All weight information was self-reported. From the first pregnancy interview, we had information on prepregnancy weight and height, and at the interview 18 months postpartum, the women provided their current weight. Our main exposure was change in BMI (weight (kg)/height (m)2) from prepregnancy to 18 months postpartum, which allowed us to take into account both height and overall body size. For a woman of 1.68 m, a 1-unit increase in BMI corresponded to a weight gain of 2.82 kg. We divided the women into 4 groups: <−1, −1 to 1, >1 to 2, and >2 unit changes in BMI.

Total GWG was obtained from the 6 months postpartum interview and categorized as “below,” “within,” and “above” the 2009 Institute of Medicine (IOM) recommendations for GWG in their BMI category. It is recommended that women with underweight gain 12.5 to 18 kg, women with normal weight 11.5 to 16 kg, women with overweight 7 to 11.5 kg, and women with obesity 5 to 9 kg (S1 Table) [4].

Furthermore, based on prepregnancy BMI and BMI 6 and 18 months postpartum, we defined 5 different postpartum weight change patterns, which present 2 different ways to obtain an overall weight gain and 2 different ways to obtain an overall weight loss (Fig 2). Women who had an overall weight gain (>1 BMI unit) from before pregnancy to 18 months postpartum were divided into 2 groups: women who had retained weight (6 months weight ≥ 18 months weight) and women who had gained weight postpartum (6 months weight < 18 months weight). Women who had an overall weight loss (<1 BMI unit) from before pregnancy to 18 months postpartum were divided into 2 groups: women who had an early loss (6 months weight < 18 months weight) and women who had a late loss (6 months weight ≥ 18 months weight). Finally, women who had returned to their prepregnancy BMI at 18 months (±1 BMI unit) were defined as stable in weight.

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