Racial and ethnic disparities in postpartum weight retention: A narrative review mapping the literature to the National Institute on Minority Health and Health Disparities Research Framework

Three out of four people who give birth retain excess weight at 1-year postpartum. This is concerning, as postpartum weight retention is associated with increased morbidity risk. People from racial and ethnic minority groups are disproportionately affected by postpartum weight retention; 80% of Black and 69.5% of Hispanic/Latina/o/x birthing people begin pregnancy overweight or obese compared to 55% of white, non-Hispanic birthing people. Black and Hispanic/Latina/o/x birthing people also may be more likely to experience postpartum weight retention. Investigating these risks in people from racially/ethnically diverse backgrounds may be an important way to address disparities in morbidity and mortality. This narrative review uses an intersectional approach to the investigation of U.S.-based racial and ethnic disparities in postpartum weight retention, applying both the framework of Reproductive Justice and the National Institute on Minority Health and Health Disparities Research Framework. The results illustrate the Levels and Domains of research in this field of investigation, revealing that efforts have been focused at the Level of the Individual (i.e. diet, activity). Mapping the literature to the National Institute on Minority Health and Health Disparities Research Framework reveals that gaps in research exist in areas recognized as key drivers of health and health disparities (e.g. the finding that no studies have investigated postpartum weight retention within the Healthcare System Domain). Furthermore, participant-driven insights into postpartum weight retention illuminated barriers to health behaviors encountered by birthing people. Among these insights is the need for postpartum weight retention efforts to address participants’ real-life circumstances and social settings so we may address structural factors that impact postpartum weight retention. Last, stakeholder engagement and further elucidation of the social-determinants-of-health contexts will be essential to the development of high-quality interventions. Researchers must consider how the intersections of the National Institute on Minority Health and Health Disparities Research Framework’s Levels and Domains can help to provide a route for understanding the complexities related to postpartum weight retention among minority-health and health-disparity populations. PLAIN LANGUAGE SUMMARY: A Review of the Literature Using the National Institutes of Health, National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to Create a Roadmap of the Studies Investigating Racial and Ethnic Disparities in Excess Weight Retained After Pregnancy WHY WAS THIS STUDY DONE? Three out of four people who give birth retain excess weight at 1-year post-pregnancy. This is concerning, as weight that is retained following pregnancy is associated with increased risk for the development of disease. People from racial and ethnic minority groups experience weight retention more frequently post-pregnancy. Black and Hispanic/Latina/o/x birthing people are more likely to begin pregnancy overweight or obese. They are also more likely to retain excess weight following pregnancy. Investigating these risks in people from racially/ethnically diverse backgrounds may be an important way to address disparities in excess weight retained post-pregnancy. WHAT DID THE RESEARCHERS DO? This review of the literature used a tool called the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to map the literature to date on racial and ethnic disparities in excess weight retained post-pregnancy. WHAT DID THE RESEARCHERS FIND? We used the NIMHD Research Framework as a visual guide of the existing research about excess weight retained following pregnancy. Results illustrate the levels and domains at which research has been investigated. These results reveal that efforts have been focused at the individual level, with most attention given to diet and activity. Mapping the literature to the NIMHD Research Framework sheds light on gaps in the research. WHAT DO THE FINDINGS MEAN? Mapping the literature has revealed a need for investigations that make connections between the levels and domains of the Framework, so that we may understand underlying factors that contribute to health disparities.