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. 2026 Jun 6;26:877. doi: 10.1186/s12884-026-09393-7

Body composition changes in the postpartum: a systematic review on measurements and predictors

Malith Kumarasinghe 1,#, Andrew P Hills 1,#, Kiran DK Ahuja 1,✉
PMCID: PMC13459293  PMID: 42251348

Abstract

Introduction

This systematic review investigated changes in maternal body composition and specific anthropometric indices during the postpartum period, and the factors influencing these changes.

Methods

Longitudinal observational studies with at least two measurements of postpartum maternal body composition and anthropometry were included. Studies that assessed only BMI or included a single postpartum measurement without a corresponding preconception measure were excluded. Medline/PubMed, Scopus, EMBASE, CINAHL, Web of Science, and ProQuest databases were searched for studies published up to 30th September 2025. Conference proceedings or studies not published in English were excluded.

The risk of bias was assessed using the Assessing risk of bias and confounding in observational studies of interventions or exposures tool from the Agency for Healthcare Research and Quality. Data on the changes in body composition and associated factors were summarised and presented in graphical and tabular formats. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Results

Of 1,273 abstracts screened, 86 studies were retained for data extraction. Sixty-one studies assessed changes in body composition and anthropometry, while 44 studies examined the association between various factors and body composition outcomes. Overall, 73 body composition and anthropometric indices were reported, with fat mass ratio/percentage being the most frequently used measure. Waist circumference showed a substantial reduction during the first month of the postpartum. The timing of initial measurements, length of follow-up, and techniques varied widely; 59% of studies concluded follow-up at or before 9 months postpartum. Techniques used to assess body composition ranged from skinfold thickness and circumference measurements to bioelectrical impedance analysis and dual-energy X-ray absorptiometry.

Conclusions

This systematic review underscores the complexity and variability of postpartum body composition changes. Given the association between postpartum adiposity and adverse long-term maternal health outcomes, integrating body composition and anthropometric assessments alongside BMI is essential. Extending follow-up beyond one year postpartum may further improve understanding and management of postpartum adiposity in clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-026-09393-7.

Keywords: Postpartum, Body composition, Factors, Systematic review

Background

Progressive changes in maternal body composition and specific anthropometry occur during pregnancy to facilitate the optimal foetal development and are reflected as variations in fat mass (FM) and fat-free mass (FFM). A return to pre-pregnancy body composition following delivery is important to facilitate healthy transition from pregnancy to the non-pregnancy state [1]. Conversely, suboptimal postpartum maternal body composition and anthropometry may result in both short-and long-term health consequences, including persistently elevated visceral FM [2], and an increased risk of cardiovascular diseases, and metabolic syndrome [3].

A range of maternal sociodemographic, lifestyle, and clinical factors influence postpartum changes in body composition and anthropometry. These include commonly considered 2009 Institute of Medicine (IOM) guidelines for gestational weight gain such as age, diet, breastfeeding gestational diabetes, and pregnancy-induced hypertension [4–9]. While the relationship of primary drivers such as excessive gestational weight gain, breastfeeding, diet, and physical activity and overall body weight or BMI have been widely appraised [10–12], evidence related to specific body composition indices and anthropometric measure remain poorly synthesized [13]. The lack of a systematic evaluation limits the ability to differentiate changes in adiposity from overall body weight and makes it difficult to identify gaps in the literature or inform clinical guidelines. Consequently, the limited evidence on factors influencing postpartum body composition may hinder efforts to optimise maternal health outcomes [14]. Thus, the objective of this systematic review was to investigate changes in maternal body composition and specific anthropometric measures during the postpartum period, and the factors influencing these changes.

