A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Promotoras' Roles in Integrative Validity and Treatment Fidelity Efforts in Randomized Controlled Trials The protocol of a randomized controlled trial for playgroup mothers: Reminder on Food, Relaxation, Exercise, and Support for Health (REFRESH) Program Design of an intervention addressing multiple levels of influence on dietary and activity patterns of low-income, postpartum women. MobileMums: A Randomized Controlled Trial of an SMS-Based Physical Activity Intervention A randomized pilot test of “moms on the move”: A physical activity intervention for WIC mothers Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. First Steps for Mommy and Me: A Pilot Intervention to Improve Nutrition and Physical Activity Behaviors of Postpartum Mothers and Their Infants Reducing postpartum weight retention – a pilot trial in primary health care Effect of physical activity intervention based on a pedometer on physical activity level and anthropometric measures after childbirth: a randomized controlled trial Pilot Study of an Individualised Early Postpartum Intervention to Increase Physical Activity in Women with Previous Gestational Diabetes The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Design of the New Life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. [ISRCTN85313483] The effects of exercise and social support on mothers reporting depressive symptoms: a pilot randomized controlled trial. Reducing postpartum weight retention through a correspondence intervention Moms in motion: a group-mediated cognitive-behavioral physical activity intervention Supporting postpartum weight loss in women living in deprived communities – design implications for a randomised control trial Participant recruitment and retention in a pilot program to prevent weight gain in low-income overweight and obese mothers Increasing physical activity in postpartum multiethnic women in Hawaii: results from a pilot study Practical aspects of randomization and blinding in randomized clinical trials. Ethnic-Specific Weight-Loss Interventions for Low-Income Postpartum Women Effects of energy restriction and exercise on bone mineral density during lactation. Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale. A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. The effect of weight loss in overweight, lactating women on the growth of their infants. Diet and exercise weight-loss trial in lactating overweight and obese women. Structured diet and physical activity prevent postpartum weight retention. Postpartum exercise regardless of intensity improves chronic disease risk factors. Use of MyPyramid Menu Planner for Moms in a weight-loss intervention during lactation. New mothers' interest in web-based health promotion: association with healthcare barriers, risk status, and user characteristics. A pilot study evaluating a telephone-based exercise intervention for pregnant and postpartum women. The feasibility and effectiveness of pram walking groups for postpartum women in western Sydney. Effect of exercise training on loss of bone mineral density during lactation. Weight and Behavioral and Psychosocial Factors Among Ethnically Diverse, Low-Income Women After Childbirth: II. Trends and Correlates Stages of change for weight management in postpartum women.
OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed OBJECTIVE to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum , or from birth to six months post partum , on weight retention among Taiwanese women . DESIGN a r and omised controlled trial assigned participants to two experimental groups [ from pregnancy to six months post partum ( EP ) and from birth to six months post partum ( EPP ) ] and one comparison group . SETTING a 3900-bed medical centre in northern Taiwan with around 3000 births annually . PARTICIPANTS a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre . INTERVENTIONS the comparison group received the routine outpatient department obstetric educational programme . The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum , and received on brochure . The EPP group received the same educational intervention as the EP group from 24 - 48 hours after birth to six months post partum . MEASUREMENTS body weight , body mass index , health-promoting behaviour and psycho-social variables ( self-efficacy , body image , depression and social support ) . FINDINGS average gestational weight gain was 14.02 , 15.27 and 16.22 kg in the three EP , EPP and comparison groups respectively , and average weight retention at six months post partum was 2.34 , 4.06 and 5.08 kg in the three groups , respectively . KEY CONCLUSIONS a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention . IMPLICATION S FOR PRACTICE the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle Promotoras from the communities in which interventions are implemented can be effective contributors to validity and fidelity efforts . This article describes a 48-week r and omized controlled trial Madres para la Salud ( Mothers for Health ) and illustrates the use of promotoras as collaborative members of the research team to contribute to attaining integrative validity and treatment fidelity . Madres para la Salud implements a culturally tailored physical activity program to effect changes in body fat , systemic and fat tissue inflammation , and depression symptoms . The significance of Madres para la Salud treatment validity and fidelity processes includes cultural tailoring of a social support intervention , and a promotora model to incorporate initial and ongoing fidelity monitoring Background Mother 's physical activity levels are relatively low , while their energy consumption is generally high result ing in 58 % of Australian women over the age of 18 years being overweight or obese . This study aims to confirm if a low-cost , accessible playgroup based intervention program can improve the dietary and physical activity behaviours of mothers with young children . Methods / Design The current study is a r and omized controlled trial lifestyle ( nutrition and physical activity ) intervention for mothers with children aged between 0 to 5 years attending playgroups in Perth , Western Australia . Nine-hundred participants will be recruited and r and omly assigned to the intervention ( n = 450 ) and control ( n = 450 ) groups . The study is based on the Social Cognitive Theory ( SCT ) and the Transtheoretical Model ( TTM ) , and the Precede-Proceed Framework incorporating goal setting , motivational interviewing , social support and self-efficacy . The six month intervention will include multiple strategies and re sources to ensure the engagement and retention of participants . The main strategy is home based and will include a specially design ed booklet with dietary and physical activity information , a muscle strength and flexibility exercise chart , a nutrition label reading shopping list and menu planner . The home based strategy will be supported by face-to-face dietary and physical activity workshops in the playgroup setting , posted and emailed bi-monthly newsletters , and monthly Short Message Service ( SMS ) reminders via mobile phones . Participants in the control group receive no intervention material s. Outcome measures will be assessed using data that will be collected at baseline , six months and 12 months from participants in the control and intervention groups . Discussion This trial will add to the evidence base on the recruitment , retention and the impact of