High incidence of body image dissatisfaction in pregnancy and the postnatal period: Associations with depression, anxiety, body mass index and weight gain during pregnancy

Problematic social media use and psychological distress in pregnancy: The mediating role of social comparisons and body dissatisfaction

BACKGROUND

Pregnancy can be experienced as a significant transition for many women with associated body dissatisfaction, depression, pregnancy-related anxiety, and disordered eating attitudes. Problematic Social Media Use (PSMU) creates abundant opportunities for women to compare themselves with others and expose themselves to sociocultural influences which may increase body dissatisfaction and psychological distress.

AIMS

This study examined whether the relationship between PSMU and psychological distress (defined as depression, pregnancy-related anxiety and disordered eating attitudes) was mediated by negative social comparisons and body dissatisfaction.

METHOD

A sample of 225 pregnant Australian women (Mage = 31.91 years, SDage = 4.39) recruited online, completed self-report measures related to the variables of interest.

RESULTS

PSMU was associated with higher levels of depression, pregnancy-related anxiety, and disordered eating attitudes. Negative social comparisons and body dissatisfaction partially mediated the relationship between PSMU and pregnancy-related anxiety and depression, and fully mediated the relationship between PSMU and disordered eating attitudes.

LIMITATIONS

Cross-sectional nature of the study limited our ability to determine the direction of the relationships. Moreover, the recruitment method via social media led to high rates of non-completion.

CONCLUSION

The findings of this study suggest that problematic social media usage during pregnancy may increase depression, pregnancy-related anxiety and disordered eating attitudes. This study identified potential pathways that may explain this relationship, (via social comparisons and body dissatisfaction). This study highlights the potentially negative impact of social media use amongst expectant mothers and the importance of screening for body dissatisfaction in routine antenatal care.

The trajectory of body image dissatisfaction during pregnancy and postpartum and its relationship to Body-Mass-Index

BACKGROUND

During pregnancy, women's bodies undergo rapid body weight and size changes within a relatively short period. Pregnancy may therefore, be associated with an increased vulnerability for developing body image dissatisfaction linked to adverse health outcomes for the mother (e.g., depression, eating disorders) and child (e.g., impaired self-regulation, childhood obesity). The present study aims to examine the prevalence and trajectories of body image dissatisfaction during pregnancy and postpartum and its relationship to pre-pregnancy BMI. This is the first study that investigates prevalence rates of body image dissatisfaction not only ante- but also postpartum, and that compares trajectories of women with normal weight and overweight.

METHODS

A prospective longitudinal design with a quantitative approach was applied. Healthy pregnant women (N = 136) answered paper-pencil or online questionnaires at four time points (18th-22nd and 33rd-37th week of gestation, 3 and 6 months postpartum). Body image dissatisfaction was assessed using the German version of the Body Shape Questionnaire (BSQ) and the Eating Disorder Examination Questionnaire (EDE-Q). Both questionnaires are considered reliable and valid measures of several aspects of body image, and the BSQ allows for calculating prevalence rates by providing cut-off values. Using not just one but two body image questionnaires, trajectories of body image dissatisfaction can be compared. Pre-pregnancy BMI was assessed retrospectively via self-reported weight and height.

RESULTS

The proportion of women reporting elevated levels of body image dissatisfaction was 6.6% (n = 9) in the second trimester, 2.9% (n = 4) in the third trimester, 11.0% (n = 15) three months postpartum, and 10.3% (n = 14) six months postpartum. Repeated measures ANOVA revealed that body image dissatisfaction significantly decreased from pre-pregnancy to pregnancy, remained stable during pregnancy, and returned to pre-pregnancy levels three to six months postpartum. Mixed between-within ANOVA showed that the overweight/obese group reported significantly higher levels of body image dissatisfaction at each measurement point except during the third trimester than women in the normal weight group. Significant but small interaction effects between time and pre-pregnancy BMI were found.

CONCLUSIONS

The results revealed that approximately every tenth woman is affected by body image dissatisfaction after childbirth. Women with a higher BMI level before pregnancy are particularly at risk of experiencing body image dissatisfaction. Healthcare providers should screen for body image dissatisfaction, in particular after childbirth, and inform affected women about possible adverse health outcomes and treatment options. Study limitations concern the drop-out rate of 51.4% and the retrospective and self-reported assessment of pre-pregnancy BMI. Future studies should include additional assessment points in the first trimester and more than six months postpartum and try to include a matched control group of non-pregnant women to compare prevalence rates and trajectory of body image dissatisfaction.

Reliability and validity of the Japanese version of the Pregnancy and Weight Gain Attitude Scale

This study aimed to develop the Japanese version of the Pregnancy and Weight Gain Attitude Scale (J-PWGAS) as a measurement of body image regarding body weight and shape during pregnancy. This cross-sectional study was conducted at a perinatal medical center in Osaka, Japan, between March and November 2020. We recruited pregnant women in their second or third trimester, who were 20 years old or older and without pregnancy complications. This study evaluated the criterion validity, construct validity, internal consistency, and test-retest reliability. Of the participants, 218 and 102 women participated in the validation and test-retest reliability studies, respectively. An exploratory factor analysis revealed a 17-item, five-factor structure. The J-PWGAS indicated acceptable criterion validity, internal consistency, and test-retest reliability. The J-PWGAS can measure attitudes toward gestational weight gain in Japanese pregnant women and would be useful in examining the association of body image with weight gain and psychological status during pregnancy.

The role of bodily experiences during pregnancy on mother and infant outcomes

Pregnancy is a transformative time for women and their bodies, and therefore thoughts and feelings and about one's own body and internal bodily sensations may understandably change during this period. Body satisfaction and interoception have been found to influence factors such as antenatal attachment (AA) and maternal mental health. However, mixed results in the literature suggest complex relationships between the bodily experience during pregnancy and outcomes, necessitating a broader investigative approach. We aim to examine the relationship between the pregnancy bodily experience and multiple mother-infant outcomes. It is hypothesised that poor bodily experiences during pregnancy will have negative impacts on these outcomes. Cross-sectional online survey data was collected from individuals at various gestations throughout pregnancy as part of a larger longitudinal study (N = 253, mean age = 32). We analysed validated measures of pregnancy body satisfaction, interoceptive sensibility, AA and mood, as well as intentions to breastfeed. Linear regressions were used to confirm findings from previous literature and a network analysis allowed for a more exploratory approach to understanding the importance of the bodily experience during pregnancy. Multiple regressions found low body satisfaction predicts higher levels of anxiety, depression and AA. A network analysis revealed relationships between body satisfaction and interoception during pregnancy and mother-infant outcomes, including depression and AA. Our results highlight the far-reaching effects of poor bodily experiences during pregnancy on a variety of outcomes. Understanding the impact of the pregnant bodily experience can help identify at-risk individuals and inform interventions.