Materials & methods

Eligibility criteria

Longitudinal, cohort, and case-control studies published in peer-reviewed journals, or thesis/dissertation repositories, on or before 30th September 2025 were included (Supplementary Table 1). This review considered body composition changes up to two years postpartum to capture the influence of maternal breastfeeding, consistent with the World Health Organization’s breastfeeding recommendations [15]. Studies assessing the efficacy of intervention or treatment designed to modify body composition in the postpartum period [16, 17] were excluded as the aim was to describe the ‘natural’ changes in postpartum body composition and specific anthropometric measures, and the factors influencing this change. The review protocol was prospectively registered in PROSPERO (ID: CRD42024556305).

Information sources

Medline/PubMed, Scopus, EMBASE, CINAHL, Web of Science, and ProQuest were searched.

Search strategy

A combination of Medical Subject Headings (MeSH) and relevant keywords relating to the postpartum period and body composition were used (Supplementary Table 2; Supplementary Sheet 1). Terms related to potential determinants were not explicitly included in the search strategy to maximise sensitivity and ensure that relevant documents were not missed.

Study selection

Search results from individual databases were imported into EndNote® (Version 21, Clarivate, United Kingdom), to remove duplicates, before exporting them to Covidence® (Veritas Health Innovation, Australia) for screening. Title and abstract screening were conducted independently by two reviewers (MK and KDKA). Full texts of potentially eligible studies were retrieved. One reviewer (MK) performed the full-text screening, while the second reviewer (KDKA) independently reviewed studies where eligibility was uncertain or where disagreements arose during the initial screening. Reasons for exclusion were recorded and verified by both authors (Supplementary Sheet 2, 3 & 4).

Data extraction and management

Two authors independently extracted relevant data from all the eligible studies using a purpose-built Excel template (Supplementary Sheet 2, 3 & 4).

Assessment of risk of bias

The risk of bias was assessed using the Agency for Healthcare Research and Quality’s Assessing Risk of Bias and Confounding in Observational Studies of Interventions or Exposures tool [18]. This tool assesses 13 criteria across six domains: selection bias, performance bias, detection bias, attrition bias, selective outcome reporting, and confounding [18].

Data synthesis

Eligible studies were summarised based on body composition and specific anthropometric indices (e.g., FM, and FFM), timing of initial postpartum measurements (within 7 days, between 7 and 42 days, and > 42 days postpartum), and factors assessed for association with these outcomes (e.g., mother’s age, education, and breastfeeding). Data were also stratified by preconception BMI (< 18.5 kg/m2, 18.5 kg/m2–24.9 kg/m2, and ≥ 25 kg/m2), to explore patterns of change in body composition and anthropometry. Where studies reported subgroup specific data rather than total population estimates, each sub-group was treated as a separate dataset. Graphs were generated using GraphPad Prism (Version 10, GraphPad Software, USA). Results for the top five commonly reported body composition and anthropometry measures (calculated as change), as well as factors assessed for their association were visualised. A minor discrepancy exists between the study counts reported in the text and figures: figures include only studies with two or more postpartum measurements, while the text also includes studies with preconception baseline measurement.

Results

From 1,273 abstracts screened, 86 studies published between 1983, and 30 September 2025 met the eligibility criteria. Of these, 61 studies assessed changes in body composition and specific anthropometric measures, and 44 examined the association between maternal factors and these changes (Supplementary Fig. 1; Supplementary Sheet 2, 3 & 4). Overall, detection and selection bias were generally low. All studies used valid measurement methods, although one study applied inconsistent inclusion criteria with postpartum participants selected based on breastfeeding status and maternal/infant health factors, while controls were selected based on BMI, weight stability, and general health status [19]. Attrition bias was the most prominent concern: 40 studies reported > 20% loss to follow-up [4, 20–58], yet only seven studies assessed its potential impact [20–26]. Attrition could not be determined in five studies [59–63]. Reporting bias was identified in seven studies [27, 64–69]. Performance bias and comparative confounding were largely not applicable due to the single‑arm longitudinal designs.