community based dietary and physical activity interventions for mothers with young children . Trial Registration Australian and New Zeal and Clinical Trials Registry Low-income , multi-ethnic women are at elevated risk for obesity and chronic diseases , yet influences at different levels may act as barriers to changing risk behaviors . Following the birth of a child , childrearing and social isolation can exacerbate these influences . The social ecological framework integrates behavior-change strategies at different levels , providing a strong theoretical base for developing interventions in this high-risk population . The primary purpose of this r and omized controlled trial is to test the efficacy of an educational model delivered by community-based paraprofessionals in improving diet , activity and weight loss  among new mothers over a 12-month postpartum period and a 6-month maintenance period . This model fosters institutional change to support behavior changes influenced at intrapersonal and interpersonal levels , through collaboration with federal programs for low-income families : the Special Supplemental Food Program for Women , Infants and Children ( WIC ) , and the Exp and ed Food and Nutrition Education Program ( EFNEP ) . Participants are r and omized to the Usual Care , e.g. WIC nutrition and breastfeeding education , or Enhanced EFNEP intervention arm , consisting of Usual WIC Care plus a sustained , multi-component intervention including home visits , group classes and monthly telephone counseling . If shown to be efficacious , this program will be readily sustainable through existing federal agencies Background Postnatal women ( < 12 months postpartum ) are at increased risk of physical inactivity . Purpose To evaluate the efficacy and feasibility of a theory-based physical activity ( PA ) intervention delivered to postnatal women primarily via mobile telephone short message service ( SMS ) . Methods Eighty-eight women were r and omized to the intervention ( n = 45 ) or minimal contact control ( n = 43 ) condition . The 12-week intervention consisted of a face-to-face PA goal - setting consultation , a goal - setting magnet , three to five personally tailored SMS/week and a nominated support person who received two SMS per week . SMS content targeted constructs of social cognitive theory . Frequency ( days/week ) and duration ( min/week ) of PA participation and walking for exercise  were assessed via self-report at baseline , 6 and 13 weeks . Results Intervention participants increased PA frequency by 1.82 days/week ( SE ± 0.18 ) by 13 weeks ( F(2,85 ) = 4.46 , p = 0.038 ) and walking for exercise frequency by 1.08 days/week ( SE ± 0.24 ) by 13 weeks ( F(2,85 ) = 5.38 , p = 0.02 ) . Positive trends were observed for duration ( min/week ) of PA and walking for exercise . Conclusions Intervention exposure result ed in increased frequency of PA and walking for exercise in postnatal women Background : Sedentary mothers are important to reach with physical activity promotion . Purpose : This study pilot tested “ Moms on the Move ” a Transtheoretical Model (TTM)-derived physical activity ( PA ) intervention for low-income mothers enrolled in the Women , Infants , and Children ( WIC ) program . Method : Sedentary mothers ( N = 44 ) were r and omized to ( a ) Moms on the Move ( PA intervention ) or ( b ) counseling on self-breast examination ( control ) . Pre- and posttest measurement ( baseline and 2 weeks after the 8-week interventions ) included ( a ) stage of PA behavior change , ( b ) PA behavior , ( c ) selected TTM constructs , and ( d ) social support . Pre- and posidifference scores , chi-square , and one-way analyses of variance ( ANOVAs ) were used . Results : The experimental group progressed in stage of change more than control , x2(1 , N = 44)=20.50 , p < .001 . The experimental group had greater PA behavior : weekly minutes of PA , F(l , 42 ) = 46.85 , p < .001 ; daily energy expenditure ( EE ) , F(1 , 42 ) = 23.01,p < .001 ; and weekly moderate PA EE , F(1 , 42 ) = 32.63 , p < .001 . Experimental subgroup ( n = 11 ) step counts increased pre-post , t(l 0)=6.16,p7lt;. 001 . AnANOVA showed that the experimental group had greater improvements in all TTM constructs and social support , ps < .001 . Conclusions : WIC mothers are at risk for sedentary living and have not been targeted for  PA behavior change using a provider-counseled approach . Although further testing is needed , Moms on the Move appears to be efficacious BACKGROUND Limiting postpartum weight retention is important for preventing adult obesity , but the effect of weight loss on lactation has not been studied adequately . OBJECTIVE We evaluated whether weight loss by dieting , with or without aerobic exercise , adversely affects lactation performance . DESIGN At 12+/-4 wk postpartum , exclusively breast-feeding women were r and omly assigned for 11 d to a diet group ( 35 % energy deficit ; n = 22 ) , a diet plus exercise group ( 35 % net energy deficit ; n = 22 ) , or a control group ( n = 23 ) . Milk volume , composition , and energy output ; maternal weight , body composition , and plasma prolactin concentration ; and infant weight were measured before and after the intervention . RESULTS Weight loss averaged 1.9 , 1.6 , and 0.2 kg in the diet , diet + exercise , and control groups , respectively ( P < 0.0001 ) and was composed of 67 % fat in the diet group and nearly 100 % fat in the diet + exercise group . Change in milk volume , composition , and energy output and infant weight did not differ significantly among groups . However , there was a significant interaction between group and baseline percentage body fat : in the diet group only , milk energy output increased in fatter women and decreased in leaner women . The plasma prolactin concentration was higher in the diet and diet + exercise groups than in the control group . CONCLUSIONS Short-term weight loss ( approximately 1 kg/wk ) through a combination of dieting and aerobic exercise appears safe for breast-feeding mothers and is preferable to weight loss achieved primarily by dieting because the latter reduces maternal lean body mass . Longer-term studies are needed to confirm these findings To assess the feasibility of a pediatric primary care based intervention to promote healthful behaviors among 0–6 month old infants and their mothers . We enrolled  two intervention practice s ( 60 mother-infant pairs ) and one usual care control practice ( 24 pairs ) in a non-r and omized controlled trial . We completed visits and interviews with 80 ( 95 % ) pairs at birth and 6 months . The intervention included ( 1 ) brief focused negotiation by pediatricians , ( 2 ) motivational counseling by a health educator , and ( 3 ) group parenting workshops . We evaluated the intervention effects on infant feeding , sleep duration , TV viewing , and mothers ’ responsiveness to satiety cues . Maternal behavioral targets included postpartum diet , physical activity , TV and sleep . At 6 months , fewer intervention than control infants had been introduced to solid foods ( 57 % vs. 82 % ; P = 0.04 ) , and intervention infants viewed less TV ( mean 1.2 vs. 1.5 h/d ; P = 0.07 ) . Compared to control infants , intervention infants had larger increases in their nocturnal sleep duration from baseline to follow up ( mean increase 1.9 vs. 1.3 h/d ; P = 0.05 ) ; larger reductions in settling time ( mean reduction −0.70 vs. −0.10 h/d ; P = 0.02 ) ; and larger reductions in hours/day of nighttime wakefulness ( mean reduction −2.9 vs. −1.5 h/d ; P = 0.08 ) . There were no differences in breastfeeding , response to satiety cues , or maternal health behaviors . A program of brief focused negotiation by pediatricians , individual coaching by health educators using motivational interviewing , and group parenting workshops tended to improve infant feeding , sleep and media exposure , but had less impact on mothers ’ own health-related behaviors Background Postpartum weight retention may contribute to the development of obesity . We studied whether individual counselling on diet and physical activity from 2 to 10 months postpartum has positive effects on diet and leisure time physical activity and increases the proportion of primiparas returning to their pre-pregnancy weight . Methods A controlled trial including ninety-two postpartum primiparas was conducted in three intervention and three control child health clinics in primary health care in Finl and . The intervention included individual counselling on diet and physical activity during five routine visits to a public health nurse ; the controls received the usual care . Results In total , 50 % of the intervention group and 30 % of the control group returned to their pre-pregnancy weight ( weight retention ≤ 0 kg ) by 10 months postpartum ( p = 0.06 ) . The confounder-adjusted odds ratio for returning to pre-pregnancy weight was 3.89 ( 95 % CI 1.16–13.04 , p = 0.028 ) for the intervention group compared with the controls . The mean proportion of high-fibre bread ( of total weekly amount of bread ) increased by 16.1 % ( 95 % CI 4.3–27.9 ) by 10 months postpartum in the intervention group compared with the controls when adjusted for confounders ( p = 0.008 ) . No significant differences were observed in changes in leisure time physical activity between the groups . Conclusion The intervention increased the proportion of  primiparas returning to pre-pregnancy weight  and the proportion of high-fibre bread in their diet . Larger r and omized controlled trials are needed to show whether counselling can improve dietary and leisure time physical activity habits in postpartum women and also to confirm the results concerning the effect on reducing postpartum weight retention . Trial registration Current Controlled Trials IS RCT Background Pregnancy and childbirth are associated with weight gain in women , and retention of weight gained during pregnancy can lead to obesity in later life . Diet and physical activity are factors that can influence the loss of retained pregnancy weight after birth . Exercise guidelines exist for pregnancy , but recommendations for exercise after childbirth are virtually nonexistent . The aim of this study was to evaluate the effect of physical activity intervention based on pedometer on physical activity level and anthropometric measures of women after childbirth . Methods We conducted a r and omized controlled trial in which 66 women who had given birth 6 weeks to 6 months prior were r and omly assigned to receive either a 12 week tailored program encouraging increased walking using a pedometer ( intervention group , n = 32 ) or routine postpartum care ( control group , n = 34 ) . During the 12-week study period , each woman in the intervention group wore a  pedometer and recorded her daily step count .  The women were advised to increase their steps by 500 per week until they achieved the first target of 5000 steps per day and then continued to increase it to minimum of 10,000 steps per day by the end of 12th week . Assessed outcomes included anthropometric measures , physical activity level , and energy expenditure per week . Data were analyzed using the paired t-test , independent t-test , Mann-Whitney , chi-square , Wilcoxon , covariance analysis , and the general linear model repeated measures procedure as appropriate . Results After 12 weeks , women in the intervention group had significantly increased their physical activity and energy expenditure per week ( 4394 vs. 1651 calorie , p < 0.001 ) . Significant differences between-group in weight ( P = 0.001 ) , Body Mass Index ( P = 0.001 ) , waist circumference ( P = 0.001 ) , hip circumference ( P = 0.032 ) and waist-hip ratio ( P = 0.02 ) were presented after the intervention . The intervention group significantly increased their mean daily step count over the study period ( from 3249 before , to 9960 after the intervention , p < 0.001 ) . Conclusion A physical activity intervention based on pedometer is an effective means to increase physical activity ; reducing retention of weight gained during pregnancy and can improve anthropometric measures in postpartum women . Trial registration IS RCT N : I RCT Optimal strategies to prevent progression towards overt diabetes in women with recent gestational diabetes remain ill defined . We report a pilot study of a convenient , home based exercise program with telephone support , suited to the early post-partum period . Twenty eight women with recent gestational diabetes were enrolled at six weeks post-partum into a 12 week r and omised controlled trial of Usual Care ( n = 13 ) versus Supported Care ( individualised exercise program with regular telephone support ; n = 15 ) . Baseline characteristics ( Mean ± SD ) were : Age 33 ± 4 years ; Weight 80 ± 20 kg and Body Mass Index ( BMI ) 30.0 ± 9.7 kg/m2 . The primary outcome , planned physical activity { Median ( Range ) } , increased by 60 ( 0–540 ) mins/week in the SC group versus 0 ( 0–580 ) mins/week in the UC group ( P = 0.234 ) . Walking was the predominant physical activity . Body weight , BMI , waist circumference , % body fat , fasting glucose and insulin did not change significantly over time in either group . This intervention design ed to increase physical activity  in post-partum women with previous gestational diabetes proved feasible . However , no measurable improvement in metabolic or biometric parameters was observed over a three month period Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Preventing excessive weight gain during pregnancy is potentially important in the prevention of overweight and obesity among women of childbearing age . However , few intervention studies aim ing at weight management during pregnancy have been performed and most of these interventions were not as successful as expected . In this paper the design of the New Life(style ) study is described as well as the content of the individually tailored intervention program , which focuses on controlling weight development during pregnancy . Methods The effectiveness of the New Life(style ) intervention program versus usual care by midwives is evaluated in a r and omised controlled trial . Women who expect their first child and visit one of the participating midwifery practice s are included . The intervention is st and ardised in a protocol and executed by trained counsellors with the women who are r and omised in the intervention group . During 5 sessions – at 18 , 22 , 30 and 36 weeks of pregnancy and at 8 weeks postpartum – individual weight gain is discussed in relation to weight gain guidelines for pregnant women of the American Institute of Medicine . Counsellors coach the women to maintain or optimise a healthy lifestyle , in a period of drastic physical and mental changes . Data is collected at 15 , 25 , 35 weeks of pregnancy and at 6 , 26 , and 52 weeks after delivery . Primary outcome measures are body weight , BMI , and skinfold thickness . Secondary outcome measures include physical activity , nutrition and blood levels of factors that