The body image experiences of breastfeeding mothers in the UK: A qualitative exploration

Despite the well-documented benefits of breastfeeding, the UK has one of the lowest breastfeeding rates in the world. One of the areas that has been identified as impacting on a woman's experience of breastfeeding is body image. The aim of this study was to explore the body image experiences of breastfeeding mothers in the UK. Eighteen female participants were interviewed about their thoughts and feelings around their body image, specifically in relation to their breastfeeding. Three themes were developed following thematic analysis of the data: Breastfeeding as a functional tool, Body confidence and breastfeeding in public and Not feeling like the real me: a loss of identity. Implications of the findings are discussed, with suggestions for health promotion and ideas for encouraging a more positive body image in pregnant and breastfeeding women, with the hope of improving breastfeeding rates and experiences.

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.

Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety

INTRODUCTION

Over the past few years, Lebanon-a developing country-has faced a plethora of economic and political challenges, with more than half of the general population presenting depressive and anxiety symptoms. However, when it comes to maternal mental health during pregnancy, the last examination in Lebanon dates far back to 2005. Our study's aim was to help delineate the factors associated with Lebanese women's mental health disorders during pregnancy, namely antepartum depression and anxiety.

METHODS

We launched a cross-sectional study among Lebanese pregnant women (age ≥ 18 years) between June and July 2021, during the COVID-19 lockdown (N = 433).

RESULTS

In total, 87.8% of the participants experienced depression (mild to severe), where severe depression was observed in 7.9%. In addition, 70.3% had a significant level of anxiety. Increased pregnancy-specific hassles (beta = 0.93), being Muslim compared to Christians (beta = 3.19), being afraid of an existing aggressor (beta = 8.75), urinary tract infections (beta = 2.02), and higher gestational age (beta = 0.07) were significantly associated with higher depression, whereas higher physical activity index (beta =  - 0.09) and increased disordered eating attitudes during pregnancy (beta =  - 0.27) were significantly associated with less depression, all accounting for 60.4% of the model's variance. Additionally, increased pregnancy-specific hassles (beta = 0.54), being Muslim compared to Christians (beta = 2.42), urinary tract infections (beta = 1.72), and having been emotionally or physically abused (beta = 1.19) were significantly associated with higher levels of anxiety and could predict 49% of the total variance.

CONCLUSION

Our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese pregnant women, namely cultural beliefs, pregnancy-related distress, medical complications during pregnancy, and a history of abuse. Therefore, it would be judicious to implement screening programs targeting pregnant women at risk for antepartum depression and anxiety. In addition, high rates of prenatal depression and anxiety were detected among our sample, supporting that recognizing and treating maternal mental health disorders should be prioritized during antenatal care in Lebanon.

Effect of social media on body image of pregnant and postpartum women in India

In the present times, there is a high influence caused by social media platforms in case of body image issues faced by an individual. Pregnancy is a stage for women where they go through several mental and physical changes. Realizing the inseparable role played by social media in this aspect, it is an attempt here to determine the effect caused by social media on the body image of pregnant women as well for those in their post-partum stages. The PRISMA method is used by the authors to arrive at 55 research papers from the Scopus databases that are systematically reviewed. The authors' review reveals that social media can have both negative and positive effects on women's perception of body image during pregnancy and the postpartum period.

Validation of an Arabic version of the eating disorder inventory's body dissatisfaction subscale among adolescents, adults, and pregnant women

INTRODUCTION

The 9-item Body Dissatisfaction Subscale (BDS) of the Eating Disorder Inventory is one of the most used tools for assessing thinness-oriented body dissatisfaction in research and clinical practice. However, no validated Arabic version of this scale exists to date. In this study, we sought to validate this instrument in three samples of native Arabic-speaking adolescents, adults, and pregnant women from Lebanon.

METHODS

A total of 826 adults, 555 adolescents, and 433 pregnant women were included. To examine the factor structure of the BDS, we performed an exploratory factor analysis (EFA), using a principal component analysis via the FACTOR software on the first split-half subsample among Lebanese adults. We used data from the second split-half in the adult sample to conduct a Confirmatory Factor Analysis (CFA) through the SPSS AMOS v.29 software. That verified model was tested via CFA on adolescents and pregnant women.

RESULTS

The EFA showed a bidimensional structure for the BDS, with all 9 items retained and divided into Factor 1 = Body Satisfaction (negatively-worded items) and Factor 2 = Body Dissatisfaction (positively-worded items). The CFA demonstrated invariable goodness-of-fit of the instrument in the three studied populations. McDonald's omega values were also adequate in the three samples, demonstrating its reliability. Moreover, the BDS showed invariance across sex among both adolescents and adults. Finally, higher BDS scores were correlated with more disordered eating, less body appreciation and less functionality appreciation, thus attesting to convergent validity of the scale. In addition, BDS scores correlated positively with depression and anxiety scores, indicating adequate patterns of divergent validity.

CONCLUSION

In light of our findings, we endorse the use of the BDS by healthcare professionals in Arabic-speaking countries, in order to assess thinness-oriented body dissatisfaction in an appropriate and timely manner and ease early referral to a specialist, thereby preventing the deleterious health-related risks associated with this condition.

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.

Depression, sleep quality, and body image disturbances among pregnant women in India: a cross-sectional study

BACKGROUND

Pregnancy is associated with a number of physical, emotional, and biological changes that can exacerbate maternal psychological disturbances, such as body image concerns and depression. Sleep disturbances during pregnancy can also have adverse impacts. This study aimed to determine the prevalence of depression, sleep disturbances, and body image concerns among pregnant women. The study also examined the relationship between these factors and pregnancy-related variables, such as bad obstetric history and whether the pregnancies were unplanned.

METHODS

A cross-sectional study of 146 pregnant patients was conducted at a tertiary care center over 15 months. The patients were administered the Beck Depression Inventory, Pittsburgh Sleep Quality Index, and Body Image Concern Inventory questionnaires. Contingency tables, Fisher exact test, and Spearman correlation were used to identify underlying relationships.

RESULTS

The prevalence of depression was 22.6%. Although body image disturbance was noted in only 2.7% of patients, 46.6% had poor sleep quality. Poor sleep was associated with primigravida status. Bad obstetric history and unplanned pregnancy were associated with depression. Depression was found to be significantly correlated with body image disturbances and poor sleep quality.

