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Background: Obesity during pregnancy has a high incidence rate worldwide. At the same time, postpartum weight of pregnant obese patients can lead to a series of complications. This study aimed to examine the effectiveness of independent self-monitoring (SM) interventions during pregnancy and postpartum on reducing postpartum weight retention in women with obesity during pregnancy. Methods: A multicenter observational study was conducted, involving 448 participants diagnosed with obesity during pregnancy, from five medical organizations. Participants were divided into two groups: those with independent SM activities (SM; n = 201) and those without independent self-monitoring activities (no-SM, NSM; n = 247). Independent SM behaviors included dietary and weight measurements. Linear mixed-effects models with repeated measures, and multiple logistic regression models were employed to assess continuous and categorical weight outcomes, respectively. Results: Changes in body weight were observed from the prepregnancy period to the 12-month postpartum phase. An observable SM effect was evident, resulting in reduced weight retention in the SM group across various time intervals. Notably, at the 12-month postpartum mark, the SM effect retained a slight but significant impact, with the SM group maintaining 2.4 kg less weight compared to the NSM group (95% confidence interval (CI): –4.5 to –0.3). Furthermore, relative to NSM participants, the SM group exhibited a 2.5-fold increased likelihood (95% CI: 1.2–4.8) of experiencing no weight retention at 3 months postpartum compared to their prepregnancy weight. Additionally, SM was associated with a higher probability of vaginal delivery and a decreased likelihood of cesarean sections (p = 0.046). Importantly, no significant distinctions were observed in neonatal outcomes or among participants with varying gestational weight gain (GWG) levels (p = 0.144 and p = 0.064). Conclusion: Independent SM interventions, comprising dietary and weighting, are effective in limiting postpartum weight retention among women with obesity during pregnancy, and enhance delivery method. Healthcare professionals should consider incorporating independent SM strategies into prenatal and postnatal care programs, to support healthy weight management and reduce the risk of adverse pregnancy outcomes and long-term obesity development.
Pregnancy and postpartum periods represent critical life stages, predisposing women to obesity development. Excessive gestational weight gain (GWG) is a known predictor of postpartum weight retention [1, 2]. Globally, nearly 39 million pregnancies per year are complicated by maternal obesity, with some countries reporting prevalence rates of overweight and obesity in pregnancy exceeding 60% (South Africa 64%, Mexico 65%, USA 55%–63%) [3, 4]. In England, overweight and obesity prevalence among women aged 16–24 years is 35%, rising to 61% among those aged 35–44 years, emphasizing the potential risk among women of reproductive age [5].
According to the Pregnancy Risk Assessment Monitoring System, the prevalence of
obesity prior to conception in the United States of America (USA) has increased
by 69.3% over the past decade, with rates as high as 22% [6, 7]. In China, a
national nutrition survey conducted in 2002 indicated that the prevalence of
overweight and obesity among women aged 18–44 was 21.8% and 6.1%, respectively
[8], with an increasing trend observed particularly among women of childbearing
age [9]. In the United Kingdom (UK), approximately 1 in 1000 births involve
women with a body mass index (BMI)
In comparison to women of normal weight, those who were diagnosed as obese or overweight at the beginning of pregnancy, are two to three times more likely to exceed the Institute of Medicine’s GWG recommendations and are less likely to regain their prepregnancy weight [13]. A higher risk of different unfavorable pregnancy outcomes in subsequent pregnancies is linked to postpartum weight retention, or an increase in BMI between pregnancies [14]. The obesity pandemic among women is fueled in part by excessive prenatal weight gain and postpartum weight retention [2, 15, 16, 17]. Research has indicated that GWG is linked to the risk of pregnancy complications, maternal postpartum weight retention, and obesity in offspring [18]. While GWG is necessary for ensuring the health of the fetus, excessive weight gain during pregnancy has been associated with unfavorable outcomes [19, 20, 21, 22, 23, 24].
