A key for perinatal depression early diagnosis: The body dissatisfaction

The effectiveness of interventions on improving body image for pregnant and postpartum women: a systematic review of randomized clinical trials

BACKGROUND

Body image dissatisfaction, leading to a variety of negative emotions and adverse pregnancy or birth outcomes. Studies on body image interventions for pregnant and postpartum women have been reported, yielding mixed results. Existing evidence lacks a comprehensive review of the effectiveness of body image interventions for pregnant and postpartum women.

OBJECTIVE

The aim of this study was to systematically review interventions which aimed at improving body image during pregnancy and postpartum in women of childbearing age, and further to explore their effectiveness.

METHODS

A comprehensive literature search was conducted using electronic databases, including PubMed, Embase, Web of Science, Cochrane Library, CINAHL, SinoMed, CNKI, and Wanfang Database, to retrieve relevant studies. Body image was reported employing descriptive analysis, whereas the Cochrane Handbook tool was used to evaluate the quality and potential bias of each included study.

RESULTS

Following established inclusion and exclusion criteria, 11 studies were identified from an initial 1,422 records for further analysis, involving 1290 participants. This systematic review grouped body image interventions into lifestyle interventions and psychological interventions based on their content. These interventions yielded more pronounced positive effects on improving body image in pregnant and postpartum women when compared to control groups. And, the statistical difference on psychological interventions is more significant on the whole.

CONCLUSIONS

Our work offers a comprehensive overview of the effectiveness of body image interventions for pregnant and postpartum women. Psychological interventions are considered to be a suitable measure to improve body image for pregnant or postpartum women. Additional research and practical applications are recommended to enhance the mental health and well-being of perinatal women.

TRIAL REGISTRATION

PROSPERO registry: CRD42024531531.

Body image perceptions of pregnant women in the third trimester in Turkey: A qualitative study

RATIONALE

Body image undergoes significant changes during pregnancy, marking a pivotal phase in a woman's life.

AIM AND OBJECTIVE

This study aimed to explore the body image perceptions of primiparous pregnant women during their third trimester.

METHODS

Employing a qualitative research approach grounded in phenomenology, the study involved interviews to explore the experiences of primiparous pregnant women in their third trimester. The interviews were conducted via an online platform, with a sample group of 13 participants chosen through purposive sampling. Data analysis followed a content analysis approach, with the information being transferred to MAXQDA Analytics Pro Qualitative Data Analysis Programme for coding. The study adhered to the reporting guidelines outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

RESULTS

Systematic analysis of the interview transcripts led to the identification of three main themes under the overarching framework of body image experiences among primiparous pregnant women during the third trimester: Physical Changes, Mental Changes, and Behavioural and Social Changes. Among the identified themes, pregnant women demonstrated a relatively lower level of discourse regarding Physical Changes, in contrast to a significant emphasis on Mental Changes. Within the latter theme, pregnant women exhibited significant dissatisfaction with their pregnancy experiences significantly.

CONCLUSION

It was determined that pregnant women experience physical and psychological changes related to body image during pregnancy.

Meta-analysis of association between caesarean section and postpartum depression risk

Background

The association of caesarean section (CS) for postpartum depression (PPD) remains controversial. This study aims to explore the relationship between CS and the risk of PPD, in order to provide a basis for preventing PPD.

Material and methods

We searched PubMed, Web of Science, Cochrane Library, and EMBASE databases for literature about the correlation between CS and PPD published as of February 2024. The combined odds ratios (ORs) and 95% confidence intervals (Cls) were obtained by flexible use of fixed-effects models or random-effects models.

Results

A total of 18 publications were ultimately included in the analysis. Among these, 14 were cohort studies and 4 were case-control reports, encompassing 844,328 total cases. All of the included studies were deemed to be of moderate or higher quality. The meta-analysis indicated that the prevalence of PPD among parturients undergoing CS was 13.4% (95% CI: 6.5%-25.5%).The adjusted odds ratio (OR) for the association between CS and PPD was 1.12 (95% CI: 1.04-1.20) compared to the natural vaginal delivery (NVD) group. Specifically, the adjusted OR for the association between CS and PPD was 1.29 (95% CI: 1.18-1.40) during the first 1-6 months postpartum, and 1.23 (95% CI: 1.14-1.33) after 6 months postpartum. Furthermore, in comparison to the NVD group, the adjusted OR for elective caesarean section (ELCS) and emergency caesarean section (EMCS) were 0.96 (0.83, 1.10) and 1.20 (1.08, 1.34), respectively.

Conclusion

Our findings suggest that PPD risk may rise in the presence of CS. In particular, the risk was increased by 20% in the EMCS group, and the risk of PPD within one to six months postpartum after CS increases by 6% compared to that at six months postpartum. In the future, more rational designs and in-depth studies are needed to obtain more accurate information.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023389265.

Predictors of body image dissatisfaction among women at different stages of pregnancy:A cross-sectional study

OBJECTIVE

To explore the levels and predictors of body image dissatisfaction among women at different stages of pregnancy.

DESIGN

This was a cross-sectional study design.

SETTING AND PARTICIPANTS

A total of 863 Chinese pregnant women were recruited from a tertiary hospital via a convenience sampling method.