CONCLUSION

Psychiatric disorders were prevalent during pregnancy. This study highlights the importance of screening for depression in pregnant patients. Counselling and caregiver education can be useful for mitigating psychological disturbances. Management of pregnancies by multidisciplinary teams that include psychiatrists could be immensely useful in improving the pregnancy experiences of patients.

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.

Internalized Weight Bias, Weight-Related Experiences, And Peripartum Weight

INTRODUCTION

The purpose of this study was to investigate internalized weight bias (IWB) and its relationship with pregnancy-related weight changes and postpartum depression. IWB is defined as the internalization of negative attitudes and beliefs about people due to their weight. Although IWB has been linked with weight change and depression in other samples, it has never been investigated in the postpartum period.

METHODS

We used a cross-sectional survey design. Participants were 251 women recruited via social media who were living in the United States and 6 to 12 months postpartum. We calculated percentage of body weight gained during pregnancy and percentage of that weight that was retained postpartum from self-reported weights. Participants completed self-report measures of IWB (modified version of the Weight Bias Internalization Scale) and postpartum depression (Edinburgh Postnatal Depression Scale).

RESULTS

Gestational weight gain was not significantly associated with IWB or depression. Postpartum retention of gestational weight was significantly positively associated with both IWB and depressive symptoms. Furthermore, IWB mediated the relationship between postpartum weight retention and depressive symptoms.

DISCUSSION

Postpartum retention of weight gained during pregnancy, but not weight gain itself, was related to both IWB and depressive symptoms. The relationship between pregnancy-related weight changes and psychological distress is complex. Sociocultural pressures to return to a prepregnancy physical state swiftly after giving birth may increase risk for IWB during a time in life when stress is already likely to be high, posing additional psychological risk. IWB existing prepregnancy may also worsen postpartum self-concept, contributing to depression. This is the first study, to our knowledge, to directly assess associations among gestational weight change, IWB, and postpartum depression. In addition to discussing weight in pregnancy, perinatal care providers could improve postpartum health by helping women set realistic, body-positive goals 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.

Exploring body dissatisfaction in pregnancy and the association with gestational weight gain, obesity, and weight stigma

OBJECTIVE

Body dissatisfaction in pregnancy has been associated with negative psychological maternal outcomes, including increased risk of postpartum depression. This study aimed to explore weight-related factors that influence body dissatisfaction in pregnancy, including gestational weight gain (GWG), weight stigma, obesity, and weight loss attempts before pregnancy.

DESIGN

Secondary analysis of a larger cross-sectional study.

SETTING

Online survey administered via Qualtrics.

PARTICIPANTS

≥12 weeks pregnant, ≥18 years of age, having a singleton pregnancy and residing in Canada.

MEASUREMENTS AND FINDINGS

A battery of questionnaires were completed, including the Body Image in Pregnancy Scale (BIPS) sub-scale. The BIPS scores were compared based on experiences of weight stigma in pregnancy, perception towards their GWG, weight loss attempts before pregnancy, obesity, and GWG category classified as excessive or not referring to Institute of Medicine (2009) guidelines. Significant differences were entered into a linear regression model with BIPS scores as the dependent variable. Significance was accepted as p<0.05. A total of 182 participants completed the survey. There were no differences in BIPS scores based on GWG category (p = 0.160), or obesity (p = 0.230). Poorer BIPS scores were reported by those who felt they had gained 'too much' pregnancy weight than 'appropriate' (p<0.001), and among those who were trying to lose weight before pregnancy compared to those who were not (p = 0.002). Poorer BIPS scores were also reported by individuals who indicated they had experienced weight stigma during pregnancy compared to those who had not (p<0.001). Regression results showed that significant variables were perceptions towards GWG (p = 0.003) and experiencing weight stigma in pregnancy (p = 0.011).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Perceptions towards GWG and experiencing weight stigma can influence body dissatisfaction in pregnancy. Given the detrimental physical and psychological consequences of body dissatisfaction, effective strategies to reduce prenatal weight stigma are needed, such as training maternal healthcare providers to offer sensitive preconception and prenatal weight counselling.

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.

How prepartum appearance-related attitudes influence body image and weight-control behaviors of pregnant Japanese women across pregnancy: Latent growth curve modeling analyses

A thin female physique is idealized in modernized societies, leading many pregnant women to experience body dissatisfaction and avoid weight gain, as pregnancy directs their body away from the sociocultural ideal of thinness. However, not all pregnant women report body dissatisfaction and/or weight-control behavior. We aimed to discern how prepartum weight-related attitudes-thin-ideal internalization, drive for thinness, and appearance comparison tendency-influence changes in negative attitudes toward a pregnant body, body image, and weight-control behavior across pregnancy. Data were longitudinally collected from 208 Japanese pregnant women (Mage = 27.0, SD = 1.74) across three pregnancy periods. Results indicated that overall, negative attitudes toward appearance change during pregnancy, weight-control behaviors, and restrained eating significantly changed across pregnancy. Moreover, those with higher prepartum thin-ideal internalization showed greater decreases in negative attitudes toward appearance change during pregnancy and greater increases in body dissatisfaction, whereas those with higher prepartum drive for thinness and appearance comparison tendency showed greater decreases in restrained eating across pregnancy. Our findings suggest that pregnant women with certain prepartum weight-related attitudes may experience an aggravation of body dissatisfaction while following dietary regimen during pregnancy. Thus, prevention programs may selectively help them reduce their negative body image during pregnancy.

A Conceptual Analysis of Mental Health Maladaptation in Postpartum

Aim: This concept analysis aims to explore how the concept of maladaptation applies to mental health changes among postpartum women. Background: The concept of maladaptation is utilized throughout various disciplines but minimally in women's health, including a limited focus on maladaptive body dissatisfaction and perfectionistic beliefs of women in the postpartum period. Methods: The Walker and Avant eight-phase model was used to guide this analysis. Data Source: A search for maladaptation articles through Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, ProQuest, and PubMed databases, as well as Google Scholar, was conducted. Results: A review of the literature concerning maladaptation in postpartum mental health resulted in defining two key attributes, including conforming to cultural norms of body image and pressure of perfection. In understanding maladaptation and its attributes, childbirth educators and health-care professionals will be able to better determine more contributing factors for postpartum depression (PPD) and formulate a plan that includes early intervention and support. Conclusion: This concept analysis is intended to improve maternal and neonatal health outcomes by understanding mental health maladaptations related to PPD.

