Postpartum women are saddled with the tasks of infant care. They lack time, energy and motivation to manage or lose their excessive weight retained post-pregnancy. They fail to seek knowledge and counselling from healthcare providers about the diet they should consume and the physical activity they should engage in. Subsequently, they follow the advice of their elders and start practising common socio-cultural myths such as consuming high-calorie foods and restricting physical activity. These challenges and barriers not only impede the shedding of the extra weight retained but also escalate the risk of weight gain and associated health complications.

There is a great need for postpartum women to identify the implications of postpartum obesity. There is also need for healthcare professionals to treat postpartum women with greater competency, having a structured postpartum follow up with counselling and motivation for weight loss and investigations like haemoglobin, TSH and blood sugars at follow up. Bringing various healthcare professionals like Obstetrician, counsellor, psychiatrist, medical specialist and women together in managing the postpartum weight. Special consideration should be given to women belonging to low socioeconomic status who are grappling with obesity like their peers.

The Government of India along with Department of Science and Technology, The Federation of Obstetric and Gynaecological Societies of India, Indian Menopause Society, Association of Physicians of India, Academy of Family Physicians of India, Association of Obstetricians & Gynaecologists of Delhi, Indian Dietetic Association, and The Indian Society of Clinical Nutrition have attempted to form guidelines for this problem.

The Government of India along with Department of Science and Technology, The Federation of Obstetric and Gynaecological Societies of India, Indian Menopause Society, Association of Physicians of India, Academy of Family Physicians of India, Association of Obstetricians & Gynaecologists of Delhi, Indian Dietetic Association, and The Indian Society of Clinical Nutrition have attempted to form guidelines for this problem.

The summary of the recommendations is as follows:

1. Initiation of Discussion for weight management.
2. Screening and risk assessment of the target population for initiation of weight management advice.
3. Management of Weight.
4. Follow up for sustainable weight loss

Various myths are related to physical activity during the postpartum period.

Especially in Asian countries like India, the period of confinement for the first forty days post-delivery is usually practiced. Consequently, postpartum women land up being sedentary. It is crucial to burst myths related to physical activity specifically during the postpartum period and raise awareness among these women about the type, intensity and importance of various exercises that should be performed during this period.

This narrative review is aimed to practically review and evaluate the existing evidence and illuminate the effectiveness of physical activity, yoga, and exercise for postpartum and midlife weight management. A comprehensive review was conducted using electronic databases such as PubMed and google scholar using search terms physical activity, exercise, yoga, postpar- tum, midlife, weight loss, weight reduction, and all the probable terms. This helped in generating evidence-based information and formulating practical physical activity prescriptions to be used by obstetricians, general clinicians, nutritionists, and other allied healthcare personnel. Overweight and obesity in postpartum and midlife women present long-term health risks and complications. Indulging in optimum physical activity comprising exercise and yoga will help in weight management, increasing muscular strength, and endurance thus improving overall health and well-being.

Weight retention and weight gain during the postpartum and midlife periods subsequently increase the risk of chronic health conditions, thereby deteriorating the overall health. Dietary intervention is the pivotal component of sustainable weight management. However, in resource restricted settings, where dietitians may not be present, other healthcare professionals such as physicians, obstetricians and paediatricians should play a vital role in providing timely weight management advice to these women. Therefore, this article provides dietary advice including the setting of realistic weight loss goals, identifying an individual's calorie needs, distribution of macronutrients and consideration of important micronutrients. Healthcare professionals can follow the stepwise approach to prescribe dietary advice to postpartum and midlife women for their weight management. Various dietary principles such as cultural and regional preferences of an individual, portion size, hypocaloric diets, and nutrient-dense meals, eating habits, cultural beliefs and myths along with co-morbid conditions should be taken into consideration by healthcare professionals while providing the dietary prescription.

Background and Aims Gestational diabetes mellitus is one of the most important issue related to health status of mothers and their children throughout life. This meta-analysis has been conducted to assess relationship between maternal birth weight and gestational diabetes.

Methods and Results This article is written using PRISMA guideline for systematic review and meta-analysis. We searched epidemiological studies without a time limit from following databases—Scopus, PubMed, Science Direct, Embase, Web of Science, CINAHL, Cochrane, EBSCO, and Google Scholar search engine using MESH keywords. Heterogeneity was determined using the Cochran Q test and I2 index. Data were analyzed using comprehensive meta-analysis, version 2. The significance level of the tests was considered as P < 0.05.