The nutritional status of expectant mothers is widely regarded as a valuable prognostic indicator for perinatal and long-term adverse outcomes in both the infant and the mother [25]. Preexisting overweight or obesity before conception constitutes a significant risk factor for gestational diabetes mellitus, hypertensive syndrome, and fetal growth disorders [26, 27]. Postpartum weight retention is also more common among mothers with excessive weight gain. In terms of fetal and neonatal risks, excessive weight gain can lead to macrosomia, neonatal hypoglycemia, and an elevated risk of childhood obesity for the offspring [28, 29, 30, 31, 32, 33]. Additionally, excessive weight gain is associated with an increased risk of developing gestational diabetes mellitus [34], gestational hypertension [35], preeclampsia [30], and the need for cesarean sections [36].
This study aimed to examine the effectiveness of pregnancy and postpartum self-monitoring (SM) on postpartum weight retention in patients with obesity during pregnancy. We hypothesized that women receiving higher-term SM activities would retain less weight during postpartum than women receiving fewer-term independent SM activities, or no independent SM (no-SM, NSM) activities.
This multicenter observational study involved participants diagnosed with obesity during pregnancy from five medical organizations. We followed the Preferred Reporting Items for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) standardized reporting requirements for this study (Supplementary Table 1) [37].
In a prospective observational study, we have enrolled 3675 pregnant patients with obesity at the hospital between June 2017 and May 2022, and have linked them to the hospital’s database. A total of 2515 patients were excluded from the postpartum weight retention analysis due to outlier data. This exclusion comprised 1872 patients with missing database records, 578 patients diagnosed with severe complications, and 65 patients who experienced adverse pregnancy outcomes.
All participants provided informed consent either through written consent forms or verbal consent. A cohort of 1160 patients completed the 12-month postpartum follow-up, with 516 of them engaging in independent SM, and 644 not participating in independent SM activities (NSM). The final analysis was based on 448 patients, which included 201 individuals who continued independent SM activities from baseline to 12 months postpartum, and 247 individuals who did not engage in independent (No-SM, NSM) activities throughout the postpartum period, or who had abandoned these activities. The participants in the SM group had SM behaviors in the postpartum 12-month period. Participants were matched into the NSM group based on their weight, postpartum complications, and gestational age in the SM group.
During the postpartum follow-up period, 288 patients were excluded due to loss of contact, low-reliability data provision, or severe postpartum complications. The study’s flowchart is presented in Fig. 1 for reference. The sample size was calculated by performing a power analysis, which was conducted based on the most rigorous planned analysis for the data (multivariate analysis of variance, MANOVA), and estimated a minimum of 183 participants. According to the results of sensitivity analysis, the sample goal was inflated to a minimum of 201 to account for any invalid or missing data.
Study flow. SM, self-monitoring; NSM, no-self-monitoring.
The inclusion criteria comprised the following: (1) Singleton pregnancy status;
(2) Gestational age
Obesity was defined as a prepregnancy BMI of 30 kg/m
In this study, participants demonstrated their engagement in independent SM by supplying various forms of evidence, such as mobile phone software data screenshots, daily check-in group chat logs, and photographs of paper-based independent SM records. The collected data encompassed daily food intake quantity, daily food type, and monthly body weight measurements. Researchers gathered data from the participants every three months through phone and internet communication.
