Almost half of women begin their pregnancies either overweight or obese. Now a new study reports that the majority of obese women gained more than the recommended weight during pregnancy, and a year after delivery, those women retained an average of 40 percent of that extra weight.
Dr. Kimberly Vesco of the Kaiser Permanente Center for Health Research led a study of 1,656 obese women that documented their weight before, during, and after pregnancy. Almost three quarters of the women gained more than 15 pounds while pregnant, which was the minimum weight gain recommended for obese women at the time of the study. (In May the Institute of Medicine lowered its minimum recommended weight gain to 11 pounds.)
The more weight a woman gained, the more likely she was to retain it a year after childbirth. Compared with women who put on fewer than 15 pounds, those who gained from 15 to 25 pounds were twice as likely to keep an 10 extra pounds. Women who gained more than 35 pounds were more than seven times as likely to retain 10 or more pounds.
Obesity poses many health risks, but for pregnant women extra weight also increases the likelihood of problems during pregnancy for both the baby and the mother, including gestational diabetes and birth injuries.
BOTTOM LINE: Obese women who gain more weight than recommended during pregnancy retain almost half those pounds a year after they deliver their babies.
CAUTIONS: Most of the study participants were white, so the results might be different for women from other racial groups.
WHAT’S NEXT: A new study led by the authors will randomly assign women to a program to help them eat a healthy diet while pregnant and compare their weight one year after childbirth to similar women not enrolled in the program.
WHERE TO FIND IT: Obstetrics & Gynecology, November
Racial gap in honoring patients' dying wishes
Black cancer patients were less likely than white cancer patients to get the type of end-of-life care they desired, according to a study led by Holly Prigerson of the Dana-Farber Cancer Institute.Her team followed 302 patients at Dana-Farber and other centers until their deaths, asking them about their wishes for end-of-life care, talking to their loved ones, and examining their medical records. Black patients were much more likely than white patients to receive aggressive end-of-life care. But among patients who expressed a preference for aggressive care, white patients were about three times more likely than black patients to receive it.
No white patients who discussed end-of-life care with their physicians or signed a “do not resuscitate’’ order received aggressive care as they were dying. But among similar black patients, some did receive aggressive care, against their wishes.
Some of the difference may be explained by gaps in communication when patients were moved from one care facility to another, which was more common among black patients. “It points to disparities in effective communication and a lack of continuity of care,’’ Prigerson said.
BOTTOM LINE: Black cancer patients were less likely than white cancer patients to have their wishes honored at the end of life.
CAUTIONS: Only 68 black patients were enrolled in the study, so the results need to be confirmed in a larger trial.
WHERE TO FIND IT: The Journal of Clinical Oncology, online Oct. 13 ELIZABETH COONEY 
