Postpartum weight retention among women
in Rio de Janeiro: a follow-up study
Re te nç ão d e p e so ao lo ng o d e no ve me se s
p ó s-p arto e m mulhe re s re sid e nte s no Munic íp io
d o Rio d e Jane iro : um e stud o d e se g uime nto
1 Dep a rt a m en t o d e N u t riçã o Socia l e Ap lica d a , In st it u t o d e N u t riçã o Josu é d e Ca st ro, U n iv ersid a d e Fed era l d o Rio d e Ja n eiro. Av . Briga d eiro T rom p ow sk y s/n , Bloco J, 2oa n d a r, Rio d e Ja n eiro, RJ 21941- 590, Bra sil. gk a c@gb l.com .b r
2 Dep artam en to d e N u trição, Fa cu ld a d e d e Sa ú d e Pú b li ca , U n iv ersid a d e d e Sã o Pa u lo. Av . Dr. Arn a ld o 715, Sã o Pa u lo, SP 01246- 904, Bra sil. b en icio@u sp .b r 3 Dep a rt a m en t o d e Ep id em iologia e M ét od os Qu a n t it a t iv os em Sa ú d e, Escola N a cion a l d e Sa ú d e Pú b lica , Fu n d a çã o Osw a ld o Cru z . Ru a Leop old o Bu lh ões 1480, Rio d e Ja n eiro, RJ 21041- 210, Bra sil. jv a len t e@en sp .fiocru z .b r 4 In stitu to d e M ed icin a Socia l, U n iv ersid a d e Est a d u a l d o Rio d e Ja n eiro. Ru a Sã o Fra n cisco Xa v ier 524, 7oa n d a r, Rio d e Ja n eiro, RJ 20559- 900, Bra sil. 5 Dep art am en t o d e En ferm a gem M a t ern o In fa n t il e Sa ú d e Pú b lica , Escola d e En ferm a gem , U n iv ersid a d e Fed era l d e M in a s Gera is. Av . Alfred o Ba len a 190, Belo H oriz on t e, M G 30130- 100, Bra sil. gu v em e@lcc.u fm g.b r Gilb ert o Ka c 1
M a ria H elen a D ’Aq u in o Ben icio 2 Joa q u im Gon ça lv es Va len t e 3,4 Gu st a v o Velá sq u ez - M elén d ez 5
Abstract Th is st u d y p resen t s follow - u p resu lt s on t ren d s in p ost p a rt u m w eigh t ret en t ion a m on g w om en in t h e cit y of Rio d e Ja n eiro, Bra z il, a t 0.5, 2, 6, a n d 9 m on t h s p ost p a rt u m . T h e ou t com e v a ri a b l e, w ei gh t ret en t i o n , w a s ca l cu l a t ed b y su b t ra ct i n g t h e rep o rt ed p re- p regn a n cy w ei gh t f ro m t h e o b serv ed w ei gh t a t ea ch i n t erv i ew . St a t i st i ca l a n a lyses u sed m ea n s a n d a 95% co n f i -d en ce in t erv a l for w eigh t ret en t ion . M ea n w eigh t ret en t ion w a s 4.7, 4.1, 3.4, a n -d 3.1k g a t 0.5, 2, 6 a n d 9 m on t h s p ost p a rt u m , resp ect iv ely. At com p let ion of t h e st u d y, t h e la rgest w eigh t ret en t ion w a s o b serv ed i n w o m en o v er 30 yea rs o f a ge (4.2k g) a n d w i t h 30% o r m o re o f b o d y f a t (5.9k g). T h e ra t e of red u ct ion in w eigh t ret en t ion w a s 0.4k g/m on t h , 0.2k g/m on t h , a n d 0.1k g/ m on t h for t h e p eriod s 0.5- 2, 2- 6, a n d 6- 9 m on t h s, resp ect iv ely. T h e la rgest red u ct ion s w ere ob serv ed a m on g you n g, sin gle w om en a n d t h ose w it h < 30% of b od y fa t a t b a selin e. T h e resu lt s su ggest t h a t v a ri -a b les su ch -a s -a ge, p -a ri t y, sch o o li n g, -a n d b o d y f -a t m -a y b e i m p o rt -a n t p red i ct o rs o f p o st p -a rt u m w eigh t ret en t ion .
Key words Ob esit y; M a t ern a l W elfare; M a t ern a l N u t rit ion
Resumo O o b j et i v o d est e est u d o é a p resen t a r resu l t a d o s so b re a ev o l u çã o d a m a gn i t u d e d a ret en çã o d e p eso em m u lh eres b ra sileira s, a com p a n h a d a s d u ra n t e n ov e m eses p ós- p a rt o. O d e-sen h o co n si st i u d e u m est u d o d e segu i m en t o co m m ed i çõ es a o s 0,5, 2, 6 e 9 m eses p ó s- p a rt o . A v a riá v el ret en çã o d e p eso foi ca lcu la d a su b t ra in d o- se o p eso p ré- gest a cion a l rep ort a d o p ela m ã e, d o p eso ob serv a d o em ca d a con su lt a . A a n á lise est a t íst ica en v olv eu o cá lcu lo d e m éd ia s e in t er-v a lo d e con fia n ça d e 95% p a ra ret en çã o d e p eso. A ret en çã o m éd ia foi d e 4,7, 4,1, 3,4 e 3,1k g a os 0 ,5 , 2 , 6 e 9 m eses p ó s- p a rt o , resp ect i v a m en t e. Ao f i n a l d o est u d o , a s m a i s el ev a d a s ret en çõ es fora m ob serv a d a s en t re m u lh eres com m a is d e t rin t a a n os (4,2k g) e com 30% ou m a is d e gord u ra corp ora l (5,9k g). A t a x a d e red u çã o n a ret en çã o d e p eso foi d e 0,4k g/m ês, 0,2k g/m ês e 0,1k g/m ês, p a ra os p eríod os 0,5- 2; 2- 6 e 6- 9 m eses, resp ect iv a m en t e, e a s m a iores red u ções fora m ob serv a d a s en t re m u lh eres com m en os d e v in t e a n os, solt eira s e a s com m en os d e 30% d e gord u ra corp ora l n o in ício d o est u d o. Os resu lt a d os su gerem q u e id a d e, p a rid a d e, escola rid a d e e gord u ra corp ora l se con st it u em em im p ort a n t es p red it ores d a ret en çã o d e p eso n o p ós- p a rt o.
