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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 1  |  Page : 18-23

Factors affecting body mass index of female individuals at 1 year after delivery


Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission25-Dec-2018
Date of Decision24-Jan-2019
Date of Acceptance26-Jan-2019
Date of Web Publication25-Mar-2020

Correspondence Address:
Nehad Abd El Moneam Mohamed
Al-Santa, Gharbia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_411_18

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  Abstract 


Objective
This study was conducted to assess factors affecting the BMI of women at 1 year after delivery.
Background
The postpartum period is a very special phase during a woman's life. A woman's ability to manage her weight through the postpartum transition has life-long implications for her weight status.
Patients and methods
A case–control study was conducted on female individuals who attended the Kafrekla Family Health Unit at 1 year after delivery; 278 cases with a BMI more than or equal to 25 and 278 controls with a BMI less than 25 were included in the study during the period spanning from August 2017 to October 2017. The data were collected by a predesigned questionnaire, which consisted of the following (and they are): sociodemographic data, obestetric history, breastfeeding data, contraceptive use data, and dietary behavior data.
Results
The most significant factors increasing the BMI of female individuals at 1 year after delivery were type of infant feeding [odds ratio (OR), 84.11], type of delivery (OR, 1.96), and hormonal contraception use (OR, 0.858), with exact P value (P = 0.0001, 0.003, 0.001, respectively).
Conclusion
Predictive factors for BMI of female individuals at 1 year after delivery were type of delivery, duration and type of breastfeeding, hormonal contraception use, breakfast consumption, multigravidity, last gestational period, and last birth interval, respectively.

Keywords: BMI, breastfeeding, hormonal contraception, postpartum


How to cite this article:
Hegazy NN, El-Fatah Badr SA, El Moneam Mohamed NA. Factors affecting body mass index of female individuals at 1 year after delivery. Menoufia Med J 2020;33:18-23

How to cite this URL:
Hegazy NN, El-Fatah Badr SA, El Moneam Mohamed NA. Factors affecting body mass index of female individuals at 1 year after delivery. Menoufia Med J [serial online] 2020 [cited 2020 Aug 15];33:18-23. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/18/281305




  Introduction Top


Obesity is the fastest growing cause of chronic disease worldwide, and its prevalence is progressive, unrelenting, and challenging, with serious public health and economic implications. Current international trends confirm that women are gaining more weight than men, with younger women of reproductive age at highest risk, with rapid weight gain and high levels of obesity[1].

Overweight and obesity is prevalent among women of reproductive age (25–34 years), with 42% having a BMI more than 25 kg/m2[2]. Having children is associated with maternal weight gain, particularly in the long term[3]. Fifty to eighty percent of women retain 1.4–5 kg up to 12 months postpartum, with 20–50% retaining 5 kg or more[4].

The postpartum period is a very special phase during a woman's life and that of her newborn child. It is marked by strong emotion, dramatic physical changes, new and altered relationships, and the assumption of and adjustment to a new role. New mothers move from the social status of a 'woman' to that of a 'mother.' Postpartum is the time during which, the mother's body, including hormonal levels and general and reproductive systems, returns to a nonpregnant state. It is one of the most important stages for the mother–child dichotomy, and has been influenced by multiple cultural beliefs and practices handed down from generation to generation, and by multiple risk factors that the mother faces, which contribute to major changes in the BMI and obesity of the mother later on[5].

Different researchers studied the risk factors for BMI changes as a measure of overweight and obesity in female individuals during the first 6 weeks after delivery and the first 6 months after delivery[6]. Few research studies have been carried out on the risk factors for BMI changes at 1 year after delivery[7].

The aim of this study was to assess the factors affecting BMI of female individuals at 1 year after delivery.


  Patients and Methods Top


The study design was reviewed and formally approved by the ethics committee of Faculty of Medicine, Menoufia University. Communications with the university and health professions were oriented to the objectives and procedures of the study, and permission was obtained to conduct the study. All participants were informed about the nature of the study, and those who consented were included in the study. This study was a case–control study that was conducted on 278 cases who were female individuals with a BMI more than or equal to 25 at 1 year after delivery, and 278 controls who were female individuals with a BM1 less than 25 at 1 year after delivery, who attended the Kafrkela Family Health Unit, Gharbia governate, during the period spanning from the beginning of August 2017 to the end of October 2017, with a response rate of 100%.

All female individuals at 1 year after delivery who were not pregnant and who were not in a program to lose weight were included in the study, whereas female individuals who were pregnant or planning to become pregnant or who were in a program to lose weight were excluded from the study.

The predesigned questionnaire consisted of five parts: The first part intended to collect sociodemographic data related to the studied persons that included the six domains of occupation, education, computer use, family economy, and home sanitation. The second part focused on obstetric history (gravidity, last birth interval, gestational duration, birth order, sex of baby, and gestational weight gain (GWG)).