We use linear mixed-effects models with repeated measures assess the weight
retention outcomes. The time effect incorporated six levels: prepregnancy,
baseline (
The baseline characteristics of the 448 participants revealed a mean age of 32.6
years (standard deviation (SD): 12.1) at recruitment. The average BMI of the
cohort was 34.8 kg/m
Total (n = 448) | SM group (n = 201) | NSM group (n = 247) | p-value | ||
Age (year), mean |
32.6 |
34.7 |
30.5 |
0.144 | |
Prepregnancy BMI (kg/m |
34.8 |
33.6 |
34.9 |
0.271 | |
Baseline weight (kg), mean |
89.2 |
88.2 |
93.1 |
0.414 | |
Weight at delivery (kg), mean |
103.8 |
102.9 |
105.5 |
0.084 | |
Prepregnancy weight (kg), mean |
86.6 |
85.8 |
87.4 |
0.059 | |
Obese before pregnancy (BMI |
240 (53.6) | 106 (52.7) | 134 (54.2) | 0.142 | |
Total GWG (kg), mean |
13.8 |
14.6 |
13.6 |
0.274 | |
Hypertensive disorder during pregnancy, n (%) | 141 (31.5%) | 64 (31.8%) | 77 (31.2%) | 0.414 | |
Gestational diabetes, n (%) | 94 (21.0%) | 43 (21.4%) | 51 (20.6%) | 0.076 | |
History of diabetes, n (%) | 40 (8.9%) | 18 (9.0%) | 22 (8.9%) | 0.952 | |
History of smoking, n (%) | 238 (53.1%) | 107 (53.2%) | 131 (53.0%) | 0.095 | |
History of drink alcohol, n (%) | 188 (42.0%) | 84 (41.8%) | 104 (42.1%) | 0.068 | |
Marital status (married), n (%) | 422 (94.2%) | 191 (95.0%) | 231 (93.5%) | 0.197 | |
Parity (primipara), n (%) | 363 (81.0%) | 166 (82.6%) | 197 (79.8%) | 0.095 | |
Pregnancy rate (%) | 66.8% | 65.4% | 67.7% | 0.062 | |
Family income, n (%) | 0.091 | ||||
129 (28.8) | 48 (23.9) | 81 (32.8) | |||
73 (15.0) | 31 (15.4) | 42 (17.0) | |||
83 (18.5) | 36 (17.9) | 47 (19.0) | |||
163 (36.4) | 86 (42.8) | 77 (31.2) | |||
Education, n (%) | 0.088 | ||||
171 (38.2) | 75 (37.3) | 96 (38.9) | |||
College 1–3 years or more | 277 (61.8) | 126 (62.7) | 151 (61.1) |
SM, self-monitoring; NSM, no-self-monitoring; SD, standard deviation; BMI, body mass index; GWG, gestational weight gain.
Table 2 and Fig. 2 illustrate the changes in weight from prepregnancy, baseline,
and delivery room BMI to 3, 6, and 12 months postpartum. The results showed an
increase in weight from prepregnancy to delivery, followed by a rapid decline
from delivery to 3 months postpartum. However, the weight began to gradually
rebound after 3 months postpartum, with a significant SM effect observed at
different time points (p
SM group (n = 201) | NSM group (n = 247) | Difference | p-value | ||
Weight change from prepregnancy weight to postpartum weight, kg | |||||
6 months postpartum | 1.3 (0.1, 2.5) | 5.4 (4.0, 6.8) | –4.1 (–5.7, –2.5) | ||
12 months postpartum | 1.7 (0.2, 3.2) | 4.1 (2.4, 5.8) | –2.4 (–4.5, –0.3) | 0.024 | |
Weight change from baseline weight to postpartum weight, kg | |||||
6 months postpartum | –0.9 (–2.6, 0.7) | 2.7 (1.2, 4.2) | –2.5 (–4.5, –0.4) | ||
12 months postpartum | –0.6 (–1.9, 0.8) | 1.3 (0.2, 2.3) | –1.8 (–3.9, –0.3) | 0.036 | |
Weight change from delivery room weight to postpartum, kg | |||||
6 months postpartum | –12.8 (–14.1, –11.4) | –7.1 (–9.1, –5.0) | –5.6 (–7.1, –4.1) | ||
12 months postpartum | –12.4 (–13.8, –11.0) | –8.8 (–10.5, –7.1) | –4.6 (–6.8, –2.4) | 0.009 |
SM, self-monitoring; NSM, no-self-monitoring; BMI, body mass index.
