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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo do presente estudo foi investigar a associação entre a depressão pós-parto e a retenção de peso no pós-parto. Trata-se de um estudo longitudinal, com 563 mulheres no baseline acolhidas em unidades de saúde do município do Rio de Janeiro entre 2005 e 2009, acompanhadas até o 6 mês pós-parto, com dados sobre peso e estatura aos 15 dias pós-parto e peso pré-gestacional. O peso retido após o parto foi calculado a partir da diferença entre o peso aferido nas ondas de seguimento (15 dias, 1, 2, 4 e 6 mês) e o peso pré-gestacional. O estado nutricional pré-gestacional foi classificado de acordo com a OMS. A presença de depressão pós-parto foi avaliada a partir da versão em português da Escala de Depressão Pós-parto de Edimburgo (EPDS) aos 15 dias e no 2 mês após o parto, utilizando-se 11/12 da EPDS como ponto de corte. Considerou-se depressão recorrente quando houve presença de depressão nos dois momentos. Inicialmente analisaram-se características da população. Para as análises estatísticas do efeito do estado nutricional pré-gestacional e do efeito da depressão pós-parto sobre a retenção de peso pós-parto empregou-se o proc mixed do pacote estatístico SAS. Dentre os principais achados, destaca-se que 22,7% (IC 95% 19,3-26,4) das mulheres iniciaram a gravidez com sobrepeso e 10,9% (IC 95% 7,0-15,7) apresentaram depressão recorrente. A retenção média de peso foi de 5,6 kg (IC 95% 5,1-6,1) aos 15 dias pós-parto. Na análise das trajetórias no tempo do peso pós-parto por estado nutricional pré-gestacional ajustadas por idade, escolaridade, número de filhos, aleitamento materno e ganho de peso gestacional, observou-se diminuição da retenção de peso pós-parto para os grupos de baixo peso e sobrepeso pré-gestacional e aumento da retenção de peso pós-parto para o grupo de obesidade pré-gestacional. Na análise das trajetórias no tempo do peso pós-parto por depressão pós-parto verifica-se que o efeito entre o tempo e a retenção de peso pós-parto se modifica para mulheres com depressão pós-parto recorrente nas análises bruta e ajustadas por idade, escolaridade, estado nutricional pré-gestacional, número de filhos, ganho de peso gestacional, aleitamento materno e rede social, nas quais observa-se que as mulheres com depressão pós-parto recorrente perdem menos peso. Os resultados permitem identificar que há no pós-parto perda e ganho de peso, apesar de ser esperada perda de peso almejando o retorno ao peso pré-gestacional. Ressalta-se o impacto da depressão pós-parto observado nesta dinâmica de peso, uma vez que mulheres com depressão pós-parto recorrente apresentaram menor perda de peso. Destaca-se a relevância dos resultados deste estudo para o desenvolvimento da promoção da saúde e da segurança alimentar e nutricional, visando um monitoramento do estado nutricional pós-parto e avaliação da saúde mental materna de forma a contribuir para a prevenção da obesidade feminina e comorbidades / The objective of this study was to evaluate the association between postpartum depression and weight retention in the same period. This is part of a cohort study conducted with 563 women in the baseline that were treated in public services from the city of Rio de Janeiro, between 2005 and 2009, followed up to the 6th month after delivery, and data regarding weight and height at 15 days after delivery (baseline) and this pre-pregnancy weight were collected. The retained weight after delivery was calculated as the difference between the weight measured at 15 days, 1, 2, 4 and 6 months after delivery and the pre-pregnancy weight. The womens nutritional status was classified according to WHO. The presence of postpartum depression was evaluated using the portuguese version of the Edinburgh Postpartum Depression Scale (EPDS) at 15 days and 2 months after delivery, and using as cutoff 11/12 points in the Scale. Recurrent depression was considered when there was presence of depression at both times. Firstly, general, characteristics of the population were analyzed. To the statistical analysis of the effect of pre-pregnancy nutritional status and the effect of postpartum depression on postpartum weight retention the package proc mixed from SAS was applied. The results show that 22.7% (95% CI 19.3-26.4) of the women started pregnancy overweight, 10.9% (95% CI 7.0-15.7) presented recurrent depression. The average weight retention was 5.6 kg (95% CI 5.1-6.1) at 15 days postpartum. When the time trajectories of weight after delivery according to pre-pregnancy nutritional status were analyzed adjusted for age, schooling years, number of