Results The result of combining ten studies with a sample size of 228,409 cases using a fixed-effect model showed that low maternal birth weight increased the risk of gestational diabetes mellitus (1.71 [95% CI 1.43–2.06, P < 0.001]). In addition, the result of combining nine studies with a sample size of 227,805 cases using a random-effects model showed that macrosomia did not increase the risk of gestational diabetes mellitus, and there was no significant relationship between them (1.04 [95% CI 0.79–1.38; p value: 0.730]).

Conclusion The results of this systematic review and meta-analysis showed that low maternal birth weight could be a risk factor for gestational diabetes in adulthood.

Behaviour change is the basic foundation in the management of obesity. Such behaviour change is difficult to achieve due to several psycho-social and behavioural barriers that often remain unidentified and unaddressed in a weight management program. This is even more challenging in postpartum and midlife women because of several biopsychosocial factors. The non-availability of psychologists or trained healthcare counsellors further complicates the attainment of behavioural changes. Therefore, clinicians who are often the first point of contact for treating these population groups, are hamstrung by the lack of a multidisciplinary approach for weight reduction. Some of the common psychological, social and behavioural barriers have been identified in this article, and evidence-based techniques such as goal setting, stimulus control, and cognitive restructuring are presented in a step-wise approach, to help clinicians cater to these population groups in a holistic manner.

Introduction

Maternal Body Mass Index (BMI) is a vital predictor of the nutritional status of any pregnant woman. Several developing countries like India are facing double burden of both obesity and malnutrition due the extreme socioeconomic distribution of our population. Thus, this study was undertaken to study the effect of pre-pregnancy maternal BMI on the obstetric outcomes. Materials and methods A retrospective observational study was conducted during the time period of 1 year (December 2018- December 2019), wherein we analysed 3940 women who delivered in Goa Medical College. Depending on the maternal BMI calculated at the first antenatal visit, all the study participants were divided into 5 BMI groups and their obstetric outcomes were studied.

Results

Majority of the study participants were in the normal BMI category (49.8%), however a large number of women were overweight (37.3%), 3.2% were obese and 0.1% were morbidly obese and 9.6%were underweight. Antenatal complications like anaemia and IUGR were more common in underweight women whereas preeclampsia, GDM, macrosomia, antepartum haemorrhage, preterm labour were more common in obese women. Increased rate of caesarean sections and postpartum complications like PPH, wound sepsis and puerperal sepsis was observed in overweight and obese women.

Conclusion

Thus adverse obstetric outcomes were observed in extremes of maternal BMI. Hence there is a need to provide pre-conception counselling to all women in the reproductive age group so that they can achieve normal BMI prior to conception and thus reduce maternal morbidity and mortality rates in our country.

Background

To study maternal–fetal outcomes in patients of GDM diagnosed by International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria but subsequently using a twenty-four-hour seven-value sugar profile to evaluate patients before instituting management. Methods This prospective observational study was conducted at a tertiary hospital in New Delhi, India, over a period of one year. During this period, women diagnosed as GDM between 24 and 28 weeks of gestation using IADPSG criteria underwent seven-value sugar profile in twenty-four hours before initiating any therapy. Those with normal profile were kept on observation only, whereas others were managed by Medical Nutrition Therapy (MNT) with or without pharmacotherapy as required to maintain euglycemia. Maternal and fetal outcomes were documented and analysed to detect differences between the groups.

Results

Out of 2279 pregnant women, 201 (8.8%) were diagnosed as GDM. The twenty-four-hour seven-value sugar profile was normal in 78 (38.8%) patients, who were managed only by close observation. Treatment was given to other patients; 93 (46.2%) patients were managed with MNT only, whereas pharmacotherapy by way of metformin was added to 22 (10.9%) patients and 8 (3.9%) patients required insulin. Differences in maternal–fetal outcomes between the treated and untreated groups were not found to be statistically significant.

Conclusions

The policy of evaluating patients with twenty-four-hour seven-value sugar profile after an abnormal Oral Glucose Tolerance Test eliminated over one-third women from receiving treatment and interventions for GDM without compromising maternal–fetal outcomes.

Background

No previous study compared ACOG and DIPSI criteria for diagnosing gestational diabetes (GDM). This study compared diagnostic accuracy of Diabetes in pregnancy study group of India (DIPSI) with Carpenter–Coustan (CC) and National Diabetes Data Group (NDDG) criteria for diagnosis of GDM and correlation with fetomaternal outcome.

