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What is the relationship between breastfeeding and maternal weight change? (DGAC 2010)

Conclusion

A moderate body of consistent evidence shows that breastfeeding may be associated with maternal post-partum weight loss. However this weight loss is small, transient, and depends on breastfeeding intensity and duration.

Grade

Moderate
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Evidence Summaries

What is the evidence that supports this conclusion? For more information, click on the Evidence Summary link below.
 
What is the relationship between breastfeeding and maternal weight change?

Research Recommendations

1. Invest in well-designed randomized controlled trials with long-term follow-up periods to assess the influence of different dietary intake and physical activity patterns, and their combinations, on gestational weight gain patterns. Rationale: The new gestational weight gain guidelines are based on observational studies. Randomized controlled trials are urgently needed to answer these questions. 2. Conduct studies to refine gestational weight gain recommendations among obese women according to their level of pre-pregnancy obesity. Rationale: The recommended gestational weight gain range for obese women was based mostly on evidence from class I obese women (BMI: 30 to 34.9). This represents an important gap in knowledge at a time when the prevalence of class II (BMI: 35- to 39.9) and class III obese (BMI=40) women continues to rise in the US, with 14.2 percent of women (25.5% of non-Hispanic black women) falling in these two categories (IOM, 2009). 3. Substantially improve prepregnancy BMI and gestational weight gain monitoring and surveillance in the US. Rationale: No nationally representative data are available to describe pre-gravid BMI and gestational weight gain patterns in the US population. 4. Conduct longitudinal studies with adequate designs to further examine the association between breastfeeding and maternal post-partum weight changes, as well as impact on offspring. Rationale: Studies need to have a sample size large enough to take into account the small effect size thus far detected and the large inter-subect variability in maternal post-partum weight loss. (Ohlin & Rossner [1990] found that maternal weight loss ranged from -12.3kg to +26.5kg during the first year following the delivery of the child). Studies need to have adequate comparison groups that are clearly and consistently defined according to their breastfeeding intensity/duration patterns. Women who practice different infant feeding methods have different background characteristics. Thus, it is essential that future observational studies control statistically for key confounders including pre-pregnancy BMI, gestational weight gain, socio-economic and demographic characteristics and intentional weight loss. Studies need to measure maternal weight at different time points to be able to validate the use of either self-reported weights or weights recorded in clinical charts.

Search Plan and Results

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What is the relationship between breastfeeding and maternal postpartum weight change?