are associated with energy homeostasis . Discussion Results of the current RCT will improve the knowledge of determinants of weight gain during pregnancy , weight retention after childbirth and of the effectiveness of the intervention program that is described . Caregivers and research ers in the field of health promotion are offered more insight in specific elements of the New Life(style ) intervention program A 12-week r and omized controlled trial was conducted ( n = 20 ) investigating the effects of a multi-intervention programme of exercise and social support compared to a control group . Both groups had given birth in the past 12 months and were experiencing depressive symptomatology . Pretest data of physical fitness and structured question naires were compared to post-test data . The results from the study showed that mothers who were in the multi-intervention group improved their fitness levels and depressive symptomatology significantly more than the control group . However , there were no significant changes to either group 's social support levels . These results are encouraging and suggest that a pram push walking intervention might be an effective treatment for mothers suffering postnatal distress OBJECTIVE : Since post-pregnancy weight retention may contribute to the development of obesity , we sought to determine whether a behavioral weight loss intervention was effective in returning women to their pre-pregnancy weight . METHOD : Ninety women who had given birth in the past 3–12 months and whose weight exceeded their pre-pregnancy weight by at least 6.8 kg were r and omly assigned to either : a ) a six-month behavioral weight loss intervention , delivered via correspondence or b ) a no-treatment control group . Assessment s of body weight , physical activity and eating patterns were conducted at pre-treatment and six months ( post-treatment ) . RESULTS : During the six month treatment , subjects in the correspondence condition lost significantly more weight than control subjects ( 7.8 kg vs 4.9 kg , P=0.03 ) and lost a greater percentage of their excess postpartum weight ( 79 % vs 44 % , P=0.01 ) . Furthermore , a significantly greater percentage of correspondence subjects than controls returned to their pre-pregnancy weight ( 33 % vs 11.5 % , P<0.05 ) . Weight loss in the correspondence group was correlated with completion of self-monitoring records ( r=0.50 , P<0.005 ) . CONCLUSIONS : A behavioral weight loss intervention , delivered via correspondence , appears to be effective in reducing  women ’s postpartum weight retention . Future studies should examine the acceptability and the long-term impact of a correspondence postpartum weight loss intervention Background When examining the prevalence of physical inactivity by gender and age , women over the age of 25 are at an increased risk for sedentary behavior . Childbearing and motherhood have been explored as one possible explanation for this increased risk . Post natal exercise studies to date demonstrate promising physical and psychological outcomes , however few physical activity interventions have been theory-driven and tailored to post natal exercise initiates . The purpose of this study was to compare the effects of a group-mediated cognitive behavioral intervention based upon social-cognitive theory and group dynamics ( GMCB ) to a st and ard care postnatal exercise program ( SE ) . Method A r and omized , two-arm intervention design was used . Fifty-seven post natal women were r and omized to one of two conditions : ( 1 ) a st and ard exercise treatment ( SE ) and ( 2 ) a st and ard exercise treatment plus group-mediated cognitive behavioral intervention ( GMCB ) . Participants in both conditions participated in a four-week intensive phase where participants received st and ard exercise training . In addition , GMCB participants received self-regulatory behavioral skills training via six group-mediated counseling sessions . Following the intensive phase , participants engaged in a four-week home-based phase of self-structured exercise . Measures of physical activity , barrier efficacy , and proximal outcome expectations were administered and data were analyzed using ANCOVA procedures . Results and discussion ANCOVA of change scores for frequency , minutes , and volume of physical activity revealed significant treatment effects over the intensive and home-based phases ( p 's < 0.01 ) . In addition , ANCOVA of change in mean barrier efficacy and proximal outcome expectations at the conclusion of the intensive phase demonstrated that GMCB participants increased their initial level of barrier efficacy and outcome expectations while SE participants decreased ( p < 0.05 ) . Conclusion While both exercise programs result ed in improvements to exercise participation , the GMCB intervention produced greater improvement in overall physical activity , barrier efficacy and proximal outcome expectations Background / Objectives : Pregnancy is a life stage where excess weight gain may occur and the postpartum period is often characterised by weight retention . The aim of the current study was to evaluate the feasibility of undertaking a r and omised controlled trial of a weight loss intervention ( WeighWell ) in postpartum women living in areas of social disadvantage . Subjects/ Methods : The study aim ed to recruit 60 women who were not pregnant , 6–18 months postpartum with a body mass index > 25 kg/m2 living in areas of deprivation within Tayside , UK . Recruitment strategies focused on visits to community groups ; writing directly to postpartum women living in areas of deprivation and primary care teams who covered the most deprived 15 % of the population and advertising in community setting s. The 12-week intervention used motivational interviewing techniques to promote an energy deficit diet and increased physical activity , delivered by three face-to-face consultations plus three structured telephone calls . Results : Of 142 women screened , 63 were eligible and 52 ( 83 % ) were recruited and r and omised to an intervention ( n=29 ) or comparison group ( n=23 ) . Over the 12-week intervention , body weight changed significantly by −1.6±2.0 kg in the intervention group compared with + 0.2±2.2 kg in the comparison group , indicating the potential efficacy of the intervention . Loss to follow-up was 24 % in the intervention group and 39 % for the comparison group . Conclusions : The findings support the development of a definitive trial that embraces personalised recruitment strategies and the development of approaches to improve retention over a clinical ly relevant intervention period Background Recruitment and retention are key functions for programs promoting nutrition and other lifestyle behavioral changes in low-income population s. This paper describes strategies for recruitment and retention and presents predictors of early ( two-month post intervention ) and late ( eight-month post intervention ) dropout ( non retention ) and overall retention among young , low-income overweight and obese mothers participating in a community-based r and omized pilot trial called Mothers In Motion . Methods Low-income overweight and obese African American and white mothers ages 18 to 34 were recruited from the Special Supplemental Nutrition Program for Women , Infants , and Children in southern Michigan . Participants ( n = 129 ) were r and omly assigned to an intervention ( n = 64 ) or control ( n = 65 ) group according to a stratification procedure to equalize representation