Kac Gilberto, Benício Maria H D A, Velásquez-Meléndez Gustavo, Valente Joaquim G, Struchiner Cláudio J
Department of Social and Applied Nutrition, Institute of Nutrition, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
J Nutr. 2004 Mar;134(3):661-6. doi: 10.1093/jn/134.3.661.
The objective of the study was to test the association between gestational weight gain, reproductive factors, and postpartum weight retention based on a cohort conducted with 405 women aged 18-45 y with follow-up waves at 0.5, 2, 6, and 9 mo postpartum. The outcome variable, postpartum weight retention, was calculated as the difference between the measured weight at each visit minus the prepregnancy weight. We estimated the statistical associations between the outcome variable and potential explanatory covariates of interest by fitting a longitudinal mixed-effects model. Women with gestational weight gain above the recommendations of the Institute of Medicine (IOM) retained significantly more weight than women with weight gain within or below the recommendations, independently of prepregnancy BMI [weight (kg)/height (m(2))] or body fat at baseline. Women with the highest gestational weight gain and with body fat >/=30 g/100 g at baseline had the highest likelihood of developing maternal obesity. The final longitudinal model showed that 35% of each kilogram of weight gained during pregnancy was retained 9 mo postpartum, even after adjustment for age, prepregnancy BMI, body fat at baseline, and years since first parturition. Each unit of increase in prepregnancy BMI was associated with a decrease of -0.51 kg in postpartum weight retention. In conclusion, gestational weight gain was one of the most important predictors for postpartum weight retention and must be monitored systematically with the aim of preventing postpartum obesity and the diseases that follow.
本研究的目的是基于一项对405名年龄在18 - 45岁的女性进行的队列研究，检验孕期体重增加、生殖因素与产后体重滞留之间的关联，该队列在产后0.5、2、6和9个月进行随访。结局变量产后体重滞留的计算方法是每次就诊时测量的体重减去孕前体重的差值。我们通过拟合纵向混合效应模型来估计结局变量与感兴趣的潜在解释性协变量之间的统计关联。孕期体重增加超过医学研究所（IOM）建议值的女性比体重增加在建议值范围内或低于建议值的女性滞留的体重显著更多，这与孕前体重指数[体重（kg）/身高（m²）]或基线体脂无关。孕期体重增加最多且基线体脂≥30 g/100 g的女性发生母体肥胖的可能性最高。最终的纵向模型显示，即使在调整了年龄、孕前体重指数、基线体脂和首次分娩后的年限后，孕期每增加1千克体重，产后9个月仍会滞留35%。孕前体重指数每增加一个单位，产后体重滞留会减少 -0.51千克。总之，孕期体重增加是产后体重滞留最重要的预测因素之一，必须进行系统监测，以预防产后肥胖及随之而来的疾病。
