Prevention and intervention of postpartum weight retention: recommendations on breastfeeding, dietary patterns and exercise

I. Definition and Hazards of Postpartum Weight Retention Postpartum weight retention (PPWR) refers to the difference between postpartum weight and pre-pregnancy weight. Severe weight retention is defined as an increase of 5 kg or more in weight compared to pre-pregnancy weight 6 months and 1 year after delivery. PPWR can lead to maternal obesity, primarily characterized by central fat deposition, and is closely associated with an increased risk of cardiovascular disease. Approximately 75% of women do not return to their pre-pregnancy weight within 1 year postpartum. II. Risk Factors The most prominent risk factor is excessive weight gain during pregnancy. Other factors include excessive food intake, pre-pregnancy overweight, poor postpartum sleep quality, low levels of breastfeeding, and reduced physical activity. Depression and stress symptoms are also associated with retention. III. Prevention

Preconception management: Women who start pregnancy with an overweight or obese BMI have a greater risk of retention, and it is wiser to bring their BMI down to the normal range before trying to conceive.

Pregnancy management: Controlling gestational weight gain (GWG) is key to reducing postpartum weight loss (PPWR). Women who gain more weight in the second and third trimesters are more likely to experience postpartum weight retention. Nutritional counseling tailored to the second and third trimesters can help prevent PPWR. IV. Interventions

Breastfeeding: Exclusive breastfeeding is negatively correlated with PPWR, especially during breastfeeding periods of 6-12 months. Lactation requires up to 500 kcal of energy per day. Hormonal changes (decreased progesterone, increased prolactin) enhance fat mobilization. Notably, breastfeeding for less than 3 months has little effect on PPWR.

Lifestyle interventions: (1) Dietary patterns: Studies suggest that a diet high in fresh vegetables, soy milk, and fungi/algae is negatively correlated with PPWR. Trans fat intake should be reduced, as it may increase waist circumference by increasing systemic inflammation. (2) Physical activity: Physical activity has been shown to promote postpartum weight loss. Many women can walk in their daily lives (e.g., pushing a stroller), which is effective in reducing disease risk. (3) Continuous contact and technical support: Building adherence is central to the intervention. Providing personalized feedback and positive reinforcement via SMS using apps or online platforms helps improve patient engagement. Flexible, continuous contact interventions should be adopted postpartum.