Introduction
P o s t p a r t u m w e igh t r e t e n t io n is c o n s id e r e d a m a jo r p u b lic h e a lt h p ro b le m d u e t o it s m a gn i-t u d e a n d e sp e cia lly d u e i-t o i-t h e risks ii-t p o se s fo r t h e d e ve lo p m e n t o f o b e sit y (Ka c , 2001; Le d e r -m a n , 2001).
Th e r e a r e fe w s t u d ie s o n w e igh t r e t e n t io n in Bra zilia n wo m e n (Fo rn e s & Do re a , 1995; Gi-ga n te e t a l., 2001; Ka c, 2002), a n d th e re is a lso a m a jo r ga p in th e d iscu ssio n o f its d eterm in a n ts. In t h e in t e r n a t io n a l s c e n a r io , t h e m a in st u d ie s co n d u ct e d t h u s fa r h a ve id e n t ifie d t h e fo llo w in g p r in c ip a l d e t e r m in a n t s o f p o s t p a r -t u m we igh -t r e -t e n -t io n : ge s-t a -t io n a l we igh -t ga in , h igh p a rit y, a n d d u ra tio n o f b re a stfe e d in g ( Jan -n e y e t a l., 1997; Le d e rm a -n , 1993; Oh li-n & Ro ssn e r, 1990). Th e lit e ra t u re st ill p re se ssn t s co ssn flict in g r e s u lt s in r e la t io n t o t h e e ffe c t o f b r e a s t -fe e d in g, b u t t h e r e is a c o n s e n s u s t h a t h igh e r we igh t in cr e a se s d u r in g p r e gn a n cy a r e a sso ci-a t e d wit h gre ci-a t e r p o st p ci-a rt u m we igh t re t e n t io n (Le d e rm a n , 2001). Ot h e r d e t e rm in a n t s su ch a s r e p r o d u c t ive va r ia b le s , p h ys ic a l a c t ivit y, a n d d ie t re q u ire fu rth e r in ve stiga tio n .
Th e c u r r e n t a r t ic le p r e s e n t s t h e r e s u lt s o n t h e e vo lu t io n in w e igh t r e t e n t io n o ve r t h e co u rse o f n in e m o n t h s p o st p a rt u m in Bra zilia n wo m e n , p a rt icu la rly id e n t ifyin g t h e m a gn it u d e o f t h e p r o b le m a m o n g va r io u s su b gr o u p s a c -co rd in g t o a ge , skin -co lo r, sch o o lin g, a n d p a ri-ty, a m o n g o th ers.
M ethods
Th e d a t a p r e se n t e d b e lo w we r e o b t a in e d fr o m a co h o r t st u d y wit h n in e m o n t h s fo llo w- u p o n we igh t r e t e n t io n , b o d y co m p o sit io n , a n d o b e -s it y. Th e -s t u d y w a -s c o n d u c t e d w it h Br a zilia n wo m e n r a n gin g in a ge fr o m 15 t o 45 ye a r s, r e -s id in g in t h e c it y o f Rio d e Ja n e ir o . Th e -s t u d y w a s p e r fo r m e d w it h u s e r s o f t h e “M a r c o lin o Ca n d a u ” M u n ic ip a l H e a lt h Ce n t e r , lo c a t e d in t h e c e n t r a l r e gio n o f t h e c it y o f Rio d e Ja n e ir o (Pro gra m Are a 1 / 3rdMu n icip a l Ad m in ist ra t ive Re gio n ), wh ich p r o vid e s h e a lt h ca r e t o t h e Es tá cio , Ca tu m b i, Rio Co m p rid o , a n d Cid a d e No -va n e igh b o rh o o d s.
Th e d ata collection p rocess lasted 24 m o n t h s (15 m o n t h s o f re cru it m e n t a n d 9 m o n t h o f fo l-lo w- u p ) a n d wa s ca r r ie d o u t fr o m Ma y 1999 t o Ap r il 2001. A t o t a l o f 709 wo m e n we r e r e c r u it -e d , 479 w -e r -e -e n r o ll-e d in t h -e c o h o r t , a n d 405 we re se le cte d fo r th e p re se n t a n a lysis, in wh ich t h e y w e r e s t u d ie d t h r o u gh a lo n git u d in a l d e s ign w it h fo u r w e igh t m e a s u r e m e n t s , a t a p -p ro xim a tely 0.5, 2, 6, a n d 9 m o n th s -p o st-p a rt u m .