MEASUREMENT AND FINDINGS

Eligible participants completed a demographic questionnaire and self-reported measures of body image dissatisfaction, pregnancy-related anxiety, prenatal depression, and appearance comparison. Results showed no statistical difference in body image dissatisfaction levels among early-mid pregnancy (47.6 ± 6.17), late-mid pregnancy (47.3 ± 7.56), and late pregnancy stages (48.4 ± 6.22). The generalized linear model showed that gestational weight gain, pregnancy-related anxiety, own/family's perception of pregnancy weight, and current ideal weight change were predictors of body image dissatisfaction in the early-mid pregnancy stage. In addition, pre-pregnancy BMI, appearance comparison, own /family's perception of pregnancy weight, current ideal weight change, and overeating during pregnancy significantly predicted body image dissatisfaction in the late-mid pregnancy stage. Predictors of body image dissatisfaction in the late pregnancy stage comprised planned pregnancy, pre-pregnancy eating disorders, own perception of pregnancy weight, current ideal weight change, pregnancy-related anxiety, and prenatal depression.

KEY CONCLUSION AND IMPLICATION FOR PRACTICE

The findings suggest that predictors of body image dissatisfaction differed according to pregnancy stage. Self-perception of pregnancy weight was primary predictor of body image dissatisfaction. Healthcare professionals are recommended to provide prenatal health education to reduce own/family's negative perception of pregnancy weight, so as to alleviate the body image dissatisfaction level of pregnant women.

Enhancing body image in motherhood: A randomised controlled trial of Expand Your Horizon among mothers of young children

Motherhood can increase vulnerability to body dissatisfaction, but positive body image interventions may mitigate this. Expand Your Horizon (Alleva et al., 2015), an online writing intervention, enhances functionality appreciation, an aspect of positive body image. The intervention's demonstrated efficacy and focus on body functionality indicate its potential use among mothers. However, its original 3-session format may be unfeasible for mothers alongside other commitments. Thus, we tested the impact of a single 15-minute Expand Your Horizon session on state body appreciation and functionality appreciation. Mothers (N = 143) of 0-10-year-olds were randomly allocated to either the intervention group, or an active control group. State body appreciation and functionality appreciation were assessed pre- and post-intervention. Trait self-compassion was tested as a potential moderator. Participants who completed Expand Your Horizon reported greater state body appreciation and functionality appreciation post-intervention than those in the control group. Self-compassion moderated the intervention's effect on state functionality appreciation, with effects strongest for those with lower levels of self-compassion. Overall, findings support the intervention's suitability for mothers, particularly those with low self-compassion. Practical implications include possibly tailoring Expand Your Horizon and similar interventions to benefit all mothers. Future research directions include longitudinal and qualitative designs, and extension to other specific populations.

Comparing body image dissatisfaction between pregnant women and non-pregnant women: a systematic review and meta-analysis

Body image dissatisfaction refers to negative thoughts and feelings individuals have towards their own body appearance and this is thought to be affected by the physiological changes that occur during pregnancy. There are two main conflicting theories as to the effect pregnancy has on body image dissatisfaction: 1) Pregnancy related changes are in direct conflict with social ideas of female beauty (e.g. weight gain) and so increase body image dissatisfaction; 2) Due to changes in expectations of bodily appearance during pregnancy, women are liberated from social ideals at this time and thus body image dissatisfaction would decrease. This study aimed to assess these theories by synthesising the current literature. Six databases were searched, and 2,017 study abstracts were screened based on strict inclusion and exclusion criteria. Following screening and quality assessment by two blind reviewers, 17 studies (comprising 17 effect sizes) were subject to full review and meta-analysis following PRISMA guidelines. These studies included cross-sectional, longitudinal and retrospective designs. Results varied with some studies showing women to feel more positive about their body during pregnancy, others showing a more negative body experience and yet others showing no statistical difference. Overall the analysis showed no statistical difference in body image dissatisfaction between pregnant women and non-pregnant women (p = 0.39). Any changes that do occur are heterogeneous and likely to be largely dependent on the individual experience as well as moderator variables and other factors such as differences in methodology of research studies. Studies in this field of research would benefit from more explicit and complete reporting of data and key variables, in order to allow early intervention for women who display body image dissatisfaction in pregnancy.

A prospective study on body image disturbances during pregnancy and postpartum: the role of cognitive reappraisal

Background

During pregnancy, body size rapidly modifies over a relatively short period. Literature emphasizes the need to identify the factors that influence body image during peripartum as the extent of women's adaptation to these changes has significant repercussions on both mother's and newborn's health. Emotion regulation strategies (i.e., expressive suppression and cognitive reappraisal) were linked to body image in the general and clinical population, but no studies were conducted in the peripartum. The present study aims to investigate the longitudinal impact of prepartum body image disturbances on postpartum body image disturbances and to evaluate the mediational role of emotional regulation strategies.

Methods

A total of 133 pregnant women completed a three-phase longitudinal study. Women answered online questionnaires during the second (T1) and the third (T2) trimesters of pregnancy, and at about 6 months postpartum (T3).

Results

Findings indicated that body image disturbances at T1 were a significant predictor of body image disturbances in the postpartum (1 year after the first assessment). Moreover, cognitive reappraisal measured at T2 partially mediated this relationship: body image disturbances in the second trimester of pregnancy were linked to less use of cognitive reappraisal in the third trimester of pregnancy, and this, in turn, was associated with worse body image disturbances at 6 months after birth.

Conclusion

Findings of this longitudinal study highlight the importance of assessing body image disturbances during pregnancy to early identify women at risk, and suggest cognitive reappraisal as a possible target intervention.

Pregorexia: a systematic review and meta-analysis on the constructs of body image dissatisfaction and eating disturbances by gestational age in the peripartum

PURPOSE

Pregorexia is a phenomenon posited to occur in the peripartum, characterized by an attempt to counter pregnancy's physiological changes in body shape through reduced calorie intake or increased physical activity.

