A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors The influence of the fullness of milk in the breasts on the concentration of lactic acid in postexercise breast milk. Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation. Active Mothers Postpartum (AMP): rationale, design, and baseline characteristics. 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 More Active Mums in Stirling (MAMMiS): a physical activity intervention for postnatal women. Study protocol for a randomized controlled trial Baseline Results from Hawaii's Nā Mikiniiki Project: A Physical Activity Intervention Tailored to Multiethnic Postpartum Women 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 Major mineral concentrations in human milk do not change after maximal exercise testing. Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum The effect of health and nutrition education intervention on women's postpartum beliefs and practices: a randomized controlled trial An Exercise and Education Program Improves Well-Being of New Mothers: A Randomized Controlled Trial Reducing postpartum weight retention – a pilot trial in primary health care Recruitment of lactating women into a randomized dietary intervention: successful strategies and factors promoting enrollment and retention. Effect of physical activity intervention based on a pedometer on physical activity level and anthropometric measures after childbirth: a randomized controlled trial Diet and lifestyle interventions in postpartum women in China: study design and rationale of a multicenter randomized controlled trial Galactose promotes fat mobilization in obese lactating and nonlactating women. The effects of exercise and social support on mothers reporting depressive symptoms: a pilot randomized controlled trial. The effects of dieting on food and nutrient intake of lactating women. Reducing postpartum weight retention through a correspondence intervention Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care 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 Physical activity counseling in maternity and child health care – a controlled trial Ethnic-Specific Weight-Loss Interventions for Low-Income Postpartum Women A comparison of Mediterranean-style and MyPyramid diets on weight loss and inflammatory biomarkers in postpartum breastfeeding women. The effectiveness of a pram-walking exercise programme in reducing depressive symptomatology for postnatal women. An Evaluation of Mother-Centered Anticipatory Guidance to Reduce Obesogenic Infant Feeding Behaviors A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. Effect of energy restriction and exercise on vitamin B-6 status of women during lactation. Does exercise intensity or diet influence lactic acid accumulation in breast milk? Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program. 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. A prospective study of obesity and risk of coronary heart disease in women. Postpartum exercise regardless of intensity improves chronic disease risk factors. Effect of exercise on milk immunoglobulin A. Madres para la Salud: design of a theory-based intervention for postpartum Latinas. Multiparity is associated with high motivation to change diet among overweight and obese postpartum women. Impact of a Health Promotion Intervention on Maternal Depressive Symptoms at 15 months Postpartum Use of MyPyramid Menu Planner for Moms in a weight-loss intervention during lactation. Should lactating women exercise? The feasibility and effectiveness of pram walking groups for postpartum women in western Sydney. Mediator Analysis of Moms on the Move Effect of exercise training on loss of bone mineral density during lactation. Infant acceptance of breast milk after maternal exercise. Stages of change for weight management in postpartum women. Intervention fidelity: lessons learned from an unsuccessful pilot study. Infant acceptance of postexercise breast milk.
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 The purpose of this study was to observe the influence of the fullness of breast milk in the breasts prior to exercise on the concentration of lactic acid in breast milk following exercise . Twenty-three lactating women were r and omly assigned to Group E ( n = 11 ) , which nursed and /or collected as much of the breast milk as possible prior to maximal exercise , and Group F ( n = 12 ) , which did not nurse or collect milk at least two hours prior to maximal exercise . Milk was collected at rest preexercise and 10 , 30 , 60 and 90 minutes postexercise and was analyzed for concentrations of lactic acid . ANOVA demonstrated 1 ) a significant increase in lactic acid in the milk at all postexercise collection s for both groups and 2 ) a significant group vs postexercise time interaction for lactic acid concentration in milk . These differences represented differences in 1 ) time to peak lactic acid concentrations in milk ( Group F = 10 min ; Group E = 30 min ) and 2 ) time for postexercise decreases in lactic acid concentrations in milk . Thus , the state of fullness of milk in the breasts is a factor which affects the concentration of lactic acid in breast milk following maximal exercise BACKGROUND No evidence -based recommendations exist concerning what dietary macronutrient composition optimizes weight loss during lactation while maintaining milk production . OBJECTIVES The study was design ed to test the following hypotheses : compared with a reduced-calorie , high-carbohydrate ( H-CHO ) diet , an isonitrogenous , isocaloric high-fat ( H-F ) diet will decrease milk production and carbohydrate oxidation , increase gluconeogenesis and hexoneogenesis , and not affect energy balance . DESIGN Seven healthy lactating mothers and their infants were studied on 2 occasions in r and om order for 8 d separated by 1 - 2 wk . On one occasion , the subjects received the H-F ( 30 % of energy as carbohydrate and 55 % as fat ) diet and on the other occasion received the H-CHO ( 60 % of energy as carbohydrate and 25 % as fat ) diet .  