The third part consisted of breastfeeding data (duration, intensity, type of breastfeeding, or nonbreastfeeding). The fourth part comprised the contraceptive method they used, duration of use, complaint from overweight after usage, and discontinuation of contraception method because of weight gain. The fifth part included dietary history data and physical activity data.

The results from the study were collected, revised, coded, tabulated, and statistically analyzed by statistical package for the social science [SPSS, version 20 IBM personal computer; IBM (Armonk, USA)]. Quantitative data were expressed as mean and SD.

Qualitative data were expressed as number and percentage and were analyzed applying the χ2 test and Fisher's exact test for comparison of qualitative data with expected number of cells less than five.


  Results Top


There was a statistically significant relation between BMI of female individuals at 1 year after delivery and gravidity, last birth interval, last gestational period, and gestational weight gain (P = 0.0001) for all, and there was a statistically significant relation between BMI and type of delivery (P = 0.003) [Table 1].
Table 1: Relationship between BMI and obstetric history data among the studied group

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There was a statistically significant relation between BMI and duration and type of breastfeeding (P = 0.0001).

However, there was no statistically significant relation between BMI and time of introduction of breastfeeding (P = 0.153) [Table 2].
Table 2: Relationship between BMI and breastfeeding among the studied group

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There was a statistically significant relation between BMI and contraceptive method used and duration of contraception (P = 0.0001, 0.003, respectively) [Table 3].
Table 3: Relationship between BMI and contraceptive method used among the studied group

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There was a statistically significant relation between BMI and daily breakfast consumption, total calories consumed daily, water consumption, and doing physical activity (P = 0.0001) for all [Table 4].
Table 4: Relationship between BMI and dietary data and physical activity among the studied group

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In binary logistic regression, the most significant factors affecting BMI of female individuals at 1 year after delivery were type of infant feeding [odds ratio (OR), 84.11; confidence interval (CI), 17.3–406.6], followed by type of delivery (OR, 1.96; CI, 1.19–3.23), followed by hormonal contraception use (OR, 0.858; CI, 0.192–3.8) followed by duration of breastfeeding (OR, 0.631; CI, 0.37–1.06), followed by gravidity (OR, 0.497; CI, 0.255–0.97), followed by last gestational period (OR, 0.431; CI, 0.095–1.9), followed by daily breakfast consumption (OR, 0.428; CI, 0.2–0.87), and last birth interval (OR, 0.315; CI, 0.07–1.3) [Table 5].
Table 5: Binary logistic regression for factors affecting BMI among the studied group

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  Discussion Top


As regards gravidity, the present study revealed that there was a highly statistically significant association between gravidity and postpartum weight gain.

In agreement with the result of the current study, Gunderson et al.[8] reported a significant association between parity and BMI; the more number of mother's gravidity, the more postpartum BMI.

The study revealed that there was a highly statistically significant association between gestational duration and postpartum BMI. In contrast, Scholl et al.[9] found no association between gestational duration and high postpartum weight gain among 274 women with normal BMI.

In the current study, there was a highly statistically significant association between birth interval and postpartum BMI. It is in line with Gunderson who reported that substantial excess weight gain is associated with short interval between pregnancies. The more short time elapsed between pregnancies, the more the risk for weight gain[8].

There was a statistically significant association between mean GWG and postpartum BMI. In agreement with the present study, a number of studies had shown that appositive relationship exists between gestational weight gain and postpartum weight retention[10],[11]. The Brazilian study found that women who had gestational weight gain above recommendations had significantly higher postpartum weight retention at 9 months than women who gained within or below the guideline independent of prepregnant BMI[12].

The study revealed that there was a highly statistically significant association between the type and duration of breastfeeding and postpartum BMI.

Baker et al.[13] showed that for women who breastfed for the recommended duration and intensity and who gained weight reasonably during pregnancy of around 12 kg, breastfeeding could also make a meaningful contribution, eliminating postpartum weight retention (PPWR) by 6 months postpartum in many women. Furthermore, Janney used longitudinal data for 110 USA women to construct four patterns of breastfeeding practice that reflected both the duration and intensity of breastfeeding. They found that women who breastfed achieved their pre-pregnancy weight nearly 6 months earlier than did women who only bottle-fed their infants[14]. Moreover, Linne et al.[15] found that breastfeeding was associated with reduced postpartum weight retention at long-term follow-up.

As regards hormonal contraception use, there was a highly statistically significant association between the use of hormonal contraception and postpartum BMI.

In agreement with the result of the current study, Sivin et al.[16] conducted a 5-year follow-up of women in the USA and South America who used hormonal contraception; his study revealed that women gained weight at an average of 1.1 kg per year. A recent Cochrane systematic review found that there was insufficient evidence to determine the effect of combination contraceptive on weight[17].

In the present study, as regards breakfast consumption, there was a highly statistically significant association between breakfast consumption and postpartum BMI.

