Page 61 - Retail Pharmacy Magazine October 2020

weight gain with childbearing. This cohort also have a higher risk of gaining weight in subsequent pregnancies.28 Postpartum weight retention may be determined by many factors, including low socio-economic status, parity and high prepregnancy BMI. However, excessive weight gain during pregnancy is the strongest predictor of postpartum weight retention.29 While postpartum weight retention contributes to women’s weight trajectories over their lifespan, it is unrealistic for women to expect a rapid return to their pre- gravid weight. However, media of all forms have created an abnormal expectation that women should ideally lose weight ‘fast’ rather than ‘smart’ postpartum. Negative body image is common during pregnancy but tends to escalate postpartum, as women re-evaluate their body image.14,15 Perception of body image can worsen across the postpartum period and, at the end of the first postpartum year, when women report more heightened body dissatisfaction than they did prepregnancy or in their last trimester of pregnancy.30 This negative self-evaluation has been shown to contribute not only to inappropriate dietary restraint in pregnancy, but also unhealthy eating behaviour, psychological distress and postpartum depression.14-16 Understanding women’s experiences with weight changes during pregnancy and postpartum can help them lose weight following pregnancy, avoid long term weight gain and reduce the risk of obesity. Strategies to promote healthy postpartum weight loss Evidence-based weight loss advice is critical in the postpartum period to optimise maternal health before the next pregnancy. As many of the physiological changes of pregnancy associated with maternal obesity are present from early pregnancy onward, progressive weight reduction before the next conception minimises impacts on breastfeeding and is probably the best strategy to decrease the health burden associated with maternal obesity. Expressions such as the ‘yummy mummy’ are widely used in association with persuasive internet marketing of products (eg, shakes, complementary medicines, meal plans, and exercise challenges, with or without online support) to achieve rapid weight loss. Pharmacists may also be asked to comment on products and strategies for postpartum weight loss. So, what does the evidence tell us? Diet and exercise Three meta-analyses highlighted that the most effective approach to reduce postpartum weight retention is a combination of structured and monitored dietary intervention (low glycaemic index foods) together with exercise.29,31,32 There were also certain requirements for exercise to be effective:31 • Proper intensity (moderate physical activity or 10,000 steps per day). • Appropriate duration (at least 30 minutes daily). • Some form of self-monitoring (eg, use of heart rate monitors or pedometers). CPD ACTIVITY 59 Other characteristics associated with effective strategies were personalised, face-to-face participatory and content targeted encounters with dietitians and healthcare providers. Modifying high- risk lifestyle interventions with positive behaviour (water intake, fruit and vegetable snacks, increased walking) administered via a combination of home visits, group meetings and internet activities led to lesser weight gains.33 Finally, interventions must be regular and sustained.34 Breastfeeding There is an inter-relationship between breastfeeding and maternal weight. Observational studies among women who breastfeed indicate a decreased risk of: 35 • Diabetes. • Hypertension. • Metabolic syndrome. • Cardiovascular disease. • Ovarian cancer. • Breast cancer. However, obese women have an overall decreased rate and duration of breastfeeding.36 Contributing factors cited include: 37 • Prolonged elevation in progesterone levels post-delivery, inhibiting lactogenesis. • Labour complications leading to maternal separation postpartum (neonatal intensive care unit admission). • Challenges with positioning and latching. Pharmacists should promote breastfeeding and for breastfeeding TO PAGE 60 RETAIL PHARMACY • OCT 2020