Milk production , infant intakes , and substrate and hormone concentrations were measured . Glucose rates of appearance , production , gluconeogenesis , glycogenolysis , and hexoneogenesis were measured by using stable-isotope gas chromatography-mass spectrometric techniques , and energy expenditure and substrate oxidation were measured by using indirect calorimetry . RESULTS Milk volume , lactose , and protein concentrations were unaffected . Milk fat , energy , and infant intakes were higher ( P < 0.05 ) during the H-F diet . Neither gluconeogenesis nor hexoneogenesis was different . During the H-F diet , energy expenditure and fat and protein oxidation rates were higher ( P < 0.05 ) , and the daily energy balance deficit was greater ( P < 0.01 ) . CONCLUSIONS Milk fat , energy output , and energy expenditure were higher during the H-F diet , which result ed in a greater negative energy balance . The lactating mothers adapted to a low carbohydrate intake by decreasing carbohydrate oxidation . Additional studies are warranted to determine whether a hypocaloric H-F diet might promote weight loss to a greater extent than the H-CHO diet while maintaining milk production BACKGROUND Pregnancy and the postpartum period have been suggested as important contributors to overweight and obesity among women . This paper presents the design , rationale , and baseline participant characteristics of a r and omized controlled intervention trial to enhance weight loss in postpartum women who entered pregnancy overweight or obese . METHODS Active Mothers Postpartum ( AMP ) is based on the rationale that the birth of a child can be a teachable moment . AMP 's primary objectives are to promote and sustain a reduction in body mass index ( BMI ) up to 2 years postpartum via changes in diet and exercise behavior , with a secondary aim to assess racial differences in these outcomes . Women in the intervention arm participate in ten physical activity group sessions , eight healthy eating classes , and six telephone counseling sessions over a 9-month period . They also receive motivational tools , including a workbook with recipes and exercises , a pedometer , and a sport stroller . RESULTS Four hundred fifty women aged > or = 18 ( mean 30.9 ) , with a BMI > or = 25 kg/m(2 ) ( mean 33.0 ) at baseline ( 6 weeks postpartum ) were enrolled ; 45 % of the final sample are black and 53 % are white . Baseline characteristics by study arm and by race are presented . CONCLUSIONS Our intervention is design ed to be disseminated broadly to benefit the public health . Behavior change interventions based on principles of social cognitive theory , stage of readiness , and other models that coincide with a teachable moment , such as the birth of a child , could be important motivators for postpartum weight loss 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 Many postnatal women are insufficiently physically active in the year after childbirth and could benefit from interventions to increase activity levels . However , there is limited information about the efficacy , feasibility and acceptability of motivational and behavioral interventions promoting postnatal physical activity in the UK . Methods The MAMMiS study is a r and omized , controlled trial , conducted within a large National Health Service ( NHS ) region in Scotl and . Up to 76 postnatal women will be recruited to test the impact of two physical activity consultations and a 10-week group pram-walking program on physical activity behavior change . The intervention uses evidence -based motivational and behavioral techniques and will be systematic ally evaluated using objective measures ( accelerometers ) at three months , with a maintenance measure taken at a six-month follow-up . Secondary health and well-being measures and psychological mediators of physical activity change are included . Discussion The ( MAMMiS study will provide a test of a theoretical and evidence -based physical activity behavior change intervention for postnatal women and provide information to inform future intervention development and testing within this population .Trial registration Current Controlled Trials IS RCT During the postpartum period , ethnic minority women have higher rates of inactivity/under-activity than white women . The Nā Mikimiki ( “ the active ones ” ) Project is design ed to increase  moderate-to-vigorous physical activity  over 18 months among multiethnic women with infants 2–12 months old . The study was design ed to test , via a r and omized controlled trial , the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website material s-only condition .  Healthy , underactive women ( mean age = 32 ± 5.6 years ) with a baby ( mean age = 5.7 ± 2.8 months ) were enrolled from 2008–2009 ( N = 278 ) . Of the total sample , 84 % were ethnic minority women , predominantly Asian – American and Native Hawaiian . Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition , ethnicity , infant 's age , maternal body mass index , or maternal employment . Women had high scores on perceived benefits , self-efficacy , and environmental support for exercise but low scores on social support for exercise . This multiethnic sample 's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women . The Nā Mikimiki Project 's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women 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 Fourteen healthy , lactating women ( aged 25 - 38 y and between 2 and 8 mo postpartum ) participated in both a maximal grade d exercise test and a 30-min rest period to determine the influence of exercise on the concentration of selected milk minerals and electrolytes . Treatment order was r and omized and treatments were conducted on different days . Milk was expressed before treatment and at 10 , 30 , and 60 min postexercise or after the rest period . Milk was wet-ashed by using nitric and sulfuric acids . Aliquots were analyzed for total phosphorus concentration by colorimetric assay and for calcium , magnesium , sodium , and potassium by inductively coupled plasma atomic emission spectrophotometry . Baseline mineral concentrations were not significantly different ( P>0.05 ) . Repeated expression of milk at 10 , 30 , and 60 min did not show significantly altered mineral concentrations ( P>0.05 ) . Interwoman variation was responsible for most of the variation in mineral concentrations . A portion of this may be explained by the variation in stage of lactation , which is known to affect mineral composition . Stage of lactation was inversely correlated with concentration of calcium , total phosphorus , magnesium , and sodium ( P<0.05 ) . In conclusion , maximal exercise did not alter concentrations of phosphorus , calcium , magnesium , potassium , or sodium in milk . Thus , with respect to mineral concentrations in milk , there is no contraindication for exercise during lactation 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 OBJECTIVES : ( 1 ) To describe the relative importance of gestational weight gain , postpartum exercise , food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum ; and ( 2 ) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing . DESIGN : A prospect i ve cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York . SUBJECTS : A total of 540 healthy adult women who gave birth to full-term singleton infants . MEASUREMENTS : Sociodemographic characteristics , exercise , food-related behaviors and breastfeeding were assessed using the medical record and a mailed question naire .  Body weight was measured at prenatal visits and 1 y postpartum . Weight retained and major weight gain ( 4.55 kg ) at 1 y postpartum were the main outcomes . ANALYSIS : Linear and logistic regression analyses were conducted . RESULTS : Women were on average 1.51±5.95 kg heavier at 1 y postpartum than they were in early pregnancy . Nearly 25 % of women experienced a major weight gain of 4.55 kg or more at 1 y postpartum . Gestational weight gain , exercise frequency , change in food intake and breastfeeding were each significantly related to postpartum weight retention . With the exception of breastfeeding , all of these factors were also associated with major weight gain .  