children, breastfeeding and gestational weight gain, it was observed a reduction of weight retention after delivery to those women who were classified as underweight and overweight before pregnancy and an increased in the same trajectory for the who were obese. When the time trajectories of weight after delivery according to postpartum depression were analyzed it was showed that the effect between time and weight retention changes for women with recurrent postpartum depression in the crude and adjusted analyzes by age, schooling years, pre-pregnancy nutritional status, number of children, gestational weight gain, breastfeeding and social network, in this analysis women with recurrent postpartum depression lose less weight. The results show that during the postpartum period the impact of postpartum depression in this dynamic weight is important, since women with recurrent postpartum depression showed less weight loss. The results of this study present the importance of it to the development of health promotion and food and nutrition security, assessment of maternal mental health in order to contribute to the prevention of female obesity and comorbities

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo do presente estudo foi investigar a associação entre a depressão pós-parto e a retenção de peso no pós-parto. Trata-se de um estudo longitudinal, com 563 mulheres no baseline acolhidas em unidades de saúde do município do Rio de Janeiro entre 2005 e 2009, acompanhadas até o 6 mês pós-parto, com dados sobre peso e estatura aos 15 dias pós-parto e peso pré-gestacional. O peso retido após o parto foi calculado a partir da diferença entre o peso aferido nas ondas de seguimento (15 dias, 1, 2, 4 e 6 mês) e o peso pré-gestacional. O estado nutricional pré-gestacional foi classificado de acordo com a OMS. A presença de depressão pós-parto foi avaliada a partir da versão em português da Escala de Depressão Pós-parto de Edimburgo (EPDS) aos 15 dias e no 2 mês após o parto, utilizando-se 11/12 da EPDS como ponto de corte. Considerou-se depressão recorrente quando houve presença de depressão nos dois momentos. Inicialmente analisaram-se características da população. Para as análises estatísticas do efeito do estado nutricional pré-gestacional e do efeito da depressão pós-parto sobre a retenção de peso pós-parto empregou-se o proc mixed do pacote estatístico SAS. Dentre os principais achados, destaca-se que 22,7% (IC 95% 19,3-26,4) das mulheres iniciaram a gravidez com sobrepeso e 10,9% (IC 95% 7,0-15,7) apresentaram depressão recorrente. A retenção média de peso foi de 5,6 kg (IC 95% 5,1-6,1) aos 15 dias pós-parto. Na análise das trajetórias no tempo do peso pós-parto por estado nutricional pré-gestacional ajustadas por idade, escolaridade, número de filhos, aleitamento materno e ganho de peso gestacional, observou-se diminuição da retenção de peso pós-parto para os grupos de baixo peso e sobrepeso pré-gestacional e aumento da retenção de peso pós-parto para o grupo de obesidade pré-gestacional. Na análise das trajetórias no tempo do peso pós-parto por depressão pós-parto verifica-se que o efeito entre o tempo e a retenção de peso pós-parto se modifica para mulheres com depressão pós-parto recorrente nas análises bruta e ajustadas por idade, escolaridade, estado nutricional pré-gestacional, número de filhos, ganho de peso gestacional, aleitamento materno e rede social, nas quais observa-se que as mulheres com depressão pós-parto recorrente perdem menos peso. Os resultados permitem identificar que há no pós-parto perda e ganho de peso, apesar de ser esperada perda de peso almejando o retorno ao peso pré-gestacional. Ressalta-se o impacto da depressão pós-parto observado nesta dinâmica de peso, uma vez que mulheres com depressão pós-parto recorrente apresentaram menor perda de peso. Destaca-se a relevância dos resultados deste estudo para o desenvolvimento da promoção da saúde e da segurança alimentar e nutricional, visando um monitoramento do estado nutricional pós-parto e avaliação da saúde mental materna de forma a contribuir para a prevenção da obesidade feminina e comorbidades / The objective of this study was to evaluate the association between postpartum depression and weight retention in the same period. This is part of a cohort study conducted with 563 women in the baseline that were treated in public services from the city of Rio de Janeiro, between 2005 and 2009, followed up to the 6th month after delivery, and data regarding weight and height at 15 days after delivery (baseline) and this pre-pregnancy weight were collected. The retained weight after delivery was calculated as the difference between the weight