Does Appearance Matter during Pregnancy? A Cross-Sectional Study of Body Satisfaction from Pre-Pregnancy to Late Gestation

Few studies have explored the associations between body satisfaction and physical activity and weight gain during pregnancy, and none have been conducted in Scandinavia. Hence, the aim of the present study was to evaluate changes in body satisfaction from pre-pregnancy to late pregnancy and investigate whether this differed according to parity. We also wanted to explore the association between body satisfaction and physical activity and weight gain among pregnant women in Norway. This cross-sectional survey used an electronic questionnaire to assess physical activity level, weight gain and women's satisfaction with body weight and size. In total, 150 pregnant women answered the questionnaire. Related-samples Wilcoxon signed rank tests, Mann-Whitney U tests and chi-square tests were used to answer our research questions. The proportion of women who were dissatisfied with their body weight and shape increased from pre-pregnancy to late gestation (body weight p = 0.030 and body shape p = 0.040). Body dissatisfaction before and during pregnancy was linked to weight gain above recommendations. Characterising oneself as physically active prior to pregnancy was associated with satisfaction with body shape pre-pregnancy. Given that mothers strongly influence how a child will judge their body later in life, the results of this study underline the importance of addressing these issues during pregnancy.

Self-compassion and body image in pregnancy and postpartum: A randomized pilot trial of a brief self-compassion meditation intervention

The current study evaluated the efficacy of a three-week self-compassion (SC) meditation intervention in improving body image and SC during pregnancy and postpartum. Participants (n = 71; age = 31.92 ± 3.98 years; white = 61, 85.9%; intervention = 35, 49.3%; pregnant = 33, 46.5%; postpartum = 38, 53.5%) were recruited from a health coaching program and 35 were randomly assigned into a three-week SC meditation intervention while 36 were randomly assigned to a waitlist control condition. Linear regressions using full-information maximum likelihood estimation examined the effect of intervention group on body image and SC outcomes controlling for baseline level of outcome, pregnancy or postpartum status, previous meditation experience, and physical activity. Results indicated women in the intervention group reported significantly reduced body shame and body dissatisfaction and improved body appreciation and self-compassion compared to women in the control group. Implementation of a brief SC meditation intervention during pregnancy and postpartum has potential to improve mental health outcomes related to body image. Future work should replicate this study with a larger, more diverse sample of women.

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.

Interoceptive sensibility and body satisfaction in pregnant and non-pregnant women with and without children

Pregnancy is a time of great physical and psychological change. As well as prominent changes in the external appearance of the body, such as the baby bump, there are also substantial changes taking place within the body. Our awareness of, and attention towards, internal bodily signals (interoception) is thought to have a direct impact on how we feel about our bodies. Therefore, understanding how our experience of these interoceptive signals might change during pregnancy may have important implications for maternal wellbeing. This study examined body satisfaction and interoceptive sensibility (subjective experience of interoception) in pregnant and non-pregnant women with and without children. Feelings towards pregnancy-specific changes in body satisfaction and interoceptive sensibility were also examined in women in their first pregnancy (primigravida) and subsequent pregnancies (multigravida). It was found that pregnancy did not directly impact levels of body satisfaction, instead pregnant and non-pregnant women with children reported less satisfaction with their bodies compared to those without children. Primigravida women were more satisfied with the appearance of pregnancy specific bodily changes compared to multigravida women. Interestingly, these differences in body satisfaction in those with children (pregnant and non-pregnant) were mediated by the extent to which women trusted their bodies (measure of interoceptive sensibility). All other pregnancy related changes in interoceptive sensibility and body satisfaction were either non-significant or had small effect sizes. These results may suggest body trust as an important factor to support during the transition to parenthood in order to improve body satisfaction in mothers.

Course and prediction of body image dissatisfaction during pregnancy: a prospective study

Background

During pregnancy, women`s bodies undergo rapid changes in body weight and body size within a relatively short period of time. Pregnancy may therefore be associated with an increased vulnerability for the development of body image dissatisfaction that has been linked to adverse health outcomes for mother and child. The present study aims to examine changes in body image during pregnancy as well as predictors of body image dissatisfaction. This is the first study using a tailored, multidimensional measure of body image especially developed for the pregnant population.

Methods

A prospective longitudinal design with a quantitative approach was applied. Healthy pregnant women (N = 222) were assessed using standardized instruments at two time points (T1: 18th-22th week of gestation, T2: 33th-37th week of gestation). The impact of demographic, weight- and health-related, behavioral, and psychological factors assessed at T1 on body image dissatisfaction at T1 and T2 was examined using stepwise linear regression analyses.

Results

T-tests for paired samples revealed that dissatisfaction with strength-related aspects of body image, dissatisfaction with body parts, and concerns about sexual attractiveness increased significantly from the middle to the end of pregnancy. In contrast, preoccupation with appearance, dissatisfaction with complexion, and prioritization of appearance over function were significantly reduced over time. Stepwise linear regression analyses revealed that factors influencing body image depend on the component of body image investigated. Overall, a low level of self-esteem and a high level of pregnancy-specific worries were risk factors for several components of body image dissatisfaction. Besides these, poor sleep quality, low levels of physical activity, disturbed eating behavior, and higher levels of BMI and weight gain were significant predictors.

Conclusions

The results highlight the multidimensional nature of body image and show positive as well as negative changes during pregnancy. Overall, modifiable psychological, behavioral, and weight-related factors appear relevant to the extent of body image dissatisfaction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05050-x.

The role of body dissatisfaction and self-compassion in pregnancy-related anxiety

BACKGROUND

Women undergo significant physical, physiological, and psychological changes during pregnancy. They are also exposed to sociocultural pressure to meet appearance-related ideals. These pregnancy-related changes and sociocultural appearance-related pressures may place pregnant women at greater vulnerability to developing body dissatisfaction and psychological distress. To date, however, little is known about how sociocultural pressure may influence pregnancy-related anxiety, or factors that may protect against such distress during pregnancy. This study examined whether body dissatisfaction mediated the relationship between appearance-related sociocultural pressure and pregnancy-related anxiety, and whether this relationship was moderated by self-compassion and/or self-criticism.

METHOD

A cross-sectional sample of 253 pregnant women (M_age = 26.28, SD_age = 4.43) completed an online questionnaire measuring sociocultural pressure, body dissatisfaction, pregnancy-related anxiety, and self-compassion.

RESULTS

Moderated mediation analyses revealed body dissatisfaction fully mediated the relationship between sociocultural pressure and pregnancy-related anxiety. Analyses confirmed the moderating role of self-compassion and self-criticism on the relationship between sociocultural pressure and body dissatisfaction, but not on the relationship between body dissatisfaction and pregnancy-related anxiety.

LIMITATIONS

The cross-sectional nature of this study limits confirmation of the direction of relationships between sociocultural pressure, body dissatisfaction and pregnancy-related anxiety.