Women under 20 y or over 40 y at delivery , and single women retained significantly more weight .  Lower income women with gestational weight gains above the Institute of Medicine ( IOM ) range retained 3.73 kg more than lower income women who gained within the range . They were also 4.7 times more likely to experience major weight gain with childbearing . The impact of exceeding the IOM gestational weight gain guidelines was three times greater in lower income women than it was in higher income women . CONCLUSION : Gestational weight gain , postpartum exercise frequency , and food intake are significantly associated with weight change from early pregnancy to 1 y postpartum and major weight gain with childbearing . Lower income women who gain more weight in pregnancy than the IOM recommends are at high risk for major weight gain with childbearing Background ' Sitting month ' is the Chinese tradition for postpartum customs . Available studies indicate that some of the traditional postpartum practice s are potentially harmful for women 's health . However , no intervention study aim ing at postpartum practice s has been performed . In this paper we evaluated the effect of a health and nutrition education intervention , which focused on improving postpartum dietary quality and optimal health behaviors . Methods The study design was a r and omized controlled trial conducted in both urban and rural area of Hubei between August 2003 and June 2004 . A total of 302 women who attended the antenatal clinic during the third trimester with an uncomplicated pregnancy were recruited . Women r and omized to the education intervention group in both urban and rural area received two two-hour prenatal education sessions and four postpartum counseling visits . Control group women received usual health care during pregnancy and postpartum period . Women were followed up until 42 days postpartum . Outcome measures were nutrition and health knowledge , dietary behavior , health behavior and health problems during the postpartum period . Results Women in the intervention groups exhibited significantly greater improvement in overall dietary behaviors such as consumption of fruits , vegetables , soybean and soybean products as well as nutrition and health knowledge than those in the control groups . Significantly more women in the intervention groups give up the traditional behavior taboos . The incidence of constipation , leg cramp or joint pain and prolonged lochia rubra was significantly lower in the intervention groups as compared with the control groups . Conclusion The study shows that health and nutrition education intervention enable the women take away some of the unhealthy traditional postpartum practice s and decrease the prevalence of postpartum health problems . The intervention has potential for adaptation and development to large-scale implementation . Trial registration Objective The purpose of this study was to evaluate the effect of a physical therapy exercise and health care education program on the  psychological well-being of new mothers . Design This was a r and omized controlled trial . Participants Primiparous and multiparous English-speaking women ready for discharge from The Angliss Hospital postnatal ward were eligible for this study . Women who were receiving psychiatric care were excluded . One hundred sixty-one women were r and omized into the trial . Intervention The experimental group ( n=62 ) received an 8-week “ Mother and Baby ” ( M&B ) program , including specialized exercise provided by a women 's health physical therapist combined with parenting education . The other group ( education only [ EO ] , n=73 ) received only the same educational material as the experimental group . Main Outcome Measures Psychological well-being ( Positive Affect Balance Scale ) , depressive symptoms ( Edinburgh Postnatal Depression Scale ) , and physical activity levels were assessed at baseline , after 8 weeks ( post-program ) , and then 4 weeks later . Results There was significant improvement in well-being scores and depressive symptoms of the M&B group compared with the EO group over the study period . More specifically , there was a significant positive effect on well-being scores and depressive symptoms at 8 weeks , and this effect was maintained 4 weeks after completion of the program . The number of women identified as “ at risk ” for postnatal depression pre-intervention was reduced by 50 % by the end of the intervention . Limitations Although this study provides promising short-term ( 4-week ) outcomes , further work is needed to explore whether the intervention effects are maintained as sustained psychological and behavioral benefits at 6 months . Conclusions A physical therapy exercise and health education program is effective in improving postnatal well-being . Routine use of this program may reduce longer-term problems such as postnatal depression 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 INTRODUCTION Recruitment and retention of lactating women require unique strategies to prevent high attrition . The purpose of this report is to identify successful recruitment strategies and evaluate demographic and lifestyle characteristics associated with study completion . METHODS A r and omized , controlled trial was initiated to test the hypothesis that  lactating women adhering to a Mediterranean diet  will show a significant reduction in anthropometric measurements as compared to lactating women r and omized to the USDA 's MyPyramid diet for Pregnancy and Breastfeeding ( control diet ) . Measurements were collected at baseline , 2 months , and 4 months . Recruitment methods and baseline characteristics of completers and non-completers are described . RESULTS The largest percentage of women , 24.8 % , were recruited from a local parenting magazine , 20.9 % from Craig 's List , 20.2 % from local hospitals , and 34.1 % from various other sources . At baseline , women ( n = 129 ) were mostly Non-Hispanic ( 75.2 % ) , average age 29.7 years , BMI averaged 27.2 kg/m(2 ) , waist : hip ratio 0.84 cm ( SD : 0.07 ) , and body fat averaged 30.8 % . Approximately 72 % were exclusively breastfeeding , a mean 17.5 weeks postpartum , and 69.0 % had a college degree . Non-completers were more likely to have supplemented with formula at baseline as compared to completers ( P<0.001 ) . No other characteristics were significantly associated with attrition . CONCLUSION Research ers conducting studies with lactating women may consider " exclusive breastfeeding " as a study inclusion criterion to prevent high attrition rates or include additional breastfeeding support to study participants 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 Background " Doing the month " , or " sitting month " , is a traditional practice for postpartum women in China and other Asian countries , which includes some taboos against well-accepted healthy diet and lifestyles in general population . Previous