International Journal of Current Research and Review
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IJCRR - 9(18), September, 2017

Pages: 29-35

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Postpartum Weight Retention in Congolese Pregnant in Kinshasa

Author: Kahindo P. Muyayalo, Njiri A. Olivia, Mbungu M.R.

Category: Healthcare

Abstract:Objectives: This study's objectives were to determine proportion of Congolese women with post-partum weight retention and its average level; to identify its risk factors; to determine the proportion of obese women 6 weeks after delivery.
Materials and Methods: A prospective study was conducted from 1st October 2012 to 30th June 2013. We followed up a cohort of 199 women, with a singleton pregnancy, recruited during antenatal care (which began at least at 20 weeks of gestation) in 2 maternity hospitals of Kinshasa. These women were also examined in the labor room and 6weeks after delivery. Our variables of interest were pre-gestational BMI, gestational weight gain and postpartum lifestyle. All data was analyzed using the SPSS 18.0 software.
Results: The mean post-partum weight retention was 3.14 kg with a median of 3kg and extremes ranging from -5 to 17 kg; 75.4% of women were affected by this weight retention. High economic status (p = 0.04) and GWG (p = 0.000) are the main factors associated with weight retention 6 weeks after childbirth. The proportion of obese women increased by 8%.
Conclusion: Our study found that majority of women had weight retention 6 weeks after delivery. They retained an average of 3.14 kg. Care providers should monitor the nutritional status (BMI) of postpartum women through lifestyle counseling.

Keywords: Gestational weight gain, Post-partum weight retention, Obesity

Full Text:

Introduction

Pregnancy is a period characterized by significant changes in the maternal organism (1). In addition to the effects produced by hormones of placental origin, there is a tissue neoformation mainly on the uterus, breasts and the extracellular fluid (1, 2). These modifications, associated with development of fetus, result in a gestational weight gain (GWG). After delivery the physiological return to non-pregnant state, of organs that have undergone changes during pregnancy, usually occurs around the 6th week of postpartum (3, 4). However, many women retain their GWG several months after childbirth (5-7). The difference between that weight retained and pre-gestational weight defines postpartum weight-retention (PPWR) (8, 9). This PPWR exposes affected women to an increased risk of obesity (6), chronic cardiovascular diseases (10) as well as certain very frequent pathologies during pregnancy, such as pre-eclampsia and gestational diabetes (5-7).

Obesity is spreading at an alarming rate, not only in industrialized countries, but also in developing countries (11). World Health Organization (WHO) estimates that one in 10 (1/10) people are obese worldwide and, according to its predictions, more than half of the adult population in the world will become obese or overweight by 2030 (11). At that time, 80% of obese people will live in developing countries (12).

Democratic Republic of Congo (DRC) is not spared of this world "pandemic". According to the survey of risk factors for non-communicable diseases in Kinshasa (DRC), the prevalence of obesity was 5.7% (2.6% for men and 7.7% for women) (13).

Women are the most affected by obesity worldwide (14) and a lot of studies (5-7) have highlighted pregnancy as a trigger for obesity.

So, to prevent obesity in women involves not only identification of people at risk and risk periods, but also detection and suppression of risk factors including PPWR.

This study's objectives will be to determine the frequency and the average of weight retention 6 weeks after delivery; to identify risk factors and behaviors associated with PPWR and determine the proportion of obese women 6 weeks after delivery in the study population.

Material and Methods

A cohort of 199 pregnant women with a single pregnancy, who started their prenatal care at least the 20th week of gestation, were followed from 1st October 2012 to 30th June 2013 in 2 maternities of Kinshasa (University Hospital of Kinshasa and Saint Joseph Hospital). These pregnant women were recruited during prenatal care, re-examined at the labor room and also at the 6th week post partum's appointment.

Pre-gestational weight was the one taken before the 20th week of pregnancy in accordance with a previous study which demonstrated the absence of significant weight change until the 20th week (26).

Maternal information collected were age, economic status, marital status, education level, pre-gestational weight, height, pre-gestational body mass index (BMI), gestational weight gain (GWG), parity, weight at term (at the end of pregnancy), mode of delivery. Maternal weight and type of breastfeeding was collected at the postpartum week six. The newborn information collected was birth weight.