Pa rt icip a n t s we re ch ild b e a rin g-a ge wo m e n re cru it e d vo lu n t a rily fo r t h e st u d y a t t h re e d if-fe r e n t m o m e n t s a n d in d is t in c t p la c e s : (i) in t h e ce n t ra l re fe re n ce m a t e rn it y h o sp it a l in t h e s t u d y a r e a d u r in g im m e d ia t e p o s t p a r t u m , (ii) d u rin g p re n a t a l co n su lt a t io n s, a n d (iii) a t ro u -t in e in fa n -t BCG im m u n iza -t io n , -t h e la -t -t e r -t w o in t h e M u n ic ip a l H e a lt h Ce n t e r. Re c r u it m e n t d u r in g p r e n a t a l c o n s u lt a t io n s a n d a t r o u t in e BCG im m u n iza t io n wa s p e rfo rm e d b y t h e p rin -c ip a l r e s e a r -c h e r (G. K.), w h ile r e -c r u it m e n t a t t h e P r a ç a XV M a t e r n it y H o s p it a l w a s d o n e b y t h r e e in t e r n s t r a in e d a c c o r d in g t o a s t a n d a r d p ro to co l.
Fo r t h e cu rre n t a n a lysis, t h e o n ly e ligib ilit y c r it e r io n in a d d it io n t o t h o se im p le m e n t e d in t h e r e s e a r c h w a s a ge ≥18 ye a r s (n = 47). Th e fo llo win g e xclu sio n crite ria we re a lso u se d : la ck o f in fo r m a t io n o n p r e - p r e gn a n c y w e igh t (n = 13) a n d e xt r e m e w e igh t r e t e n t io n va lu e s (n = 14), sp e cifica lly lyin g o u t sid e t h e -10.0/ +16.0kg in t e rva l, t h u s e n su rin g t h e e xclu sio n o f a d o le s-c e n t s s t ill in t h e ir p h ys io lo gis-c a l gr o wt h p h a s e an d wom en with b iologically im p rob ab le we igh t r e t e n t io n va lu e s . Th u s , 47, 13, a n d 14 w o m e n we r e e xc lu d e d o n t h e b a sis o f t h e a b o ve c r it e -r ia , -r e s p e c t ive ly. Th e fin a l s a m p le fo -r t h e fi-r s t fo llo w- u p m e a su r e m e n t t h u s c o n sist e d o f 405 w o m e n . Fo r t h e o t h e r o b s e r va t io n p o in t s , t h e sa m p le s we re 359, 298, a n d 271 wo m e n a t 2, 6, a n d 9 m o n th s, re sp e ctive ly.
An a lys e s w e r e p e r fo r m e d u s in g a b s o lu t e p o st p a rt u m we igh t re t e n t io n a s t h e d e p e n d e n t va ria b le . Th is va ria b le wa s ca lcu la t e d b a se d o n t h e d iffe r e n ce b e t we e n t h e we igh t o b se r ve d a t e a ch fo llo wu p co n su lt a t io n a n d p re p re gn a n -cy we igh t re p o rte d b y th e m o th e r. Co -va ria b les in c lu d e d t h e fo llo w in g s o c io - d e m o gr a p h ic va ria b le s: m a rita l sta tu s (sin gle , m a rrie d , livin g with p a rtn e r), a ge ca te go ry (18-19, 20-29, 30-45 ye a rs), skin co lo r (wh it e , b ro wn , b la ck – co rre sp o n d in g t o t h re e o fficia l Bra zilia n ce n su s ca t -e go r i-e s b ra n ca, p a rd a, a n d n egra), p la c e o f b ir t h (Rio d e Ja n e ir o , a n o t h e r St a t e o f Br a zil), re sid e n t ia l st ra t u m (u rb a n , ru ra l), sch o o lin g (≤ 4, ≥5 ye a rs); life st yle : sm o kin g (sm o ke r, n e ve r s m o ke d , fo r m e r s m o ke r ); r e p r o d u c t ive va r i-a b le s: p i-a rity (1, ≥2 ch ild re n ); a n d m a te rn a l n u -t r i-t io n a l s -t a -t u s : h e igh -t (&l-t; 159, ≥ 159c m ) a n d b o d y fa t (BF) (< 30, ≥30%).
We igh t r e t e n t io n va lu e s a r e p r e s e n t e d a s m e a n s w it h a 95% c o n fid e n c e in t e r va l fo r t h e fo u r st u d y fo llo w-u p m e a su re m e n t s fo r se ve ra l o f th e va ria b le s d e scrib e d a b o ve . In o rd e r to a l-lo w b e t t e r visu a liza t io n o f t h e t e n d e n c ie s a n d t h e ir d iffe re n ce s u sin g t h e co n fid e n ce in t e rva l, w e s e le c t e d va r ia b le s w it h t h e gr e a t e s t vis u a l im p a ct a n d co n st ru ct e d t e n d e n cy gra p h s.
We a ls o p r e s e n t lo s s - t o - fo llo w - u p d a t a o n s e ve r a l s t u d y va r ia b le s . Th e t r a d it io n a l a p -p ro a ch t o a sse ss t h e -p re se n ce o f se le ct io n b ia s (se le c t ive lo ss) wa s im p le m e n t e d a n d c o n sist -e d o f c o m p a r in g t h -e fin a l fo llo w - u p r a t -e s fo r th e ta rge t va ria b le s a cco rd in g to th e ch i-sq u a re t e st (χ2). Th e va ria b le s u se d in t h e co m p a riso n a n d wh ich h a ve n o t b e e n d e scrib e d th u s fa r a re lis t e d a s fo llo w s : w o r k in la s t 12 m o n t h s (ye s , n o , n e ve r w o r ke d ), t o t a l in c o m e in q u a r t ile s (0- 279, 280- 499, 500- 869, ≥870 rea is), t yp e o f b re a st fe e d in g (e xclu sive o r p re d o m in a n t / p a r-t ia l o r a r r-t ificia l), d ich o r-t o m ize d p r e - p r e gn a n cy w e igh t (< 56, ≥56kg), a n d p o s t p a r t u m w e igh t reten tio n (< 7.5, ≥7.5kg).