Only 33 of the 86 studies consisted of ≥ 50 participants [20–22, 24, 26, 29–31, 35, 36, 38, 41, 43, 44, 50, 52, 58–64, 67, 70–78], and 18 of these had sample size exceeding 100 participants [20–22, 24, 26, 29, 30, 35, 36, 38, 52, 59, 62, 63, 75–78]. Across all studies, 73 unique body composition and anthropometric indices were reported.

The five most common indices with at least two measurements in the postpartum (Fig. 1) were fat mass ratio (FMR; 42 studies), FM (32 studies), waist circumference (WC; 27 studies), FFM (21 studies), and triceps skinfold thickness (TC; 15 studies). The initial measurement for most studies was within 42 days postpartum (n = 62). Follow up duration ranged from 30 days postpartum [59] to up to 2 years [41, 60, 75, 79–81].

Fig. 1.

Fig. 1

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Number of eligible studies investigating changes in body composition and/or anthropometric measures and associated factors, separated by timing of initial postpartum measurement

Of the 21 studies assessing FFM [2, 4, 19, 20, 22, 27, 31, 41, 44–47, 49, 65, 67, 71, 81–85], only seven reported sample sizes ≥ 50 [20, 22, 31, 41, 44, 67, 71]. All but two studies [2, 44] measured FFM after 7 days postpartum. Additionally, just over half (12/21) obtained initial FFM measurement within 42 days postpartum [2, 19, 22, 27, 44–46, 49, 65, 67, 83, 86], and only seven studies followed participants for at least one year [4, 27, 41, 46, 71, 81, 83].

Fifteen studies assessed TC [20, 24, 32, 44, 48, 52, 59, 65, 66, 68, 80, 81, 87–89] with 10 initiating measurement within 42 days postpartum [32, 44, 48, 52, 59, 65, 68, 80, 87, 88]. Among the 27 studies measuring WC [19, 21, 23, 24, 26, 30, 32, 34–37, 51, 54, 59, 60, 62, 63, 65, 69, 75–78, 80, 85, 89, 90], 17 initiated follow-up within 42 days postpartum [19, 21, 23, 30, 32, 34, 36, 37, 51, 54, 59, 63, 65, 69, 77, 78, 80] and13 studies followed participants for one year [23, 26, 30, 32, 34, 35, 51, 54, 60, 62, 75, 76, 80].

Overall, 46 factors (Fig. 1) were assessed for their association with changes in body composition and anthropometric measures. The most frequently assessed factors were breastfeeding (16 studies), maternal risk factors (16 studies), socio-demographic characteristics (9 studies), exercise and nutrition (9 studies). Newborn/child related factors were assessed in four studies. Most other factors were evaluated by only a single study. For example, with exception of breastfeeding, maternal weight indices, age, and income, all other factors related to FMR were assessed by individual studies only. Notably, the largest study assessing breastfeeding and postpartum body composition change included 100 participants and was published in 1989 [38]. None of the studies investigating the association of breastfeeding or weight-related factors with body composition change followed participants beyond one year postpartum. Only one study exploring socio-demographic factors (occupation) continued until 13 months [81].

Most studies used multiple assessment methods, including body circumference, skinfold thickness, bioelectrical impedance analysis (BIA), and dual-energy X-ray absorptiometry (DXA). Similarly, a wide range of measurements were reported, including 14 different circumference indicators (e.g., waist, hip, mid-arm circumferences), 16 skinfold thickness measurements or their composite scores (e.g., triceps, thigh, the sum of four skinfolds), 23 regional fat/lean mass measures (e.g., arm fat mass, android fat mass, visceral fat mass). Measures of fluid balance and whole-body fat, lean, or cell mass were also reported.

