"Who does this body belong to?" The development and psychometric evaluation of the Body Experience during Pregnancy Scale

Body understanding measure for pregnancy scale (BUMPs): Cross-cultural adaptation and psychometric properties among Brazilian pregnant women

The Body Understanding Measure for Pregnancy Scale (BUMPs) is a scale developed and validated for British pregnant women to assess body satisfaction during pregnancy. The aim of this study was to perform a cross-cultural adaptation and verify the psychometric properties of BUMPs for Brazilian adult pregnant women. The cross-cultural adaptation was performed using translation, back-translation, expert committee, expert analysis, and pre-testing, which showed easy comprehension by pregnant women. Psychometric analyses were evaluated in a sample of 618 pregnant women (31.08 ± 4.94 years old). Exploratory and confirmatory factor analyses resulted in 19 items and three factors, with satisfactory fit indices. BUMPs presented an invariant measurement across white vs. nonwhite women and across the three gestational trimesters. BUMPs showed good indicators of convergent, internal consistency, and test-retest reproducibility validity. It was concluded that the Brazilian version of BUMPs has adequate psychometric properties for Brazilian pregnant women, being an excellent instrument for analyzing body satisfaction in this population, facilitating additional investigations into these constructs.

The experience of bearing a child: implications on body boundaries and their link to preterm birth

BACKGROUND

Preterm birth, which occurs when a baby is born before 37 weeks, has enormous implications for public health. It is the leading cause of infant death and mortality in children under the age of five. Unfortunately, the multifaceted causes of preterm birth are not fully understood. One construct that has received increasing attention in women's transition to motherhood is body boundaries, i.e., the metaphorical barriers that separate the self from the outer, surrounding "not self." This study aims to examine the role of well-defined and disturbed body boundaries in predicting preterm birth.

METHODS

A sample of 655 Israeli pregnant women reported their sense of body boundaries (BBS, as measured by the Sense of Body Boundaries Survey) pre- and postnatally. We performed a General Linear Model (GLM) testing the effect of the BBS total score on the days women delivered before their due date and controlling for whether it was the women's first child.

RESULTS

Our GLMs controlling for whether it was the women's first child showed that the BBS total mean exhibited a significant predictive effect on the number of days delivered before the due date (F(57,313) = 3.65, p < .001).

CONCLUSIONS

These results demonstrate heterogeneity in women's sense of body boundaries during pregnancy and are the first to disentangle a link between disturbed body boundaries and preterm birth. Mediating mechanisms in this relation, e.g., psychosocial stress, as well as clinical implications are discussed in detail.

Self-objectification during the perinatal period: The role of body surveillance in maternal and infant wellbeing

Pregnancy represents a unique time during which women's bodies undergo significant physical changes (e.g., expanding belly, larger breasts, weight gain) that can elicit increased objectification. Experiences of objectification set the stage for women to view themselves as sexual objects (i.e., self-objectification) and is associated with adverse mental health outcomes. Although women may experience heightened self-objectification and behavioral consequences (such as body surveillance) due to the objectification of pregnant bodies in Western cultures, there are remarkably few studies examining objectification theory among women during the perinatal period. The present study investigated the impact of body surveillance, a consequence of self-objectification, on maternal mental health, mother-infant bonding, and infant socioemotional outcomes in a sample of 159 women navigating pregnancy and postpartum. Utilizing a serial mediation model, we found that mothers who endorsed higher levels of body surveillance during pregnancy reported more depressive symptoms and body dissatisfaction, which were associated with greater impairments in mother-infant bonding following childbirth and more infant socioemotional dysfunction at 1-year postpartum. Maternal prenatal depressive symptoms emerged as a unique mechanism through which body surveillance predicted bonding impairments and subsequent infant outcomes. Results highlight the critical need for early intervention efforts that not only target general depression, but also promote body functionality and acceptance over the Western "thin ideal" of attractiveness among expecting mothers.

Effect of lifestyles on fear of pregnancy: Development and psychometric testing of the fear of pregnancy scale

OBJECTIVE

Pregnancy may be a cause of fear for some women. Fear of pregnancy is a woman's belief that her health or life may get worse due to pregnancy. This study aimed to develop a valid and reliable instrument to measure fear of pregnancy in women, and determine the effect of lifestyle on fear of pregnancy.