METHODS

In this pre-registered systematic review and meta-analysis, body image dissatisfaction and eating psychopathology in the peripartum according to gestational age were formally assessed. PubMed was searched up to May 2023. Selection criteria were represented by studies on body image concerns or eating psychopathology in the peripartum (up to 1 year after delivery). The population needed to include women from the general population or among patients with a history of (or current) eating disorder. For the meta-analysis, 17 studies were included: 10 for body image dissatisfaction (2625 individuals overall), 7 for eating behaviors (2551 individuals overall). The interplay between body image and the following themes was examined in depth: the adoption of breastfeeding, peripartum depression, sociocultural influences on body image, sexual disturbances, experiencing or reporting an altered food intake.

RESULTS

Progressive dissatisfaction with body image during pregnancy by gestational age was observed, stably elevated for at least 12 months postpartum. Eating psychopathology was observed as elevated only at 12 months in the postpartum, but not during pregnancy.

DISCUSSION

The current work offers normative values of body image satisfaction and eating psychopathology in the peripartum by gestational age. The relevance of current results was discussed, in order to inform both current clinical practice and future public policies.

LEVEL OF EVIDENCE

Level I-Evidence obtained from: systematic reviews and meta-analyses.

Supporting optimal dietary behaviors in women with perinatal depression: A qualitative exploration of experiences, practices, and challenges

BACKGROUND

Women with perinatal depression (PD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for women with PD have been developed. The objectives of this study were to identify nutrition-related challenges and needs among women with PD and to elucidate the role that feeding plays in mother-infant interaction, to inform the development of nutrition interventions.

METHODS

Using a qualitative study design, in-depth interviews were conducted with 18 mothers with a history of PD and 10 interdisciplinary healthcare providers with expertise in PD. Data were thematically analyzed using a hybrid inductive and deductive coding approach.

RESULTS

Mean age of mothers was 31 ± 6 years, 56% identified as non-Hispanic White, and 33% identified as Black/African American. Eighty percent of healthcare providers practiced for more than five years. Six themes were identified: (a) Time scarcity mindset; (b) Importance of social support; (c) Unrealistic expectations of motherhood; (d) Mom as the last priority; (e) Postpartum body changes and shape ideals; and (f) Contentment associated with infant and young child feeding.

CONCLUSION

Women with PD have several needs pertaining to their nutrition and that of their children. The findings from this study illustrate key considerations and recommendations for addressing these needs.

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.

Psychological Characteristics of Women with Perinatal Depression Who Require Psychiatric Support during Pregnancy or Postpartum: A Cross-Sectional Study

Antenatal depression may be distinct from postpartum depression in terms of prevalence, severity of symptoms, comorbidities, prognosis, and risk factors. Although risk factors for perinatal depression have been identified, it is unclear whether there are differences in the onset of perinatal depression (PND). This study explored the characteristics of women requiring mental health support during pregnancy or postpartum. A sample of 170 women (58% in pregnancy; 42% postpartum) who contacted the SOS-MAMMA outpatient clinic was recruited. Clinical data sheets and self-report questionnaires (EPDS, LTE-Q, BIG FIVE; ECR; BSQ; STICSA) were administered, hypothesizing possible risk factors, such as personality traits, stressful life events, body dissatisfaction, attachment style, and anxiety. Hierarchical regression models were carried out in the pregnancy (F_10;36 = 8.075, p < 0.001, adjR2 = 0.877) and postpartum groups (F_10;38 = 3.082, p < 0.05, adjR2 = 0.809). Recent stressful life events and conscientiousness were associated with depression in both the pregnant (29.3%, 25.5% of variance) and postpartum groups (23.8%, 20.7% of variance). In pregnant women, "openness" (11.6%), body dissatisfaction (10.2%), and anxiety (7.1%) symptoms were predictive of depression. In the postpartum group, "neuroticism" (13.8%) and insecure romantic attachment dimensions (13.4%; 9.2%) were the strongest predictors. Perinatal psychological interventions should consider the differences between mothers with depression during pregnancy and postpartum.

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.

Does the postpartum body image of primiparous women giving vaginal delivery affect their sexual functions and depression and fatigue levels?

The body image-related problems can negatively affect women's lives in many ways. The study was aimed at investigating the effects of postpartum body image on sexual functions, and fatigue and depression levels of primiparous women who gave birth vaginally. This cross-sectional study was conducted with 133 women who presented to the obstetrics and gynecology clinics of a state hospital in Turkey between June 2021 and December 2021. At the end of the study, a moderate relationship was determined between the women's body image and their depression (r = 0.500; p < 0.001) and fatigue (r = 0.666; p < 0.001) levels, and a weak relationship between their body image and sexual functions (r = -0.372; p < 0.001). According to the backward regression model used in the study, the women's fatigue and education levels accounted for their body image by 45.7%.

The relationship between body dissatisfaction and postpartum depressive symptoms: A cross-sectional study

BACKGROUND

Women are least satisfied with their bodies during the postpartum period. There is a potential correlation between body dissatisfaction and depressive symptoms post delivery.The aim of this study was to explore the relationship of appearance and body areas satisfaction with depressive symptoms and examine the risk factors of depressive symptoms at 4-6 weeks postpartum.

METHODS

A total of 330 postpartum women participated in the study. Body dissatisfaction was measured using the Appearance Evaluation (AE) scale and Body Areas Satisfaction Scale (BASS), while depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS), 4-6 weeks postpartum.