Change in postpartum body composition

Two distinct patterns of FMR change emerged, irrespective of the day of initial postpartum measurement (Fig. 2a1-a3). Majority of studies (30/42) showed a rapid FMR decline of up to 4% within the first six months postpartum, followed by a slower loss or plateau through one year and beyond [4, 20, 21, 24, 27, 30–32, 34, 42–44, 48, 55, 56, 58, 60, 64, 65, 71, 72, 80, 83–85, 87–89, 91, 92]. In contrast, 18 of 42 studies observed an initial FMR increase of 1–2% during the first 3 months, followed by a modest reduction of approximately 2% or less [2, 23, 24, 30, 31, 46, 49, 54, 56, 59, 61, 64, 65, 67, 70, 79, 81, 93] (Fig. 2a1 & a2). While examining the change from preconception to postpartum, only one of five studies reported a 0.9% decrease in FMR [82], whereas all other demonstrated increases of at least 2% [46, 93–95].

Fig. 2.

Fig. 2

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Change in postpartum fat mass ratio by timing of initial measurement and preconception BMI

Ten studies reported an increase in FM during the first 2–3 months postpartum, although this initial rise was generally small (typically < 1 kg) [2, 20, 22, 24, 30, 31, 65, 67, 79, 93] (Supplementary Fig. 2a1-a3). Regardless of this initial rise, most studies (28 out of 32) demonstrated an overall decline in FM across the postpartum period [4, 19, 20, 22, 24, 27, 30, 31, 34, 41, 44–46, 49, 65, 67, 69, 71, 73, 79, 81, 83–87, 93, 96]. From preconception to postpartum, only one of six studies observed a 2.3 kg reduction in FM [82] whereas other studies reported increases of at least 2 kg [46, 47, 50, 86, 97].

FFM followed a similar pattern to FM during the first 42 days postpartum. However, only seven of the 21 studies reported a reduction greater than 1 kg [2, 4, 22, 46, 65, 83, 86] (Fig. 3a1-a3). Beyond this period, changes in FFM were generally modest, with fluctuations typically < 1 kg after three to four months postpartum.

Fig. 3.

Fig. 3

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Change in postpartum fat-free mass by timing of initial measurement and preconception BMI

TC appeared to increase in varying degrees during the first 2–3 months postpartum. In 10 [20, 22, 24, 44, 65, 66, 68, 80, 87, 88] of the15 studies, the increase was < 2 mm (Fig. 4a1-a3) [20, 24, 32, 44, 48, 52, 59, 65, 66, 68, 80, 81, 87–89]. Following this initial increase, two distinct trajectories emerged: five studies reported decreases towards the baseline or slightly below [22, 44, 48, 65, 66, 87], while three studies showed continued increases [65, 80, 88].

Fig. 4.

Fig. 4

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Change in postpartum triceps skinfold thickness by timing of initial measurement and preconception BMI

Twenty-two of 27 studies on demonstrated at least 1 cm reduction in WC during the postpartum period [21, 23, 26, 30, 32, 34, 36, 37, 51, 54, 59, 62, 63, 65, 69, 75–78, 85, 89, 90]. The largest decreases were observed in studies with initial assessment within the first seven days after delivery – where 5 out of 6 studies reported reductions > 4 cm [23, 37, 54, 59, 63, 69]. Studies initiating measurements between 7 and 42 days postpartum reported reductions over 2 cm (5 out of 11 studies) [19, 21, 30, 32, 34, 36, 51, 65, 77, 78, 80]. Among studies beginning after 42 days, seven of ten studies reported decreases > 1 cm) [24, 26, 35, 60, 62, 75, 76, 85, 89, 90] (Supplementary Fig. 3a1-a3).

Factors associated with change in postpartum body composition and anthropometry

Influence of maternal preconception and postpartum weight-related factors

FMR did not substantially deviate from the overall change in postpartum following the grouping by pre-conception BMI of 18.5 to 24.9 kg/m2 (Fig. 2b1-b3). However, among women with preconception BMI > 25 kg/m2, most studies (3/5 studies) showed that FMR did not decline after the early increase when measurements were initiated within first postpartum week [2, 54, 59] (Fig. 2: c1).