METHODS

This study was conducted in three phases. For the first phase, item generation and selection were made through qualitative interviews and literature review. In the second phase, items were administered to 398 women of reproductive age. The scale development phase was completed with exploratory factor analysis and internal consistency analysis. In the third phase, the Fear of Pregnancy Scale was developed, and was administered, together with the Lifestyle Scale, to women of reproductive age (n = 748).

RESULTS

The Fear of Pregnancy Scale was found to be a valid and reliable instrument for women of reproductive age. Perfectionism, control and self-esteem lifestyles were found to influence fear of pregnancy. Furthermore, fear of pregnancy was significantly more common in primiparous women and women with insufficient information about pregnancy.

CONCLUSION

This study found that fear of pregnancy was moderate and varied with lifestyle. Factors associated with fear of pregnancy that remain unspoken, and how they affect women's lives are not yet known. Evaluation of fear of pregnancy in women can be an important step in showing adaptation to future pregnancy, and revealing its effects on reproductive health.

Caring for myself while I'm growing somebody else: Mindful self-care buffers between pregnancy body disconnection and distress

Pregnancy embodiment describes the way a pregnant individual inhabits their body, including disconnection and connection, likely influencing both distress and well-being. Emerging work indicates that acceptance of pregnancy-related bodily change may support well-being, particularly when co-occurring with self-care behaviors. Yet, specific associations of pregnant embodiment and intentional, individualized self-care practices (mindful self-care; MSC) with well-being and distress remain unexamined. The present study tested independent and interactive associations between MSC and positive embodiment (body agency), and negative embodiment (body estrangement), respectively, with maternal distress and well-being in a sample of US pregnant women (N = 179; M_age = 31.3 years, aged 21-43; 85.6 % White, 4.9 % Hispanic/Latinx). Challenge and threat/harm appraisals of the COVID-19 pandemic were included in the model to represent responses to the unique sociohistorical context. Measurement-corrected path analytic models explained a substantial proportion of variation in well-being and a smaller proportion in prenatal distress. Among those with higher MSC, the association between body estrangement and prenatal distress was weaker. Results support mindful self-care as protective for pregnancy distress in the setting of body disconnection. Future individualized health promotion might consider how high-stress contexts influence application of self-care practices and impact distress and well-being during pregnancy.

Self-objectification during the perinatal period: The role of body surveillance in maternal and infant wellbeing

Pregnancy represents a unique time during which women's bodies undergo significant physical changes (e.g., expanding belly, larger breasts, weight gain) that can elicit increased objectification. Experiences of objectification set the stage for women to view themselves as sexual objects (i.e., self-objectification) and is associated with adverse mental health outcomes. Although women may experience heightened self-objectification and behavioral consequences (such as body surveillance) due to the objectification of pregnant bodies in Western cultures, there are remarkably few studies examining objectification theory among women during the perinatal period. The present study investigated the impact of body surveillance, a consequence of self-objectification, on maternal mental health, mother-infant bonding, and infant socioemotional outcomes in a sample of 159 women navigating pregnancy and postpartum. Utilizing a serial mediation model, we found that mothers who endorsed higher levels of body surveillance during pregnancy reported more depressive symptoms and body dissatisfaction, which were associated with greater impairments in mother-infant bonding following childbirth and more infant socioemotional dysfunction at 1-year postpartum. Maternal prenatal depressive symptoms emerged as a unique mechanism through which body surveillance predicted bonding impairments and subsequent infant outcomes. Results highlight the critical need for early intervention efforts that not only target general depression, but also promote body functionality and acceptance over the Western "thin ideal" of attractiveness among expecting mothers.

Body Image Assessment Tools in Pregnant Women: A Systematic Review

Pregnancy is a remarkable time and generates several changes in women in a short period. Body image is understood as the mental representation of the body itself, and, although bodily changes are considered healthy, they can impact pregnant women's body image. Problems related to body image during pregnancy can affect the health of the mother and fetus; thus, it is essential for health professionals to detect potential disorders as soon as possible. The objective of this systematic review was to identify instruments for assessing body image in pregnant women, highlighting their main characteristics. To this end, we applied the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to searches in the EMBASE, PubMed, and American Psychological Association databases from 5 January to 10 August 2021. We included studies on adult pregnant women without comorbidities in the validation and adaptation of (sub)scales that analyze components of body image. We excluded studies that considered nonpregnant, adolescent, postpartum, and/or clinical populations, as well as smoking/drug use studies that were not validation studies or did not assess any aspect of body image. We investigated the quality of the studies using the Quality Assessment Tool for Studies with Diverse Designs. In all, we examined 13 studies. The results point to a growing concern over body image during pregnancy, as there has been an increase in the number of validation and adaptation studies involving scales for different cultures that scrutinize different constructs. The findings suggest that the listed instruments be used in future research.

