Association of Pre-pregnancy BMI and Postpartum Weight Retention Before Second Pregnancy, Washington State, 2003–2013


Background Maternal overweight and obesity is one of the most common high-risk obstetric conditions associated with adverse birth outcomes. Smaller studies have suggested that pre-pregnancy body mass index (BMI) is associated with postpartum weight retention. Objective The primary objective of this study was to examine the association between pre-pregnancy BMI status and maternal weight retention. Study design We conducted a population-based retrospective cohort study using Washington State birth certificate data from 2003–2013. We included women who had two sequential births during this time period, with the second birth occurring within 18–36 months of the first singleton delivery date. BMI before a women’s first pregnancy (“pre-pregnancy BMI”) was categorized as normal (18.5–24.9 kg/m2) and overweight/obese (25–40 kg/m2). Women were classified as having returned to first pre-pregnancy BMI if their BMI before their second pregnancy was no more than 1 kg/m2 more compared to their BMI before their first pregnancy. Analyses were stratified by gestational weight gain during the first pregnancy (below, met, exceeded recommended gestational weight gain). Results A total of 49,132 mothers were included in the study. Among women who met their recommended gestational weight gain, compared to mothers with a normal BMI, obese/overweight mothers were less likely to return to their pre-pregnancy BMI (76.5 vs 72.3%; RRObese/Overweight = 0.88; 95% CI: 0.85–0.92). A similar pattern was observed among women who exceeded their recommended gestational weight gain (62.6 vs 53.2%; RRObese/Overweight = 0.79, 95% CI: 0.78–0.80). Conclusion Pre-pregnancy BMI in the overweight/obese range is associated with a decreased likelihood of returning to pre-pregnancy BMI. Further research to support women during and after their pregnancy to promote behavior changes that prevent excessive weight gain during pregnancy and weight retention after birth is needed.

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This investigation was supported by the National Institutes of Health under Ruth L. Kirschstein National Research Service Award T32CA009351.

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Correspondence to Tyler G. Ketterl.

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Ketterl, T.G., Dundas, N.J., Roncaioli, S.A. et al. Association of Pre-pregnancy BMI and Postpartum Weight Retention Before Second Pregnancy, Washington State, 2003–2013. Matern Child Health J 22, 1339–1344 (2018).

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  • Body mass index
  • Gestational weight gain
  • Obesity
  • Overweight
  • Postpartum weight retention