Gestational weight gain, cardiometabolic health, and long-term weight retention at 17 years post delivery

High gestational weight gain (GWG) is positively associated with acute postpartum adiposity, long-term postpartum weight retention (LPPWR), and later cardiometabolic health, but whether associations persist into midlife remains unknown.

Among Black and Dominican women from a prospective cohort (N = 210), GWG adherence to 2009 Institute of Medicine (IOM) guidelines and restricted cubic spline GWG z scores were calculated. At 17 years post delivery, weight, height, waist circumference (WC), systolic and diastolic blood pressure, fat mass (FM), and fat-free mass were measured. Linear and logistic regression estimated associations between GWG and long-term postpartum outcomes, adjusting for covariates.

Over one-half (60%) of participants had GWG above IOM guidelines. At 17 years, mean (SD) BMI was 31.2 (6.7) kg/m². GWG above IOM guidelines was positively associated with 17-year FM (β = 5.11 kg; 95% CI: 2.35-7.88), WC (β = 4.95 cm; 95% CI: 2.07-7.83), and LPPWR from prepregnancy to 17 years (β = 6.10 kg; 95% CI: 2.46-9.75), but not with blood pressure. Positive associations were also observed between GWG z scores and body fat percentage, FM, fat-free mass, WC, and LPPWR.

As women age into midlife, high GWG continues to be associated with higher adiposity, as well as weight gain more than 6 kg above prepregnancy weight, compared with those who gain within or below IOM guidelines.