Maternal Body Weight Prior to and Following Pregnancy

1
Maternal Body Weight Prior to and Following
Pregnancy

• LCDR Andrea Sharma, PhD, MPH
• Division of Nutrition, Physical Activity and
  Obesity
• National Center for Chronic Disease Prevention
  and Health Promotion
• Centers for Disease Control and Prevention

2
Context New Pregnancy Weight Gain Guidelines

• 1990, Institute of Medicine (IOM), Nutrition
  During Pregnancy
• Pregnancy weight gain (PWG) guidelines based on
  prepregnant BMI
• Poor maternal nutrition and PWG results in small
  for gestational age
• Reexamination of PWG guidelines
• Obesity epidemic
• Excess gestational weight gain
• Short- and long-term outcomes for both mother and
  child

3
Presentation Overview

• 1. Describe distribution and trends in BMI among
  women of reproductive age in the U.S.
• Describe associations between PWG and post-partum
  weight retention
• Summarize briefly new IOM recommendations

4
Trends and Distribution of BMI among Women of
Reproductive Age
5
Data Source

• National Health and Nutrition Examination Survey
  (NHANES)
• US civilian, non-institutionalized population
• Height and weight measured

6
Classification of adult underweight, overweight
and obesity by BMI
World Health Organization (WHO)
7
Historical trends in obesity among U.S. women
aged 20-39 years, 1960-2006
HP 2010
1960-62
1988-94
1999-00
2003-04
1971-74
1976-80
2005-06
2001-02
Source NHES and NHANES Flegal et al, JAMA 2002
Ogden et al, JAMA 2006 Ogden et al, NCHS data
brief 1, 2007. Obesity defined as BMI30.
8
Change in the distribution of BMI between 1988-94
and 2005-06 among U.S. women aged 20-49 years
NHANES III 1988-94 NHANES 2005-06
9
Prevalence of underweight, overweight and obesity
among U.S. women aged 20-49 y
Source NHANES, unpublished analysis
10
Trends in obesity among U.S. women of
reproductive age by age group, 1988-2006
2001-02
1988-94
1999-00
2003-04
2005-06
Source NHANES unpublished analysis Obesity
defined as BMI30.
11
Prevalence of overweight and obesity among U.S.
women aged 20-49 years by age group, 2005-2006
63.2
60.0
57.8
47.8
Source NHANES unpublished analysis Overweight
defined as BMI 25.0-29.9 Obesity defined as
BMI30.
12
Trends in obesity among U.S. women aged 20-49
years by race/ethnicity, 1988-2006
2001-02
1988-94
1999-00
2003-04
2005-06
Source NHANES unpublished analysis Obesity
defined as BMI30. NHnon-Hispanic.
13
Prevalence of overweight and obesity among U.S.
women aged 20-49 years by race/ethnicity,
2005-2006
78.1
70.1
58.0
52.0
Source NHANES unpublished analysis Overweight
defined as BMI 25-29.9 Obesity defined as
BMI30. NHnon-Hispanic.
14
Prevalence of underweight among U.S. women aged
20-49 years by race/ethnicity, 2001-2006
Source NHANES unpublished analysis Underweight
defined as BMIlt18.5. NHnon-Hispanic.
15
Summary

• Underweight relatively stable
• Since 1980, obesity doubled among women but may
  be reaching a plateau
• More than 58 of reproductive age women above a
  normal weight
• Racial disparities
• Obesity higher among older populations

16
Pregnancy Weight Gain and Postpartum Weight
Retention
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Data Source

• Pregnancy Nutrition Surveillance System (PNSS)
• Low-income mothers
• Special Supplemental Nutrition Program for Women,
  Infants, and Children (WIC)
• 2004-2006
• Singleton, term pregnancies
• About 1.4 million records

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Data Analysis

• Descriptive analysis and logistic regression
• Postpartum weight retention
• Postpartum weight - Prepregnant weight
• Time postpartum (lt12, 12-24, gt24 wks)
• Prepregnant BMI category
• Pregnancy weight gain category
• Underweight 28-40 lbs
• Normal weight 25-35 lbs
• Overweight 15-25 lbs
• Obese 15-25 lbs
• Race/ethnicity

