Breastfeeding Benefits & Barriers: Postpartum weight loss

During pregnancy most women are advised to gain 25 to 30 pounds. This breaks down as follows:

1. The baby will weigh approximately 7 to 8 pounds.

2. Increased uterine blood vessels and amniotic fluid weigh approximately 3-6 pounds.

3. At least 10 pounds of the weight gain are fat stores that are laid down to enable a woman to breastfeed.

Women who choose not to breastfeed will have to diet to lose those ten pounds.

The 10 pounds of stored fat allow a breastfeeding woman to continue to nurse her baby, eat an extra 500 kilocalories a day, and still slowly lose weight over the first six months of breastfeeding.

Obese women who limited their caloric intake to approximately 500 Kcal per day less than their daily normal intake plus lactation needs and exercised 4 days per week averaged a 4.8 Kg. weight loss over 10 weeks of a study. Their infants grew similarly to the infants of a control group of similarly obese women who lost an average of 0.8 Kg. ( Lovelady, 2000 ).

A study of more than 33,000 Danish women who had given birth between 1999 and 2002 evaluated the effect of breastfeeding on maternal weight at 6 and 18 months postpartum compared to reported prepregnancy weight. The authors calculated that a Danish woman with normal or obese prepregnancy weight who gained 11-12 kg during the pregnancy and exclusively breastfed her infant for 6 months would be back to her prepregnancy weight by then. At 18 months postpartum, women who exclusively breastfed for 6 months and continued breastfeeding until their infant was 12 months of age had the lowest probability of retaining 5 or more kg of weight no matter how much weight they gained during the pregnancy ( Baker, 2008 ).

A second retrospective study of maternal weight gain found that women aged 50-64 had a mean BMI (Body Mass Index) of 26.2. This ranged from 25.6 in women who had never been pregnant to 27.2 in women with four or more children. Seventy percent (70%) of women who had children had breastfed. The mean BMI of these women decreased by 1% for every 6 months they had breastfed (p <.0001) ( Bobrow, 2012 ).

A women's breastfeeding has been shown to be associated with a decreased risk of hypertension in later life. This risk for hypertension decreased in one study with breastfeeding for 1-6 months. A second study which evaluated breastfeeding duration of the mother's first pregnancy, found that mothers who did not breastfeed or breastfed for less than 3 months had a 27-29% increased risk of developing hypertension then women who breastfed for more than 3 months ( Schwarz, 2013 ).

The Metabolic Syndrome is a group of metabolic abnormalities including insulin resistance, high triglycerides, low levels of high density lipoproteins, high blood pressure, and obesity. The Metabolic Syndrome is seen as a precursor of diabetes mellitus and cardiovascular disease. The SWAN study evaluated 2516 perimenopausal women who had had at least one child. Women who had ever breast fed had a lower prevalence of the Metabolic Syndrome, adjusted Odds Ratio of 0.77 (95%CI, 0.62-0.96). The adjusted Odds Ratio for each year increase in total breastfeeding time on the prevalence of Metabolic Syndrome was 0.88 (95%CI, 0.77-0.99) ( Ram, 2008 ).

Case Study 2, part A

A mother brings her 2 month old infant in for his routine check-up. He has been growing well on only breast milk, however she plans to wean the baby because she is having "dizzy spells," especially after the first nursing in the morning.