CONCLUSIONS

While the findings of this study need to be replicated in prospective and longitudinal studies, they suggest that sociocultural pressure to meet appearance-related standards contribute to body dissatisfaction, which in turn may facilitate pregnancy-related anxiety. Self-compassion may protect the body image of pregnant women against negative effects of appearance-related sociocultural pressure.

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.

Relationship of Self-Esteem With Body Image and Attitudes Toward Motherhood and Pregnancy

The current study aimed to determine the relationship of self-esteem with attitudes toward motherhood and pregnancy and body image in Iranian pregnant women. This cross-sectional study included 228 women from Tabriz, Iran. A cluster random sampling method was used. Instruments were the Rosenberg Self-Esteem Scale, Scale of Attitudes Toward Motherhood and Pregnancy, and Multidimensional Body-Self Relations Questionnaire. To determine the correlation of self-esteem with attitudes toward motherhood and body image, Pearson correlation test was used in bivariate analysis, and the general linear model (GLM) with adjustment of potential confounders was used in multivariate analysis. There was a direct correlation between self-esteem and body image (r = 0.63) and attitudes toward motherhood (r = 0.45). Results of the GLM showed a significant improvement in attitudes toward motherhood (p < 0.001) and body image (p < 0.001) as self-esteem increased. Based on these results, mental health counseling is recommended to promote pregnant women's self-esteem. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Validity and reliability of the Turkish version of the Body Understanding Measure for Pregnancy scale (BUMPs)

PURPOSE

This study aimed to determine the validity and reliability of the Body Understanding Measure for Pregnancy scale by adapting it to Turkish society.

DESIGN AND METHODS

This methodological study was conducted with 265 pregnant women.

FINDINGS

We performed exploratory factor analysis and determined that the scale consists of 17 items and 2 subdimensions. The two-factor structure was confirmed as a result of the confirmatory factor analysis. The Cronbach's alpha value of the scale was 0.87.

PRACTISE IMPLICATIONS

The Body Understanding Measure for Pregnancy scale is a valid and reliable measurement tool for measuring the body satisfaction of pregnant women for Turkish society.

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.

The psychometric properties and validity of the Turkish version of the Body Image in Pregnancy Scale (BIPS-Turkish)

In our study, we aimed to assess the validity and reliability of the Turkish version of the Body Image in Pregnancy Scale (BIPS). A total of 220 pregnant women participated in the study. The content validity of the scale was evaluated by the content validity index (CVI) and its construct validity was evaluated by confirmatory factor analysis (CFA). The reliability of the scale was assessed with internal consistency analysis, item analysis, test-retest reliability, and parallel forms reliability. After the modification, the t values, factor loadings and fit indices of the scale items were at a good and acceptable level (χ2 = 1114.57, df = 505, χ2/df = 2.20, RMSEA = 0.07, SRMR = 0.07, CFI = 0.95, GFI = 0.90). Hence, a 34-item, 7-factor construct was confirmed for the Turkish version of the BIPS. Cronbach's alpha internal consistency coefficient of the overall scale was 0.90 and Cronbach's alpha internal consistency coefficients of the subscales were within the range of 0.65-0.94. Test-retest and parallel forms reliability of the scale were at a sufficient level. In conclusion, it was determined that BIPS can be used as a valid and reliable measurement tool to evaluate body image perceptions of Turkish pregnant women.

Predictors and occurrence of antenatal depressive symptoms in Galle, Sri Lanka: a mixed-methods cross-sectional study

Background

There is a high prevalence of antenatal depression in low-or-middle-income countries, but information about risk factors in these settings is still lacking. The purpose of this study is to measure the prevalence of and explore risk factors associated with antenatal depressive symptoms in Galle, Sri Lanka.

Methods

This study used a mixed-method approach. The quantitative portion included 505 pregnant women from Galle, Sri Lanka, with health record data, responses to psychometric questionnaires (MSPSS and PRAQ-R2), and antenatal depression screening (EPDS). The qualitative portion included interviews with public health midwives about their experiences and routine clinical practices with women with antenatal depressive symptoms.

Results

Prevalence of antenatal depressive symptoms was 7.5%, highest in women over the age of 30 (13.0%, OR = 3.88, 95%CI = 1.71 – 9.97), with diabetes (21.9%, OR = 3.99, 95%CI = 1.50 – 9.56), or pre-eclampsia in a previous pregnancy (19.4%, OR = 3.32, 95%CI = 1.17 – 8.21). Lower prevalence was observed in the primiparous (3.3%, OR = 0.29, 95%CI = 0.12 – 0.64) employed outside the home (3.6%, OR = 0.33, 95%CI = 0.13 – 0.72), or upper-middle class (2.3%, OR = 0.17, 95%CI = 0.04 – 0.56). Anxiety levels were elevated in depressed women (OR = 1.13, 95%CI = 1.07 – 1.20), while perceived social support was lower (OR = 0.91, 95%CI = 0.89 – 0.93). After multivariable adjustment, only parity (OR = 0.20, 95%CI 0.05 – 0.74) and social support from a “special person” (OR = 0.94, 95%CI = 0.77 – 0.95) remained significantly associated with depressive symptoms. Qualitative findings also identified antenatal health problems and poor social support as risk factors for depressive symptoms. They also identified different contributing factors to poor mental health based on ethnicity, higher stress levels among women working outside the home, and misinformation about health conditions as a cause of poor mental health.

Conclusions

Prevalence of antenatal depressive symptoms in Galle is lower than the recorded prevalence in other regions of Sri Lanka. Risk factors for antenatal depressive symptoms were identified on biological, psychological, and social axes. These variables should be considered when developing future guidelines for mental health and obstetric treatment in this context.

Positive attitudes toward weight gain in late pregnancy are associated with healthy eating behaviours

PURPOSE

This cross-sectional study examined the associations between 3rd trimester attitudes toward weight gain and (1) pre-pregnancy BMI, (2) gestational weight gain (GWG) and (3) eating behaviours assessed in the 3rd trimester.

METHODS

Seventy-nine (79) pregnant women completed the French version of the Pregnancy Weight Gain Attitude Scale (PWGAS), the Three-Factor Eating Questionnaire (TFEQ) and the Intuitive Eating Scale-2 (IES-2) in their 3rd trimester. Total GWG was calculated as the difference between the weight recorded before delivery and self-reported pre-pregnancy weight.

