To the Editor.
—Dr Smith and colleagues1 conclude that there is an association between a first pregnancy and adverse adiposity changes independent of demographic and behavioral factors. This conclusion is flawed. One of the most important behavioral factors related to postpartum weight changes that was not discussed in this study or the accompanying Editorial2 is lactation. The weight gain in pregnancy not only is related to fetal development, but also is in preparation for prolonged lactation.The benefits of breast-feeding to infants are well recognized and physicians have been urged to be a source of breast-feeding support.3 The benefits of breast-feeding to the woman herself, including reduction in the risk of premenopausal breast cancer, are increasingly being recognized.4 It is likely that the adverse weight consequences of a first pregnancy relate to inadequate lactation in the majority of women.The authors of this article noted that
Thacker HL. Changes in Adiposity Associated With Pregnancy. JAMA. 1994;272(23):1820. doi:10.1001/jama.1994.03520230030025