Weight at different time points. SM, self-monitoring; NSM,
no-self-monitoring. Prepregnancy: before pregnancy; Baseline:
Compared to NSM participants, the SM group had 2.5 times higher odds (95% CI:
1.2–4.8) of experiencing no weight retention at 3 months postpartum from their
prepregnancy weight. And the SM group had 3.9 times higher odds (95% CI:
2.2–7.8) of experiencing no weight retention at 3 months postpartum from
baseline. However, at 6 months postpartum, both groups showed similar trends in
weight retention outcomes. In terms of the percentage of participants who
retained
SM group (n = 201) | NSM group (n = 247) | Confidence interval | AOR | ||
Percentage with no weight retention | |||||
From prepregnancy to 3 months postpartum | 48.3 (29.6, 66.2) | 26.1 (16.5, 36.9) | 95% | 2.5 (1.2, 4.8) | |
From baseline to 3 months postpartum | 77.3 (63.5, 90.8) | 34.4 (21.7, 46.1) | 95% | 3.9 (2.2, 7.8) | |
From prepregnancy to 6 months postpartum | 45.1 (26.8, 64.2) | 32.4 (19.8, 44.5) | 95% | 2.1 (1.0, 4.1) | |
From baseline to 6 months postpartum | 70.4 (55.8, 84.6) | 38.2 (24.4, 51.7) | 95% | 3.8 (2.0, 7.4) | |
From prepregnancy to 12 months postpartum | 41.9 (22.3, 61.6) | 36.5 (22.7, 50.8) | 95% | 1.5 (0.6, 3.3) | |
From baseline to 12 months postpartum | 60.1 (44.2, 75.4) | 52.6 (38.8, 66.3) | 95% | 1.1 (0.5, 2.1) | |
Percentage who retained | |||||
From prepregnancy to 3 months postpartum | 25.4 (17.7, 33.0) | 60.9 (48.1, 68.7) | 95% | 0.3 (0.1, 0.4) | |
From baseline to 3 months postpartum | 20.2 (12.0, 27.6) | 38.1 (27.9, 49.4) | 95% | 0.5 (0.2, 0.9) | |
From prepregnancy to 6 months postpartum | 22.7 (15.7, 29.1) | 51.7 (39.6, 63.8) | 95% | 0.3 (0.2, 0.6) | |
From baseline to 6 months postpartum | 16.2 (8.5, 24.8) | 30.4 (18.6, 31.6) | 95% | 0.6 (0.2, 1.2) | |
From prepregnancy to 12 months postpartum | 19.2 (11.1, 27.6) | 42.7 (29.0, 54.4) | 95% | 0.3 (0.3, 0.7) | |
From baseline to 12 months postpartum | 14.7 (8.6, 20.4) | 23.9 (14.4, 32.0) | 95% | 0.6 (0.3, 1.0) |
AOR, adjusted odds ratios; SM, self-monitoring; NSM, no-self-monitoring.
Table 4 presents the associations between independent SM and delivery methods. Compared with NSM group, the participants in SM group report more vaginal delivery (57.2% vs. 31.6%) and less caesarean section deliveries (42.8% vs. 68.4%) from delivery room (p = 0.046). Regarding neonatal outcome, both survival (94.0% vs. 93.5%) and death (6.0% vs. 6.5%) were evaluated, and there are no significant differences observed between the two groups (p = 0.144). In participants with adequate or excessive GWG, there are no significant differences observed between the groups (p = 0.064).
SM group (n = 201) | NSM group (n = 247) | p-value | ||
Delivery methods | 0.046 | |||
Caesarean section | 86 (42.8%) | 169 (68.4%) | ||
Vaginal delivery | 115 (57.2%) | 78 (31.6%) | ||
Neonatal outcome | 0.144 | |||
Survival | 189 (94.0%) | 231 (93.5%) | ||
Death | 12 (6.0%) | 16 (6.5%) | ||
GWG | 0.064 | |||
5–9 kg | 107 (53.2%) | 79 (32.0%) | ||
69 (34.3%) | 121 (49.0%) |
SM, self-monitoring; NSM, no-self-monitoring; GWG, gestational weight gain.
