International Journal of Obesity volume 30, pages 1234–1239 (2006)Cite this article

Abstract

Background:

It has been known for long time that pregnancy associated with weight problems women but few important factors have been identified, except for weight gain during pregnancy itself.

Objective:

To identify cutoffs for weight gain during pregnancy for identification of women at risk of high weight retention after pregnancy.

Methods:

A longitudinal analysis of 563 women who gave birth in 1984–1985 was used. Weight development during pregnancy was used as diagnostic test for high weight retention at 1 and 15 years follow-up. True positives for high weight retention were defined as >90th percentile at 1 and 15 years. Receiver Operating Characteristic (ROC) analyses were performed to derive cutoffs minimizing the absolute and relative number of misclassifications.

Results:

The average weight retention at 1 year (WR1y) and 15 years (WR15y) was 1.1±3.6 and 7.6±7.4, respectively. There was a moderately strong correlation between weight gain during pregnancy and weight retention at 1 and 15 years follow-up (r2=0.13 and r2=0.05, respectively; both P<0.001) and weight gain during pregnancy as diagnostic test to find high weight retainers performed better than chance both for WR1y (AUC=0.76±0.04, P<0.01) and WR15y (0.63±0.04, P<0.05). To minimize the absolute number of misclassifications of high weight retention, a highly specific and insensitive cut-off of around 24 kg weight gain during pregnancy was needed. The best trade-off between sensitivity and specifity, minimizing the relative number of misclassifications, was at a cutoff of around 16 kg, but this resulted in three times as many absolute misclassifications.

Conclusion:

Weight gain during pregnancy was found to be a moderately strong diagnostic test for weight retention after pregnancy. In order to implement weight gain recommendations for clinical practice larger studies need to be conducted and the demands on the reference values specified, since decisions about the trade-offs between types and extent of misclassifications need to be made.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Mullins A . Overweight in pregnancy. Lancet 1960; i: 146–147.

    Article  Google Scholar 

  2. Greene J . Clinical stydy of the etiology of obesity. Ann Intern Med 1939; 12: 1797–1803.

    Article  Google Scholar 

  3. Sheldon J . Metarnal obesity. Lancet 1949; ii: 869–873.

    Article  Google Scholar 

  4. Abrams B, Laros R . Prepregnancy weight, weight gain, and birth weight. Am J Obstet Gynecol 1986; 154: 503–509.

    Article  CAS  PubMed  Google Scholar 

  5. Cederlöf R, Kaij L . The effect of childbearing on body weight: a twin control study. Acta Psychiatry Scand Suppl 1970; 219: 47–49.

    Article  Google Scholar 

  6. Forster J, Bloom E, Sorensen G, Jeffery R, Prineas R . Reproductive history and body mass index in black and white women. Prev Med 1986; 15: 685–691.

    Article  CAS  PubMed  Google Scholar 

  7. Smith DE, Lewis CE, Caveny JL, Perkins LL, Burke GL, Bild DE . Longitudinal changes in adiposity associated with pregnancy. The CARDIA Study. Coronary Artery Risk Development in Young Adults Study. Jama 1994; 271: 1747–1751.

    Article  CAS  PubMed  Google Scholar 

  8. Rössner S . Pregnancy, weight cycling and weight gain in obesity. Int J Obes Relat Metab Disord 1992; 16: 145–147.

    PubMed  Google Scholar 

  9. Dieckman W . The Toxemias of Pregnancy. St Louise: Mosby, 1952.

    Google Scholar 

  10. Instiute of Medicine soDIaNSDP. Committee on Nutritional Status During Pregnancy, weight Gain and Nutrient Supplementd. National Academy Press: Washington DC, 1990.

  11. Öhlin A, Rössner S . Maternal body weight development after pregnancy. Int J Obes Relat Metab Disord 1990; 14: 159–173.

    Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. Öhlin A, Rössner S . Trends in eating patterns, physical activity and socio-demographic factors in relation to postpartum body weight development. Br J Nutr 1994; 71: 457–470.

    Article  PubMed  Google Scholar 

  14. Schauberger C, Rooney B, Brimer L . Factors that influence weight loss in the puerperium. Obstet Gynecol 1992; 3: 424–429.

    Article  Google Scholar 

  15. Öhlin A, Rössner S . Factors related to body weight changes during and after pregnancy: the Stockholm Pregnancy and Weight Development Study. Obes Res 1996; 4: 271–276.

    Article  PubMed  Google Scholar 

  16. Walker LO . Weight and weight-related distress after childbirth: relationships to stress, social support, and depressive symptoms. J Holist Nurs 1997; 15: 389–405.

    Article  CAS  PubMed  Google Scholar 

  17. Parker JD, Abrams B . Differences in postpartum weight retention between black and white mothers. Obstet Gynecol 1993; 81 (Part 1): 768–774.

    CAS  PubMed  Google Scholar 

  18. Gunderson E, Abrams B, Selvin S . Does the pattern of postpartum weight change differ according to pregravida body size? Int J Obes Relat Metab Disord 2002; 25: 853–862.