RESULTS

The prevalence of postpartum depressive symptoms among postpartum women was 40 % while 12.1 % of the women had thoughts of self-harm. Those with depressive symptoms or thoughts of self-harm had lower AE and BASS scores. Body dissatisfaction was significantly associated with factors such as postpartum weight retention of >5 kgs, no exercise, lower education level, and cesarean delivery. The three body areas that women were most dissatisfied with were weight, mid-torso, and lower torso. Education level, delivery method, and BASS score significantly predicted postpartum depressive symptoms.

LIMITATIONS

The selection bias might have occurred if those with depressive symptoms neglected routine postpartum care visits due to emotional distress.

CONCLUSIONS

The results indicate an association between body dissatisfaction and depressive symptoms at 4-6 weeks postpartum. Awareness of this relationship and focus on these risk factors will help healthcare providers plan peripartum programs to decrease the likelihood of postpartum depressive symptoms.

Modifiable Maternal Factors and Their Relationship to Postpartum Depression

The purpose of the study was to examine how modifiable maternal factors (body mass index (BMI), household income, fatigue, sleep, breastfeeding status, diet, and physical activity) relate to postpartum depression (PPD) at 6 and 12 months postpartum. Participants (n = 26) participated in two study visits (6 and 12 months postpartum) where vitals, weight, body composition (skinfold anthropometrics), and physical activity levels (Actigraph GTX9 accelerometer) were assessed. Validated instruments (BRUMS-32, Subjective Exercise Experience Scale, Pittsburg Sleep Quality index, NIH breastfeeding survey, NIH Dietary History Questionnaire, and Edinburg Postnatal Depression Scale) assessed lifestyle and demographic factors of interest. PPD at six months was correlated to PPD at 12 months (r = 0.926, p < 0.001). At six months postpartum, PPD was positively correlated to BMI (r = 0.473, p = 0.020) and fatigue (r = 0.701, p < 0.001), and negatively correlated to household income (r = -0.442, p = 0.035). Mothers who were breastfeeding had lower PPD scores (breastfeeding 3.9 ± 3.5 vs. not breastfeeding 7.6 ± 4.8, p = 0.048). At 12 months, PPD was positively correlated to sleep scores (where a higher score indicates poorer sleep quality) (r = 0.752, p < 0.001) and fatigue (r = 0.680, p = 0.004). When analyzed collectively via regression analyses, household income and fatigue appeared to be the strongest predictors of PPD at six months postpartum.

Body image dissatisfaction and interoceptive sensibility significantly predict postpartum depressive symptoms

BACKGROUND

During pregnancy women experience rapid and unique changes in body weight, shape and size over a relatively short time period. While research focused on the role of external bodily modifications during pregnancy, research on internal bodily variations is missing.

METHODS

In a longitudinal study, we recruited healthy pregnant women and measured whether and how depressive symptoms, body image dissatisfaction and the subjective tendency to focus on one's own internal bodily sensations, i.e., interoceptive sensibility, changed during pregnancy and postpartum. Pregnant women filled online self-report questionnaires during pregnancy (i.e. second and third trimester) and after (i.e. six weeks) the delivery, including the Body Areas Satisfaction Scale, the Multidimensional Assessment of Interoceptive Awareness, and the Edinburgh Postnatal Depression Scale.

RESULTS

While depressive symptoms remained stable in the peripartum, body image dissatisfaction increased in the postpartum compared to the pregnancy period, and interoceptive sensibility increased over pregnancy. Findings showed that the increase of body dissatisfaction through the peripartum and the levels of interoceptive sensibility in the early phase of pregnancy predicted depressive symptoms in the postpartum.

LIMITATIONS

Interoception was evaluated as a subjective measure (i.e., interoceptive sensibility). Future studies may include objective measures of interoceptive accuracy and interoceptive awareness.

CONCLUSIONS

The current study supports the importance of body image dissatisfaction and interoceptive sensibility in the development of postpartum depressive symptoms. Future studies need to investigate if interventions aimed to increase interoceptive sensibility might be useful in preventing depressive symptoms and identify the mechanisms that can lead to these changes.

Body dissatisfaction and disordered eating in the perinatal period: an underrecognized high-risk timeframe and the opportunity to intervene

The normal physical changes associated with pregnancy may increase the risk of body dissatisfaction, which is associated with negative mental health outcomes including depression and disordered eating. The purpose of this study was to explore body image and eating concerns among a sample of participants in pregnancy and postpartum and to assess interest and suggestions for a relevant intervention. This was a cross-sectional survey study requiring 10-15 min to complete. Individuals were eligible to participate in the study if they were pregnant or within 1 year postpartum, between the ages of 18 and 45, able to read and write in English, and provided online informed consent. The survey included measures and open-text questions to explore body image, eating behaviors, and related concerns in the perinatal period and to inform the development of an intervention. There were 161 participants, and over 50% were dissatisfied with their body image; 52% were among pregnant participants and 56.2% of postpartum participants. Approximately 80% reported that they would have appreciated the opportunity to participate in a program focused on body acceptance or expectations of body changes in pregnancy and postpartum. We identified intervention preferences as well as commonly reported themes regarding experiences of body image and eating concerns in pregnancy and postpartum. Body dissatisfaction and eating concerns are prevalent issues in pregnancy and postpartum, and our findings underscore an opportunity to tailor an intervention relevant to body image and disordered eating for the perinatal population.