Th e in d ica to rs a b so lu te re d u ctio n in we igh t r e t e n t io n a n d r e la t ive r e d u c t io n in w e igh t r e -t e n -t io n we re a lso co n s-t ru c-t e d . Th e fo rm e r wa s c a lc u la t e d a s t h e a b so lu t e d iffe r e n c e b e t we e n fin a l we igh t re t e n t io n a t n in e m o n t h s p o st p a r tu m a n d th e in itia l va lu e a t 15 d a ys, a n d th e la t t e r a s a p r o p o r t io n b e t w e e n t h e a b s o lu t e r e d u c t io n in we igh t r e t e n t io n a n d we igh t r e t e n -t io n a -t 15 d a ys. Fo r -t h e la -t -t e r in d ica -t o r, 95% CI a re a lso p re se n te d .
Th e c u r r e n t st u d y wa s a p p r o ve d b y t h e r e -s e a r c h e t h ic -s c o m m it t e e o f t h e N u c le u -s fo r St u d ie s in Co lle ct ive H e a lt h (NESC) a t t h e Fe d -e ra l Un iv-e rsity in Rio d -e Ja n -e iro (UFRJ). All p a r-t icip a n r-t s sign e d a r-t e rm o f in fo rm e d co n se n r-t r-t o e n t e r t h e st u d y. Fu rt h e r d e t a ils o n m e t h o d o lo -gy a re p ro vid e d in Ka c (2002).
Results
Th e d a t a in Ta b le 1 s h o w t h e d is t r ib u t io n o f so m e st u d y va r ia b le s fo r ce n su r e s a n d wo m e n wh o co m p le t e d fo llo w- u p . Th e fin a l fo llo w- u p r a t e wa s 66.9%, t h a t is, a 33.1% lo ss- t o - fo llo w-u p r a t e . Age ca t e go r y wa s t h e o n ly va r ia b le fo r w h ic h s ign ific a n t n o n - r a n d o m lo s s o c c u r r e d . N o sign ifica n t d iffe r e n ce s we r e fo u n d in a d d it io n a l a n a lys e s c o m p a r in g it h e m e d ia n d u r a -t io n o f p r e d o m in a n -t b r e a s -t fe e d in g a n d m e a n we igh t re te n tio n a t first fo llo w-u p , fo r ce n su re s a n d co m p le t e fo llo wu p , st ra t ifie d b y a ge ca t e -go ry (Figu re 1).
Me a n we igh t re te n tio n wa s 4.7, 4.1, 3.4, a n d 3.1kg a t 0.5, 2, 6, a n d 9 m o n th s p o stp a rtu m , re
-sp e ct ive ly. M e a n wh ile , t h e m e a n d iffe r e n ce in w e igh t r e t e n t io n b e t w e e n t h e fin a l a n d in it ia l o b s e r va t io n s wa s 1.6kg. Ba s e d o n t h e s lo p e o f t h e c u r ve s , o n e n o t e s t h a t t h e r e d u c t io n w a s m o r e in t e n se in t h e fir st in t e r va l a s c o m p a r e d to th e la tte r two (Figu re 2).
As s h o w n in Ta b le 2, w h it e w o m e n a n d sm o ke rs st a rt e d wit h t h e h igh e st we igh t re t e n -t io n va lu e s so o n a f-t e r c h ild b ir -t h , wh ile b r o wn wo m e n p r e se n t e d t h e lo we st r e t e n t io n va lu e s a t th e e n d o f th e stu d y.
Figu r e s 3 a n d 4 p r e s e n t t h e e vo lu t io n in p o st p a rt u m we igh t re t e n t io n fo r se le ct e d va ria b le s. Mria rrie d wo m e n stria rte d ria t th e h igh e st re -t e n -t io n va lu e s s o o n a f-t e r c h ild b ir -t h , fo llo w e d b y t h o se o ve r 30 ye a rs o f a ge . At t h e e n d o f t h e st u d y, sin gle wo m e n a n d t h o se u n d e r 20 ye a r s o f a ge we r e t h e o n e s wit h t h e lo we st r e t e n t io n va lu e s (Figu re 3). In re la tio n to sch o o lin g, th e re wa s a to ta l a b sen ce o f red u ctio n a m o n g wo m e n with fo u r ye a rs o f sch o o lin g o r le ss, wh ile th e re wa s a cle a r te n d e n cy to wa rd s re d u ctio n a m o n g wo m e n with five o r m o re ye a rs o f sch o o lin g. An a n a lo go u s b e h a vio r wa s o b se r ve d fo r t h e va r i-a b le p i-a r it y, w h e r e o n ly p r im ip i-a r o u s w o m e n s h o w e d a n im p o r t a n t r e d u c t io n in w e igh t r e t e n t io n . Th e m o s t c o n t r a s t in g p a t t e r n fo r r e -d u c t io n in w e igh t r e t e n t io n is o b s e r ve -d w h e n th e wom en a re ca tegorized a ccord in g to BF p e r-ce n t a ge . N o re d u ct io n in we igh t re t e n t io n wa s ob served in ob ese wom en , wh ile for wom en wit h < 30% BF th e re d u ctio n wa s in te n se (Figu re 4).