studies have shown this practice may be associated with higher prevalence of postpartum problems . The current multicenter r and omized controlled trial ( RCT ) aims to evaluate outcomes of diet and lifestyle interventions in Chinese postpartum women . Methods / Design The current multicenter RCT will be conducted in three representative areas in China , Sh and ong province , Hubei province and Guangdong province , which locate in northern , central and southern parts of China , respectively . Women who attend routine pregnancy diagnosis in hospitals or maternal healthcare centers will be invited to take part in this study . At least 800 women who meet our eligibility criteria will be recruited and r and omly assigned to the intervention group ( n > = 400 ) and the control group ( n > = 400 ) . A three-dimension comprehensive intervention strategy , which incorporates intervention measures simultaneously to individual postpartum woman , their family members and community environment , will be utilized to maximize the effectiveness of intervention . Regular visiting and follow-up will be done in both group ; nutrition and health-related measurements will be assessed both before and after the intervention . Discussion To our knowledge , this current study is the first and largest multicenter RCT which focus on the effectiveness of diet and lifestyle intervention  on reducing the incidence rate of postpartum diseases and improving health status in postpartum women .  We hypothesize that the intervention will reduce the incidence rates of postpartum diseases and improve nutrition and health status due to a balanced diet and reasonable lifestyle in comparison with the control condition . If so , the results of our study will provide especially important evidence for changes in both the concept and action of traditional postpartum practice in China . Trial Registration Clinical Trials.gov ID NCT01039051 BACKGROUND Galactose consumption as the only carbohydrate source results in little increase in plasma glucose and insulin concentrations when compared with fasting . Lower insulin might promote endogenous lipolysis during meal absorption , which may facilitate fat loss . OBJECTIVE The objective was to test the hypothesis that consumption of an isocaloric , isonitrogenous galactose drink will result in higher rates of lipolysis and fat oxidation than consumption of a glucose drink in obese lactating and nonlactating women . DESIGN Seven healthy , obese , exclusively breastfeeding women and 7 healthy , obese , nonlactating women were studied on 2 occasions according to a r and omized , crossover , single-blinded design . Subjects received drinks providing ≈70 % of the daily estimated energy requirement , of which 60 % was either glucose or galactose . The primary outcomes were the rate of appearance ( Ra ) of glycerol and palmitate , and the secondary outcomes were glucose Ra , milk production , energy expenditure , and substrate oxidation . RESULTS Plasma glucose and insulin concentrations were lower ( P < 0.05 ) and those of glycerol , palmitate , free fatty acids , and triglycerides were higher ( P < 0.05 ) during galactose than during glucose feeding in both nonlactating and lactating women . During galactose feeding , glucose Ra was lower ( P < 0.01 ) and glycerol , palmitate , and free fatty acid Ra were higher ( P < 0.01 ) in both groups . During galactose feeding in all women combined , fat oxidation was higher ( P = 0.01 ) and protein oxidation was lower ( P < 0.01 ) . Milk production , energy expenditure , and carbohydrate oxidation were similar between glucose and galactose feeding . CONCLUSIONS Galactose consumption is associated with higher endogenous fat mobilization and oxidation during meal absorption . Long-term studies are required to determine whether galactose as an exclusive carbohydrate source would promote body fat loss in obese subjects 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 The purpose of this report was to identify and evaluate dietary changes in women who were participating in a study on the effects of weight loss in overweight lactating women on the growth of their infants . Women were r and omly assigned at 4 weeks postpartum to either restrict energy intake by 500 kcal/day ( diet and exercise group ) or to maintain usual dietary intake ( control group ) for 10 weeks . The diet and exercise group significantly decreased fats , sweetened drinks , sweets and desserts , snack foods , and energy intake . Micronutrient intake decreased in the diet and exercise group ; however , mean intakes were not significantly different from those of the control group except for calcium and vitamin D. Both groups consumed less than 76 % of the Recommended Dietary Allowance for vitamins E and C at the end of the study . Mean intake of all other nutrients was adequate in both groups . These results suggest that overweight lactating women can restrict their energy intake by 500 kcal per day by decreasing consumption of foods high in fat and simple sugars . However , they must be advised to increase their intakes of foods high in calcium and vitamin D. Increased intake of fruits and vegetables should also be recommended to all lactating women , as well as multivitamin and calcium supplements to those who do not consume adequate amounts of these foods 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 Excessive gestational weight gain and postpartum weight retention may predispose women to long-term overweight and other health problems . Intervention studies aim ing at preventing excessive pregnancy-related weight gain are needed . The feasibility of implementing such a study protocol in primary health care setting was evaluated in this pilot study . Methods A non-r and omized controlled trial was conducted in three intervention and three control maternity and child health clinics in primary health care in Finl and . Altogether , 132 pregnant and 92 postpartum women and 23 public health nurses ( PHN ) participated in the study . The intervention consisted of individual counselling on physical activity and diet at five routine visits to a PHN and of an option for supervised group exercise until 37 weeks ' gestation or ten months postpartum . The control clinics continued their usual care . The components of the feasibility evaluation were 1 ) recruitment and participation , 2 ) completion of data collection , 3 ) realization of the intervention and 4 ) the public health nurses ' experiences . Results 1 ) The recruitment rate was slower than expected and the recruitment period had to be prolonged from the initially planned three months to six months . The average participation rate of eligible women at study enrolment was 77 % and the drop-out rate 15 % . 2 ) In total , 99 % of the data on weight , physical activity and diet and 96 % of the blood sample s were obtained . 3 ) In the intervention clinics , 98 % of the counselling sessions were realized , their contents and average duration s were as intended , 87 % of participants regularly completed the weekly records for physical activity and diet , and the average participation percentage in the group exercise sessions was 45 % . 