The overall trajectory of FM persisted regardless of the preconception BMI status (Supplementary Fig. 2: b1-b3 & c1-c3). Moreover, the course of FFM or TC also did not vary with preconception BMI (Fig. 3b1-b3 & c1-c3; Fig. 4b1-b3 & c1-c3). Few studies (n = 4) reporting an increase in WC in the postpartum period were conducted among women classified as overweight or obese prior to pregnancy [24, 30, 60, 77] (Supplementary Fig. 3: c2-c3).

Nine studies investigated the association between weight-related factors, namely preconception BMI, weight, postpartum weight, and postpartum BMI changes in FM, FMR, FFM, TC, and WC [26, 36, 38, 54, 63, 65, 67, 92, 98] (Fig. 5). However, only four studies were published after 2012 [26, 36, 54, 63]. Deuterium dilution, an isotope-based method for estimating total body water and deriving FM, and FFM, was the most commonly used technique in these analyses. No significant association was observed between preconception weight and either FM or FMR [92, 98]. A higher postpartum BMI was associated with FM, FMR, and TC [38, 65], while higher postpartum weight was associated with higher WC [26, 36]. Additionally, higher preconception BMI was consistently associated with FM, FMR, and WC [54, 67].

Fig. 5.

Fig. 5

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Association between maternal weight-related factors and changes in selected postpartum body composition and anthropometric measures

Sociodemographic factors

A range of sociodemographic factors were examined, including age, education, ethnicity, family support, geographical location, income and occupation (Fig. 6) [29, 30]. White ethnicity was associated with higher body composition and anthropometric indices compared to Black ethnicity from the two-month to one year postpartum [30]. In contrast, among Asian and Hispanic ethnicities, the association with FMR shifted over time from lower to higher values relative to non-Hispanic White women in early (2–3 months) postpartum [29]. However, maternal age, education, and occupation were not significantly associated with the changes in postpartum body composition and anthropometric measures [38, 59, 81, 92] (Fig. 6). The influence of place of residence and family support on FMR was inconsistent, with findings ranging from non-significant to significant beyond the first 2 to 3 months [29, 92] (Fig. 6).

Fig. 6.

Fig. 6

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Association between sociodemographic factors and changes in selected postpartum body composition and anthropometric measures

Influence of breastfeeding-related factors on changes in postpartum body composition and anthropometry

Several breastfeeding-related factors were examined in relation to changes in postpartum body composition and anthropometry measures, including as 24-hour milk intake, feeding duration, exclusivity of breastfeeding, feeding frequency, and overall duration and volume of breastfeeding (Fig. 7). Only two longitudinal studies reported a sample size exceeding 100 [24, 38], one of which was conducted over three decades ago [38] (Fig. 7). within the 42 days postpartum, exclusive breastfeeding mothers generally exhibited higher FM, FMR, and TC alongside a lower WC compared to formula feeding mothers, however, most of these differences were not statistically significant [55, 58, 59, 87]. Beyond 42 days postpartum, results were inconsistent. Some studies reported lower FM, FMR, and TC among exclusive breastfeeding mother, whereas others showed a continuation of the relatively higher body composition indices [24, 31, 55, 58, 59, 87] (Fig. 7). In contrast, the lower FM and FMR were reported with larger milk volumes, increased feeding frequency, and higher 24-hour milk intake up to 6 to 12 months postpartum [4, 92, 98] (Fig. 7).

Fig. 7.