Body Image Dissatisfaction as a Risk Factor for Postpartum Depression

Background and Objectives: Pregnancy and postpartum are periods that imply numerous physical and psychological changes that could lead to mental health consequences. The aim of the present study is to identify whether women who had body image dissatisfaction had a higher incidence of postpartum depression 6 months after birth than women who did not have body image dissatisfaction. Materials and Methods: A descriptive cross-sectional study was designed with a sample of 450 women from two hospitals in Andalusia. Quantitative variables were age and scores on the Edinburgh Postnatal Depression Scale (EPDS) and the Body Shape Questionnaire (BSQ) for body image dissatisfaction. The qualitative variables used were marital status, self-perceived health status, diet or physical exercise, type of delivery, and others. Results: Body dissatisfaction was positively correlated with the symptomatology of postpartum depression. Thus, for each point increased in body dissatisfaction, the occurrence of depression also increased. There was a relationship between the study variables, so women who were more dissatisfied with their body image were more frequently depressed. Conclusions: In conclusion, it can be established that postpartum depression seems to be related to the presence of poor body image.

Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study

BACKGROUND

Postnatal depression (PND) is a universal mental health problem that prevents mothers' optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities.

OBJECTIVE

This study aimed to investigate the PND risk factors among mothers attending Lang'ata and Riruta Maternal and Child Health Clinics (MCH) in the slums, Nairobi.

METHODS

This study was cross-sectional. It is part of a large study that investigated the effectiveness of a brief psychoeducational intervention on PND. Postnatal mothers (567) of 6-10 weeks postanatal formed the study population. Depression rate was measured using the original 1961 Beck's Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Multivariable logistic regression analysis was used to explore predictors of PND.

RESULTS

The overall prevalence of PND in the sample of women was 27.1%. Women aged 18-24 (β = 2.04 95% C.I.[0.02; 4.05], p = 0.047), dissatisfied with body image (β = 4.33 95% C.I.[2.26; 6.41], p < 0.001), had an unplanned pregnancy (β = 2.31 95% C.I.[0.81; 3.80], p = 0.003 and felt fatigued (β = - 1.85 95% C.I.[- 3.50; 0.20], p = 0.028) had higher odds of developing PND. Participants who had no stressful life events had significantly lower depression scores as compared to those who had stressful life events (β = - 1.71 95% C.I.[- 3.30; - 0.11], p = 0.036) when depression was treated as a continuous outcome. Sensitivity analysis showed that mothers who had secondary and tertiary level of education had 51 and 73% had lower likelihood of having depression as compared to those with a primary level of education (A.O.R = 0.49 95% C.I.[0.31-0.78], p = 0.002) and (A.O.R = 0.27 95% C.I.[0.09-0.75], p = 0.013) respectively.

CONCLUSION

This study reveals key predictors/risk factors for PND in low-income settings building upon the scanty data. Identifying risk factors for PND may help in devising focused preventive and treatment strategies.

Body Appreciation, Depressive Symptoms, and Self-Esteem in Pregnant and Postpartum Brazilian Women

Background

During pregnancy and the postpartum period, women experience tremendous biopsychosocial changes in a short period of time. Poor body appreciation, depressive symptoms, and low self-esteem during the perinatal period may cause negative consequences for both the mother and the infant's physiological and psychological health. The aim of this study was to analyze the differences in body appreciation, depressive symptoms, and self-esteem between the three gestational trimesters and the postpartum period.

Methods

Participants (N = 1,423 pregnant and postpartum Brazilian women), aged between 18 and 42 years old (M = 29.22; SD = ±5.72), answered questionnaires on body appreciation, depressive symptoms, and self-esteem. BMI was self-reported. Descriptive and nonparametric covariance analysis were performed, comparing women who were in the first, second, and third trimesters and the postpartum period.

Results

Body appreciation was significantly higher among women in the third trimester compared to those in the first and second trimester. However, it was lower for women in all three gestational trimesters than for those in the postpartum. There was no difference in self-esteem during pregnancy, but it was significantly lower in the postpartum group. Similarly, depressive symptoms did not vary through pregnant groups but it was significantly higher in the postpartum group.

Conclusions

The results showed that the postpartum period can be a difficult experience for women. They presented poor body appreciation and lower self-esteem and higher depressive symptoms compared to the pregnancy period. Therefore, it is necessary for public health policies to support women in this period, preserving their mental health and making this experience more positive.

A Community Prenatal Intervention in Social Nutrition: Evaluating the Impact on Pregnancy and Birthweight Outcomes

This study aims to assess the associations between structural features of the Montreal Diet Dispensary’s social nutrition intervention and pregnancy (i.e., anemia, gestational diabetes mellitus (GDM), gestational weight gain (GWG), hypertension) and birthweight outcomes (i.e., small- or large-for-gestational-age) among pregnant women, most of them recent immigrants. The study consists of a secondary analysis of the digital client database of the Montreal Diet Dispensary (n = 2925). Logistic regressions were used to estimate the odds of pregnancy and birthweight outcomes, depending on structural features of the intervention. Pregnant women who attended a welcoming group session presented lower odds of GDM and anemia compared to those who did not attend. A longer duration of intervention was also associated with lower odds of GDM and anemia. Each additional appointment with a dietitian was associated with higher odds of excessive GWG and lower odds of insufficient GWG only among women with a pre-pregnancy BMI lower than 25 kg/m². This study emphasizes the importance of providing nutritional services early in pregnancy to reduce the risk of GDM and anemia. It also stresses the importance of using appropriate nutritional guidelines to avoid increasing the risk of excessive GWG.