4 ) The PHNs regarded the extra training as a major advantage and the high additional workload as a disadvantage of the study . Conclusion The study protocol was mostly feasible to implement , which encourages conducting large trials in comparable setting s . Trial registration Current Controlled Trials IS RCT 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 The purpose of the study is to examine the effects and feasibility of individual physical activity ( PA ) counseling in maternity and child health clinics in Finl and . Methods Three clinics including both maternity and child health care signed up for the experimental ( EXP ) and three for the control group ( CON ) . The participants were 132 pregnant and 92 postpartum primiparas . The nurses in EXP integrated a primary and four booster PA counseling sessions into routine visits . An option for supervised group exercise was offered . In CON former practice s , usually including brief PA advice , were continued .  Leisure-time PA ( LTPA ) prior to pregnancy was elicited by question naire and followed 16–18 and 36–37 weeks ' gestation in maternity clinics and 5 and 10 months postpartum in child health clinics . Feasibility included safety , participant responsiveness , realization of counseling and applicability . Results According to analysis of covariance adjusted for baseline LTPA and possible confounders , no relative between-group differences in LTPA were found at the first follow-up in either maternity or child health clinics . At the last follow-up in maternity clinics the weekly number of at least moderate-intensity LTPA days was 43 % ( 95 % CI : 9 , 87 ) higher and the weekly duration of at least moderate-intensity LTPA 154 % ( 95 % CI : 16 , 455 ) higher in EXP compared with CON . Counseling proved feasible in both maternity and child health clinics . Conclusion Counseling  encouraged pregnant women to sustain their moderate-intensity LTPA and was feasible in routine practice s. No effects were observed if counseling was initiated postpartum . Trial registration Current Controlled Trials IS RCT 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 BACKGROUND Of postpartum women , 15%-20 % retain ≥ 5 kg of their gestational weight gain , increasing risk for adult weight gain . Postpartum women are also in a persistent elevated inflammatory state . Both factors could increase the risk of obesity-related chronic disease . We hypothesized that breastfeeding women r and omized to a Mediterranean-style ( MED ) diet for 4 months would demonstrate significantly greater reductions in body weight , body fat , and inflammation than women r and omized to the U.S. Department of Agriculture 's ( USDA ) MyPyramid diet for Pregnancy and Breastfeeding ( comparison diet ) . METHODS A r and omized , controlled dietary intervention trial was conducted in 129 overweight ( body mass index [ BMI ] 27.2 ± 4.9 kg/m(2 ) ) , mostly exclusively breastfeeding ( 73.6 % ) women who were a mean 17.5 weeks postpartum . Dietary change was assessed using a vali date d Food Frequency Question naire ( FFQ ) before and after intervention as well as plasma fatty acid measures ( gas chromatography/flame ionization detector [ GC/FID ] ) . Anthropometric measurements and biomarkers of inflammation , tumor necrosis factor-α ( TNF-α ) and interleukin-6 ( IL-6 ) , also were assessed at baseline and 4 months via enzyme-linked immunosorbent assay ( ELISA ) . RESULTS Participants in both diet groups demonstrated significant ( p<0.001 ) reductions in body weight ( -2.3 ± 3.4 kg and -3.1 ± 3.4 kg for the MED and comparison diets , respectively ) and significant ( p ≤ 0.002 ) reductions in all other anthropometric measurements ; no significant between-group differences were shown as hypothesized . A significant decrease in TNF-α but not IL-6 was also demonstrated in both diet groups , with no significant between-group difference . CONCLUSIONS Both diets support the promotion of postpartum weight loss and reduction in inflammation ( TNF-α ) in breastfeeding women The purpose of the research project was to examine the effects of exercise , social support and depression on postnatal women who reported experiencing postnatal depression . A 12-week r and omized , controlled trial was conducted investigating the effects of an exercise intervention group ( a pram-walking programme for mothers and their babies ) compared to a social support group ( non-structured sessions , similar to a playgroup ) .  Participants in both groups had given birth in the past 12 months . Pretest data of physical fitness and structured question naires were compared to post-test effects . The primary outcomes were to reduce the depressive symptomatology and improve fitness levels of participants in the pram-walking group . Secondary outcomes were to improve the social support levels of the participants in both groups and explore women 's views about the programmes . It was hypothesized that the pram-walking group participants would improve their feelings of depression and fitness levels compared to the social support group , but that both groups would improve their perceived levels of social support . The results showed that mothers in the pram-walking intervention group improved their fitness levels and reduced their level of depressive symptomatology significantly more than the social support group . There were no significant changes to social support levels for both groups . Therefore , a direct association between improvement in fitness was related to improvement in depression for the pram-walking group . However , it is also suggested that other factors in combination with improvements in fitness influenced improvements in depression levels . It is recommended that pram-walking programmes for mothers with postnatal depression be implemented as pilot research into existing available services OBJECTIVE : To evaluate the effect of 2 anticipatory guidance styles ( maternal focused [ MOMS ] and infant focused [ Ounce of Prevention ] ) directed at mothers of infants aged newborn to 6 months on their infant feeding behaviors at 1 year compared with routine advice as outlined in Bright Futures ( BF ) . METHODS : This is a cluster r and omized trial . A total of 292 mother/infant dyads were enrolled at their first well-child visit to 3 urban pediatric clinics in Columbus , Ohio .  