in two racial groups ( African American and white ) and three body mass index categories ( 25.0 - 29.9 kg/m2 , 30.0 - 34.9 kg/m2 , and 35.0 - 39.9 kg/m2 ) . The 10-week theory-based culturally sensitive intervention focused on healthy eating , physical activity , and stress management messages that were delivered via an interactive DVD and reinforced by five peer-support group teleconferences . Forward stepwise multiple logistic regression was performed to examine whether dietary fat , fruit and vegetable intake behaviors , physical activity , perceived stress , positive and negative affect , depression , and race predicted dropout as data were collected two-month and eight-month after the active intervention phase . Results Trained personnel were successful in recruiting subjects . Increased level of depression was a predictor of early dropout ( odds ratio = 1.04 ; 95 % CI = 1.00 , 1.08 ; p = 0.03 ) . Greater stress predicted late dropout ( odds ratio = 0.20 ; 95 % CI = 0.00 , 0.37 ; p = 0.01 ) . Dietary fat , fruit , and vegetable intake behaviors , physical activity , positive and negative affect , and race were not associated with either early or late dropout . Less negative affect was a marginal predictor of participant retention ( odds ratio = 0.57 ; 95 % CI = 0.31 , 1.03 ; p = 0.06 ) . Conclusion Dropout rates in this study were higher for participants who reported higher levels of depression and stress . Trial registration Current Controlled Trials Background Mothers of an infant are much less likely to exercise regularly compared to other women . This study tested the efficacy of a brief tailored intervention to increase physical activity ( PA )  in women 3–12 months after childbirth . The study used a pretest-posttest design . Sedentary women ( n = 20 ) were recruited from a parenting organization . Half the participants were ethnic minorities , mean age was 33 ± 3.8 , infants ' mean age was 6.9 ± 2.4 months , 50 % were primiparas , and mean body mass index was 23.6 ± 4.2 . Methods The two-month intervention included telephone counseling , pedometers , referral to community PA re sources , social support , email advice on PA/pedometer goals , and newsletters . The primary outcome of the study was minutes per week of moderate and vigorous leisure-time physical activity measured by the Godin physical activity instrument . Results All women ( 100 % ) returned for post-test measures ; thus , paired t-tests were used for pre-post increase in minutes of moderate and vigorous leisure-time physical activity and comparisons of moderate and vigorous leisure-time physical activity increases among ethnic groups . At baseline participants ' reported a mean of 3 ± 13.4 minutes per week moderate and vigorous leisure-time physical activity . At post-test this significantly increased to 85.5 ± 76.4 minutes per week of moderate and vigorous leisure-time physical activity ( p < .001 , Cohen 's d = 2.2 ; effect size r = 0.7 ) . There were no differences in pre to post increases in minutes of moderate and vigorous leisure-time physical activity among races . Conclusion A telephone/email intervention tailored to meet the needs of postpartum women  was effective in increasing physical activity levels . However , r and omized trials comparing tailored telephone and email interventions to st and ard care and including long-term follow-up to determine maintenance of physical activity are warranted R and omization and blinding are important tools in determining the effectiveness of a new intervention and ensuring the validity of a clinical trial . However , r and omness and haphazardness are not equivalent . R and omization can not overcome poor experimental design or technique . Several types of r and omization including historical controls and pseudor and omization are discussed , as well as methods of treatment allocation , stratification , and minimization techniques . The importance of decreasing bias and the advantages and disadvantages of blinding in r and omized clinical trials are also covered Promoting  weight loss among overweight low-income postpartum women has proven difficult . The study ’s aims were to pilot-test ethnic-specific weight-loss interventions using r and omized control-group design s for White/Anglo ( n = 23 ) , African American ( n = 25 ) , and Hispanic low-income postpartum women ( n = 23 ) and draw lessons from psychosocial data and follow-up interviews . Interventions lasting 13 weeks were offered in group setting s in the community . Similar to other r and omized trials with low-income mothers , weight changes between intervention and control groups were nonsignificant in each ethnic group ; however , changes correlated significantly with self-efficacy ( Spearman r = .50 ) for White/Anglo women and self-efficacy ( Spearman r = −.48 ) and perceived stress ( Spearman r = .48 ) for African American women . In follow-up interviews , women felt interventions gave a good foundation for weight loss , but program and situational factors affected participation and weight loss . Control groups ( mailed interventions later ) were generally more pleased with their assignment than intervention groups UNLABELLED Modest energy restriction combined with resistance training ( RT ) has been shown in nonlactating women to protect bone during periods of weight loss . However , there is a paucity of research on dietary interventions and exercise in lactating women aim ed at promoting bone health and weight loss . PURPOSE This study aim ed to investigate the effects of energy restriction and exercise on bone mineral density ( BMD ) and hormones during lactation . METHODS At 4 wk postpartum , participants were r and omized to either a  16-wk intervention ( diet restricted by 500 kcal and RT 3 d·wk ) group ( IG = 14 ) or minimal care group ( CG = 13 ) . Measurements included BMD by DXA , three 24-h dietary recalls , and hormones . Repeated- measures ANOVA was used to test for group differences over time . RESULTS Energy intake decreased more in IG ( 613 ± 521 kcal ) than CG ( 171 ± 435 kcal ) ( P = 0.03 ) . IG lost more weight ( 5.8 ± 3.5 kg vs CG = 1.6 ± 5.4 kg , P = 0.02 ) . BMD decreased over time , P < 0.01 , with no group differences in lumbar spine ( IG = 3.4 % ± 2.5 % , CG = 3.7 % ± 3.3 % ) or hip ( IG and CG = 3.1 ± 1.8 % ) . Prolactin and estradiol decreased over time in both groups , P < 0.01 . Basal growth hormone remained stable ; however , there was a significant increase in growth hormone response to exercise in IG . CONCLUSIONS These results suggest that moderate energy restriction combined with RT  promotes weight loss with no adverse effects on BMD during lactation BACKGROUND Obesity and excessive weight gain during pregnancy are associated with adverse pregnancy outcomes . Observational studies suggest that minimal or no gestational weight gain ( GWG ) may minimize the risk of adverse pregnancy outcomes for obese women . OBJECTIVE This report describes the design of Healthy Moms , a r and omized trial testing a weekly , group-based , weight management intervention design ed to help limit GWG to 3 % of weight ( measured at the time of r and omization ) among obese pregnant women ( BMI ≥30 kg/m(2 ) ) . Participants are r and omized at 10 - 20 weeks gestation to either the intervention or a single dietary advice control condition . PRIMARY OUTCOMES The study is powered for the primary outcome of total GWG , yielding a target sample size of 160 women . Additional secondary outcomes include weight change between r and omization and