Table 7a.

Table 7a. Infant growth in weight (g) by mother's post-partum body mass index (BMI), at 4-7 weeks

Mother's BMI
	*< 17*			*17-18.4*			�18.5
	n	Mean	SD	n	Mean	SD	n	Mean	SD
Birthweight <2800
Weight: at birth	17	2577	185	63	2419	217	106	2558	173
3 months	17	4866	532	63	5051	631	106	5235	677
6 months	17	6094	535	63	6285	759	106	6481	713
12 months	17	7699	568	63	7792	1104	106	7902	935
Weight gain 0-6 months		3579	452		3802	668		3928	676
6-12 months		1520	444		1505	617		1453	562
Birthweight �2800
Weight: at birth	27	2891	168	124	3105	226	369	3145	263
3 months	27	5186	772	124	5301	642	369	5515	716
6 months	27	6260	681	124	6560	704	369	6660	829
12 months	27	7540	831	124	8012	820	369	8082	936
Weight gain 0-6 months		3278	646		3426	732		3515	829
6-12 months		1240	500		1528	569		1415	516

Numbers at birth adapted to numbers at 3 months.

Table 7b. Statistical analysis

Test: < 2800, < 17 vs 17-18.4:	attained weight + weight gains	NS
< 17 vs �17:	attained weight + weight gains	NS
< 18.5 vs �18.5:	birth weight	t = -1.98	P = 0.049
	weight at 3 months	t = -2.35	P = 0.020
	weight at 6 months	t = -2.24	P = 0.026
	weight at 12 months	NS
	weight gains at 0-6 months/6-12 months	NS
�2800, <17 vs 17-18.4:	birth weight	t = -2.68	P = 0.008
	weight at 3 months/6 months	NS
	weight at 12 months	t = -2.64	P = 0.009
	weight gain at 0-6 months	NS
	weight gain at 6-12 months	t = -2.38	P = 0.019
< 17 vs �17:	birth weight	t = -3.10	P = 0.002
	weight at 3 months	t = -1.97	P = 0.050
	weight at 6 months	t = -2.34	P = 0.020
	weight at 12 months	t = -2.88	P = 0.004
	weight gains at 0-6 months/6-12 months	NS
<18.5 vs �18.5:	birth weight	t = -2.76	P = 0.006
	weight at 3 months	t = -3.56	P < 0.001
	weight at 6 months	t = -2.48	P = 0.014
	weight at 12 months	NS
	weight gains at 0-6 months/6-12 months	NS
< 2800 vs �2800, BMI < 17:	birth weight	t = -7.37	P < 0.001
	weight at 3, 6 and 12 months	NS
	weight gains at 0-6 months/6-12 months	NS
BMI 17-18.4:	birth weight	t = -19.47	P < 0.001
	weight at 3 months	t = -3.01	P = 0.004
	weight at 6 months	t = -2.27	P = 0.024
	weight at 12 months	NS
	weight gains at 0-6 months/6-12 months	NS
BMI �18.5:	birth weight	t = -25.88	P < 0.001
	weight at 3 months	t = -4.14	P < 0.001
	weight at 6 months	t = -2.01	P = 0.046
	weight at 12 months	NS
	weight gain at 0-6 months	t = 4.98	P < 0.001
	weight gain at 6-12 months	NS

As commonly observed in undernourished communities, Madurese women were able to produce about 700 g breast milk per day in the first year (Steenbergen et al., 1989). However, these women happen to have a 4-7 week postpartum BMI of �18.5. To assess lactation performance of CED women, infant growth can be used as a proxy for breast milk intake.

Although it is customary to force-feed infants from as early as the first week after birth, the semi-solid additional food (mashed rice and banana) did not influence milk production in the study population (Steenbergen et al., 1991). To adjust for birth weight, infant growth is presented in two categories with a birth weight of 2800 g as cut-off. The infant growth was obviously determined by birth weight (Table 7). The data also reveal the expected upward gradient in weight and weight gain in the first 6 months by increasing post-partum BMI of women in both birth weight categories but only attained weight was significantly lower in the group with a BMI <18.5. Hence, infants remained in their growth channel and there was no catch-up growth. At 12 months the differences by BMI categories disappeared, indicating that the heavier babies at birth started to falter in growth in the second half year of life.

Table 8. Maternal weight (kg) changes in the first year post partum by 4-7 week post-partum (BMI) categories, mean and SD

	*4-7 week post-partum BMI*
	*< 16*			*16.0-16.9*			*17.0-18.4*			*18.5-22.4*			*�22.5*
*Months*	n	*Mean*	SD	n	*Mean*	SD	n	*Mean*	SD	n	*Mean*	SD	n	*Mean*	SD
Post partum
1	16	35.2	3.1	52	37.5	2.2	230	40.7	2.7	512	44.9	3.6	52	54.8	5.4
3	16	35.7	3.0	52	38.0	2.7	230	40.9	3.0	512	44.7	3.8	52	54.6	5.4
6	11	36.5	4.3	39	38.3	3.1	210	40.9	3.3	502	44.2	4.0	43	54.	6.0
12	11	36.9	4.2	39	38.4	3.6	210	41.1	3.5	502	43.9	4.1	43	52.7	5.6
Change at 1-6	11	+1.3	2.3	39	+0.9	2.6	210	+0.1	2.2	502	-0.7	1.9	52	-0.7
2.6 at 1-12	11	+2.5	3.1	39	+0.8	3.3	210	+0.4	2.9	502	-0.9	2.3	43	-2.1	3.3

Weight changes between

< 16 vs 16-16.9: NS.
< 17 vs 17-18.4: t = -2.40 P = 0.018.
< 17 vs �17: t = -4.56 P <0.001.
< 18.5 vs �18.5: t = -6.57 P <0.001.

Interestingly, in the first 6 months the weight gains of infants with a birth weight <2800 g were consistently and significantly higher than those of the heavier ones at birth. It is tempting to attribute this difference to a substrate limitation to milk production, being insufficient for the bigger babies. One can at least conclude that infants, born to CED women, are not 'in the driving seat', in determining energy intake according to their needs.

The repercussion of lactation on the women is illustrated in Table 8. Contrary to the appreciable weight loss commonly observed among well-nourished lactating women (NAS, 1991), as a group Madurese women did not lose much weight in the first year post partum (0.2 kg, not shown in Table 8). Broken down by post-partum BMI categories at 4-7 weeks, the same pattern of weight changes can be observed as during pregnancy. The severe CED women gained weight (1.3 kg) in the first 6 months and 2.5 kg in the whole year. So did the moderate CED group but only in the first 6 months and to a lesser extent (0.9 kg). Mild CED women had only a slight weight increment of 0.4 kg over the 12 months. On the other hand, the non-CED group lost weight and the fatter women more so (2.1 kg) at BMI (22.5 and 0.9 kg at BMI 18.5-22.4 over the year. There was no difference between primiparae and multiparae. As for the weight changes over pregnancy, the differences in the first 6 months and over the whole period of infancy were highly significant at BMI cut-offs of 17.0 and 18.5 (P < 0.0001).

Trends over two consecutive reproduction cycles

There were 217 women who had given birth twice in the study period and from whom complete data were available on pre-pregnant weight and post-partum weight at 6 and 12 months for the consecutive reproduction cycles. Table 9 shows a remarkable similarity in weight trends by BMI categories as compared with the cross-sectional data. The most severe CED women gained weight while among non-CED weight did not change much.

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