measured at 15 days, 1, 2, 4 and 6 months after delivery and the pre-pregnancy weight. The womens nutritional status was classified according to WHO. The presence of postpartum depression was evaluated using the portuguese version of the Edinburgh Postpartum Depression Scale (EPDS) at 15 days and 2 months after delivery, and using as cutoff 11/12 points in the Scale. Recurrent depression was considered when there was presence of depression at both times. Firstly, general, characteristics of the population were analyzed. To the statistical analysis of the effect of pre-pregnancy nutritional status and the effect of postpartum depression on postpartum weight retention the package proc mixed from SAS was applied. The results show that 22.7% (95% CI 19.3-26.4) of the women started pregnancy overweight, 10.9% (95% CI 7.0-15.7) presented recurrent depression. The average weight retention was 5.6 kg (95% CI 5.1-6.1) at 15 days postpartum. When the time trajectories of weight after delivery according to pre-pregnancy nutritional status were analyzed adjusted for age, schooling years, number of children, breastfeeding and gestational weight gain, it was observed a reduction of weight retention after delivery to those women who were classified as underweight and overweight before pregnancy and an increased in the same trajectory for the who were obese. When the time trajectories of weight after delivery according to postpartum depression were analyzed it was showed that the effect between time and weight retention changes for women with recurrent postpartum depression in the crude and adjusted analyzes by age, schooling years, pre-pregnancy nutritional status, number of children, gestational weight gain, breastfeeding and social network, in this analysis women with recurrent postpartum depression lose less weight. The results show that during the postpartum period the impact of postpartum depression in this dynamic weight is important, since women with recurrent postpartum depression showed less weight loss. The results of this study present the importance of it to the development of health promotion and food and nutrition security, assessment of maternal mental health in order to contribute to the prevention of female obesity and comorbities

L’objectif de cette thèse était de mesurer l’association de l’obésité maternelle avec la durée de l’allaitement maternel, au total et exclusif, en prenant en compte les caractéristiques sociodémographiques, périnatales et psychosociales ; puis d’évaluer si l’allaitement était, en France en 2012, associé à une diminution de la rétention du poids maternel dans l’année suivant l’accouchement, en particulier chez les femmes obèses.Les données de la cohorte prospective nationale Epifane ont été utilisées. En 2012, 3368 couples mère-enfant avaient été inclus en France métropolitaine. Le recueil de l’alimentation de l’enfant à la maternité puis à 1, 4, 8 et 12 mois postpartum a permis d’estimer les durées d’allaitement. Les facteurs sociodémographiques et périnataux associés à l’obésité maternelle (Indice de Masse Corporelle (IMC) avant grossesse ≥30 kg/m2) ont été identifiés par un modèle de régression logistique multinomiale. Des régressions de Poisson ont fourni des estimations de l’association entre obésité et durées d’allaitement, exclusif et total. Les associations entre durées d’allaitement et rétention de poids à 4 et 12 mois (définie comme la différence entre le poids maternel à 4 et 12 mois et le poids avant grossesse), ont été estimées par des régressions linéaires. Les facteurs de risque d’une rétention de poids modeste (entre 0,1 et 4,9 kg) ou majeure (≥5 kg) à un an, ont été identifiés par des régressions logistiques multinomialesL’obésité maternelle était associée à un ensemble de caractéristiques sociodémographiques et de complications périnatales, de façon différente selon la parité. Par ailleurs, elle était associée à une durée totale d’allaitement plus courte, comparé à une corpulence normale, indépendamment des caractéristiques sociodémographiques, périnatales, psychosociales, et de la parité. La parité modifiait l’association entre obésité et durée d’allaitement exclusif. Ainsi, chez les primipares, la durée d’allaitement exclusif était comparable chez les femmes obèses et celles de corpulence normale, quel que soit le niveau d’ajustement. Chez les multipares, la relation entre obésité maternelle et durée d’allaitement exclusif réduite observée dans le modèle ajusté sur les caractéristiques sociodémographiques, n’était plus significative lorsque les caractéristiques périnatales et psychosociales étaient ajoutées au modèle.A 4 mois, dans tous les groupes