    Article  Google Scholar 

  19. Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH . Pregnancy complications and birth outcomes in obese and normal-weight women: effects of gestational weight change. Obstet Gynecol 1996; 87: 389–394.

    Article  CAS  PubMed  Google Scholar 

  20. Janney CA, Zhang D, Sowers M . Lactation and weight retention. Am J Clin Nutr 1997; 66: 1116–1124.

    Article  CAS  PubMed  Google Scholar 

  21. Dewey KG, Heinig MJ, Nommsen LA . Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr 1993; 58: 162–166.

    Article  CAS  PubMed  Google Scholar 

  22. Greene GW, Smiciklas-Wright H, Scholl TO, Karp RJ . Postpartum weight change: how much of the weight gained in pregnancy will be lost after delivery? Obstet Gynecol 1988; 71: 701–707.

    CAS  PubMed  Google Scholar 

  23. Linné Y, Barkeling B, Rössner S . Long-term weight development after pregnancy. Obes Rev 2002; 3: 75–83.

    Article  PubMed  Google Scholar 

  24. Schnell R . Graphisch gestutzte Datenanalyse. Munchen: Oldenbourg Verlag, 1994.

    Book  Google Scholar 

  25. Zweig MH, Campbell G . Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993; 39: 561–577.

    CAS  PubMed  Google Scholar 

  26. Hanley JA . The robustness of the ‘binormal’ assumptions used in fitting ROC curves. Med Decision Making 1988; 8: 197–203.

    Article  CAS  Google Scholar 

  27. Williamson DF, Madans 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 Relat Metab Disord 1994; 18: 561–569.

    CAS  PubMed  Google Scholar 

  28. Linne Y, Dye L, Barkeling B, Rossner S . Weight development over time in parous women-The SPAWN study-15 years follow-up. Int J Obes Relat Metab Disord 2003; 27: 1516–1522.

    Article  CAS  PubMed  Google Scholar 

  29. Thompson ML, Theron GB, Fatti LP . Predictive value of conditional centile charts for weight and fundal height in pregnancy in detecting light for gestational age births. Eur J Obstet Gynecol Reprod Biol 1997; 72: 3–8.

    Article  CAS  PubMed  Google Scholar 

  30. Thompson ML, Fatti LP . Construction of multivariate centile charts for longitudinal measurements. Stat Med 1997; 16: 333–345.

    Article  CAS  PubMed  Google Scholar 

  31. Williams DP, Going SB, Lohman TG, Harsha DW, Srinivasan SR, Webber LS et al. Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. Am J Public Health 1992; 82: 358–363.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Dwyer T, Blizzard CL . Defining obesity in children by biological endpoint rather than population distribution. Int J Obes Relat Metab Disord 1996; 20: 472–480.

    CAS  PubMed  Google Scholar 

  33. Stevens J, Juhaeri, Cai J, Jones DW . The effect of decision rules on the choice of a body mass index cutoff for obesity: examples from African American and white women. Am J Clin Nutr 2002; 75: 986–992.

    Article  CAS  PubMed  Google Scholar 

  34. Linne Y, Barkeling B, Rossner S . Long-term weight development after pregnancy. Obes Rev 2002; 3: 75–83.

    Article  CAS  PubMed  Google Scholar 

  35. Rossner S, Ohlin A . Pregnancy as a risk factor for obesity: lessons from the Stockholm Pregnancy and Weight Development Study. Obes Res 1995; 3 (Suppl 2): 267s–275s.

    Article  PubMed  Google Scholar 

  36. Barker DJ, Godfrey KM, Osmond C, Bull A . The relation of fetal length, ponderal index and head circumference to blood pressure and the risk of hypertension in adult life. Paediatr Perinat Epidemiol 1992; 6: 35–44.

    Article  CAS  PubMed  Google Scholar 

  37. Wadsworth ME, Kuh DJ . Childhood influences on adult health: a review of recent work from the British 1946 national birth cohort study, the MRC National Survey of Health and Development. Paediatr Perinat Epidemiol 1997; 11: 2–20.

    Article  CAS  PubMed  Google Scholar 

  38. Baker HW . Reproductive effects of nontesticular illness. Endocrinol Metab Clin North Am 1998; 27: 831–850.

    Article  CAS  PubMed  Google Scholar 

  39. Wadsworth M, Rodgers B . Longterm follow-up studies; a critical overwiew. Rev Epidemiol Sante Publique 1989; 37: 533–547.

    CAS  PubMed  Google Scholar 

  40. Stunkard A, Sorensen T . Obesity and socioeconomic status: a complex relation. N Engl J Med 1993; 329: 1036–1037.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Obesity Unit, Karolinska University Hospital, Stockholm, Sweden

    Y Linné & M Neovius

Authors
  1. Y Linné
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Neovius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y Linné.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Linné, Y., Neovius, M. Identification of women at risk of adverse weight development following pregnancy. Int J Obes 30, 1234–1239 (2006). https://doi.org/10.1038/sj.ijo.0803258

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0803258

Keywords

This article is cited by

Search

Advanced search

Quick links