RESULTS

Most (55.6%) women gained weight above the Institute of Medicine's (IOM) recommendations, but there was no association between PWGAS scores and total or 3rd trimester GWG. Women with obesity had lower PWGAS total scores compared to women with overweight (3.48 ± 0.6 vs. 3.99 ± 0.3, p = 0.005), indicating more negative attitudes in women with obesity vs. overweight. Higher total PWGAS scores were positively correlated with intuitive eating scores (r = 0.28, p < 0.05), and inversely associated with unfavourable eating behaviours such as dietary restraint (r =  - 0.42, p < 0.01).

CONCLUSION

Women with positive attitudes toward weight gain reported healthier eating behaviours in late pregnancy, which remains to be confirmed in prospective studies. Interventions addressing body image issues during pregnancy may positively influence pregnant women's health, including eating behaviours.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Postpartum Stress and Neural Regulation of Emotion among First-Time Mothers

Early parenting relies on emotion regulation capabilities, as mothers are responsible for regulating both their own emotional state and that of their infant during a time of new parenting-related neural plasticity and potentially increased stress. Previous research highlights the importance of frontal cortical regions in facilitating effective emotion regulation, but few studies have investigated the neural regulation of emotion among postpartum women. The current study employed a functional neuroimaging (fMRI) approach to explore the association between perceived stress, depressive symptoms, and the neural regulation of emotion in first-time mothers. Among 59 postpartum mothers, higher perceived stress during the postpartum period was associated with less self-reported use of cognitive reappraisal in everyday life, and greater use of emotion suppression. While viewing standardized aversive images during the Emotion Regulation Task (ERT), mothers were instructed to experience their natural emotional state (Maintain) or to decrease the intensity of their negative emotion by using cognitive reappraisal (Reappraise). Whole-brain analysis revealed a two-way interaction of perceived stress x condition in the right dorsolateral prefrontal cortex (DLPFC) at p < .05 cluster-wise corrected, controlling for postpartum months and scanner type. Higher levels of perceived stress were associated with heightened right DLPFC activity while engaging in cognitive reappraisal versus naturally responding to negative stimuli. Higher right DLPFC activity during Reappraise versus Maintain was further associated with elevated parenting stress. Findings suggest that stress and everyday reappraisal use is reflected in mothers' neural regulation of emotion and may have important implications for their adaptation to parenthood.

Level of exercise and physical activity among pregnant women in Saudi Arabia: A systematic review

The current study aimed to clarify the health benefits of physical activity on the mother and fetus in the Saudi women population. Besides, it is intended to provide recommendation based on the literature and results of studies from Saudi Arabia for exercise in pregnancy to improve the general health of women in Saudi Arabia. Prenatal physical exercise enhances physical and mental health of pregnant women. It can also reduce the risk of multiple pregnancy-related complications such as; lower back pain, fluid retention and risk of gestational diabetes. All these factors can affect fetal development and life later. Multiple studies showed that prenatal exercise could reduce the risk of fetal macrosomia with no effect on other perinatal or postnatal complications. The study followed the systematic literature review approach where it included multiple medical search Databases using PICOS eligibility criteria up to January 2019. The review was based on the following keywords: pregnancy, gestational, or prenatal) and (physical exercise, exercise, or physical activity. There are only two studies that dealt with physical exercises among Saudi women. The results indicated a relation between prenatal physical exercise on improving or decreasing risks on the mother and child during pregnancy.

Body perception treatment, a possible way to treat body image disturbance in eating disorders: a case-control efficacy study

BACKGROUND

The body image disturbance (BID) is a common symptom in eating disorders, often observed and described in anorexia nervosa (AN) and bulimia nervosa (BN). Recently, this symptom has also been observed in binge eating disorder (BED). The research underlines that the BID presents three different altered components: affective, cognitive, and perceptual one. Current treatments for BID have mainly focused on the affective and cognitive components. Nowadays, the need emerges for treatments focused also on the perceptual component of the BID. In this paper, we present the results of an efficacy study on the body perception treatment (BPT), a new treatment for BID focused on the perceptual component of the disorder.

OBJECTIVE

We looked for an additional treatment effect on a protocol for ED inpatients to evaluate the efficacy of BPT. We performed the study through statistical analysis of admission and discharge scores.

METHODS

We conducted a case-control study in a hospital ward specialized in eating disorders. Two groups were identified: the control group (TAU; N = 91) and the experimental group (TAU + BPT; N = 91). The experimental group performed BTP activities in addition to the treatment at usual. All patients in both groups had an eating disorder diagnosis (AN, BN, BED and EDNOS/OSFED). Sampling occurred on a time basis and not by randomization. Moreover, all patients admitted in the ED hospital ward in the time frame considered (from end-2009 to mid-2017) were included in the study. BPT activities were introduced in mid-2013 and three psychometric instruments upon entry and discharge were used: Symptom Check List-90 (SCL-90) to measure the general psychopathological state; the Eating Disorder Inventory-3 (EDI-3) to estimate the incidence of personality traits strongly correlated to eating disorders; the body uneasiness test (BUT) to measure the body uneasiness. We performed a pre/post analysis for both groups; we studied the additional effect of the treatment through deltas analysis of the three questionnaires (Δ = assessment at discharge - assessment at the entrance). Data were analyzed using the Student T and the Wilcoxon rank-sum test.

RESULTS

The pre/post analysis showed statistically significant improvement in both conditions (TAU and TAU + BPT) in the general psychopathological state (SCL-90) and in the incidence of personality traits (EDI-3). Improvements in body uneasiness (BUT) were observed only in the experimental group (TAU + BPT). Furthermore, the analysis of the deltas shows more significant improvements in TAU + BPT compared to TAU in all the variables considered.

CONCLUSION

We found an additional effect of the BPT on TAU. The usual ED protocol added with BPT activities showed significantly better clinical results. We have interpreted these results in light of recent developments in the neuroscientific field of body image.

LEVEL OF EVIDENCE

Level II: controlled trial without randomization.

Factors influencing stress, anxiety, and depression among Iranian pregnant women: the role of sexual distress and genital self-image

Background

Pregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image (GSI).

Methods

This was a descriptive, correlational, cross-sectional study performed using the two-stage cluster sampling method between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R).

Results

Analysis of Variance (ANOVA) showed significant differences in the mean scores of SD between the groups with varying degrees of depression, anxiety, and stress (P <  0.001) and in the mean score of GSI between the groups with varying degrees of depression (P = 0.01) and anxiety (P <  0.001). In multivariate linear regression analysis, higher (worse) depression, anxiety, and stress scores were found in women with more advanced age and higher SD scores; however, these scores were lower (better) in those with increased gestational age. Lower depression and anxiety scores were associated with moderate satisfaction with income, moderate satisfaction with BI in pregnancy, and lower stress and depression scores were linked to planned pregnancy. Higher (better) GSI score was a predictor of lower depression score, complication in a previous pregnancy was a predictor of higher stress score, and finally, fear of fetal abortion and being a housewife were predictors of a higher anxiety score.