Intervention-specific brief advice and 1-page h and outs were given at each well visit . In addition to infant weights and lengths , surveys about eating habits and infant feeding practice s were completed at baseline and 12 months . RESULTS : Baseline data revealed a group with high rates of maternal overweight ( 62 % ) and obesogenic habits . At 12 months , the maternal-focused group gave their infants less juice ( 8.97 oz vs 14.37 oz , P < .05 ) , and more daily servings of fruit ( 1.40 vs 0.94 , P < .05 ) and vegetables ( 1.41 vs 1.03 , P < .05 ) compared with BF mothers . Ounce of Prevention mothers also gave less juice ( 9.3 oz , P < .05 ) and more fruit servings ( 1.26 P < .05 ) than BF . CONCLUSIONS : Brief specific interventions added to well-child care may affect obesogenic infant feeding behaviors of mothers and deserves further study as an inexpensive approach to preventing childhood obesity 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 PURPOSE Lactation increases vitamin B-6 requirements because its concentration in breast milk is related to maternal intake and it is essential for infants . Exercise may also increase the requirement because it increases utilization and excretion of vitamin B-6 . Therefore , the purpose of this study was to determine whether energy restriction and exercise affected vitamin B-6 status of lactating women . METHODS Breastfeeding women with a body mass index > or = 25 and < or = 30 kg x m(-2 ) were r and omly assigned at 4 wk postpartum to either restrict energy intake by 500 kcal x d(-1 ) and exercise for 45 min x d(-1 ) , 4 d x wk(-1 ) ( weight loss group , WG ) or maintain usual diet and not exercise ( control group , CG ) for 10 wk . Women were given a supplement containing 2.0 mg of vitamin B-6 . Measurements included vitamin B-6 concentrations in breast milk and plasma , plasma pyridoxal 5'-phosphate , and erythrocyte alanine aminotransferase activity . RESULTS The WG lost more weight ( -4.4 + /- 0.4 vs -0.9 + /- 0.5 kg , P < 0.01 ) than the CG . Cardiovascular fitness increased by 12 % in the WG , compared to 3 % in the CG ( P = 0.09 ) . Milk vitamin B-6 concentrations increased in both groups ( 161 + /- 107 and 191 + /- 85 nmol x L(-1 ) , WG and CG , respectively , P = 0.05 ) . There were no significant differences in other vitamin B-6 parameters . Weight and length gain ( 2.06 + /- 0.21 and 1.83 + /- 0.17 kg ; 8.6 + /- 0.6 and 7.2 + /- 0.5 cm ; WG and CG , respectively ) of infants was not significantly different between groups . CONCLUSIONS Energy restriction and exercise from 4 to 14 wk postpartum in overweight , breastfeeding women consuming adequate dietary intakes and 2.0 mg of supplemental vitamin B-6 does not adversely affect vitamin B-6 status or infant growth PURPOSE This study examined the relationships among  diet , exercise intensity , and breast milk composition in lactating women . METHODS Twelve lactating women were r and omly assigned to either a high ( N = 6 ; 5.03 g carbohydrate ( CHO ) x kg body mass (BM)(-1 ) ) or moderate ( N = 6 ; 3.89 g CHO x kg BM(-1 ) ) carbohydrate diet .  Milk and blood sample s were collected before and after a nonexercise session ( control ) and maximal , lactic acid-threshold ( LAT ) , and 20 % below the LAT ( LAT-20 ) intensities . RESULTS The 30-min exercise LAT bout was more stressful than the 30-min LAT-20 bout ( rating of perceived exertion ( RPE ) = 15 vs 12 , respectively , P < 0.05 ) . Milk LA was significantly higher at 0 min following maximal exercise in the high and moderate CHO groups ( 1.27+/-0.56 and 1.52+/-0.49 mM , respectively ) and following LAT exercise ( 0.19+/-0.16 and 0.25+/-0.12 mM , respectively ) , when compared with the control session ( 0.08+/-0.03 and 0.09+/-0.05 mM , respectively ) . This was not observed following the LAT-20 exercise in the high and moderate CHO groups ( 0.11+/-0.04 and 0.12+/-0.08 mM , respectively ) . Elevated milk LA persisted in the 30-min collection point after maximal exercise only . There was no significant effect of dietary treatment on milk or blood LA at any of the collection points . CONCLUSIONS In lactating women whose caloric needs are being met : 1 ) dietary CHO intake , within a practical range , does not influence LA levels in breast milk at rest or after exercise ; 2 ) LA appearance in the milk is a function of exercise intensity ; and 3 ) moderate intensity exercise ( RPE = 12 ) will not increase breast milk LA levels BACKGROUND Postpartum weight retention is a risk factor for long-term weight gain . Encouraging new mothers to consume a healthy diet may result in weight loss . OBJECTIVE To assess predictors of diet quality during the early postpartum period ; to determine whether diet quality , energy intake , and lactation status predicted weight change from 5 to 15 months postpartum ; and to determine whether an intervention improved diet quality , reduced energy intake , and achieved greater weight loss compared with usual care . DESIGN R and omized clinical trial ( KAN-DO : Kids and Adults Now-Defeat Obesity ) , a family- and home-based , 10-month , behavioral intervention to prevent childhood obesity , with secondary aims to improve diet and physical activity habits of mothers to promote postpartum weight loss . PARTICIPANTS Overweight/obese , postpartum women ( n=400 ) , recruited from 14 counties in the Piedmont region of North Carolina .  INTERVENTION Eight education kits , each mailed monthly ; motivational counseling ; and one group class . METHODS Anthropometric measurements and 24-hour dietary recalls collected at baseline ( approximately 5 months postpartum ) and follow-up ( approximately 10 months later ) . Diet quality was determined using the Healthy Eating Index-2005 ( HEI-2005 ) . STATISTICAL ANALYSES Descriptive statistics , χ(2 ) , analysis of variance , bi- and multivariate analyses were used . RESULTS At baseline , mothers consumed a low- quality diet ( HEI-2005 score=64.4 ± 11.4 ) . Breastfeeding and income were positive , significant predictors of diet quality , whereas body mass index was a negative predictor . Diet quality did not predict weight change . However , total energy intake , not working outside of the home , and breastfeeding duration /intensity were negative predictors of weight loss . There were no significant differences in changes in diet quality , decreases in energy intake , or weight loss between the intervention ( 2.3 ± 5.4 kg ) and control ( 1.5 ± 4.7 kg ) arms . CONCLUSIONS The family-based intervention did not promote postpartum weight loss . Reducing energy intake , rather than improving diet quality , should be the focus of weight-loss interventions for overweight/obese postpartum women 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 We examined the incidence of  nonfatal and fatal coronary heart disease in relation to obesity in a prospect i ve cohort study of 115,886 U.S. women who were 30 to 55 years of age in 1976 and free of diagnosed coronary disease , stroke , and cancer . During eight years of follow-up ( 775,430 person-years ) , we identified 605 first coronary events , including 306 nonfatal myocardial infa rct ions , 83 deaths due to coronary heart disease , and 216 cases of confirmed angina pectoris . A higher Quetelet index ( weight in kilograms divided by the square of the height in meters ) was positively associated with the occurrence of each category of coronary heart disease . For increasing levels of current Quetelet index ( less than 21 , 21 to less than 23 , 23 to less than 25 , 25 to less than 29 , and greater than or equal to 29 ) , the relative risks of nonfatal myocardial infa rct ion and fatal coronary heart disease combined , as adjusted