Considerations in the Nutritional Assessment

Anthropometrics

Good reference data for body composition during lactation and the postpartum period are not available. Women lose approximately 13 pounds during delivery and another 5-15 pounds puerperium. The average rate of weight loss by lactating women (after the initial rapid weight loss in the first few weeks postpartum) is 0.5 to 1.0 kg per month for the first 6 months. This is highly variable, however. Patterns of weight loss among adolescents are even more variable, but adolescents are at a higher risk of postpartum weight retention. This is probably related to differences in pre-pregnancy growth status and gestational weight gain patterns. (Berens, 2018)

Postpartum weight retention is associated with several factors, including excessive weight gain during pregnancy, race - African American, obesity, quitting cigarette smoking. (Berens, 2018)

Clinical judgment should be used when evaluating the weight and body mass index (BMI) in the postpartum period. Questions to consider include:

• What was the client’s prepregnancy weight? BMI?
• What was her rate of weight gain during pregnancy?
• What are her goals for weight?

Risk factors include:

• Underweight (e.g. low weight-for-height or BMI) (IOM, 1991)
• Excessive weight gain during pregnancy
• Unrealistic (or excessive) weight loss goals