Ethnic Differences in Weight Retention After Pregnancy in Hawai`i

G. Baruffi, C. Hardy, C. Waslien, S. Uyehara, D.

Krupitsky

Introduction Obesity in the U.S. has become

an epidemic Obesity rates have increased by

nearly 60% since 1991, and by 6% between 1998 and 1999 (CDC)

50% of women 25-55 yrs of age are either overweight or obese

Introduction (cont) Adequate weight gain during

pregnancy is important for optimal pregnancy outcomes

Excessive weight gain during pregnancy and retention of weight 6 months after delivery are predictors of long-term obesity

Introduction (cont) Weight gain during pregnancy

and weight retention postpartum vary by: Prepregnancy BMI Parity, Age Breastfeeding, Smoking, Exercise Race/ethnicity

Purpose of the study Reported racial differences are

between Black and White women

Purpose of this study: to investigate weight gain during pregnancy and weight retention postpartum in a multiethnic population of women in Hawai`i

Methods Cross sectional study of

postpartum women attending the Hawai`i WIC Program in 1997-98

Weight gain during pregnancy self reported

Weight and height at postpartum visit measured by WIC staff

Methods (cont) Ethnicity self reported Seven ethnic groups:

Asian (Japanese, Chinese, Korean) Black Caucasian (White, Puerto Rican, Spanish) Filipino Hawaiian (Hawaiian, Part-Hawaiian) Samoan Other

Analysis First postpartum visit

5,863 women

Bivariate and multivariate analysis

SAS

Distribution of postpartum women by ethnicity. Hawai`i WIC 1997-98 Ethnicity N %Asian BlackCaucasianFilipinoHawaiianSamoanOtherTOTAL

405 (6.9) 254 (4.3) 1593 (27.2) 1162 (19.8) 1751 (29.9) 236 (4.0) 456 (7.8) 5,863 (100)

Distribution of women by post partum duration and ethnicity. Hawai`i WIC 1997-98Ethnicity Postpartum duration

(months)% <1 % 1-2 % 3-4 % 5-6 % >6

AsianBlackCaucasianFilipinoHawaiianSamoanOther

21252021192624

42474047484441

19151819211919

5685434

1481488812

Total % 21 45 19 5 10

IOM recommendations for WT gain by prepregnancy BMI BMI Weight gain

(lbs)< 19.8 28 – 4019.8 – 26 25 – 3526.1 – 29.0 15 – 25> 29.0 15

Distribution of women by prepregnancy BMI and WT gain. Hawai`i WIC 1997-98 BMI %

WomenWT gain (lbs)

<19.8 17.4 33.7 +12.7

19.8–26 51.7 34.6 +15.2

26.1–29.0

10.8 32.0 +16.6

>29.0 20.1 27.2 +20.0

Prepregnancy BMI and pregnancy weight gain by ethnicity. Hawai`i WIC 1997-98Ethnicity BMI

Mean SDWeight gain(lbs)Mean SD

AsianBlackCaucasianFilipinoHawaiianSamoanOther

22.7 +5.3 25.2 +5.0 24.5 +5.4 22.5 +4.4 26.1 +6.3 29.7 +6.9 24.6 +6.1

29.1 +12.9 32.1 +16.4 33.4 +15.9 30.0 +13.3 34.1 +17.7 37.3 +22.0 32.9 +16.7

Overall ethnic differences in prepregnancy BMI: p-value <.0001Overall ethnic differences in mean weight gain: p-value <.0001

Postpartum weight loss and retention by postpartum duration. Hawai`i WIC 1997-98 PP months

WT loss (lbs) Mean SD

WT retention (lbs) Mean SD

< 1 1 - 2 3 - 4 5 - 6 7 - 8 > 8

18.7 +11.1

20.8 +10.7

21.1 +11.9

23.4 +13.6

23.8 +15.3

23.7 +14.3

14.8 +15.7

11.8 +13.4

11.5 +14.1

9.4 +13.5

8.7 +16.0

7.4 +15.0

Overall difference in weight loss: p-value <.0001Overall difference in weight retention: p-value <.0001

Postpartum weight loss and retention by ethnicity. Hawai`i WIC 1997-98 Ethnicity

WT loss (lbs)Mean SD

WT ret (lbs) Mean SD

AsianBlackCaucasianFilipinoHawaiianSamoanOther

19.5 +9.620.4 +12.122.2 +11.619.1 +9.221.8 +12.619.8 +16.019.5 +13.4

9.6 +11.211.7 +14.111.1 +13.511.0 +11.312.3 +15.717.5 +21.713.3 +16.3

Overall differences in WT loss: p-value <. 0001Overall differences in WT retention: p-value <.0001

Multiple regression of WT retention by ethnicity. Hawai`i WIC 1997-98Ethnicity Β coefficient p-

valueAsianBlackFilipinoHawaiianSamoanOther

1.095 0.0494 0.958 0.1559 1.606 <.0001 0.363 0.2951 3.469 <.0001 2.308 <.0001

NOTE: Reference category = Caucasian. Weight retention is adjusted for weight gain during pregnancy, postpartum days, and age.

Conclusions 30% of women were overweight or

obese before pregnancy

Overweight and obese women had an excessive weight gain during pregnancy

Average weight retention at 5-6 months pp was 9.4 lbs, and 7.4 lbs after 8 months pp

Conclusions (cont) Overall significant ethnic

differences in prepregnancy BMI

Samoan had the highest mean prepregnancy BMI (29.7)

Filipino had the lowest mean prepregnancy BMI (22.5)

Conclusions (cont) Overall significant ethnic

differences in weight gain during pregnancy

Samoans had the highest mean weight gain (37.3 lbs)

Asian had the lowest mean weight gain (29.1 lbs)

Conclusions (cont) Overall significant ethnic

differences in weight retention

Samoan had the largest average wt retention (17.5 lbs)

Asian had the smallest average wt retention (9.6 lbs)

Conclusions (cont) Adjusting for weight gain during

pregnancy, pp duration, and age, all ethnicities, except Black and Hawaiian, retained significantly more weight than Caucasian.

Samoan retained the most (3.5 lbs) Asian retained the least (1.1 lbs)

Recommendations For each lb of weight gained

during pregnancy there was almost 2/3 lb adjusted weight retention

Importance of controlling weight gain during pregnancy

Importance of loosing weight after delivery