Evaluating the development, woman-centricity and psychometric properties of maternity patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs): A systematic review protocol

INTRODUCTION

Woman-centred care is the right of every woman receiving maternity care, irrespective of where care is being received and who is providing care. This protocol describes a planned systematic review that will identify, describe and critically appraise the psychometric properties of maternity patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). The woman-centricity of PROM and PREM development and content validation (ie, the extent to which women were involved in these processes) will also be assessed. This information will be used to develop a maternity PROMs and PREMs database to support service and system performance measurement, and value-based maternity care initiatives.

METHODS AND ANALYSIS

This study will be guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of outcome measurement instruments. Studies identified via MEDLINE, CINAHL Plus, PsycINFO and EMBASE describing the development, content validation and/or psychometric evaluation of PROMs and PREMs specifically designed for maternity populations throughout pregnancy, childbirth and postnatal periods will be considered if published from 2010 onward, in English, and available in full text. The COSMIN risk of bias checklist will be used to evaluate the quality of studies reporting on the development, content validation and/or psychometric evaluation of PROMs and PREMs. COSMIN criteria for good content validity will be used to assess the woman-centricity of PROM and PREM development and content validation studies. COSMIN standards of good psychometric properties will be used to evaluate the validity and reliability of the identified instruments.

ETHICS AND DISSEMINATION

Ethical permission for this research is not required. The findings of this research will be submitted for publication in an international, peer-reviewed journal. Abstracts for national and international conference presentations will also be submitted. The proposed maternity PROMs and PREMs database will be freely accessible online, and developed with consumer input to ensure its usefulness to a range of maternity care stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42021288854.

Sensory challenges experienced by autistic women during pregnancy and childbirth: a systematic review

PURPOSE

The aim of this systematic review was to identify challenges faced by autistic women during pregnancy and birth due to sensory issues or other features of Autism Spectrum Disorder.

METHODS

A systematic search of literature was conducted using Medline, PubMed, Embase, PsycINFO, CINAHL, MIDIRS, ProQuest Dissertations and Theses Global, and Open Access Theses and Dissertations. Eligible studies addressed autistic women's pregnancy or birth experiences, and were assessed for methodological quality.

RESULTS

The search generated 2656 results, with six meeting inclusion criteria. Data from 427 autistic participants were extracted from four qualitative and two quantitative studies for synthesis.

CONCLUSION

We found that the literature was exploratory and lacked focussed research questions addressing sensory issues in pregnancy. Sensory challenges were, however, identified as a key finding in all qualitative studies. Other challenges faced by autistic women during pregnancy and birth included communication issues in healthcare settings and lack of appropriate information and supports for pregnancy and birth. Implications for health professionals and challenges associated with research in this area are discussed.

Body functionality: A review of the literature

Body functionality describes everything that the body is able to do, across diverse domains (e.g., bodily senses, creative endeavours). Nearly a decade ago, leading scholars identified research on body functionality as a priority for the body image field. The field has responded, as shown by the recent rise of body functionality research. We considered this an opportune time to (a) define body functionality (what it is and is not); (b) present theoretical frameworks of body functionality; (c) articulate first-generation and current measures relating to body functionality; (d) offer functionality-focused body image interventions that can improve appreciation for one's body functionality (and body image more broadly); (e) summarise additional areas of research related to body functionality and positive body image; and (f) provide considerations and directions for future research and interventions incorporating body functionality. Research has underscored body functionality as a valuable construct with respect to positive body image and well-being, particularly when individuals appreciate what their bodies can do and conceptualise their body functionality holistically. Yet, the experience of body functionality is nuanced across social identities. Overall, the field has greatly advanced knowledge about body functionality, and we are excited to see the next generation of research that emerges.