Fig. 7

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Association between breastfeeding-related factors and changes in selected postpartum body composition and anthropometric measures

Influence of selected factors on the change in postpartum fat mass ratio

A range of maternal and neonatal factors were assessed for their association with changes in postpartum FMR, including maternal clinical risk factors, dietary behaviour, and pregnancy-related morbidities (Fig. 8). BIA was the commonly used technique in these studies [4, 32, 59, 60]. Higher leptin levels, increased energy intake, and male infant sex were associated with a significantly higher FMR during the postpartum period [29, 57, 59]. Additionally, food enjoyment and participation in routine nutritional programs were linked to a higher FMR between 90 and 180 days postpartum, although these associations did not persist through the entire postpartum period [29]. Conversely, smoking and early resumption of ovulation were associated with lower postpartum FMR [57, 59]. An increased number of daily snacks consumed was linked with a greater decline in FMR in the latter half of the first postpartum year; however, this association was not significant when considering the overall change in FMR [29]. Conversely, higher gestational weight gain was associated with a significant reduction in overall postpartum FMR in the same study [29] (Fig. 8).

Fig. 8.

Fig. 8

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Association between selected factors and changes in postpartum fat mass ratio/ percentage

Evidence on the association of HIV status on postpartum body composition and anthropometry was limited. Only TC demonstrated a reduction among women with HIV between the second to ninth months postpartum [20, 22] (Supplementary Fig. 4). No consistent associations were observed between HIV status and FM, FMR, and FFM [20, 22, 52] (Supplementary Fig. 4).

Discussion

Aim of the review

This review aimed to synthesise evidence on postpartum changes in body composition and specific anthropometry markers, and their association with maternal factors. Understanding natural trajectories of body composition; and existing knowledge gaps is essential for informing clinical guidelines and supporting optimal maternal outcomes in subsequent pregnancies.

Although our methodology was robust, the included studies showed substantial heterogeneity in measurement timing, techniques of body composition and anthropometric measurements, and data reporting. While 44 studies examined 46 maternal most were assessed in only one or two studies (e.g., parity 1 study; mode of delivery 1 study; ethnicity 2 studies) limiting meaningful comparison and synthesis. Similarly, variability in data presentation (e.g., breastfeeding type 6 studies but with different combinations of exclusivity of breastfeeding/ formula feeding) further complicated the interpretation. Attrition was also a key limitation, with 40 out of 86 studies reporting loss to follow up rates of ≥ 20% [4, 20–58]. Post hoc analyses showed similar attrition across identified fat mass ratio (FMR) trajectories (rapid reduction: 56.7%; transient increase: 55.5%), suggesting comparable distribution between patterns. However, attrition in postpartum studies is unlikely to be random [99, 100], as women experiencing adverse outcomes may be more likely to withdraw. This may bias findings toward more favourable trends, warranting cautious interpretation of commonly observed fat mass reductions by 6–12 months postpartum.

Overall, the strength of evidence for specific maternal behavioural and sociodemographic factors remains low-to-moderate due to heterogeneity and limited data per factor. While the natural trajectories are well-mapped, more standardized, low-attrition longitudinal designs are required to strengthen the certainty of evidence. Accordingly, we highlight key areas requiring further investigation.

Time of measurement

Determining the timing, duration and frequency of body composition measurements is critical for accurately capturing postpartum changes. Although early measurement (soon after delivery) is ideal, it is often impractical during the immediate (first 24 h) and early postpartum period (days 2–7/14) [99]. In the first 1–2 weeks postpartum, rapid diuresis from pregnancy-related fluid loss distorts FM and FFM estimates [2, 44, 100–104], with the initial exponential decline slowing to a more gradual, linear pattern by the end of this period [102].

In our review, the rapid decrease of up to 4% FMR in the first six postpartum months may partly reflect inconsistencies in early measurement (Fig. 2). Initiating assessments after the first 1–2 weeks could therefore yield more physiologically representative data. However, measurements taken after days 7–14 should be viewed as a pragmatic stabilization point rather than a return to full physiological homeostasis.