one-year postpartum and proportion of infants with birth weight>90th percentile for gestational age . Statistical analyses will be based on intention-to-treat . METHODS Following r and omization , all participants receive a 45-minute dietary consultation . They are encouraged to follow the Dietary Approaches to Stop Hypertension diet without sodium restriction . Intervention group participants receive an individualized calorie intake goal , a second individual counseling session and attend weekly group meetings until they give birth . Research staff assesses all participants at 34-weeks gestation and at 2-weeks and one-year postpartum with their infants . SUMMARY The Healthy Moms study is testing weight management techniques that have been used with non-pregnant adults . We aim to help obese women limit GWG to improve their long-term health and the health of their offspring BACKGROUND The potential risks and benefits of regular exercise during lactation have not been adequately evaluated . We investigated whether regular aerobic exercise had any effects on the volume or composition of breast milk . METHODS Six to eight weeks post partum , 33 sedentary women whose infants were being exclusively breast-fed were r and omly assigned to an exercise group  ( 18 women ) or a control group ( 15 women ) . The exercise program consisted of supervised aerobic exercise ( at a level of 60 to 70 percent of the heart-rate reserve ) for 45 minutes per day , 5 days per week , for 12 weeks . Energy expenditure , dietary intake , body composition , and the volume and composition of breast milk were assessed at 6 to 8 , 12 to 14 , and 18 to 20 weeks post partum . Maximal oxygen uptake and the plasma prolactin response to nursing were assessed at 6 to 8 and 18 to 20 weeks . RESULTS The women in the exercise group expended about 400 kcal per day during the exercise sessions but compensated for this energy expenditure with a higher energy intake than that recorded by the control women ( mean [ + /- SD ] , intake , 2497 + /- 436 vs. 2168 + /- 328 kcal per day at 18 to 20 weeks ; P < 0.05 ) . Maximal oxygen uptake increased by 25 percent in the exercising women but by only 5 percent in the control women ( P < 0.001 ) . There were no significant differences between the two groups in maternal body weight or fat loss , the volume or composition of the breast milk , the infant weight gain , or maternal prolactin levels during the 12-week study . CONCLUSIONS In this study , aerobic exercise performed four or five times per week beginning six to eight weeks post partum had no adverse effect on lactation and significantly improved the cardiovascular fitness of the mothers BACKGROUND The retention of weight gained during pregnancy may contribute to obesity . Lactation should promote weight loss , but weight loss is highly variable among lactating women . The risks associated with the restriction of energy intake during lactation have not been adequately evaluated . The purpose of this study was to determine whether weight loss by women during lactation affects the growth of their infants . METHODS We r and omly assigned 40 breast-feeding women who were overweight ( defined as a body-mass index [ the weight in kilograms divided by the square of the height in meters ] of 25 to 30 ) at 4 weeks post partum either to restrict their energy intake by 500 kcal per day and to exercise for 45 minutes per day for 4 days per week ( the diet- and -exercise group ) or to maintain their usual dietary intake and not exercise more than once per week for 10 weeks ( the control group ) . We measured the weight and fat mass of the women and the weight and length of the infants before , during , and at the end of the study period . RESULTS The mean ( + /-SD ) energy intake decreased by 544+/-471 kcal per day in the diet- and -exercise group . As compared with the control group , the women in the diet- and -exercise group lost more weight ( 4.8+/-1.7 kg vs. 0.8+/-2.3 kg , P<0.001 ) and fat mass ( 4.0+/-2.0 kg vs. 0.3+/-1.8 kg , P<0.001 ) . The gains in weight and length of the infants whose mothers were in the diet- and -exercise group ( 1925+/-500 g and 7.8+/-2.0 cm , respectively ) were not significantly different from those of the infants whose mothers were in the control group ( 1861+/-576 g and 7.3+/-1.7 cm ) . CONCLUSIONS Weight loss of approximately 0.5 kg per week between 4 and 14 weeks post partum in overweight women who are exclusively breast-feeding does not affect the growth of their infants BACKGROUND Current evidence suggests a combined treatment of postpartum weight loss of diet and exercise . However , to our knowledge , neither their separate and interactive effects nor long-term outcomes have been evaluated . OBJECTIVE We evaluated whether a 12-wk dietary behavior modification ( D ) treatment to decrease energy intake , physical exercise behavior modification ( E ) treatment to implement moderate aerobic exercise , or combined dietary and physical exercise behavior modification ( DE ) treatment compared with control ( usual care ) ( C ) reduces body weight in lactating women measured at the end of treatment and at a 1-y follow-up 9 mo after treatment termination . DESIGN At 10 - 14 wk postpartum , 68 lactating Swedish women with a prepregnancy BMI ( in kg/m² ) of 25 - 35 were r and omly assigned to D , E , DE , or C groups . Measurements were made at baseline , after the intervention , and again at a 1-y follow-up 9 mo later . A 2 × 2 factorial approach was used to analyze main and interaction effects of treatments . RESULTS Weight changes after the intervention and 1-y follow-up were -8.3 ± 4.2 and -10.2 ± 5.7 kg , respectively , in the D group ; -2.4 ± 3.2 and -2.7 ± 5.9 kg , respectively , in the E group ; -6.9 ± 3.0 and -7.3 ± 6.3 kg , respectively , in the DE group ; and -0.8 ± 3.0 and -0.9 ± 6.6 kg , respectively , in the C group . The main effects of D treatment , but not of E treatment , on weight were significant at both times ( P < 0.001 ) . CONCLUSIONS Dietary treatment provided clinical ly relevant weight loss in lactating postpartum women , which was sustained at 9 mo after treatment . The combined treatment did not yield significant weight or body-composition changes beyond those of dietary treatment alone BACKGROUND Postpregnancy weight retention contributes to the near-epidemic prevalence of obesity in the United States . This study examines the impact of an individualized , structured diet and physical activity intervention on weight loss in overweight women during the first year postpartum . METHODS Forty overweight postpartum women were r and omized to either a structured ( STR ) or a self-directed ( SELF ) intervention . Measurements included body weight , percent body fat , daily caloric intake , habitual physical activity , and cardiorespiratory fitness . Subjects in STR received individualized diet and physical activity prescriptions derived from baseline measurements . They met weekly for the first 12 weeks and kept daily food and activity diaries . Subjects in SELF received a single 1-hour educational session about diet and activity . RESULTS Only 23 of 40 participants remained in the study at 1 year postpartum . Of those , STR ( n = 13 ) had a significant weight loss ( 7.3 kg , p < 0.01 ) , a significant decrease in percent body fat ( 6 % , p < 0.01 ) , and no change in fat-free mass . SELF ( n = 10 ) had no significant change in weight , percent body fat , or fat-free mass . CONCLUSIONS Women who committed to this one class per week for 12 