Factors affecting weight development after pregnancy : the SPAWN (Stockholm Pregnancy And Women's Nutrition) study

Abstract

Obesity is a growing problem all over the world. For some women pregnancy is a trigger event for developing overweight or obesity and 73% of female patients at the Obesity Unit indicated that they had retained more than 10 kg after each of their pregnancies. For this subgroup weight development after pregnancy was of crucial importance for their future health.

The SPAWN (Stockholm Pregnancy And Women's Nutrition) study is a long-term followup study of women who delivered children in 1984-85 in Stockholm (n =2342). 1423 participants completed questionnaires which covered eating behaviour and exercise, demographic information including social situation and status and details of the pregnancy before, during and up to one year after pregnancy. Fifteen years later these women were invited to take part in the follow-up study (SPAWN). Anthropometric measurements and the same questionnaire data were collected on the 563 women who participated. Detailed drop-out analyses indicate that this subsample was representative. We have also monitored a group of women with gestational diabetes (GDM) and studied sweet food intake in women.

Our main findings are: Both high weight gainers and high weight retainers had higher BMI values at 15 years of follow-up, although only 56% of the high weight gainers during pregnancy ended up as the high weight retainers one year after pregnancy. Weight retention at the end of the postpartum year, however, predicts future overweight. Contrary to popular belief and official recommendations, high BMI before pregnancy is not a predictor for weight retention. Women with overweight before pregnancy do not have a higher risk of postpartum weight retention than normal weight women.

Women who are diagnosed with GDM have a considerably higher risk of developing type 2 diabetes mellitus later in life. More active strategies for future weight control and lifestyle advice after delivery might therefore be indicated for women with GDM.

Our SPAWN data furthermore suggests that women with depressive traits have higher intakes of sweet foods, suggesting a link between mood regulation and consumption of in particular chocolate. Salivary counts of mutans streptococci and lactobacilli are simple, cheap and chair-side tests known to mirror the consumption of fermented carbohydrates and may thus be used as an objective indicator of the sweet food intake in dietary surveys.