Th e gr e a t e st a b so lu t e r e d u ct io n s in we igh t r e t e n t io n w e r e o b s e r ve d in w o m e n w it h le s s t h a n 30% BF, yo u n g wo m e n (< 20 ye a rs o f a ge ), p r im ip a r a e , a n d s in gle w o m e n . Th e s e r e d u c -t io n s va rie d fro m 2.5 -t o 2.8kg. Th e re su l-t s we re co m p a t ib le , co n sid e rin g t h e re la t ive re d u ct io n in we igh t re t e n t io n in d ica t o r. No te a lso th e a b -se n ce o f re la t ive re d u ct io n in we igh t re t e n t io n in wo m e n wit h ≥30% BF a n d a lo w re la t ive re -d u ct io n in b la ck wo m e n ( Tab le 3).
Discussion
d id n o t sh o w a d d itio n a l d iffe re n ce s, th u s m in im izin g th e p re se n ce o f b ia s in th e d a ta p re se n t -ed h ere.
Th e m a gn it u d e o f p o s t p a r t u m w e igh t r e t e n t io n wa s 3.1kg a t n in e m o n t h s in t h is sa m -p le o f wo m e n a n d ca n b e co n sid e re d re la t ive ly h igh a s c o m p a r e d t o t h e r e s u lt s fr o m Oh lin & Ro ssn e r (1990) a n d Ja n n e y e t a l. (1997). Th e la t -t e r -t wo s-t u d ie s sh o we d a m e a n re -t e n -t io n o f 1.5 a n d 2.5kg a t 12 a n d 9 m o n t h s p o st p a r t u m , r e -sp e ctive ly.
Wh e n t h e a n a lys e s c o n s id e r t h e gr o s s r e -d u c t io n r a t e s in w e igh t r e t e n t io n in t h e t h r e e s t u d y in t e r va ls , w e o b t a in 0.4kg/ m o n t h ,
0.2kg/ m o n t h , a n d 0.1kg/ m o n t h s fo r t h e p e r i-o d s 0.5- 2, 2- 6, a n d 6- 9 m i-o n t h s , r e s p e c t ive ly. Th e o ve r a ll r a t e wa s 0.177kg/ m o n t h , co m p a t i-b le wit h t h a t o i-b se rve d in wo m e n in d e ve lo p in g c o u n t r ie s in ge n e r a l, a c c o r d in g t o d a t a c o m -p ile d b y Bu t t e &am-p; H o -p kin so n (1998). Ac c o r d in g t o t h e se a u t h o rs, t h e m e a n re d u ct io n in we igh t re te n tio n wa s 0.8kg/ m o n th fo r wo m e n fro m a f-flu e n t c o u n t r ie s a n d o n ly 0.1kg/ m o n t h fo r wo m e n fro m d e ve lo p in g co u n trie s. Th e se co m -p a r is o n s s h o u ld t a ke in t o c o n s id e r a t io n t h e fa c t t h a t s u c h s t u d ie s w e r e c o n d u c t e d in t h e 1980s a n d e a r ly 1990s , b e s id e s r e p o r t in g o n ly t h e fir s t s ix m o n t h s p o s t p a r t u m . D e s p it e t h is Tab le 1
Distrib utio n o f fre q ue nc y o f variab le s b e twe e n c e nsure s and c o mp le te fo llo w-up and final fo llo w-up
rate fo r Brazilian wo me n fro m 18 to 45 ye ars o f ag e . Rio d e Jane iro , Brazil, 1999-2001.
Variables Init ial no. of Censures (n) Complet e Final follow-up p observat ions follow-up (n) rate (%)
Age cat egory (years)
18-19 6 0 36 24 40.0
20-24 136 42 94 69.1
25-29 114 38 76 66.7
30-45 9 5 18 77 81.0 0.0000
M arit al st at us
Sing le 7 4 18 56 75.7
Living with p artne r 230 76 154 66.9
Marrie d 101 40 61 60.4 0.1051
Worked in last 12 months
Ye s 251 79 172 68.5
No 120 42 78 65.0
Ne ve r wo rke d 3 4 13 21 64.8 0.6375
Total income in quartiles (reais)
Q 1 (0-279) 8 6 34 52 60.5
Q 2 (280-499) 109 36 73 67.0
Q 3 (500-869) 9 6 25 71 73.9
Q 4 (870-5,500) 114 39 75 65.8 0.2801
Type of breastfeeding
Exc lusive / p re d o minant 355 123 232 65.3
Partial/ artific ial 5 0 11 39 78.0 0.0751
Pre-pregnancy weight (kg)
< 56 194 63 131 67.5
≥56 211 71 140 66.3 0.8017
Body fat (%)
< 30 195 59 136 69.7
≥30 210 75 135 64.3 0.2434
Weight retention (kg)
< 7.5 295 96 199 67.4