The economic status was defined according to the ownership index of some household properties from which the mother was raised (tap water, electricity, personal toilet, radio set, television set, refrigerator and vehicle). This index distinguishes 4 categories, namely:

  • High level : tap water, electricity, internal toilet, and each of four consumption materials (radio, television, refrigerator and vehicle);

- Moderately high level : any source of drinking other than surface water; internal toilet or not; electricity or not; at least two consumption materials;

- Moderate level : any combination of water source, toilet, electricity, consumption materials which is bigger than those defined by low level but smaller than those defined moderately high level;

- Low level : surface water is used neither as drinking and undrinkable water, no toilet, no electricity, nor any consumption materials.

Parity was the number of pregnancies which was at least 28 weeks irrespective of the outcome. According to the number of these pregnancies, the primiparas was the one that had one pregnancy while the multiparous had at least two.

Signed consent was also obtained from each participant and the information published anonymously.

Statistical Methods

The data was analyzed using SPSS 18.0 software. Proportions and confidence intervals was calculated for all categorical variables and the mean with standard deviation, as well as the median and extremes for quantitative variables.

Comparison of proportions was calculated using Pearson's chi-square test and comparison of mean was calculated using Student t-test and analysis of variance (One-way ANOVA); α =0.05 level, with a 95 % confidence interval.

RESULT

  1. Maternal and neonatal anthropometric parameters

GWG varied between -4 and 27 kg with a mean of 8.8 3.9 kg; majority of pregnant women (58.8%) had a lower GWG than the IOM recommendations (Table I).

  1. Frequency and average of weight retention at the 6th week postpartum

The proportion of women who retained weight 6 weeks after delivery was 75% (Fig. 1) with an average of 14 3.597 kg and a median of 3kg (extremes from -5 to 17 kg) (Table I).

  1. Factors and behaviors associated with weight retention at the 6th week postpartum

 

  1. Sociodemographic characteristics

Only the economic status is significantly associated with weight retention 6 weeks after childbirth. Women with high economic status have a greater weight retention than those with lower status with a statistically significant difference between the high economic level and the middle one (α= 0.000) (Table II).

  1. Obstetric Parameters

Six weeks after delivery, multiparous women had a higher weight retention than primiparas; Similarly, women who gave birth by caesarean section retained more weight than women who gave birth by vaginal mode; but the difference between these groups was not statistically significant (P value 0.67 for parity and 0.83 for delivery mode) (Table III).

  1. Anthropometric parameters

We noted a statistically significant association (p = 0.000) between PPWR 6 weeks after delivery and GWG (Table IV).

  1. Postpartum behaviors (lifestyle)

None of these factors were significantly associated with weight retention 6 weeks after delivery (Table V).

  1. Evolution in BMI categories from pre-gestational period to the 6th week postpartum

The proportion of obese women (BMI ? 30 kg / m 2) increased by 8%; from 21 (10, 6%) before pregnancy to 37 (18.6%) 6weeks after childbirth with a statistically significant difference (p = 0.03) (Table VI).

Discussion

In this study, 75% of women had weight retention 6 weeks after delivery. This observation is close to those reported by Schauberger et al. (78%) (17) and Olsen et al. (72%) (18) in USA.

Six weeks seems to be a short period to allow the restoration of pre-gestational weight after childbirth not only in the Congolese women but also in USA (1, 18) and in Asia (19). This high frequency of PPWR at the 6th week postpartum can be explained by the weight loss model in the early postpartum period (20) which suggests that a woman with normal pre-gestational weight and optimal GWG (13.75 kg) can maintain about 4.75 kg during the first 2 weeks of postpartum after expulsion of the fetus (5 kg), loss of the first fluid and regression of non-fat tissue volume such as uterus (4kg) (17, 21, 22). The remaining weight is largely fat deposition (23). According to Lawrence et al. (21) loss of fat deposits in the first weeks of postpartum occurs at a rate of 0.25 kg per week. Therefore, it will take about 19 weeks to lose the 4.75 kg retained after delivery.

The mean of weight retention at the 6th week postpartum in our study population was 3.14 kg. In a meta-analysis conducted in Western countries (Europe and America) from 1986 to 2004, the mean of weight retention in the 6th postpartum week varied between 3-7 kg (24). A similar study conducted in Asia from 1990 to 2010 reported a mean of PPWR at the 6th week between 2.5 and 8.6 Kg (25). PPWR at week 6 among Congolese women is in the same range with those countries, in which obesity is currently a public health problem (23, 24% of women are obese in Western countries and 29% in Asia) (14). Congolese care providers should take preventive measures against PPWR and, in that way, be able to control in part the emerging problem of obesity (26).

In our study, gestational weight gain and economic status were significantly associated with the PPWR. Regarding GWG, it is the most important predictor of postpartum weight retention in the literature (24, 25).

