Postpartum weight retention and the early evolution of cardiovascular risk over the first 5 years after pregnancy

• Published in: Cardiovascular diabetology Vol. 23; no. 1; p. 101
• Main Authors: Kramer, Caroline K, Ye, Chang, Hanley, Anthony J, Connelly, Philip W, Sermer, Mathew, Zinman, Bernard, Retnakaran, Ravi
• Format: Journal Article
• Language: English
• Published: England BioMed Central 18.03.2024; BMC
• Subjects: Adiponectin; Age; Anthropometry; Apolipoproteins; Blood pressure; Body mass index; Breastfeeding & lactation; C-reactive protein; Cardiovascular disease; Cardiovascular diseases; Cardiovascular risk; Cholesterol; Diabetes; Diabetes mellitus (non-insulin dependent); Ethnicity; Exercise; Family medical history; Glucose; Glucose tolerance; Health risks; High density lipoprotein; Insulin resistance; Lipids; Low density lipoprotein; Overweight; Postpartum; Postpartum weight retention; Pregnancy; Questionnaires; Reagents; Regression analysis; Retention; Risk factors; Sensitivity analysis; Triglycerides; Vascular diseases; Weight; Womens health; Pregnancy; Postpartum weight retention; Lipids; Diabetes; Cardiovascular risk
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-024-02184-4

The cumulative effect of postpartum weight retention from each pregnancy in a woman's life may contribute to her risk of ultimately developing type 2 diabetes and cardiovascular disease. However, there is limited direct evidence supporting this hypothesis. Thus, we sought to characterize the impact of postpartum weight retention on the trajectories of cardiovascular risk factors over the first 5-years after pregnancy. In this prospective observational cohort study, 330 women (mean age 35.7 ± 4.3 years, mean pre-pregnancy body mass index 25.2 ± 4.8 kg/m , 50.9% primiparous) underwent serial cardiometabolic characterization (anthropometry, blood pressure, lipids, oral glucose tolerance test, insulin sensitivity/resistance (Matsuda index, HOMA-IR), C-reactive protein (CRP), adiponectin) at 1-year, 3-years, and 5-years postpartum. Based on the magnitude of weight change between pre-pregnancy and 5-years postpartum, they were stratified into the following 3 groups: weight loss (n = 100), weight gain 0-6% (n = 110), and weight gain ≥ 6% (n = 120). At 1-year postpartum, cardiovascular risk factors did not differ between the groups. However, an adverse risk factor profile progressively emerged in the weight retention groups at 3- and 5-years. Indeed, after covariate adjustment, there was stepwise worsening (from the weight loss group to weight gain 0-6% to weight gain ≥ 6% group) of the following cardiovascular risk factors at 5-years: triglycerides (p = 0.001), HDL (p = 0.02), LDL (p = 0.01), apolipoprotein-B (p = 0.003), Matsuda index (p < 0.0001), HOMA-IR (p < 0.0001), fasting glucose (p = 0.07), and CRP (p = 0.01). Moreover, on logistic regression analyses, weight gain ≥ 6% emerged as an independent predictor of pre-diabetes/diabetes at 5-years (adjusted OR = 3.40, 95%CI: 1.63-7.09). Postpartum weight retention predicts trajectories of worsening cardiovascular risk factors and glucose intolerance over the first 5-years after delivery, consistent with its postulated contribution to future vascular disease in women.