Conclusion

Various factors contribute to the development of antenatal depression, anxiety, and stress. A positive correlation was found between SD and the severity of depression, anxiety, and stress, while a negative correlation was noted between GSI and the severity of depression and anxiety. Therefore, raising awareness regarding SD and GSI through screening and counseling sessions can have beneficial effects for mothers and their fetuses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03575-1.

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.

Women's satisfaction with the quality of antenatal care services rendered at public health facilities in Northwest Ethiopia: the application of partial proportional odds model

OBJECTIVES

The study was aimed: (1) to describe the quality of antenatal care (ANC) at public health facilities in Northwest Ethiopia, including dimensions of the structure, process and outcome; and (2) to assess the relationship between ANC satisfaction and structure and process dimension of ANC quality.

DESIGN

Cross sectional.

SETTING

Healthcare facilities providing ANC services in Northwest Ethiopia.

PARTICIPANTS

795 pregnant women attending the antenatal clinics at 15 public health facilities and 41 health workers working for the surveyed facilities.

OUTCOME MEASURES

The outcome variable, women's satisfaction with ANC, was constructed from multiple satisfaction items using principal component analysis on an ordered, categorical and three-point Likert scale. The key hypothesised factors considered were structural and process aspects of care. Data were analysed using the partial proportional odds model with 95% CI.

RESULTS

The result revealed that only 30.3% of the pregnant women were highly satisfied, whereas 31.7% had a lower satisfaction level. The findings showed that process quality indicators better predicted client satisfaction. In relation to this, better scores in history taking (aOR₁=aOR₂; 1.81 (95% CI 1.25 to 2.60)), counselling (aOR₁ = aOR₂; 1.89 (95% CI 1.33 to 2.69)) and screening (aOR₁= aOR₂; 18.10 (95% CI 11.52 to 28.39)) were associated with achieving higher satisfaction. We also observed a significant but lower satisfaction among women in the late trimester of pregnancy (aOR₁ = aOR₂; 0.87 (95% CI 0.78 to 0.97)). However, we did not see any significant relationship between structural variables and client satisfaction.

CONCLUSIONS

The study demonstrated that women's satisfaction with ANC was low. The contents of ANC services covered during client-provider interaction were the main factors affecting client satisfaction. This suggests that efforts are required to improve the competencies of health professionals to make them more effective while dealing with clients.

Body dissatisfaction and Fat Talk during pregnancy: Predictors of distress

BACKGROUND

During pregnancy, women are vulnerable to mood and anxiety disorders due to the significant physical and emotional changes that occur during this period. For some women, pregnancy can also present as a period of immense body dissatisfaction due to the substantial changes in body shape and size.

OBJECTIVES

This study examined the mediating role of Fat Talk (i.e., engaging in disparaging comments about one's body shape and size with others) in the relationship between (a) body dissatisfaction and distress in pregnant women (i.e., pregnancy-related anxiety, depression and eating disorder symptomatology), and (b) sociocultural pressure to meet the thin ideal and distress.

METHOD

A nonclinical sample of 408 pregnant women (M_age = 28.24 years, SD_age = 5.04, range 18-44 years) completed measures of body dissatisfaction, sociocultural pressure, pregnancy-related anxiety, depression and eating disorder symptomatology.

FINDINGS

Analyses confirmed the partial mediating role of Fat Talk between body dissatisfaction and all three measures of distress, when examined individually. Fat Talk also mediated the relationship between sociocultural pressure (i.e., peers/family and media) and the three measures of distress. Age also partially mediated the relationship between body dissatisfaction and a composite measure of pregnancy distress.

CONCLUSIONS

The results suggest that women face sociocultural pressures for thinness and body dissatisfaction even when pregnant, and that engaging in Fat Talk contribute to greater levels of pregnancy-related anxiety, depression and eating disorder symptomatology. The role of Fat Talk in regard to pregnancy distress may be more pertinent to younger women.

Effects of demographic and obstetric variables with body image on sexual dysfunction in pregnancy: A cross-sectional and comparative study

AIM

This study was conducted to determine the effects of demographic and obstetric variables with body image on sexual dysfunction in pregnant women.

BACKGROUND

Sexual dysfunction is frequent in pregnant women. To what extent body image plays a role is incompletely understood.

METHODS

In the research, a cross-sectional and comparative study was conducted. A personal information form, body image scale, and female sexual function index were applied to 472 pregnant women. Descriptive statistics, the Student t-test, the χ² test, and logistic regression analysis were employed for evaluating the data.

RESULTS

Sexual dysfunction was found in 54.7%. The frequency of sexual dysfunction in the first trimester was lower. In addition, factors like the place of residence of the pregnant women and number of pregnancies were found to be related to sexual dysfunction in pregnant women. Each unit decrease in body image score resulted in women being 0.98 times more likely to experience sexual dysfunction.

CONCLUSION

It was determined that approximately one in two pregnant women experienced sexual dysfunction, and body image, place of residence, trimester of the pregnancy, and number of pregnancies were important factors affecting sexual function.

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.

Examining the Impact of Body Satisfaction and Physical Activity Change on Postpartum Depressive Symptoms

BACKGROUND

Relationships among moderate to vigorous physical activity (MVPA), body satisfaction, and postpartum depressive symptoms are not well understood. The purpose of this study is to examine the (1) impact of postpartum body satisfaction and changes in MVPA on postpartum depressive symptoms and (2) moderating effect of changes in MVPA over time on the relationship between postpartum body satisfaction and depressive symptoms.

METHODS

Participants (N = 269) self-reported body satisfaction, MVPA (prepregnancy through postpartum), and postpartum depressive symptoms. Differences in MVPA at 3 time points (prepregnancy, third trimester, and postpartum) were calculated to create change scores. Main effects and interactions (body satisfaction × MVPA change) were examined using multiple regression.

RESULTS

A majority of the sample did not meet MVPA recommendations at all time points. All body satisfaction measures were inversely related to postpartum depressive symptoms (P = .01 to <.001). MVPA change did not predict postpartum depressive symptoms (P = .43-.90) or moderate the relationship between body satisfaction and postpartum depressive symptoms (P = .14-.94).

CONCLUSIONS

Given the relationship between postpartum body satisfaction and depressive symptoms, intervention research should include strategies that promote positive postpartum body image; clinicians should consider screening for body dissatisfaction. Although not a predictor or moderator, pregnancy and postpartum MVPA promotion should continue, as it has numerous other benefits.