Changes of health related quality of life during pregnancy based on pregnancy context: a prospective study

Background

The significance of planned pregnancy is an accepted principle for improving the health of pregnant women; and quality of life, as one of the important indicators of women’s health, is reduced in high-risk pregnancies. The aim of this research was to investigate the changes in the health related quality of life (HRQL) in low risk pregnancies in different groups based on pregnancy context.

Methods

The present study was a prospective study conducted on 250 pregnant women divided into three groups of women with planned pregnancy, unplanned/wanted pregnancy and unwanted pregnancy. Then, using WHOQOL-26 questionnaire, the quality of life of these women was measured in physical, psychological, social and environmental dimensions at the beginning of pregnancy as well as at the end of the first, second and third trimesters.

Results

Based on the results, the mean score of environmental-HRQL in women with unwanted pregnancy was significantly lower than the other two groups. All dimensions on HRQL were influenced by time and group. However, changes in the physical, psychological and social dimensions of HRQL varied within the groups. Physical- HRQL changes were different within the groups. The intergroup effect on environmental dimension of quality of life changes was significant.

Conclusions

It was observed in this study that HRQL in the women with unwanted pregnancy was lower than the women with planned pregnancy and those with unplanned /wanted pregnancy. Moreover, increase in gestational age would lower quality of life, but this decline had a similar pattern in different groups.

The first 20 weeks of pregnancy is a high-risk period for eating disorder relapse

OBJECTIVE

Eating disorders (ED) are associated with adverse pregnancy outcome and pregnancy is associated with both relapse and remission of ED. Knowledge is lacking on the risk of ED relapse during pregnancy and the postpartum period for women in stable remission. This study examined the occurrence of perinatal ED relapse as well as obstetric and postpartum outcome in women with at least a 6-month ED remission before pregnancy.

METHOD

A total of 122 women in stable remission before pregnancy were included in a prospective longitudinal study. Changes in ED symptoms based on the Eating Disorder Examination were systematically evaluated at each antenatal visit and in the postpartum period.

RESULTS

A total of 30 (25%) women relapsed. Twenty women relapsed within the first 20 weeks of pregnancy and eight in the early weeks postpartum. Severe postpartum depression symptoms (33%) were frequent in women with ED relapse; hyperemesis gravidarum (30%) was frequently present independent of the woman's relapse status.

DISCUSSION

To prevent relapse of ED and possible consequences, attention to relapse in women in stable remission is especially important in early pregnancy and in the postpartum period.

The role of BDNF exon I region methylation in the treatment of depression with sertraline and its clinical diagnostic value

Background

Brain‐derived neurotrophic factor (BDNF) is considered to be one of the best candidate genes for depression. However, whether sertraline treatment affects the methylation level of this gene remains unknown.

Methods

Fifty‐three patients with depression and 51 healthy controls were included in the study. The methylation level of BDNF exon I was determined in blood samples from these subjects. The Hamilton Depression Scale was used to evaluate the depression status of patients. Single nucleotide polymorphism detection was used for genotyping, and a receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the methylation level of this locus in patients with depression.

Results

There was a significant difference in the methylation level of BDNF exon I between the control and depression groups. No effect of sertraline monotherapy on BDNF methylation was found in subjects with depression. Moreover, no interaction was found between BDNF genotype and the per cent methylation of BDNF exon I. However, methylation at this site was positively correlated with diurnal variation and retardation scores. Blood homocysteine concentrations were significantly reduced by sertraline treatment. No influence of genotype on serum BDNF concentration was found in subjects with depression. The ROC curve showed that methylation of BDNF exon I may be used to distinguish patients from healthy people, to a certain extent.

Conclusion

Methylation of BDNF exon I may be used as a biomarker of depression and may be a therapeutic target for previously untreated depression.

Translation of the Weight-Related Behaviours Questionnaire into a Short-Form Psychosocial Assessment Tool for the Detection of Women at Risk of Excessive Gestational Weight Gain

The identification and measurement of psychosocial factors that are specific to pregnancy and relevant to gestational weight gain is a challenging task. Given the general lack of availability of pregnancy-specific psychosocial assessment instruments, the aim of this study was to develop a short-form psychosocial assessment tool for the detection of women at risk of excessive gestational weight gain with research and clinical practice applications. A staged scale reduction analysis of the weight-related behaviours questionnaire was conducted amongst a sample of 159 Australian pregnant women participating in the Women and Their Children’s Health (WATCH) pregnancy cohort study. Exploratory factor analysis, univariate logistic regression, and item response theory techniques were used to derive the minimum and most predictive questions for inclusion in the short-form assessment tool. Of the total 49 questionnaire items, 11 items, all 4 body image items, n = 4 attitudes towards weight gain, and n = 3 self-efficacy items, were retained as the strongest predictors of excessive gestational weight gain. These within-scale items were highly correlated, exhibiting high item information function value statistics, and were observed to have high probability (p < 0.05) for excessive gestational weight gain, in the univariate analysis. The short-form questionnaire may assist with the development of tailored health promotion interventions to support women psychologically and physiologically to optimise their pregnancy weight gain. Confirmatory factor analysis is now required.

Perinatal Depression, Birth Experience, Marital Satisfaction and Childcare Sharing: A Study in Russian Mothers

BACKGROUND

Over 300,000 women in Russia face perinatal depressive disorders every year, according to the data for middle-income countries. This study is the first attempt to perform a two-phase study of perinatal depressive disorders in Russia. The paper examines risk factors for perinatal depressive symptoms, such as marital satisfaction, birth experience, and childcare sharing.