Differentiation of the self and the body and adjustment to motherhood - A latent class analysis

BACKGROUND

Self-differentiation is a recognized predictor of adjustment to transitional periods of the life cycle, such as transition to motherhood. Less, however, is known about body differentiation, its relational pattern with self-differentiation, and its effect on adjustment to motherhood. The aims of this research were to identify distinct subgroups of differentiation among pregnant women (T1) and to examine the predictive role of these classes in adjustment to motherhood, two-months postpartum (T2).

METHODS

Two studies were conducted. In Study 1, the basic clusters structure was examined among a sample of non-pregnant women (N = 583), who filled out questionnaires assessing their self- and body differentiation. In addition, stability across five months was assessed. In Study 2, the cluster classification was validated and the relational pattern to the adjustment to motherhood was tested. Three-hundred-and-ninety-four women filled out a battery of questionnaires assessing their self- and body differentiation during pregnancy (T1), and the body experience, maternal efficacy, mother-infant bonding, and depression two-months postpartum (T2).

RESULTS

Results of Study 1's latent class analysis revealed four classes:" differentiated," "moderate," "body-differentiated," and "undifferentiated," comprising women with low levels of body-self differentiation. This structure was replicated in Study 2. In addition, a series of analyses indicated that women classified as "differentiated" during their pregnancies (T1) demonstrated higher levels of adjustment to motherhood (T2), while those classified as "undifferentiated" at T1 reported the lowest levels of adjustment at T2.

CONCLUSIONS

The findings suggest a new body-self differentiation classification and emphasize that clinical interventions for women forming their new identities as mothers should target both concepts.

Suicide ideation among pregnant women: The role of different experiences of childhood abuse

BACKGROUND

Childhood abuse has a negative effect on mental health during pregnancy; however, the association between childhood abuse and suicide ideation has received relatively little attention.

METHOD

Women at 28 weeks or more into their pregnancy were recruited from a prenatal clinic in Shandong province, China. Suicide ideation was measured using item 9 of the Patient Health Questionnaire-9. Childhood abuse was measured using childhood abuse subscales of the Childhood Trauma Questionnaire.

RESULTS

Women with any experience of childhood abuse had high risk of suicide ideation (OR = 2.44, 95%CI: 1.31-4.55). The association of continuous childhood abuse scores with suicide ideation was consistent with the finding using dichotomous childhood abuse (OR = 1.07, 95%CI: 1.02-1.12). After adjustment for depression, pregnant women with only physical abuse experience had high risk of suicide ideation (OR = 3.63, 95%CI: 1.32-10.03). Pregnant women with both childhood abuse and depression had increased risk of suicide ideation compared to those with neither risk factor (OR = 17.78, 95%CI 7.20-43.92).

LIMITATIONS

Using a self-report measure to assess childhood abuse is susceptible to recall bias. Using a single item to measure suicide ideation and assessing only suicide ideation were limitations of the study.

CONCLUSIONS

Pregnant women who experienced childhood abuse, especially physical abuse, had a high risk of suicide ideation during pregnancy. Screening for both childhood abuse and antenatal depression may be an effective way to identify high-risk groups with suicide ideation.

A network analysis comparison of central determinants of body dissatisfaction among pregnant and non-pregnant women

The objective of the present study was to compare body dissatisfaction of pregnant (n = 1245 overall; n = 320 trimester 1, n = 497 trimester 2, n = 428 trimester 3) and non-pregnant (n = 547) women in terms of: (a) global dissatisfaction, (b) dissatisfaction with specific body parts/features, and (c) strength of inter-relation among these areas of dissatisfaction. While ANOVAs revealed small group differences in overall body dissatisfaction ratings for appearance and function, more sizable differences were observed at the item level. Network analysis showed that the dissatisfaction items clustered together in similar ways across groups, but that the relative importance of these items for the networks differed by group. In particular, dissatisfaction with chest was much less connected to other areas of dissatisfaction for pregnant women, whilst dissatisfaction with shape and/or weight were more strongly connected to other items for this group. Body function items were less important in the network for non-pregnant women. Findings support earlier qualitative findings suggesting that pregnant women are concerned with both appearance and functioning of their bodies. More broadly, information gleaned at the item level highlights the value in exploring areas of dissatisfaction that may increase understanding of global dissatisfaction ratings.