In agreement with the result of the current study, a Greek study carried out in 2009 found that adult women show an inverse association between breakfast consumption and BMI[18]. Moreover, in a 5-year cross-sectional and prospective study, there was an association between breakfast frequency and weight gain; in cross-sectional analyses, the frequency of eating breakfast was inversely associated with BMI in a strong dose–response manner. In the prospective analyses, the frequency of eating breakfast was also inversely associated with weight gain in a dose–response manner[19].

Frequency per day could lead to less efficient energy use by increasing dietary-induced thermogenesis and hence results in a lower BMI. Moreover, breakfast consumption may prevent overeating during the day[18].


  Conclusion Top


The study concluded that third-order child, long last gestational duration, high gestational weight gain than recommended, cesarean section, breastfeeding for less than 6 m, hormonal contraception, low breakfast consumption per week, high total calories per day, low water consumption per day, and decreasing physical activity are risk factors that increase postpartum BMI of female individuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Flegal KM, Carroll MD, Ogden CL. Prevalence and trends in obesity among US adult's 1999-2008. JAMA 2010; 288:1723–1727.  Back to cited text no. 1
    
2.
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 2014; 10:496–509.  Back to cited text no. 2
    
3.
Linne Y, Dye L, Barkeling B, Rossner S. Long-term weight development in women: a year follow-up of the effects of pregnancy. Obesity 2010; 12:1166–1178.  Back to cited text no. 3
    
4.
Rothberg BEG, Magriples U, Kershaw TS, Rising SS, Ickovics JR. Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women. Am J Obstet Gynecol 2011; 204:1–11.  Back to cited text no. 4
    
5.
Harris HE, Ellison GTH. Do the changes in energy balance that occur during pregnancy predispose parous women to obesity? Nutr Res Rev 2009; 10:57–81.  Back to cited text no. 5
    
6.
Gunderson EP, Abrams B. Epidemiology of gestational weight gain and body weight changes after pregnancy. Epidemiol Rev 2012; 22:261–274.  Back to cited text no. 6
    
7.
Pillitteri A. Maternal and child health nursing: care of the childbearing and childrearing family. 6thed Philadelphia, PA: Lippincott Williams & Wilkins; 2010;415–446.  Back to cited text no. 7
    
8.
Gunderson EP, Murtaugh MA, Lewis CE, Quesenberry CP, West DS, Sidney S. Excess gains in weight and waist circumference associated with childbearing: the coronary artery risk development in young adults study [CARDIA]. Int J Obes Relat Metab Disord 2012; 28:525–535.  Back to cited text no. 8
    
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Scholl TO, Hediger ML, Schall JI, Ances IG, Smith WK. Gestational weight gain, pregnancy outcome, and postpartum weight retention. Obstet Gynecol 2011; 86:423–436.  Back to cited text no. 9
    
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Ali AT, Crowther NJ. Factors predisposing to obesity: a review of the literature. JEMDSA 2009; 14:81–84.  Back to cited text no. 10
    
11.
Rossner S, Ohlin A. Pregnancy as a risk factor for obesity: lessons from the Stockholm Pregnancy and Weight Development Study. Obes Res 2009; 3:267–275.  Back to cited text no. 11
    
12.
Parker JD, Abrams B. Differences in postpartum weight retention between black and white mothers. Obstet Gynecol 2010; 81:768–774.  Back to cited text no. 12
    
13.
Baker JL, Michaelsen KF, Sørensen TIA, Rasmussen KM. High pre-pregnant body mass index is associated with early termination of full and any breastfeeding among Danish women. Am J Clin Nutr 2007; 86:404–411.  Back to cited text no. 13
    
14.
Janney CA, Zhang D, Sowers M. Lactation and weight retention. Am J Clin Nutr 2015; 66:1116–1124.  Back to cited text no. 14
    
15.
Linne Y, Dye L, Barkeling B, Rössner S. Weight development over time in parous women. The SPAWN study – 15 years follow-up. Int J Obes Relat Metab Disord 2010; 27:1516–1522.  Back to cited text no. 15
    
16.
Sivin I, Alvarez F, Mishell DR. Contraception with two levenorgestrel rod implants: a 5-year study in the United States. Contraception 2015; 58:275–282.  Back to cited text no. 16
    
17.
Gallo MF, Lopez LM, Grimes DA, Schulz KF, Helmerhorst FM. Combination contraceptives: effects on weight. Cochrane Database Syst Rev 2004; 29:CD003987.  Back to cited text no. 17
    
18.
Kapantais F, Chala E, Kaklamanou D, Lanaras L, Kaklamanou M, Tzotzas T. Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents. Public Health Nutr 2009; 14:101–108.  Back to cited text no. 18
    
19.
Timlin MP, Mark A, Mary S, Dianne N-S. Breakfast eating and weight change in a 5-year prospective analysis of adolescents: project eat [eating among teens]. Pediatrics 2008; 121:638–645.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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