METHODS

At 15-40 gestational weeks (M = 30.7, SD = 6.6), 343 Russian-speaking women, with a mean age of 32 years (SD = 4.4), completed the Edinburgh Postnatal Depression Scale, Couples Satisfaction Index, Birth Satisfaction Scale, and provided socio-demographic data. Two months after childbirth, 190 of them participated in the follow-up.

RESULTS

The follow-up indicated that 36.4% of participants suffered from prenatal depression and 34.3% of participants had postnatal depression. Significant predictors of prenatal depression were physical well-being during pregnancy (β = -0.25; p = 0.002) and marital satisfaction during pregnancy (β = -0.01; p = 0.018). Birth satisfaction (β = -0.08; p = 0.001), physical well-being at two months after delivery (β = -0.36; p < 0.01), and marital satisfaction during pregnancy (β = 0.01; p = 0.016) and after delivery (β = -0.02; p < 0.01) significantly predicted postnatal depression at 2 months after delivery.

CONCLUSION

Our study identified that physical well-being during pregnancy and marital satisfaction during pregnancy significantly predicted prenatal depression. Birth satisfaction, physical well-being at 2 months after delivery, and marital satisfaction during pregnancy and after delivery significantly predicted postnatal depression. To our knowledge, this is the first study of perinatal depressive disorders in the context of marital satisfaction and birth satisfaction in the Russian sample. The problem of unequal childcare sharing is widely spread in Russia. Adjusting spousal expectations and making arrangements for childcare may become the focus of psychological work with the family. The availability of psychological support during pregnancy and labor may be important in the context of reducing perinatal depression risks.

[Suicidality in the perinatal period: Descriptive study on factors associated with suicidal ideation among women hospitalized in the perinatal period at the specialized hospital center]

OBJECTIVES

Suicide is the leading cause of maternal mortality in high-resource countries. The onset of suicidal ideation is a major risk factor for suicide attempts. Suicidality has a major impact on the mother-baby relationship and on child development. The main objective of the study was to identify factors associated with the occurrence of perinatal suicidal ideation in women requiring hospitalization. The secondary objectives of the study were to describe the socio-demographic and clinical characteristics of this specific population, to specify the follow-up procedures at hospital discharge and to develop a semi-directed interview framework for psychiatric evaluation of perinatal patients admitted to a psychiatric hospital in order to better identify those at risk of suicide and improve overall management, particularly in terms of referral to existing perinatal care services.

METHODS

Descriptive and retrospective study carried out at the Specialized Hospital Center of women hospitalized in the perinatal period between 2014 and 2019. The inclusion criteria were: inpatient pregnant or postpartum within one year of delivery, 16 to 43 years. A keyword search was performed to retrieve the computerized records. All records matching the inclusion criteria were included. We studied the occurrence of suicidal ideation according to the main known clinical and socio-demographic risk factors.

RESULTS

The sample included 25 pregnant patients and 57 post-partum patients. The presence of a psychiatric history increased the risk of suicidal ideation by 4.38 (P<0.03). The association between the occurrence of a stressful life event and the risk of suicidal ideation onset was close to significant (P<0.10). One third of the patients had been admitted for a reason related to suicidality. Less than one-third of the patients had been referred to existing perinatal services.

CONCLUSIONS

Suicidality in the perinatal period has a major impact on the dyad as well as on the whole family. The search for suicidal ideas must be systematic during psychiatric interviews, a fortiori when a psychiatric history has been authenticated. Every patient hospitalized in adult psychiatry should be referred to specialized outpatient perinatal psychiatry services. Prevention involves raising awareness and training of all health professionals, networking, but also informing the general public.

Predictors of mothers' postpartum body dissatisfaction based on demographic and fertility factors

Background

There are fundamental and rapid changes in body shape during pregnancy, some of which persist for an extended time after delivery and may cause dissatisfaction with body shape. Therefore, we conducted this study to determine predictors of body dissatisfaction at six months postpartum based on demographic and fertility factors.

Methods

This cross-sectional study was conducted on 300 women who referred to seven health centers affiliated with Iran University of Medical Sciences, Tehran, Iran. The sampling was multistage and we collected data from a demographic and fertility questionnaire and Cooper’s Body Shape Questionnaire (BSQ-34). The independent t-test, Mann-Whitney U test, chi-square test, one-way ANOVA, Kruskal-Wallis, Pearson correlation coefficient, and multiple linear regression were used for data analysis. The level of significance was set at P < 0.05.

Results

The mean age of participating women was 29.77 (standard deviation: 5.9) years. Body dissatisfaction had a statistically significant association with variables such as body mass index (BMI) at six months postpartum, gestational age, the receipt of information about body shape, spouse’s views on the shape of a woman’s body, and mode of delivery. These variables predicted 34% of body dissatisfaction based on multiple linear regression.

Conclusion

Postpartum body dissatisfaction is related to a several variables. Paying attention to these variables will help to plan and improve postpartum counseling and educational programs.

Demographic and social-cognitive factors associated with gestational weight gain in an Australian pregnancy cohort

AIM

To identify and describe the demographic and social-cognitive factors associated with excessive gestational weight gain using the Weight-Related Behaviours Questionnaire, within an Australian pregnancy cohort.

BACKGROUND

Supporting women to achieve optimal weight gain in pregnancy is complex. Social-cognitive factors are recognised antecedents to, and mediators of, weight related behaviour change. Less is known about their role during pregnancy.