p r o viso , it is in t e r e st in g t o n o t e t h a t t h e gr e a t -e st r a t -e o f r -e d u ct io n , wh ich o ccu r s fr o m 0.5 t o 2 m o n t h s p o s t p a r t u m (0.4kg/ m o n t h ), is s t ill sh o r t o f t h e r e d u c t io n le ve ls r e p o r t e d in a fflu -e n t p o p u la t io n s ; s t ill, it is o n a d iff-e r -e n t l-e v-e l fr o m t h e m e a n o ve r a ll r e d u c t io n r e p o r t e d fo r d evelop in g cou n tries (Bu tte & Hop kin son , 1998). N o t e t h a t t h e re su lt s p re se n t e d in t h is a rt i-cle can p rovid e su p p ort for m ore com p lex a n a ly-s e ly-s . Fo r e xa m p le , t h e r e ily-s a c le a r n e e d t o e xp lo re t h e ro le o f m a rit a l st a t u s in we igh t re t e n -t io n , -t o -t h e e x-t e n -t -t h a -t i-t m a y re p re se n -t -t h e e f-fe c t o f s o c ia l s u p p o r t , a lr e a d y id e n t ifie d a s a d e t e r m in a n t fa c t o r in w e igh t r e t e n t io n in t h e st u d y b y Ja n n e y e t a l. (1997). An o t h e r va r ia b le t h a t a p p e a r s t o p la y a p o t e n t ia lly im p o r t a n t r o le is t h e b a s e lin e p e r c e n t a ge o f b o d y fa t , p rin cip a lly b e ca u se it is kn o wn t h a t we igh t re -t e n -t io n a -t -t h e e n d o f -t h e p o s -t p a r -t u m p e r io d re p re se n t s m a in ly b o d y fa t . Th e im p o rt a n ce o f sch o o lin g wa s a lso o b se rve d a s a lo we r te n d e n -c y t o wa r d s we igh t r e t e n t io n , a s wa s t h e e ffe -c t o f lo w e r p a r it y. M o r e s c h o o lin g h a s b e e n o b -se rve d syst e m a t ica lly a s h a vin g a p ro t e ct ive e f-fe ct a ga in st o b e sit y (Mo n t e iro e t a l., 2001), a n d h igh p a rit y h a s b e e n syst e m a t ica lly a sso cia t e d with o b e sity (Co itin h o e t a l., 2001).
Fe w st u d ie s a r e a va ila b le o n we igh t r e t e n -t io n p a -t -t e r n s in Br a zilia n c h ild b e a r in g- a ge w o m e n (Fo r n e s & D o r e a , 1995; Giga n t e e t a l., 2001; Ka c , 2002). Th e r e s u lt s p r e s e n t e d in t h e c u r r e n t a r t ic le , a lt h o u gh lim it e d t o ju s t a fe w va r ia b le s, a r e in t e r e st in g fr o m t h e p e r sp e ct ive o f id e n t ifyin g a p a t t e rn t h a t wo u ld a llo w t o im -p le m e n t w e igh t m o n it o r in g a n d c o n t r o l -p o li-cie s d u rin g p re n a ta l a n d p o stp a rtu m ca re Su ch in t e r ve n t io n s s h o u ld fo c u s p r e d o m in a n t ly o n t h e gro u p s m o st e xp o se d t o t h e risks o f we igh t r e t e n t io n a n d c o n s e q u e n t ly t h o s e o f o b e s it y. Ac c o r d in g t o t h e s e t o f d a t a p r e s e n t e d h e r e , t h e se gro u p s in clu d e wo m e n wit h e xce ss b a se -lin e b o d y fa t , b la c k w o m e n , t h o s e o ve r t h ir t y ye a rs o f a ge , a n d th o se with lim ite d sch o o lin g.
In s h o r t , s u c h in t e r ve n t io n s s h o u ld b e b a s e d o n im p r o ve m e n t s in t h e q u a lit y o f p r e n a t a l c a r e p r o vid e d b y p u b lic h e a lt h c a r e s e r vic e s , e s p e c ia lly in r e la t io n t o n u t r it io n a l is su e s. Th e se p r e n a t a l m e a su r e s sh o u ld e m p h a -size t h e co n t ro l o f ge st a t io n a l we igh t ga in , sys-t e m a sys-t ic a lly m o n isys-t o r in g w e igh sys-t sys-t h r o u gh o u sys-t p re gn a n cy, d iscu ssio n o f a se rie s o f sp e cific n u t r it io n a l gu id e lin e s, e n co u r a ge m e n t fo r e xclu -sive o r p r e d o m in a n t b r e a st fe e d in g (Ka c, 2002; Le d e rm a n e t a l., 2002), a n d ligh t p h ysica l e xe r -cise (De we y, 1998; Lo ve la d y e t a l., 2000). Th e se m e a su re s sh o u ld b e im p le m e n t e d im m e d ia t e ly in o r d e r t o p r e ve n t p e r s is t e n t ly h igh o b e s it y ra te s a sso cia te d with th e re p ro d u ctive cycle .
Fig ure 1
Me an p o stp artum we ig ht re te ntio n (a) and me d ian p re d o minant b re astfe e d ing
p atte rn (b ) at 15 d ays p o stp artum c o mp aring c e nsure s and c o mp le te fo llo w-up ,
b y ag e c ate g o ry, fo r Brazilian wo me n 18 to 45 ye ars o f ag e . Rio d e Jane iro ,
Brazil, 1999-2001.
Fig ure 1a
Fig ure 2
Evo lutio n in me ans and 95% CI fo r p o stp artum we ig ht re te ntio n in Brazilian wo me n 18 to 45 ye ars o f ag e .
Rio d e Jane iro , Brazil, 1999-2001.
