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Evidence for a Complex Relationship Among Weight Retention, Cortisol and Breastfeeding in Postpartum Women

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Abstract

Objective To assess the relationship between cortisol slope, a biologic marker of stress, and postpartum weight retention. Methods We included 696 women in a secondary analysis from a multi-site study conducted using principles of community-based participatory research to study multi-level sources of stress on pregnancy outcomes. As a stress marker, we included salivary cortisol slope; the rate of cortisol decline across the day. Pre-pregnancy weight and demographic data were obtained from the medical records. At 6 months postpartum, patients were weighed and returned saliva samples. We built stepwise regression models to assess the effect of demographic variables, cortisol slope and cortisol covariates (wake time, tobacco use and breastfeeding) on postpartum weight retention. Results 45.5 % of participants were African American, 29.2 % White, and 25.3 % Hispanic. Of the Hispanic women 62.5 % were Spanish speaking and 37.5 % were English speaking. In general, participants were young, multiparous, and overweight. Postpartum, almost half (47.6 %) of women studied retained >10 lbs. In multivariable analysis including age, pre-pregnancy BMI and public insurance, cortisol slope was significantly associated with weight retention (β = −1.90, 95 % CI = 0.22–3.58). However, when the model was adjusted for the cortisol covariates, breastfeeding (β = −0.63, 95 % CI = −1.01 to −0.24) and public insurance (β = 0.62, 95 % CI = 0.20–1.04) were the two strongest correlates of weight retention. Conclusions for Practice The association between cortisol slope and postpartum weight retention appears to be influenced breastfeeding status.

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Acknowledgments

The Community Child Health Network is supported through cooperative agreements with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U HD44207, U HD44219, U HD44226, U HD44245, U HD44253, U HD54791, U HD54019, U HD44226-05S1, U HD44245-06S1, R03 HD59584) and the National Institute for Nursing Research (U NR008929).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA

    Heather Straub, Beth A. Plunkett & Loraine Endres

  2. MultiCare Regional Maternal-Fetal Medicine, MS: 1105-2-MFM, 1105 Division Ave, Suite 201, Tacoma, WA, 98403, USA

    Heather Straub

  3. Institute for Policy Research, Northwestern University, Evanston, IL, USA

    Clarissa Simon & Emma K. Adam

  4. Research Institute, NorthShore University HealthSystem, Evanston, IL, USA

    Chelsea Mckinney & Madeleine Shalowitz

  5. Department of Psychology, University of California-Los Angeles, Los Angeles, CA, USA

    Calvin J. Hobel

  6. Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA

    John M. Thorp

  7. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

    Tonse Raju

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  1. Heather Straub
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  2. Clarissa Simon
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  3. Beth A. Plunkett
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  4. Loraine Endres
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  7. Calvin J. Hobel
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  8. John M. Thorp
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  10. Madeleine Shalowitz
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Correspondence to Heather Straub.

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Additional information

For the Community Child Health Network.

The members at each site of the Child Community Health Network are listed in the “Appendix”.

Appendix

Appendix

This paper is designated a Core Paper of the Child Community Health Network (CCHN), because it reflects major ideas and work considered central to our network. Accordingly, the last designated author is the network itself preceded by the names of those on the writing team who directly prepared this paper in the order that best reflects their relative contributions. Members of each site are listed below.

  • Baltimore, MD: Baltimore City Healthy Start, Johns Hopkins University

  • Community PI: M. Vance

  • Academic PI: C. S. Minkovitz; Co-Invs: P. O’Campo, P. Schafer

  • Project Coordinators: N. Sankofa, K. Walton

  • Lake County, IL: Lake County Health Department and Community Health Center, the North Shore University Health System

  • Community PI: K. Wagenaar

  • Academic PI: M. Shalowitz

  • Co-Invs: E. Adam, G. Duncan*, A. Schoua-Glusberg, C. McKinney, T. McDade, C. Simon

  • Project Coordinator: E. Clark-Kauffman

  • Los Angeles, CA: Healthy African American Families, Cedars-Sinai Medical Center, University of California, Los Angeles

  • Community PI: L. Jones

  • Academic PI: C. Hobel; Co-PIs: C. Dunkel Schetter, M. C. Lu; Co-I: B. Chung

  • Project Coordinators: F. Jones, D. Serafin, D. Young

  • North Carolina: East Carolina University, NC Division of Public Health, NC Eastern Baby Love Plus Consortium, University of North Carolina, Chapel Hill

  • Community PIs: S. Evans, J. Ruffin, R. Woolard

  • Academic PI: J. Thorp; Co-Is J. DeClerque, C. Dolbier, C. Lorenz

  • Project Coordinators L. S. Sahadeo, K. Salisbury

  • Washington, DC: Virginia Tech Carilion Research Institute, Virginia Tech, Washington Hospital Center, Developing Families Center

  • Community PI: L. Patchen

  • Academic PI: S. L. Ramey; Academic Co-PI R.Gaines Lanzi

  • Co-Invs: L. V. Klerman, M. Miodovnik, C. T. Ramey, L. Randolph

  • Project Coordinator: N. Timraz

  • Community Coordinator: R. German

  • Data Coordination and Analysis Center DCAC (Pennsylvania State University)

  • PI: V. M. Chinchilli

  • Co-Invs: R, Belue, G. Brown Faulkner*, M, Hillemeier, I. Paul, M. L. Shaffer

  • Project Coordinator: G. Snyder

  • Biostatisticians: E. Lehman, C. Stetter

  • Data Managers: J. Schmidt, K. Cerullo, S. Whisler

  • Programmers: J. Fisher, J, Boyer, M. Payton

  • NIH Program Scientists: V. J. Evans and T. N.K. Raju, Eunice Kennedy Shriver National Institute of Child Health and Human Development; L. Weglicki, National Institute of Nursing Research, Program Officers:

  • M. Spittel* and M. Willinger, NICHD; Y. Bryan,* NINR.

  • Steering Committee Chairs: M. Phillippe (University of Vermont) and E. Fuentes-Afflick* (University of California - San Francisco School of Medicine)

  • *Indicates those who participated in only the planning phase of the CCHN.

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Straub, H., Simon, C., Plunkett, B.A. et al. Evidence for a Complex Relationship Among Weight Retention, Cortisol and Breastfeeding in Postpartum Women. Matern Child Health J 20, 1375–1383 (2016). https://doi.org/10.1007/s10995-016-1934-z

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  • DOI: https://doi.org/10.1007/s10995-016-1934-z

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