Early Postpartum Weight Retention in Women with Gestational Diabetes Mellitus in China: Current Status and Influencing Factors

Purpose: To investigate postpartum weight retention (PPWR) in women with gestational diabetes mellitus (GDM) during the early postpartum period and to identify its key determinants. Patients and Methods: This study enrolled 342 women with GDM who delivered at Fujian Maternity and Child Health Hospital between January 2024 and June 2025. Data on sociodemographic characteristics, pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and postpartum weight were collected using questionnaires and telephone follow-ups at 42 days and 3 months postpartum. Generalized Estimating Equation (GEE) models were applied to examine factors influencing PPWR. Results: Mean PPWR at 42 days and 3 months postpartum was 5.09 ± 4.55 kg and 4.12 ± 4.17 kg, respectively. GEE analysis showed that postpartum time, monthly household income per capita, pre-pregnancy BMI, GWG, and parity significantly influenced PPWR (all P < 0.05). PPWR at 3 months postpartum was significantly lower than at 42 days (β = − 0.970, P < 0.001). Higher household income (> 5000 CNY/month) was associated with lower PPWR. Compared with women with normal pre-pregnancy BMI, overweight and obese women had lower PPWR, whereas underweight women had higher PPWR. Excessive GWG was a risk factor for PPWR (β = 3.312, P < 0.001), and multiparous women had lower PPWR than primiparous women (β = − 1.057, P = 0.009). No significant associations were observed between PPWR and age, education level, mode of delivery, infant feeding method, or sleep quality (all P > 0.05). Conclusion: Women with GDM experience significant PPWR in the early postpartum period, although weight retention decreases over time. GWG, pre-pregnancy BMI, household economic status, and parity are major determinants of early PPWR. Targeted weight management interventions should prioritize women with low income, pre-pregnancy underweight, and primiparity, with interventions initiated during pregnancy to reduce long-term metabolic risk.