Long-term maternal anthropometry and cardiovascular health after childbirth

Publikation: AfhandlingPh.d.-afhandling


Background: Obesity and cardiovascular disease (CVD) are some of the most serious public health problems worldwide. For women, childbearing is related to metabolic changes including weight gain and changes in fat distribution that may persist over time. However, breastfeeding may have the potential to reduce these long-term changes. The overall aim of this thesis was to examine how pregnancy-related weight changes, breastfeeding and maternal behavior were associated with mothers’ long-term weight, abdominal fat mass and cardiovascular health. Furthermore, the association between prepregnancy fat distribution and gestational weight gain (GWG) and breastfeeding behavior was investigated.

Methods: This thesis consists of four studies. Three studies were based on self-reported data from the Danish National Birth Cohort (DNBC). The population for the studies on pregnancy-related weight changes, breastfeeding, and maternal behavior in relation to long-term maternal weight and abdominal fat mass consisted of 23,701 women with information on prepregnancy weight and weight 7 years after delivery and no subsequent births during follow-up (Studies I and III). Data on maternal hypertension and CVD incidence was obtained from the National Patient Registry and examined in relation to previous pregnancy-related weight changes and breastfeeding behavior within 66,002 women in the DNBC (Study IV). Finally, in a study based on the Coronary Artery Risk Development in Young Adults (CARDIA) study, measured maternal prepregnancy waist circumference and body mass index (BMI) were examined in relation to GWG and breastfeeding behavior in 1,024 women with 1,371 births (Study II).

Results: Postpartum weight retention and weight gain in motherhood were highly positively associated with maternal weight, abdominal fat mass and risk of hypertension and CVD later in life. Breastfeeding reduced the risk of hypertension and CVD independently of maternal prepregnancy BMI and abdominal fat mass 7 years after delivery. A weak inverse association was observed for breastfeeding duration on long-term maternal weight and abdominal fat mass (Studies I and IV). For abdominal fat mass, almost all of the effect of breastfeeding was not mediated through postpartum weight changes (Study I). In the CARDIA study, it was shown using prepregnancy waist circumference and BMI that more abdominal fat mass before pregnancy was associated with a lower GWG and a lower probability of breastfeeding. In contrast, more lower-body fat mass was associated with a higher GWG and a higher probability of breastfeeding (Study II). Maternal lifestyle behaviors during pregnancy were associated with long-term weight gain, and each additional healthy behavior, defined as: a non-Western diet, leisure-time exercise, TV/video watching ≤2 hours/day, and breastfeeding ≥20 weeks, significantly reduced long-term maternal weight gain. Smoking cessation was associated with higher long-term weight gain than observed in non-smoking mothers, but not than observed in smoking mothers.

Conclusions: Weight retention after childbirth and weight gain in motherhood may have adverse effects on mothers’ long-term anthropometry and cardiovascular health, while breastfeeding and healthy maternal behavior during pregnancy may have a beneficial impact. More research is needed to understand how maternal health status before pregnancy, including abdominal fat mass, may influence these findings. Public health efforts to help mothers achieve healthy behaviors and weight after childbirth may improve mothers’ health later in life, and future studies should identify the most effective intervention strategies within the reproductive cycle.

StatusUdgivet - 9. jan. 2015
Udgivet eksterntJa


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