Tab le 2
Evo lutio n o f p o stp artum we ig ht re te ntio n ac c o rd ing to se le c te d variab le s amo ng Brazilian wo me n
fro m 18 to 45 ye ars o f ag e . Rio d e Jane iro , Brazil, 1999-2001.
Variables Time elapsed post part um
0.5 mo nths 2 mo nths 6 mo nths 9 mo nths
Po stp artum we ig ht re te ntio n (kg )
n x 95% CI n x 95% CI n x 95% CI n x 95% CI
Skin color
White 154 5.3 4.6-6.0 137 4.7 4.0-5.4 115 3.9 3.0-4.7 105 3.5 2.5-4.4
Bro wn 179 4.3 3.7-5.0 161 3.6 2.9-4.3 133 2.7 1.9-3.5 121 2.3 1.4-3.1
Blac k 72 4.5 3.5-5.6 61 4.1 2.9-5.3 50 4.3 2.8-5.7 45 4.2 2.7-5.8
Place of birt h
Rio d e Jane iro 263 4.8 4.2-5.4 229 4.1 3.5-4.7 194 3.5 2.9-4.2 176 3.1 2.4-3.9
O the r State 142 4.6 3.9-5.3 130 4.0 3.3-4.7 104 3.2 2.3-4.1 95 2.9 1.9-3.9
Resident ial st rat um
Urb an 330 4.8 4.3-5.3 289 4.0 3.5-4.5 243 3.2 2.6-3.8 221 2.9 2.3-3.6
Rural 75 4.5 3.5-5.4 70 4.4 3.5-5.3 55 4.2 2.9-5.4 50 3.6 2.3-5.0
Smoking
Fo rme r smo ke r 62 4.3 3.1-5.5 56 3.6 2.4-4.9 47 3.7 2.3-5.1 40 3.0 1.4-4.6
Ne ve r smo ke d 278 4.7 4.2-5.2 247 4.1 3.6-4.6 206 3.2 2.6-3.9 189 2.9 2.2-3.6
Curre nt smo ke r 65 5.3 4.1-6.5 56 4.5 3.3-5.8 45 4.0 2.5-5.4 42 3.9 2.3-5.5
Height (cm)
Fig ure 3
Evo lutio n in me ans and 95% CI fo r p o stp artum we ig ht re te ntio n ac c o rd ing to (a) marital status and (b ) ag e
c ate g o ry fo r Brazilian wo me n 18 to 45 ye ars o f ag e . Rio d e Jane iro , Brazil, 1999-2001.
Fig ure 3a
Fig ure 3
Evo lutio n in me ans and 95% CI fo r p o stp artum we ig ht re te ntio n ac c o rd ing to (a) marital status and (b ) ag e
c ate g o ry fo r Brazilian wo me n 18 to 45 ye ars o f ag e . Rio d e Jane iro , Brazil, 1999-2001.
Fig ure 3b
Fig ure 4
Evo lutio n in me ans and 95% CI fo r p o stp artum we ig ht re te ntio n ac c o rd ing to (a) sc ho o ling , (b ) p arity,
and (c ) b o d y fat fo r Brazilian wo me n 18 to 45 ye ars o f ag e . Rio d e Jane iro , Brazil, 1999-2001.
Fig ure 4a
Fig ure 4
Evo lutio n in me ans and 95% CI fo r p o stp artum we ig ht re te ntio n ac c o rd ing to (a) sc ho o ling , (b ) p arity,
and (c ) b o d y fat fo r Brazilian wo me n 18 to 45 ye ars o f ag e . Rio d e Jane iro , Brazil, 1999-2001.
Fig ure 4b
Fig ure 4
Evo lutio n in me ans and 95% CI fo r p o stp artum we ig ht re te ntio n ac c o rd ing to (a) sc ho o ling , (b ) p arity,
and (c ) b o d y fat fo r Brazilian wo me n 18 to 45 ye ars o f ag e . Rio d e Jane iro , Brazil, 1999-2001.
Fig ure 4c
Tab le 3
Ab so lute and re lative (% ) re d uc tio n in p o stp artum we ig ht re te ntio n amo ng Brazilian wo me n
fro m 18 to 45 ye ars o f ag e . Rio d e Jane iro , Brazil, 1999-2001.
Variables Absolute reduction in Relative reduction in
weight retention (kg) weight retention (95% CI)
M arit al st at us
Marrie d 2.5 41.7 (35.2-51.0)
Living with p artne r 1.2 26.7 (24.0-30.0)
Sing le 2.5 58.1 (49.0-71.4)
Age cat egory (years)
18-19 2.8 63.6 (50.9-84.8)
20-29 1.9 41.3 (36.5-47.5)
30-45 1.3 24.1 (21.0-28.3)
Skin color
White 1.9 35.8 (31.7-41.3)
Bro wn 2.1 47.7 (42.0-55.3)
Blac k 0.3 6.7 (5.4-8.8)
Smoking
Fo rme r smo ke r 1.3 31.2 (23.6-41.9)
Ne ve r smo ke d 1.9 40.4 (36.5-45.2)
Curre nt smo ke r 1.4 26.4 (21.5-34.1)
Place of birt h
Rio d e Jane iro 1.7 35.4 (32.1-40.5)
O the r State 1.8 39.1 (34.0-46.1)
Resident ial st rat um
Urb an 1.9 39.6 (35.8-44.2)
Rural 0.9 20.0 (16.7-25.7)
Parit y
1 c hild 2.7 60.0 (50.9-73.0)
≥2 c hild re n 1.1 22.0 (19.3-25.6)
Schooling (years)
≤4 1.1 22.9 (20.0-26.8)
≥5 1.9 40.4 (37.2-46.3)
Height (cm)
< 159 1.3 28.9 (25.5-33.3)
≥159 2.2 40.4 (38.6-51.2)
Body fat (%)
< 30 2.8 80.0 (70.0-96.5)
References
BU TTE, N . F. & H OPKIN SON , J. M ., 1998. Bo d y c o m -p o sit io n ch a n ge s d u rin g la ct a t io n a re h igh ly va ri-a b le ri-a m o n g w o m e n . Jou rn a l of N u t ri t i on, 128: 381S-385S.