weeks postpartum had a high likelihood of successful weight loss that persisted at 1 year . Women who were overweight before pregnancy were unlikely to lose the pregnancy-related weight without the help of a formal intervention . This suggests that healthcare professionals should strongly encourage postpartum women to enroll in a structured diet and exercise program PURPOSE Women who are unable to return to a healthy weight by 6 months postpartum increase their risk factors for the development of chronic disease ( CD ; including metabolic syndrome , obesity , and cardiovascular disease ) . In a prospect i ve r and omized intervention study , we examined the effect of exercise intensity on risk factors for CD in the postpartum . We hypothesized that women receiving an intervention targeting healthy weight loss would have improved CD risk factors compared with women not receiving the intervention . Further , we hypothesized that nutrition control and moderate-intensity exercise would have the greatest improvement in CD risk factors versus low-intensity exercise . METHODS Women were r and omly assigned to a nutrition plus low-intensity ( 30 % HR reserve ; n = 20 ) or moderate-intensity ( 70 % HR reserve ; n = 20 ) exercise intervention group . The program consisted of supervised walking for 45 min , three to four times per week for 16 wk . All women were screened for CD at the beginning ( 7 - 8 wk postpartum ) and at the end ( 23 - 25 wk postpartum ) of the study . A historical control group of 20 sedentary postpartum women was matched by body mass index , age , and parity . RESULTS The low- and moderate-intensity groups lost more body mass ( -4.2 ± 4.0 and -5.0 ± 2.9 kg , respectively ) compared with the control group ( -0.1 ± 3.3 kg , P < 0.01 ) . Plasma low-density lipoprotein was reduced for the low- and moderate-intensity groups ( -0.29 ± 0.21 and -0.28 ± 0.17 mmol · L ) compared with the control group ( 0.03 ± 0.18 mmol · L , P = 0.015 ) . In addition , glucose concentrations were reduced and adiponectin concentrations increased ( P = 0.037 ) , regardless of exercise intensity , although the sedentary controls remained unchanged or at increased risk for CD . CONCLUSIONS Women receiving a postpartum intervention targeting healthy weight loss , regardless of exercise intensity , improved CD risk factors compared with women not receiving the intervention The Internet offers a valuable re source for promotion of healthy eating and Web-based communication between the dietetics practitioner and client . In a 16-week intervention examining the effects of energy restriction ( 500 kcal/day ) and exercise on body composition in overweight/obese lactating women , MyPyramid Menu Planner for Moms  was used to support dietary counseling . R and om assignment occurred at 4 weeks postpartum to either an  Intervention group ( n=14 ) or Minimal Care group ( n=13 ) from 2008 through 2010 . Three 24-hour dietary recalls were obtained using the Nutrition Data System at 4 and 20 weeks postpartum . Individual MyPyramid Menu Planner accounts were created for the Intervention group and used in face-to-face dietary counseling . Repeated measures analysis of variance was used to test for differences between groups for change in dietary intake and weight . Changes in energy , saturated fat , and percent of energy from added sugars were significantly different between Intervention group and Minimal Care group ( -613 [ 521 ] kcal vs -171 [ 435 ] kcal ; P=0.03 ; -14.9 [ 14.0 ] g vs + 0.9 [ 13.4 ] g ; P<0.01 ; and -3.5 % [ 5.3 % ] vs + 2.2 % [ 4.8 % ] ; P<0.01 , respectively ) . The Intervention group significantly increased their whole fruit servings and decreased their total grain and milk servings compared with the Minimal Care group ( P<0.05 ) . The Intervention group lost significantly more weight ( -5.8 [ 3.5 ] kg ) than the Minimal Care group ( -1.6 [ 5.4 ] kg ) ( P=0.03 ) . Although participants must have access to an Internet-based computer and possess basic food knowledge , these results suggest MyPyramid Menu Planner might prove to be an effective dietary counseling support tool for improving dietary intake and promoting weight loss during lactation OBJECTIVE Our first aim was to assess the contributions of health-related risks , barriers to healthcare , and user characteristics to new mothers ' interest in two  Web-based health programs : postpartum weight loss or parenting advice . Our second aim was to determine if the preceding proximal variables diminished associations of income level with interest in Web-based health programs . SUBJECTS AND METHODS A mail survey of a stratified r and om sample was conducted with a result ing analytic sample that included 121 white/Anglo , African American , or Hispanic women of higher and lower income . Weight risk ( being overweight or obese ) and psychosocial/behavioral risk ( alcohol use , depression , smoking ) were the predictors of interest in a weight loss program and parenting advice , respectively . Financial , structural , and function factors served as barriers to care . Frequency of Internet use assessed user characteristics . Hierarchical logistic regression analysis was used to evaluate predictors . RESULTS Being overweight ( adjusted odds ratio [ OR ] , 5.55 ; 95 % confidence interval [ CI ] , 2.18 , 14.11 ) was the only variable to affect likelihood of interest in an Internet-based weight loss program ; income level was not a significant predictor . Having two or more psychosocial/behavioral risks ( adjusted OR , 0.22 ; 95 % CI , 0.50 , 0.92 ) was the only predictor of interest in Internet-based parenting advice ;  income level was not a significant predictor after adjusting for other variables ( OR , 0.55 ; 95 % CI , 0.19 , 1.55 ) . CONCLUSIONS The type of risk and program topic decreased or increased likelihood of interest in  Internet-based programming .  Weight risks increased interest in weight loss programming , but psychosocial/behavioral risks deceased interest in parenting advice INTRODUCTION Exercise during pregnancy is associated with reduced rates of preeclampsia , gestational diabetes , anxiety , insomnia , and excessive weight gain . Continued exercise during the postpartum period is important for healthy weight loss and reduced anxiety . Unfortunately , pregnant and postpartum women are significantly less active than nonpregnant women . The purpose of this pilot study was to evaluate a telephone-based exercise intervention design ed for pregnant and postpartum women . METHODS Healthy women ( N = 37 ) who were pregnant ( 16 weeks ' gestation or less ) or postpartum ( 6 months or less ) participated in a 3-month , telephone-based exercise intervention based on the transtheoretical model and social cognitive theory . Exercise was assessed by using the 7-Day Physical Activity Recall Interview . RESULTS Pregnant participants significantly increased their exercise from a mean ( st and ard deviation [ SD ] ) of 60.47 ( 63.1 ) minutes per week at baseline to 132.9 ( 82.3 ) minutes at 3 months , F(1,13 ) = 9.96 , P < .01 . Postpartum participants significantly increased their exercise from a mean ( SD ) of 68.9 ( 63.5 ) minutes per week at baseline to 123.8 ( 48.8 ) minutes at 3 months , F(1,15 ) = 6.56 , P < .05 . DISCUSSION Participants responded positively to the intervention by significantly increasing their exercise levels . There is a need for a large , r and omized controlled trial examining the efficacy of telephone-based exercise interventions for pregnant and postpartum women ISSUE