for age and cigarette smoking , were 1.0 , 1.3 , 1.3 , 1.8 , and 3.3 ( Mantel-extension chi for trend = 7.29 ; P less than 0.00001 ) . As expected , control for a history of hypertension , diabetes mellitus , and hypercholesterolemia -- conditions known to be biologic effects of obesity -- attenuated the strength of the association . The current Quetelet index was a more important determinant of coronary risk than that at the age of 18 ; an intervening weight gain increased risk substantially . These prospect i ve data emphasize the importance of obesity as a determinant of coronary heart disease in women . After control for cigarette smoking , which is essential to assess the true effects of obesity , even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women 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 major immunoglobulin ( Ig ) in human secretions is IgA. The immune properties of breast milk are well documented ; however , the immunological influence of maximal exercise has not been established . The objective of this study was to investigate the role that exercise has on breast milk IgA and IgA subclasses . Breast milk was collected from 17 lactating women ( 4.6 + /- 2.3 months postpartum ) before and after r and omized exercise and control periods .  The exercise treatment was a maximal grade d treadmill test ( VO2max = 30.3 + /- 5.7 mL x min-1 x kg-1 ) . Milk was collected at rest , the breasts were emptied , and sample s obtained 10 , 30 , and 60 min following either exercise or 30-min control rest periods .  IgA concentrations were established by enzyme-linked immunosorbent assay . The results indicated that sample s taken 10 and 30 min after the exercise period had significantly lower ( P < or = 0.05 ) milk IgA concentrations ( 21.0 + /- 1.8 and 21.8 + /- 1.4 microg x mL-1 , respectively ) than the corresponding control resting sample s ( 52.8 + /- 3.5 and 79.3 + /- 7.7 microg x mL-1 ) . The exercise sample s were similar to the control sample s at 60 min ( 134.0 + /- 24.6 and 116.0 + /- 15.4 microg x mL-1 , respectively ) , indicating that by 1 h , milk IgA production had recovered . The IgA1 data showed a similar significant decrease ( P < or = 0.05 ) at 10 min postexercise , which also returned to control concentrations by the 30- and 60-min collection intervals . There was no significant change in the milk IgA2 concentrations at any of the time points studied . Milk IgA concentrations increased significantly in both exercise and resting control groups after the breasts were emptied , suggesting that breast emptying stimulated milk IgA synthesis . The results provide evidence that exercise alters milk IgA and IgA1 concentrations for 10 - 30 min after exhaustive exercise , but recovers by 1 h , and provide additional support for exercise effects on the mucosal immune system BACKGROUND Weight gain in young women suggests that childbearing may be an important contributor to the development of obesity in women .  Depressive symptoms can interfere with resumption of normal activity levels following childbirth or with the initiation of or adherence to physical activity programs essential for losing pregnancy weight . Depression symptoms may function directly to promote weight gain through a physiologic mechanism . Obesity and its related insulin resistance may contribute to depressed mood physiologically . Although physical activity has well-established beneficial effects on weight management and depression , women tend to under participate in physical activity during childbearing years . Further , the mechanisms underpinning the interplay of overweight , obesity , physical activity , depression , and inflammatory processes are not clearly explained . OBJECTIVES This report describes the theoretical rationale , design considerations , and cultural relevance for " Madres para la Salud " [ Mothers for Health ] . DESIGN AND METHODS Madres para la Salud is a 12 month prospect i ve , r and omized controlled trial exploring the effectiveness of a culturally specific intervention using " bouts " of physical activity to effect changes in body fat , systemic and fat tissue inflammation , and postpartum depression symptoms in sedentary postpartum Latinas . SUMMARY The significance and innovation of Madres para la Salud includes use of a theory-driven approach to intervention , specification and cultural relevance of a social support intervention , use of a Promotora model to incorporate cultural approaches , use of objective measures of physical activity in post partum Latinas women , and the examination of biomarkers indicative of cardiovascular risk related to physical activity behaviors in postpartum Latinas BACKGROUND Pregnancy is associated with weight gain and obesity . The aim of this study was to identify the effect of parity and other factors on motivation to change diet to lose weight in a cohort of overweight and obese postpartum women . STUDY DESIGN Active Mothers Postpartum is a r and omized , controlled trial aim ed at postpartum weight reduction . At baseline , we measured motivation to change diet to lose weight  among 491 overweight/obese postpartum women .  Logistic regression was used to model the effect of parity on motivation to change diet  at baseline while adjusting for potential confounders including age , race , education , body mass index category , and breastfeeding status . RESULTS Approximately two thirds ( 68 % ) of participants were highly motivated to change their diet to lose weight . In the multivariable model , women with three or more children had 2.5 times the odds of high motivation compared with primigravid women , and women not breastfeeding had 1.6 times the odds of high motivation compared with any breastfeeding . CONCLUSION Although risk for obesity is incurred starting with a woman 's first pregnancy , women in this study were more motivated to change their diet to lose weight after their third pregnancy . Further research is needed to underst and how to best capitalize on the high motivation in women with several children as well as how to improve motivation for primigravid women and women who are breastfeeding Given that diet , physical activity , and social support are associated with depression , we examined whether a health promotion intervention design ed to modify these factors in low-income , postpartum women would reduce depressive symptoms . This study used a r and omized , controlled design to examine the effect of the Just for You ( JFY ) Program , an educational intervention promoting healthy lifestyles through home visits by nutrition paraprofessionals and motivational telephone counseling , on postpartum depressive symptoms . A total of 679 women income-eligible for the Special Supplemental Nutrition Program for Women , Infants and Children ( WIC ) were recruited at 6 - 20 weeks post delivery and r and omized to Usual WIC Care or JFY . Using an intention-to-treat analysis , the authors modeled depressive symptoms on the Center for Epidemiologic Studies Depression Scale ( CES-D ) among 403 women ( 59 % ) completing