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Population Characteristics
20
Mean weight retained over time by prepregnant BMI
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Mean weight retained over time by prepregnant BMI
22
Weight retention of gt10 lbs at 24 wks
postpartum, by PWG status
aOR3.2 (3.1, 3.4)
Referent
aOR0.47 (0.45, 0.50)
Odds Ratios adjusted for age, prepregnant BMI,
race/ethnicity, education, marital status, weeks
postpartum
23
Limitations

• Self-reported prepregnant weight and PWG
• No data on diet, physical activity, breastfeeding
  duration
• Not nationally representative
• Majority of data lt12 wks postpartum

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Summary

• Excess PWG common
• PWG associated with postpartum weight retention
• Patterns of postpartum weight loss differ by
  prepregnant BMI
• Little difference in weight retention by
  race/ethnicity or prepregnant BMI

25
Pregnancy Weight Gain Guidelines Released May
27, 2009
26
New PWG Guidelines
27
New PWG Guidelines
1990 BMI Criteria lt19.8 19.9-26.0 26.0-29.0 gt2
9.0
28
New PWG Guidelines
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Guidelines for special populations

• No modifications for
• Short stature
• Young age
• Racial/ethnic subgroups
• Primiparity
• Smokers
• Multiple Fetuses
• Underweight insufficient data
• Normal weight 37-54 lbs
• Overweight 31-50 lbs
• Obese 25-42 lbs

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Thank You!

• Contact Information
• LCDR Andrea Sharma, PhD, MPH
• Division of Nutrition, Physical Activity and
  Obesity
• AJSharma_at_cdc.gov
• 770-488-5957
• For information on new PWG guidelines
• http//www.iom.edu/CMS/3788/48191/68004.aspx

The findings and conclusions in this presentation
have not been formally disseminated by CDC and
should not be construed to represent any agency
determination or policy.
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New PWG Guidelines
Calculations assume a first-trimester weight
gain of 1.1-4.4 lb (0.5-2.0 kg)
33
Odds of retaining gt10 lbs among those gaining
above 1990 recs, relative to adequate PWG in each
R/E group
NH-White NH-Black Hispanic
Normal Overweight Obese
OR (95 CI) for retaining gt10 lbs
34
Weight retention gt 24 wks postpartum, by
prepregnant BMI and PWG
Underwt Normal Overwt Obese
PWG above recommendations OR (95 CI) 3.2
(3.1-3.4) Adjusting for age, prepregnant BMI,
race/ethnicity, education, marital status, weeks
postpartum
35
Classification of adolescent underweight,
overweight and obesity by gender- and
age-specific BMI percentile
Adolescent defined as 12-19 years. Percentiles
based on CDC growth charts. Overweight formerly
known as at risk for overweight. Obesity
formerly known as overweight.
36
Trends in obesity among U.S. adolescent girls
aged 12-19 years, 1966-2006
HP 2010
1999-00
1966-70
2001-02
1988-94
1971-74
1976-80
2003-06
Note Obesity is defined as BMI gender- and
age-specific 95th percentile from the 2000 CDC
Growth Charts. Source NHANES Ogden et al JAMA
2002 Ogden et al JAMA 2006 Ogden et al JAMA
2008.
37
Prevalence of underweight, overweight and obesity
among U.S. adolescent girls aged 12-19 y
Source NHANES, unpublished analysis
38
Trends in obesity among U.S. adolescent girls
aged 12-19 years by race/ethnicity, 1988-2006
2001-02
1988-94
1999-00
2003-06
Source NHANES MMWR 1997 Ogden et al JAMA 2006
Ogden et at JAMA 2008. Obesity defined as
BMI95th percentile. NHnon-Hispanic.
39
Prevalence of overweight and obesity among U.S.
adolescent girls aged 12-19 years by
race/ethnicity, 2003-2006
Source NHANES Ogden et al JAMA 2008 Overweight
defined as BMI 85th-94th percentile Obesity
defined as BMI95th percentile.
40
Prevalence of overweight and obesity among U.S.
adolescent girls aged 12-19 years by
race/ethnicity, 2003-2006
Source NHANES Ogden et al JAMA 2008 Obesity
defined as BMI95th percentile. NHnon-Hispanic.
41
Prevalence of underweight among U.S. adolescent
girls aged 12-19 years by race/ethnicity,
2001-2006
Source NHANES Unpublished data. Underweight
defined as BMIlt5th percentile. NHnon-Hispanic.