Translation, cultural adaptation and validation of "Pregnancy Experience Scale" for Brazilian pregnant

Abstract Introduction: The analysis of maternal psychosocial stress during pregnancy can be an important intervention tool for maternal and infant health. Objective: To translate, culturally adapt and validate the Pregnancy Experience Scale - Brief Version - into Brazilian Portuguese for Brazilian pregnant women. Method: The scale was carried out according to the guidelines recommended by Beaton and his collaborators. Data were collected between January and September of 2016, in hospitals, basic health units, and community. In total, 206 pregnant women with an average age of 25.01 ± 6.44 years and gestational age of 25.5 ± 8.72 pregnancy weeks answered the scale for the process of psychometric analysis and validation. Results: The results indicated a two-dimensional model of the scale with two factors: Positive Experiences and Negative Experiences. The reliability was established through Cronbach’s Alpha Test (α > 0.70). The value found for the positive experiences factor was appropriate, α = 0.77. The same happened to the Negative Experiences factor, α = 0.80. These values provide evidence of the scale reliability. The convergent and concurrent validity of the instrument was established. Conclusion: The result of the psychometric study of the scale pointed out that the Pregnancy Experience Scale is an important intervention tool for the health care of mother and newborn, besides being a useful instrument to assess the experience of the women with the pregnancy, especially, the level of psychosocial stress, contributing to broaden the research in this area and subsidize support strategies for this population and women’s health policies.

Maternal body dissatisfaction in pregnancy, postpartum and early parenting: An overlooked factor implicated in maternal and childhood obesity risk

BACKGROUND

Current evidence indicates that to prevent the intergenerational transfer of overweight and obesity from parent to child, interventions are needed across the early life stages, from preconception to early childhood. Maternal body image is an important but often overlooked factor that is potentially implicated in both short- and long-term maternal and child health outcomes, including maternal gestational weight gain, postpartum weight retention, obesity, child feeding practices and early parenting.

AIM

The aim of this paper is to propose a conceptual model of the relationship between maternal body image (with a specific focus on body dissatisfaction) and maternal and child excess body weight risk across the pregnancy, postpartum and early childhood periods, as well as to highlight opportunities for intervention.

CONCLUSION

Our conceptual model proposes factors that mediate the associations between antenatal and postpartum maternal body dissatisfaction and maternal and childhood obesity risk. Pregnancy and postpartum present key risk periods for excess weight gain/retention and body dissatisfaction. Psychosocial factors associated with maternal body dissatisfaction, including psychopathology and disordered eating behaviours, may increase maternal and child obesity risk as well as compromise the quality of mother-child interactions underpinning child development outcomes, including physical weight gain. Our conceptual model may be useful for understanding modifiable psychosocial factors for preventing the intergenerational transfer of obesity risk from mothers to their children, from as early as pregnancy, and highlights next steps for multidisciplinary research focused on combatting maternal and child obesity during critical risk periods.

Measuring body image during pregnancy: psychometric properties and validity of a German translation of the Body Image in Pregnancy Scale (BIPS-G)

BACKGROUND

This study aimed to provide a German translation of the Body Image in Pregnancy Scale (BIPS) - a measure tailored to pregnancy-specific aspects of body image while being consistent to the multifaceted theoretical framework of body image - and to test its psychometric properties and validity.

METHODS

The English-language original version of the BIPS was translated into German language using a forward-backward translation rationale. Face validity of the items was tested in cognitive interviews (n = 5). An online survey was conducted among 291 pregnant women. After conducting standard item analyses, factorial validity was tested using principal-axis factor analysis (PAF). Convergent and incremental validity with measures of body dissatisfaction (FFB), depression (EPDS), anxiety (GAD-7), self-esteem (RSE), and eating disorder psychopathology (EDE-Q) was tested by bivariate correlations and multiple linear hierarchical regression analyses.

RESULTS

The PFA revealed a 32 item and 6-factor solution resembling the dimensions preoccupation with appearance, dissatisfaction with strength-related aspects, dissatisfaction with body parts, dissatisfaction with complexion, prioritization of appearance over function, and concerns about sexual attractiveness. Internal consistency on a subscale level was good to excellent (.79 ≤ Cronbach's α ≤ .91). Consistent with theoretical assumptions, we found significant positive correlations of BIPS-G subscales with depression, anxiety and eating disorder psychopathology and negative correlations of BIPS-G subscales with self-esteem. BIPS-G subscales substantially improved the prediction of depression, anxiety, self-esteem and eating disorder psychopathology over demographic factors and body dissatisfaction (.03 ≤ ΔR² ≤ .15, all p-values < 0.05).

CONCLUSIONS

The German version of the BIPS appeared to be a reliable and valid measure which has the capacity to enhance future research on body image during pregnancy in German-speaking populations.

Effectiveness of Physical Activity Interventions on Pregnancy-Related Outcomes among Pregnant Women: A Systematic Review

Regular physical activity has been demonstrated to contribute to physical and psychological health. Nevertheless, pregnant women generally exhibit low levels of physical activity. Implementation of interventions that enhance the self-efficacy of pregnant women on increasing physical activity is required. This paper provides an in-depth review of studies reporting the effect of various physical activity interventions dedicated for pregnant women on pregnancy-related issues, including gestational weight gain, pain and depression, physical activity level, and quality of life among these individuals. Five databases were used in searching the literature. Findings of the included studies were presented narratively, and appraisal of their methodological quality was conducted using the quality assessment tool developed by Effective Public Health Practice Project. Review findings demonstrated that physical activity interventions are effective in enhancing physical activity levels of pregnant women. Further, they are potentially useful in alleviating pregnancy-related pain and psychological symptoms, reducing gestational weight gain, and increasing self-efficacy in enhancing physical activity levels among these individuals. Nevertheless, inconsistencies in findings between studies hamper the drawing of firm conclusions on these latter outcomes. Overall, studies demonstrated a positive effect of physical activity interventions on the well-being and physical and psychological health of pregnant women.

The effects of infertility on perception of body in pregnancy: A comparative study

PURPOSE

This study aimed to determine the effects of infertility on perception of body in pregnancy.

DESIGN AND METHODS

This comparative study was conducted with 428 pregnant women (in vitro fertilization [IVF = 214, spontaneously conceived/SC = 214]).

FINDINGS

The IVF group had a higher body image scale (BIS) score. Moreover, it was observed that the IVF group had more positive views on growth in the abdominal area, gaining weight, and changes in skin. The rates of taking precautions for these changes and thinking that these changes affected sexual life negatively were lower the in the IVF group.

PRACTICE IMPLICATIONS

Infertility has a positive effect in perception of body in pregnancy.