This study aimed to investigate the effectiveness of pregnancy and postpartum SM interventions on postpartum weight retention, among women with obesity during pregnancy. The results support our hypothesis that women receiving higher-term independent SM activities retain less weight during postpartum compared to those receiving fewer, or no independent SM activities.
Our findings revealed a significant reduction in weight retention among women in the SM group compared to the NSM group. The intervention participants experienced less weight retention at 3 months postpartum and maintained this advantage up to 12 months postpartum. These results align with previous studies demonstrating the benefits of independent SM in weight management during, and after pregnancy [38, 39, 40]. Our study extends these findings by specifically targeting women with obesity during pregnancy, who are at higher risk for adverse pregnancy outcomes and long-term obesity development.
We also observed that SM participants had higher odds of experiencing no weight
retention at 3 months postpartum from their prepregnancy weight or baseline
weight, as well as lower odds of retaining
Our results show that independent SM behavior can indeed improve delivery methods to a certain extent. The possible reason is that individuals with obesity change their BMI through independent SM behavior, leading to changes in their delivery methods. Pettersen-Dahl’s report indicate that the delivery method will be affected by the pregnant women’s BMI of [42]. Additionally, independent SM behavior is secure as independent SM behavior, and cannot affect survival rate of infants. Furthermore, our findings indicate that independent SM behavior can, to some extent, enhance delivery methods. This improvement may be attributed to individuals with obesity altering their BMI through independent SM behavior, which in turn leads to changes in their delivery methods. Pettersen-Dahl’s study [42] supports this notion, as it demonstrates that the BMI of pregnant women influences their delivery method. Furthermore, independent SM behavior is considered safe, as it does not impact the survival rate of infants.
The strengths of our study include the multicenter prospective cohort design, the large sample size, and the use of mobile software for independent SM data collection, which allowed for real-time monitoring and feedback. However, there are several limitations to consider. First, we had a high exclusion rate due to missing data and lost follow-up, which may have introduced selection bias. Second, our study population was limited to women with obesity during pregnancy, and the results may not be generalizable to women with normal or overweight BMIs. Third, we did not assess the potential impact of other factors, such as physical activity, mental health, or social support, which could influence postpartum weight retention.
Despite these limitations, our study provides valuable insights into the potential benefits of pregnancy and postpartum independent SM interventions for weight management among women with obesity during pregnancy. Healthcare professionals should consider incorporating independent SM strategies into prenatal and postnatal care programs, in order to support healthy weight management and reduce the risk of adverse pregnancy outcomes and long-term obesity development. Future research should explore the mechanisms underlying the effectiveness of independent SM interventions, as well as the optimal duration, intensity, and format of such interventions to maximize their impact on postpartum weight management.
This multicenter observational study demonstrated the effectiveness of independent SM interventions, including dietary and weight measurements, in limiting postpartum weight retention among women with obesity during pregnancy, and enhancing delivery methods. Our findings suggest that healthcare professionals should integrate independent SM strategies into prenatal and postnatal care programs to promote healthy weight management and decrease the risk of adverse pregnancy outcomes and long-term obesity development. Further research is warranted to explore the optimal duration, intensity, and format of independent SM interventions to maximize their impact on postpartum weight management.
The data sets generated and/or analyzed during the current study are not publicly available due to ruler of hospital but are available from the corresponding author on reasonable request.
HT and ZL conceived and designed the experiments. HT and ZL performed the experiments. HT and ZL analyzed the data. HT and ZL contributed reagents/materials/analysis tools. HT and ZL wrote the manuscript. HT and ZL revised the manuscript. Both authors read and approved the final manuscript. Both authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.
All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Jinan University (approval number: KY-2023-189).
Not applicable.
This research received no external funding.
The authors declare no conflict of interest.
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