ADDRESSED Women with children under five are the least physically active population group . We provided postpartum women living in western Sydney with the opportunity to participate in weekly pram walking groups and evaluated the effect of the intervention on self-reported physical activity , mental health and social indicators . METHODS Mothers living in the intervention area ( Blacktown LGA ) and control area ( Holroyd and Parramatta LGAs ) completed a baseline question naire . Women in the intervention community were invited to participate in a pram walking group starting in the next month . The control group ( n = 60 ) were also invited to participate in a pram walking group starting six months later . A follow-up question naire was completed by all mothers . RESULTS There was no significant increase in the proportion of mothers in the intervention or control groups engaging in adequate physical activity from baseline to follow-up . However , intervention mothers increased their sessions of vigorous exercise and control mothers increased the amount of time spent walking . There were no significant differences at baseline or follow-up between the intervention and control groups in frequency of social contact or size of social networks . Nor was there a significant difference in satisfaction with social contact at baseline between the two groups . However , at follow-up women in the intervention group were more satisfied with the quality of their social contacts than the controls . CONCLUSIONS Providing organised , community-based pram walking was not sufficient to increase overall physical activity levels among this group of postpartum women . The results suggest that the friendships formed in the pram walking group boosted mothers ' satisfaction with social contact and possibly their mental health PURPOSE During lactation , women transfer approximately 200 mg of calcium per day to breast milk . For 6 months , this is equivalent to 3%-9 % of bone mineral density ( BMD ) loss at trabecular-rich sites . Bone mass usually returns to prepregnancy levels with cessation of lactation but not in all women . Therefore , the purpose of this study was to determine whether exercise slows bone loss from 4 to 20 wk postpartum ( PP ) . METHODS At 4 wk PP , women were r and omized to either an exercise group [ EG , n = 10 , weight bearing aerobic exercise ( 3 d·wk(-1 ) , 45 min·d(-1 ) ) and 3 d·wk(-1 ) of resistance exercise ] or a control group ( CG , n = 10 , no exercise ) for 16 wk . Body composition and BMD were measured by dual-energy x-ray absorptiometry at the lumbar spine ( LS ) , hip , and total body . Maximal strength and predicted maximal oxygen consumption ( VO2max ) were determined by 1-repetition maximum and submaximal treadmill test , respectively . Repeated- measures ANOVA was used to test for time and time by group differences . RESULTS EG lost significantly less LS BMD than CG ( -4.8 ± 0.6 % vs -7.0 ± 0.3 % , P < 0.01 ) . There were no significant differences in total body and hip BMD . Both groups lost fat mass ( EG = -2.9 ± 0.7 kg , CG = -1.8 ± 0.4 kg ) ; however , EG lost less lean body mass ( -0.7 ± 0.3 vs -1.6 ± 0.3 kg , P = 0.05 ) . Maximal strength increased by 34 % to 221 % for all exercises in EG , whereas CG changed -5.7 % to 12 % . Predicted VO2max increased in both groups ( EG = 11.4 ± 2.0 , CG = 6.9 ± 1.7 % ) . CONCLUSIONS These results suggest that resistance and aerobic exercise may slow bone loss during lactation ABSTRACT Objective : This paper presents a longitudinal analysis of behavioral and psychosocial correlates of weight trends during the first postpartum year . Data are derived from the Austin New Mothers Study ( ANMS ) , a longitudinal study of a low-income , tri-ethnic sample of postpartum women that incorporated serial assessment of weight and behavioral and psychosocial variables . Method : Postpartum body mass index ( BMI ) was measured prospect ively ( post-delivery , 6 weeks , and 3 , 6 , and 12 months postpartum ) . The analytic sample consisted of 382 White , African American , and Hispanic women receiving maternity care funded by Medicaid who had at least three measured postpartum weights . Behavioral and psychosocial variables included energy intakes , fat intakes , physical activity , health-related lifestyle , smoking , breastfeeding , contraception , depressive symptoms , emotional eating , body image , and weight-related distress . Results : Using hierarchical linear modeling to incorporate baseline only and time-varying effects , significant associations with postpartum BMI were found for the following variables : ethnicity ( p = .001 ) , time of weight measurement ( p < .001 ) , the interaction of ethnicity and time ( p = .005 ) , prepregnant BMI ( p < .001 ) , gestational weight gain ( p < .001 ) , weight-related distress ( p < .001 ) , and energy intakes ( p = .005 ) . After adjusting for covariates , ethnic groups displayed differing trends in postpartum BMI result ing in White women having significantly lower BMI s at 12 months postpartum compared to ethnic minority women ( p 's < .01 ) . Conclusion : Behavioral and psychosocial variables contribute to a fuller underst and ing of BMI status of low-income women during the first postpartum year OBJECTIVE This study examined factors related to stages of change for weight-management behaviors in postpartum women . DESIGN Cross-sectional data , collected at baseline , are reported from the Mothers ' Overweight Management Study ( MOMS ) , a r and omized , controlled trial conducted in postpartum women who participated in the Special Supplemental Nutrition Program for Women , Infants , and Children (WIC).Subjects/ Setting Subjects were a sample of WIC recipients ( N=151 ) older than 18 years of age with a child younger than 2 years . Statistical analysis The dependent variables were the stages of change for weight-management behaviors ( losing weight , avoiding high-fat foods , eating a high-fiber diet , and exercising ) . Demographic , health , and psychosocial variables were examined as independent variables . One-way analysis of variance was used to compare means , and chi(2 ) was used for proportions . RESULTS Whereas 55 % of women were in the action stage for weight loss , fewer women were in the action stage for the following weight management behaviors : avoiding high-fat foods  ( 24 % ) , increasing fiber ( 19 % ) , and  exercising  three times per week ( 29 % ) . Identifying pros for weight management was related to stages for losing weight , high-fat food avoidance , and exercise ( F=13.4 , P<.001 ; F=10.5 , P<.001 ; F=3.7 , P<.007 , respectively ) . Self-efficacy for choosing a low-fat restaurant meal or using food labels was positively related to later stages for avoiding high-fat foods and increasing fiber intake ( chi(2)=16.4 , P=.003 ; chi(2)=11.7 , P=.02 ) . CONCLUSIONS Emphasizing the pros for weight-management behaviors , decreasing the cons for exercising , increasing confidence to select low-fat restaurant choices , and improving skills for using food labels are four strategies that nutrition professionals can use to help women become more ready to change behaviors for weight management
For women of reproductive age , excessive gestational weight gain and /or postpartum weight retention can increase the risk of obesity .
This systematic review evaluates the effectiveness of lifestyle modification control trials that utilize exercise interventions , with or without dietary intervention , on weight loss among postpartum women .