METHODS

159 women enrolled in a pregnancy cohort study completed the Weight-Related Behaviours Questionnaire (WRBQ) at approximately 19 weeks gestation, and total gestational weight gain was later measured at 36 weeks. Summary scores were reported descriptively. Multivariable logistic regression was used to test demographic (maternal age, pre pregnancy body mass index, parity, smoking status, marital status, education) and social-cognitive factors (weight locus of control, self- efficacy, attitudes towards weight gain, body image, feelings about motherhood, career orientation) as predictors of excessive gestational weight gain.

FINDINGS

Maternal age was the sole demographic factor predictive of excessive gestational weight gain. Older participants (34-41 yrs) were less likely to gain excessive weight when compare to younger participants (18-24 yrs): Odds Ratio 0.20, 95% Confidence Interval 0.05, 0.82. Body image (measured as personal satisfaction and perception of own weight) was the sole social-cognitive factor associated with excessive gestational weight gain. For every one unit improvement in body image score, there was a 33% decreased odds of excessive gestational weight gain (OR 0.67, 95% CI 0.53, 0.85).

CONCLUSION

This study suggests that younger maternal age and lower perceived body image are predictive of excessive gestational weight gain.

Mumbod? A comparison of body image and dietary restraint among women with younger, older, and no children

Pregnancy and the postpartum period are times of significant body, and body image changes for women. Adult women (N = 885) aged 21 to 47 years old completed an online questionnaire. Mothers of young children (0-5 years) had significantly lower levels of body shame, self-objectification, and dietary restraint than women without children, and women with school-aged (6-10 years) children had significantly lower self objectification than women without children, once we controlled for age. BMI predicted body shame more than motherhood status. This research has implications for the development of appropriate body image interventions for adult women.

Maternal Obesity and Perinatal Depression: An Updated Literature Review

The objective of this review was to determine if there is an association between maternal obesity and increased risk of perinatal depression. Original research articles were found by conducting an electronic database search of PubMed, ClinicalKey, PsycINFO, and Cochrane Library. Seven articles, published in the last five years, were reviewed. Of the seven articles, five demonstrated an association between some level of maternal obesity and increased risk of perinatal depressive symptoms. The two remaining articles did initially find an association, but it was no longer significant after adjusting for or mediating the analysis with covariates. There appears to be an association between peripartum depressive symptoms and some level of maternal obesity and its comorbidities. More research is needed to determine the mechanism and degree of the association and its clinical significance.

Associations of body dissatisfaction with anxiety and depression in the pregnancy and postpartum periods: A longitudinal study

BACKGROUND

Pregnancy is a time of increasing vulnerability to the development of body dissatisfaction, anxiety, and depression. The present study aims to examine associations of body dissatisfaction with anxiety and depression at the following points: 6 months before pregnancy (retrospective report); in the first, second, and third trimesters of pregnancy; and up to 6 weeks postpartum.

METHODS

A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 1,371 Chinese pregnant women in Hong Kong was assessed using standardized instruments at four time points.

RESULTS

A mixed-effects model with repeated measures revealed that body dissatisfaction and depression symptoms changed across different stages of pregnancy. Hierarchical multiple regressions showed that, after adjusting for the identified risk factors, body dissatisfaction before and during pregnancy were positively associated with antenatal anxiety and depression symptoms. Concurrent body dissatisfaction was positively associated with postpartum depression symptoms.

LIMITATIONS

There was a high attrition rate in the follow-up assessments. Antenatal anxiety symptoms were assessed using the scale for general anxiety, which may not adequately capture the experience of anxiety among pregnant women.

CONCLUSIONS

Primary healthcare practitioners should be made aware of body dissatisfaction among pregnant women in order to facilitate early intervention for anxiety and depression, because untreated psychological disturbance during pregnancy may persist into the postpartum period.

Clinical and Cost-Effectiveness of Personalized Tele-Based Coaching for Farmers, Foresters and Gardeners to Prevent Depression: Study Protocol of an 18-Month Follow-Up Pragmatic Randomized Controlled Trial (TEC-A)

Background: Farmers show high levels of depressive symptoms and mental health problems in various studies. This study is part of a nationwide prevention project carried out by a German social insurance company for farmers, foresters, and gardeners (SVLFG) to implement internet- and tele-based services among others to improve mental health in this population. The aim of the present study is to evaluate the (cost-)effectiveness of personalized tele-based coaching for reducing depressive symptom severity and preventing the onset of clinical depression, compared to enhanced treatment as usual. Methods: In a two-armed, pragmatic randomized controlled trial (N = 312) with follow-ups at post-treatment (6 months), 12 and 18 months, insured farmers, foresters, and gardeners, collaborating family members and pensioners with elevated depressive symptoms (PHQ-9 ≥ 5) will be randomly allocated to personalized tele-based coaching or enhanced treatment as usual. The coaching is provided by psychologists and consists of up to 34 tele-based sessions for 25-50 min delivered over 6 months. Primary outcome is depressive symptom severity at post-treatment. Secondary outcomes include depression onset, anxiety, stress, and quality of life. A health-economic evaluation will be conducted from a societal perspective. Discussion: This study is the first pragmatic randomized controlled trial evaluating the (cost-)effectiveness of a nationwide tele-based preventive service for farmers. If proven effective, the implementation of personalized tele-based coaching has the potential to reduce disease burden and health care costs both at an individual and societal level. Clinical Trial Registration: German Clinical Trial Registration: DRKS00015655.