d’IMC avant grossesse, la rétention moyenne de poids postpartum n’était pas différente selon la durée d’allaitement exclusif ou prédominant. Néanmoins, la durée d’allaitement mixte était associée à une augmentation de la rétention de poids à 4 mois, chez les femmes obèses uniquement. A 12 mois, ni la durée d’allaitement exclusif ou prédominant, ni celle d’allaitement mixte n’étaient associées à la rétention de poids. Les risques d’une rétention de poids modeste ou majeure une année après avoir accouché, variaient toutefois selon un ensemble de caractéristiques sociodémographiques et périnatales. La durée totale d’allaitement maternel était plus faible chez les femmes obèses. Par ailleurs, nos travaux ne montrent pas un bénéfice de l’allaitement sur la diminution de la rétention de poids à 4 et 12 mois. Finalement, nos travaux apportent une meilleure compréhension des mécanismes impliqués dans la relation entre obésité et allaitement maternel ; l’identification des facteurs de risque de la rétention de poids ouvre de nombreuses perspectives de recherche. En termes de santé publique, ces travaux réaffirment la nécessité de prendre en compte les facteurs psychosociaux, les caractéristiques sociodémographiques, et les conditions de la grossesse dans la promotion de l’allaitement, notamment exclusif, et dans les actions visant à réduire la rétention de poids postpartum. / The aim of this PhD dissertation was to measure the association of maternal obesity with any breastfeeding (ABF), and exclusive breastfeeding (EBF) durations, taking into account sociodemographic, perinatal and psychosocial factors; and to assess whether in France, in 2012, breasfeeding was associated with a reduction in PPWR during the first year of life, especially among women obese before pregnancy.We used data from the French population-based-birth-cohort Epifane. In 2012, 3,368 mother-infant dyads were included in mainland France. Information concerning infant’s feeding were collected at maternity ward and at 1, 4, 8, and 12 months, and were then used to define breastfeeding durations. Sociodemographic and perinatal factors associated with maternal obesity (Body Mass Index (BMI) before pregnancy ≥30 kg/m2) were identified using a multinomial logistic regression model. Poisson regression models have estimated associations of maternal obesity with ABF and EBF durations. Linear regression models were used to estimate the associations of breastfeeding durations (full breastfeeding (FBF) and partial breastfeeding) with PPWR at 4 and 12 months (defined as the difference between the maternal weight at 4 and 12 months after birth and maternal prepregnancy weight). Risk factors of moderate PPWR (0.1-4.9 kg) and major PPWR (≥5 kg) at 12 months were identified using multinomial logistic regression modelling.Maternal obesity was associated with sociodemographic characteristics and adverse perinatal outcomes. Such patterns varied among primiparous and multiparous women. Furthermore, maternal obesity was associated with a reduced ABF duration, compared to normal-weight, independently of sociodemographic, perinatal and psychosocial factors, and parity. Association of maternal obesity with EBF duration was modified by parity. Among primiparous women, obese women exclusively breastfed as long as normal-weight women, in all adjusted models. Among multiparous women, association between maternal obesity and reduced EBF duration, observed in the crude model and model adjusted on sociodemographic factors, was no more statistically significant when adjusting for perinatal and psychosocial factors.Four months after birth, FBF duration was not associated with PPWR, regardless of prepregnancy BMI class. However, partial breastfeeding duration was associated with an increased PPWR at 4 months among women obese before pregnancy. At 12 months, neither FBF duration nor partial breastfeeding duration was associated with PPWR. Nevertheless, we identified a set of sociodemographic and perinatal risk factors of moderate and major PPWR at 12 months.Maternal obesity was associated with a reduced ABF duration. Furthermore, our work does not confirm the hypothesis of a benefit of breastfeeding durations on PPWR at 4 and 12 months. Finally, our research provides a better understanding of mechanisms involved in the relation between maternal obesity and breastfeeding; the identification of PPWR risk factors opens new prospects of research. In terms of public health, our research reinforces the need to consider sociodemographic, perinatal and psychosocial characterictics of women in the promotion of breastfeeding, especially EBF, and in the interventions aimed at reducing PPWR.