While the onset of postpartum period is clearly defined, its end point remains less certain [105]. Although most physiologically systems return to their pre-pregnancy state within 6–12 months [106], many studies included (36 out of 61) concluded data collection ≤ 9 months postpartum. For example, studies reporting upward FMR trajectories among women with a preconception BMI > 25 kg/m² had follow-up limited to ≤ 2 months postpartum [2, 59], restricting conclusions on longer-term trajectories (Fig. 2c1). Longer follow up (≥ 12 months) may therefore be necessary since a substantial proportion of mothers retain the weight gained, even at one year postpartum [107, 108]. Additionally, this postpartum period may also overlap with the interpregnancy interval, i.e., the time between the delivery of the first pregnancy to the conception of the next pregnancy [109], thereby providing an appropriate endpoint for monitoring.

Measurement frequency should align with the study objectives, as association between a maternal factors and body composition are time dependent. For example, the relationship between breastfeeding and FM/FMR shifts overtime, with higher FM/FMR in exclusively breastfeeding women in early postpartum [55, 58, 59, 87], followed by variable trends thereafter [55, 58, 87]. These patterns may be explained by elevated prolactin and persistent insulin resistance [110–112] which together promote energy conservation and fat storage despite increased energy expenditure. Elevated prolactin during lactation promotes appetite, fat storage, and energy conservation, while reducing lipolysis and lowering estrogen levels, which may further slow metabolism [115]. Concurrently, persistent insulin resistance in some women—particularly following gestational diabetes or excess weight gain—results in elevated insulin levels that favour fat storage and inhibit lipid oxidation [112, 116]. Together, these mechanisms create a metabolic environment that supports fat retention, helping to explain postpartum weight retention despite increased energy demands [112–114].

Physical activity often increases with return to work [113, 114], potentially influencing the relationship between body composition measures and maternal factors. However, the impact of employment on body composition remains unclear due to lack of reporting on maternity leave and socioeconomic factors [115].

Finally, variations in FMR have been reported across ethnic groups [29, 30] (Fig. 6), potentially reflecting differences in diets, genetics, culture and social determinants [116, 117]. Parity and interpregnancy interval may further influence body composition through cumulative weight gain across pregnancies [118–120] and changes in activity patterns, as women often become more physically active following subsequent deliveries [121].

Technique of measurement

Across the 86 included studies, 73 valid and reliable techniques were used to assess whole-body or regional body composition and/or anthropometry ranging from simple low-cost, non-invasive, rapid measurements (e.g. waist circumference, skinfold thickness at various sites, and BIA) [122, 123] to invasive, expensive, and more onerous techniques (e.g. magnetic resonance imaging, and DXA) [124, 125]. These also varied in burden, from time-intensive but low-cost approach (e.g. deuterium dilution) [126, 127], to rapid yet techniques (e.g., air displacement plethysmography) [128].

Fluctuations in fluid status during the early postpartum period can influence body composition measurements, particularly when using hydration-sensitive techniques such as BIA and DD [129, 130] influencing the estimation of FM and FMR. However, the trajectory patterns for FMR were consistent across measurement techniques, with similar proportion of studies reporting initial rapid reduction ( 71.4% overall and 75% for BIA ) as was the initial increase followed by a reduction (42.9% overall vs. 41.7% BIA). This consistency suggests that further stratification by assessment method was not warranted.

Nevertheless, early postpartum FMR/FM trends may still reflect technique-specific assumptions, although detailed methodological appraisal is beyond the scope of this review. Further, despite BIA’s sensitivity to fluid shifts, recent evidence indicates strong agreement with DXA, with only small, clinically acceptable differences – typically slight underestimation of FM and overestimate the FFM changes [129, 130].

In the postpartum period, selecting appropriate measurement techniques requires balancing the setting constraints (clinic versus field), staff training needs, and participant burden, including maternal time and procedural invasiveness. Consequently, rapid, low-cost methods such as skinfold thickness and circumference measurements are more advantageous. However, the measurement site must also be clinically relevant. For example, studies report rapid decline in central adiposity measured as waist circumference [23, 37, 54, 59, 63, 69] (Supplementary Fig. 3) and an increase in peripheral adiposity in triceps skinfold thickness [20, 22, 24, 44, 65, 66, 68, 80, 87, 88] (Fig. 4) in early postpartum. Although triceps skinfold thickness is commonly used, this may not be a preferential site as the increased FM may potentially be due to low levels of estrogen in the postpartum period that reduce the gynoid distribution of adipose tissue, promoting upper body and peripheral fat accumulation [7]. Therefore, selecting appropriate regional site is critical with waist circumference - a measure central adiposity- potentially representing a more clinically meaningful site [131, 132].