follow-up at a mean of 15 months infant age , adjusting for baseline CES-D , age , household income and r and omization strata ( body mass index ( BMI ) , race/region ) . As a secondary analysis , the authors evaluated potential mediators related to social support and self-efficacy to change one or more health behaviors targeted by the intervention . Women r and omized to JFY reported 2.5 units lower CES-D score ( P = 0.046 ) compared with those receiving Usual WIC Care alone . This relationship was attenuated by change in self-efficacy ( β = −2.3 ; P = 0.065 ) , suggesting this construct may partially have mediated the effect of JFY on maternal depressive symptoms . A health promotion intervention delivered through home visits and telephone calls can reduce depressive symptoms at 15 months postpartum among low-income , ethnically diverse women 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 The safety of recreational exercise for lactating mothers has been examined in a prospect i ve , intervention study . Thirty-three women , who were 6 - 8 weeks postpartum and breast-feeding exclusively were r and omly chosen to join either an exercise  or a  control group . The exercise group took part in a program of aerobic activities averaging 4.5 sessions per week . After 12 weeks , aerobic capacity was significantly higher in the women who had exercised than in the controls , but no differences in body weight , body fatness , energy expenditure , or resting metabolic rate ( RMR ) were noted . The exercise program had no effect on breast milk output or composition or infant weight gain . This demonstrates that recreational exercise sufficient to improve cardiovascular fitness without substantially altering energy balance does not adversely affect lactation performance 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 This study examined whether improvements in physical activity discovered in a test of Moms on the Move were mediated by the behavioral constructs from which the intervention was derived . Identifying mediator variables is vital for intervention planning . The intervention was derived from the Transtheoretical Model ( TTM ) of behavior change and promoted moderately intense activities like walking . Sedentary mothers with children enrolled in the Women , Infants , and Children program ( N = 44 ) were r and omly assigned to the experimental intervention or attention control . Large effect sizes were reported for improvements in physical activity and changes in TTM constructs . This study examined whether the physical activity improvements were mediated by the behavioral constructs . Statistical analyses used bivariate correlation coefficients and two-stage multiple linear regression . These exploratory findings did not support the hypothesis that increased physical activity , which was associated with the experimental intervention , was mediated by the TTM constructs 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 OBJECTIVE Previous research reported that breast milk lactic acid ( LA ) levels increase after lactating women complete a bout of exhaustive exercise , result ing in poor infant acceptance of the postexercise breast milk . This highly publicized finding may not apply to more practical , everyday exercise conditions of lactating women . The purpose of the present study was to reexamine the composition and infant acceptance of postexercise breast milk while controlling maternal diet , exercise intensity , and the method , timing , and assessment of infant feeding . RESEARCH DESIGN AND METHODS Twenty-four women , 2 to 4 months ' postpartum , completed 3 test sessions : a maximal oxygen uptake test , a 30-minute bout of moderate exercise , and a resting control session . One hour before and 1 hour after each session , participants fully expressed their milk , placed it in a bottle familiar to the infant , fed their infant , and rated their infant 's acceptance of the milk . Each feeding was videotaped and viewed individually by 3 lactation consultants who rated infant acceptance ; consultants were blinded to the test sessions . Milk was analyzed for LA and infant milk consumption was measured . RESULTS There were no differences in presession versus postsession values for maternal skin temperature , breast milk temperature , and infant milk acceptance as judged by either the mothers or lactation consultants . These results prevailed despite a small but significant increase in breast milk LA premaximal versus postmaximal exercise ( 0.09 vs 0.21 mM , respectively ) ; there was no difference in milk LA premoderate versus postmoderate exercise , or prerest versus postrest . CONCLUSION These data support the hypothesis that moderate or even high-intensity exercise during lactation does not impede infant acceptance of breast milk consumed 1 hour postexercise 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 Although the design of the study we undertook was r and omized , the groups were statistically similar , the intervention was based on evidence of previous efficacy , and the treatment was delivered exactly as planned , this pilot study on an intervention to promote motivation for weight loss  in new mothers failed to produce an effect . A closer examination using criteria for intervention fidelity revealed a number of weaknesses . Both treatment integrity and differentiation merit careful consideration in intervention design The purpose of this study was to observe the  infant acceptance  of  postexercise  breast milk .  Twenty-six lactating postpartum women  exercised to maximum ( maximum oxygen consumption = 35.1 + /- 9.2 [ SD ] mL min-1 kg-1 ) on a treadmill . Breast milk was collected via self-expression at rest before exercise and at 10 and 30 minutes postexercise and analyzed for lactic acid by enzymatic methods . Following exercise , infants were presented with their mothers ' pre-exercise and postexercise milk in a double-blind design . The mother rated the infant 's acceptance of the milk sample s. There was a significant difference in acceptance of pre-exercise and postexercise milk as analyzed by analysis of variance . Maximal exercise result ed in a significant increase in lactic acid concentration in breast milk that may be high enough to affect the taste of the milk . The decreased acceptance of postexercise milk was associated with increased lactic acid concentration . Suggestions to circumvent the decreased acceptance are offered
BACKGROUND Weight retention after pregnancy may contribute to obesity .
It is known that diet and exercise are recommended components of any weight loss programme in the general population .
However , strategies to achieve healthy body weight among postpartum women have not been adequately evaluated .
OBJECTIVES The objectives of this review were to evaluate the effect of diet , exercise or both for weight reduction in women after childbirth , and to assess the impact of these interventions on maternal body composition , cardiorespiratory fitness , breastfeeding performance and other child and maternal outcomes .