Thomas F. Cash: A multidimensional innovator in the measurement of body image; Some lessons learned and some lessons for the future of the field

Accurate measurement of constructs under investigation is an often-overlooked ingredient of research. However, sound use of strategies to ensure valid and reliable assessment is the building block for any research design, data analysis, and outcome interpretation. In this paper, we note how Thomas F. Cash has pioneered and steered this process in the field of body image for over 30 years-in fact, in the inaugural issue of Body Image, the first article after the editorial introduction focused on measurement (see Thompson, 2004). In the current paper, we detail some of the seminal measures developed by Thomas Cash as well as update the common errors in the (mis)measurement of body image noted in Thompson (2004). The future of body image assessment is bright if we focus on the illumination of past work by Thomas Cash.

Motherhood status moderates the relationship between perfectionistic self-presentation and breast size dissatisfaction

Perfectionistic self-presentation refers to a desire to create an image of flawlessness in the eyes of the others and has been associated with more negative body image. We extended previous research by examining associations between perfectionistic self-presentation and breast size dissatisfaction, and also examined whether motherhood status moderated this association. A total of 484 Italian women (age M = 40.39, SD = 13.73; mothers n = 53.9%) completed measures of perfectionistic self-presentation (perfectionistic self-promotion, nondisplay of imperfection, and nondisclosure of imperfection) and breast size dissatisfaction. Preliminary analyses indicated that a majority of the sample (69.2%) reported breast size dissatisfaction, with 44.4% and 24.4% desiring larger and smaller breasts, respectively, than they currently had. Only perfectionistic self-promotion and nondisplay of imperfection were significantly correlated with breast size dissatisfaction. Both associations were additionally moderated by motherhood status, with associations being significant in non-mothers but not in mothers. Our findings suggest that motherhood may help decouple the link between perfectionistic self-presentation and breast size dissatisfaction. Future studies should assess whether this effect is due to an enhanced maternal view of breasts that emphasises nurturing and biological functions or a result of weaker investment in sociocultural norms on physical appearance.

Enlarged representation of peripersonal space in pregnancy

Our ability to maintain a coherent bodily self despite continuous changes within and outside our body relies on the highly flexible multisensory representation of the body, and of the space surrounding it: the peripersonal space (PPS). The aim of our study was to investigate whether during pregnancy - when extremely rapid changes in body size and shape occur - a likewise rapid plastic reorganization of the neural representation of the PPS occurs. We used an audio-tactile integration task to measure the PPS boundary at different stages of pregnancy. We found that in the second trimester of pregnancy and postpartum women did not show differences in their PPS size as compared to the control group (non-pregnant women). However, in the third trimester the PPS was larger than the controls’ PPS and the shift between representation of near and far space was more gradual. We therefore conclude that during pregnancy the brain adapts to the sudden bodily changes, by expanding the representation of the space around the body. This may represent a mechanism to protect the vulnerable abdomen from injury from surrounding objects.

"Neglected moms" - The implications of emotional neglect in childhood for the transition to motherhood

BACKGROUND

The transition to motherhood involves many challenges that require adjustment; included among them are adapting to body changes, forging a maternal identity, and attaching to the baby. Although these tasks may not be easy for any women, those who experienced emotional neglect during childhood may find them especially difficult.

OBJECTIVE

The aim of the current study was to examine a model illuminating the mechanism underlying the association between childhood emotional neglect and women's adjustment during pregnancy and the postpartum period.

PARTICIPANTS AND SETTING

Three hundred and ninety four Israeli women participated in the study, during their pregnancy (Time 1) and two months postpartum (Time 2).

METHODS

Participants filled out a battery of questionnaires assessing their history of childhood emotional neglect, body experience, maternal self-efficacy, attachment to the fetus/baby, and depression.

RESULTS

Results from structural equation modeling (SEM) indicated that childhood emotional neglect was associated with depression at both Time 1 and Time 2. These associations were mediated by the body experience during pregnancy (Time 1) and motherhood (Time 2) as well as by anticipated maternal self-efficacy (Time 1) and maternal self-efficacy (Time 2). The model explained 56% of the variance of postpartum depression (Time 2).

CONCLUSIONS

These findings point to the long-term implications of childhood emotional neglect for women's adjustment to the transition to motherhood. The underlying mechanism suggested by the research model is discussed.