COITIN H O, D . C.; SICH IERI, R. & D ’AQU IN O- BEN ICIO, M . H ., 2001. Ob e s it y a n d w e igh t c h a n ge r e -la t e d t o p a r it y a n d b r e a st - fe e d in g a m o n g p a r o u s wo m e n in Br a zil. Pu b lic H ea lt h N u t rit ion, 4:865-870.
DEWEY, K. G., 1998. Effe cts o f m a te rn a l ca lo ric rest ric-t io n a n d e xe rcise d u rin g la cric-t a ric-t io n . Jou rn al of N u
-trition, 128:386S-389S.
FO RN ES, N . S. & D O REA, J. G., 1995. Su b c u t a n e o u s fa t ch a n ge s in lo w- in co m e la ct a t in g m o t h e rs a n d gro wt h o f b re a st -fe d in fa n t s. Jou rn al of t h e Am er-ican College of N u trition, 14:61-65.
GIGANTE, D. P.; VICTORA, C. G. & BARROS, F. C., 2001. Br e a s t - fe e d in g h a s a lim it e d lo n g- t e r m e ffe c t o n a n t h r o p o m e t r y a n d b o d y c o m p o s it io n o f Br a zil-ia n m o t h e rs. Jou rn al of N u trition, 131:78-84. JAN N EY, C. A.; ZH AN G, D . & SOWERS, M ., 1997. La
c-t a c-t io n a n d we igh c-t r e c-t e n c-t io n . Am erica n Jou rn a l of
Clin ical N u trition, 66:1116-1124.
KAC, G., 2001. D e t e r m in a n t e s d a r e t e n ç ã o d e p e s o : U m a re visã o d a lit e ra t u ra . Ca d ern os d e Sa ú d e Pú
-blica, 17:455-466.
KAC, G., 2002. Fa t ores Det erm in a n t es d a Ret en çã o d e Peso Pós-p a rt o em u m a Coort e d e M u lh eres com 9 M eses d e Segu i m en t o. Te s e d e D o u t o r a d o , Sã o Pa u lo : Fa cu ld a d e d e Sa ú d e Pú b lica , U n ive rsid a d e d e Sã o Pa u lo .
Acknowledgments
Th e a u t h o r s wish t o t h a n k t h e Co o r d in a t in g Bo d y fo r Tra in in g U n ive rsit y Le ve l Pe rso n n e l (CAPES), t h e Jo sé Bo n ifá c io U n ive r sit y Fo u n d a t io n o f t h e Fe d e r a l U n i-ve rsit y in Rio d e Ja n e iro (FU JB/ U FRJ), a n d t h e Rio d e Ja n e iro Sta te Re se a rch Fo u n d a tio n (FAPERJ).
LED ERM AN , S. A., 1993. Th e e ffe c t o f p r e gn a n c y we igh t ga in o n la t e r o b e sit y. Ob st et rics a n d Gyn
e-cology, 82:148-155.
LED ERM AN , S. A., 2001. P r e gn a n c y w e igh t ga in a n d p o st p a rt u m lo ss: Avo id in g o b e sit y wh ile o p t im iz-in g t h e gr o w t h a n d d e ve lo p m e n t o f t h e fe t u s .
Jou rn al of th e Am erican M ed ical W om en’s Associa -tion, 56:53-58.
LED ERM AN , A. S.; ALFASI, G. & D ECKELBAU M , R. J., 2002. P r e gn a n c y a s s o c ia t e d o b e s it y in b la c k w o m e n in N e w Yo r k Cit y. M a t ern a l a n d Ch i ld Health Jou rn al, 6:37-42.
LOH MAN, T. G.; ROCH E, A. F. & MARTORELL, R., 1988.
An t h rop om et ric St a n d a rd iz a t ion Referen ce M a n -u a l. Ch a m p a ign : H u m a n Kin e t ics Bo o ks. LO VELAD Y, C. A.; GARN ER, K. E.; M O REN O , K. L. &
WILLIAM S, J. P., 2000. Th e e ffe ct o f we igh t lo ss in o ve r w e igh t , la c t a t in g w o m e n o n t h e gr o w t h o f t h e ir in fa n t s . N ew En gla n d Jou rn a l of M ed i ci n e, 342:449-453.
M O N TEIRO , C. A.; CO N D E, W. L. & P O P KIN , B. M ., 2001. In d e p e n d e n t e ffe c t s o f in c o m e a n d e d u c a -t io n o n -t h e r is k o f o b e s i-t y in -t h e Br a z ilia n a d u l-t p o p u la t io n . Jou rn al of N u trition, 131:881S-886S. OH LIN, A. & ROSSNER, S., 1990. Ma tern a l b o d y we igh t
d e ve lo p m e n t a ft e r p re gn a n cy. In tern ation al Jou
r-n al of Obesity, 14:159-173.
Su b m it t e d o n Ju ly 15, 2002