Additionally, central adiposity, as measured by waist circumference is strongly associated with CVD risk than BMI [133–135] and is also an independent predictor type 2 diabetes particularly in women [136]. Accordingly, the international guidelines recommend routine inclusion of waist circumference measurements alongside BMI to improve cardiometabolic risk assessment [137]. Emerging indices such as A Body Shape Index and Body Roundness Index, which integrate weight, height and waist circumference [138, 139] may further enhance cardiometabolic risk stratification beyond conventional measures [140]. Despite these advantages, the use of comprehensive body composition and anthropometric indices in clinical practice remains limited.

It is generally expected that weight and hence, by proxy, the body composition returns to the pre-pregnancy stage within the first postpartum year. However, only 10 studies reported pre-pregnancy body composition, and most did not specify the timing of measurement limiting the ability to determine when preconception status was reattained.

Conclusion

This systematic review synthesised evidence on postpartum changes in body composition and anthropometric indices, and their associated factors, to identify the research gaps, and inform strategies to optimise maternal health. Although definitive conclusions remain limited, the review underscores the complexity and variability in postpartum body composition trajectories, influenced measurement timing, frequency, and duration of follow-up, maternal factors, and the body composition techniques used. Nevertheless, integrating body composition and specific anthropometric assessments alongside BMI measures may improve the understanding and management of postpartum adiposity.

Supplementary Information

Supplementary Material 1. (50.8KB, zip)
Supplementary Material 2. (823.5KB, pdf)
Supplementary Material 3. (22.7KB, xlsx)
Supplementary Material 4. (55.3KB, xlsx)
Supplementary Material 5. (39.6KB, xlsx)
Supplementary Material 6. (37.1KB, xlsx)

Acknowledgements

Dr. Manoja P Herath for her assistance in abstract screening. Research librarians of the University of Tasmania for support in developing the search strategy and Centre of Research Excellence in Health in Preconception and Pregnancy (CRE HiPPP), Australia for funding.

Authors’ contributions

MK, KDKA, and APH designed the review. MK and KDKA designed the data-extraction tool. MK conducted the literature searches and extracted the data. KDKA cross-checked the data extraction. MK wrote the first draft. All authors critically reviewed subsequent drafts. All authors approve of this version for publication. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Funding

This review has been funded by the Centre of Research Excellence in Health in Preconception and Pregnancy (CRE HiPPP), Australia. Malith Kumarasinghe was supported by a Tasmania Graduate Research Scholarship Stipend and RTP Fee-Offset Scholarship.

Data availability

All datasets including the search strategy, list of the included and excluded studies, data extracted, and quality assessment, are available in the Article, and its supplementary information, sheets and files.

Declarations

Ethics approval and consent to participate

Ethical approval from an ethics body was not sought as primary data or identifiable secondary data was not used in this review.

Consent for publication

Consent for publication was not sought as primary data or identifiable secondary data was not used in this review.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Malith Kumarasinghe and Andrew P Hills contributed as first authors.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1. (50.8KB, zip)
Supplementary Material 2. (823.5KB, pdf)
Supplementary Material 3. (22.7KB, xlsx)
Supplementary Material 4. (55.3KB, xlsx)
Supplementary Material 5. (39.6KB, xlsx)
Supplementary Material 6. (37.1KB, xlsx)

Data Availability Statement

All datasets including the search strategy, list of the included and excluded studies, data extracted, and quality assessment, are available in the Article, and its supplementary information, sheets and files.

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