Methods

A total of 1029 pregnant women underwent 2 h 75 g OGTT in non-fasting state. After 3–7 days, women were called in fasting state and subjected to 100 g OGTT and fasting, 1, 2, 3 h samples were taken. GDM was diagnosed using DIPSI, CC and NDDG criteria. All women were followed till delivery, and fetomaternal outcome was noted.

Results

10.4% (107) women were diagnosed as GDM by DIPSI, 6.4% (66) by CC and 3.1% (32) by NDDG criteria. Sensitivity of DIPSI with CC was 98.48%, specificity was 95.64%, and diagnostic accuracy was 95.82%. Sensitivity of DIPSI with NDDG was 99.89%, specificity was 92.38%, and diagnostic accuracy was 95.52%. Sensitivity of NDDG with CC was 48.48%, specificity was 100%, and diagnostic accuracy was 96.7%. Women with GDM by all three criteria were seen to have a significantly higher proportion of LSCS, higher birth weight and macrosomia compared to normoglycemic women (p value<0.001).

Conclusion

Diagnostic accuracy, sensitivity and specificity of DIPSI are comparable to CC and NDDG criteria; therefore, DIPSI can be recommended for diagnosing GDM with added advantage of low cost, simplicity and convenience. Women diagnosed as GDM by DIPSI, CC and NDDG had significantly higher rate of cesarean delivery, higher birth weight and macrosomia as compared to women with normoglycemia.

Background

Postpartum period is associated with significant weight retention and weight gain. The aim of this study was to develop and validate a comprehensive questionnaire to assess the risk factors, facilitators, and barriers to postpartum weight management.

Methodology

The development and validation were done in five major steps by applying a mixed-method study design. Items were generated through literature review, focus group discussions, and in-depth interviews, followed by the assessment of content validity, face validity, construct validity, and reliability.

Result

The final questionnaire comprises 36 items which are split into five major domains assessing perceptions related to body weight, eating behaviour, physical activity, sleep pattern, and beliefs/myths associated with postpartum period. The questionnaire has a satisfactory construct validity through factor analysis (65.12) and good internal consistency and reliability with a Cronbach’s alpha of 0.79.

Conclusion

This is a comprehensive tool to assess the risk factors, facilitators, and barriers to postpartum weight management and will aid in developing women centric strategies to curb the problem.

Background and Aims

The pregnancy weight is usually retained in the form of abdominal fat during the postpartum period. The willingness to lose weight is influenced by knowledge, attitude, beliefs and practices. This study aims to comprehend the awareness, beliefs and perspectives of postpartum women regarding their perceived factors, barriers and facilitators associated with post-pregnancy weight status.

Methods

Overweight and obese postpartum women aged between 20 and 40 years and had delivered an infant in the last 2 years were recruited via convenience and purposive sampling techniques. The final sample comprised 27 participants with a mean age of 29.96±4.50 years. Four focus group discussions and eight in-depth interviews carried out were audio-recorded and transcribed verbatim. Codes, sub-themes and themes were generated using Atlasti 9 software.

Results

Major themes identified were perceived factors causing postpartum weight retention/weight gain including social and cultural beliefs related to diet and exercise specifically associated with this period, perceived motivators and deterrents of weight loss including eagerness to lose weight and perceived facilitators and barriers to weight loss including intrinsic and extrinsic factors such as time, energy, evidence-based knowledge about diet and physical activity, family support and obligation to family’s advice.

Conclusion

The unique challenges and barriers associated with postpartum weight loss efforts should be taken into consideration by healthcare professionals and public health policy-makers to design strategies specific to postpartum women.

Dietary behaviors established in adolescence usually lead to long-term health consequences. Consuming foods high in fat and sugar on one side and adopting sedentary lifestyle on the other side are responsible for overweight and obesity in adolescent girls which increases the risk of diabetes and hypertension in adult life. Meal convenience is important to many adolescents. In the bargain, they may eat too much of wrong types of food. Teenagers should be taught about the five healthy groups i.e., Grains, proteins, vegetables, fruits and dairy products. Food items with different colors, textures and tastes, both fresh and cooked should be included at every meal and for snacks. The healthiest and the cheapest drink is nothing else but clean water. Adolescent girls need iron-rich food to compensate for monthly period blood loss. Adolescence is not a good time for crash diets as girls will not get enough nutrients to reach their full potential.