The economic status is significantly associated to PPWR at the 6th week of post-partum (p <0.04). Existence of a disparity in the returning back to pre-gestational weight by economic status was also found among American women (20, 27) where low-income black women tended to have a high PPWR and developed obesity later. Unlike American studies, in our study, it is women with a higher economic status who were more likely to retain more weight. This difference could be explained by many factors (13) related to industrialization and modernization of cities in developing countrywhich lead to a change in lifestyle of high economic classes (unbalanced diet, stress, decreased physical activity) and favors the occurrence of obesity.

Conclusion

Postpartum weight retention is a new dimension in understanding the global "pandemic" of obesity. This study showed that, in Kinshasa, majority of women had weight retention at the end of the postpartum period (6th week). The main factors influencing that retention was GWG and high socio-economic level. The proportion of obese women increases in the postpartum week 6.

Perinatal care givers must place special emphasis on weight control for women both during pregnancy (to control GWG) and after childbirth. They should provide women with useful information on post-delivery behavior to avoid significant postpartum weight retention that can lead to obesity.

Acknowledgements

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors /editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Conflict of interest

The authors declare no conflict of interest.

Tables

1. Maternal and neonatal anthropometric parameters

Table I. Maternal and neonatal anthropometric parameters

 

n

%

Means SD

Max - Min

 

       

 

 

 

 

 

Pre-gestational weight (Kg)

199

 

64.6 13.3

42-109

Weight at term (Kg)

199

 

 

73.4 14.1

48-125

Height (m)

199

 

 

1.62 0.06

1.47 to 1.81

Pre-gestat. BMI. (Kg / m 2)

 

 

   

15-40

<18.5 (thin)

11

5.5

     

18.5-24.9 (normal)

111

55.8

 

24.3 4.6

 

25- 29.9 (overweight)

56

28.1

     

? 30 (obese)

21

10.6

     

GWG/IOM (Kg)

199

 

   

- 4 - 27

Insufficient

117

58.8

     

Optimal

52

26.1

 

8.8 3.9

 

Excessive

30

15.1

     

PPWR at 6 weeks

199

 

 

3.14 3.597

-5- 17

New born birth weight (g)

 

 

     

<2500 (SGA)

8

4

     

2500 - 3999 (normal)

181

91

 

3219.4 443.8

2000-4800

? 4000 (Macrosomia)

10

5

     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IOM: Institute of Medicine, SGA: Small for gestational age

3. Factors associated with weight retention at the 6th week postpartum

3.1. Sociodemographic characteristics

Table II. PPWR and socio-demographic characteristics

 

n (case)

Median

Min.

Max.

p

Age (years old)

       

0.47

<20

8

1

-2

4

 

20 - 29

92

3

-4

17

 

30 - 39

90

2.35

-5

11

 

? 40

9

3

-3

9

 

Marital status

       

0.48

Married

167

3

-5

17

 

Single

32

2

-4

15

 

Economic status

       

0.04

High *

32

4.30

-2

11

 

Moderately high

124

3

-5

17

 

Middle *

42

2

-4

11

 

low

1.00

.

     

* Statistically significant difference between the high socio-economic level and the average level (0.000).

3.2. Obstetric Parameters

Table III. PPWR and obstetric parameters

 

n

Mean SD

Median

p

Parity

     

0.67

Primiparous

75

2.76 3.837

2

 

multiparous

124

3.37 3.438

3

 

Delivery

     

0.83

Vaginal

142

3.11 3.409

2.85

 

caesarean

57

3.22 4.058

3

 

3.3. Anthropometric parameters

Table IV. Mean of PPWR and anthropometric parameters

 

n

Mean SD

Median

p

pre gesta. BMI (Kg / m 2)

     

0.141

<18.5

11

2.15 3.751

2

 

18.5 - 24.9

111

3.34 3.581

3

 

25 - 29.9

56

2.94 3.529

2.80

 

? 30

21

3.16 3.920

3

 

GWG *

     

0,000

Insufficient

117

2.15 2.032

   

Optimal

52

4.15 3.923

   

Excessive GWG

30

5.26 5.011

   

* Statistically significant difference between GWG and PPWR at week 6 (0.000).

3.4. Postpartum lifestyle

Table V. Mean PPWR and postpartum lifestyle

 

n

Mean SD

Median

p

Exclusive Breastfeeding

     

0,260

Yes

113

2.89 3.222

2.60

 

No

86

3.47 4.032

3

 

Physical activity

     

0.682

 

No

91

3.03 3.590

   

Yes

108

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A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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