The influence of psychological factors on postpartum weight retention 12 months post-birth

How does gestational weight gain influence short- and long-term postpartum weight retention? An updated systematic review and meta-analysis

This systematic review and meta-analysis provide an update of an earlier meta-analysis examining the impact of gestational weight gain (GWG) on postpartum weight retention (PPWR). Thirty-four observational studies were included, and results from 18 studies were combined in meta-analyses. We found that women with excessive GWG retained an additional 2.98 kg (95% CI: 0.59, 5.37 kg, I2  = 91%) at 0.5 years, 1.89 kg (95% CI: 0.90, 2.88 kg, I2  = 61%) at > 0.5-1 year and 2.89 kg (95% CI: 1.74, 4.04 kg, I 2  = 0%) at 2-4 years, compared to women who met the National Academy of Medicine GWG recommendations. Moreover, synthesis of confounder-adjusted regression coefficients showed that each 1 kg increase of GWG corresponded to 0.62 kg (95% CI: 0.22, 1.02 kg, I2  = 96%) additional PPWR at 6-9 months, 0.48 kg (95% CI: 0.14, 0.81 kg, I2  = 93%) at 1-3 years, and 0.31 kg (95% CI: -0.24, 0.86 kg, I2  = 89%) at 5-7 years postpartum. Findings suggest that higher GWG contributes to increased maternal body weight in the short- and long-term after childbirth, independent of prepregnancy body mass index. The heterogeneity of reported data and methodological differences across studies complicate the ability to synthesize data and interpret findings.

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.

Relationships among Postpartum Weight Retention, Stress, and Disinhibited Eating: A Scoping Review

Postpartum weight retention (PPWR) is a significant contributor to maternal cardiometabolic disease risk. The transition to motherhood is a stressful time period in which women report consuming food to cope, an eating behavior that is associated with PPWR. In this scoping review, we identified original research and review articles published since 2010 that examined relationships among PPWR, maternal stress, and disinhibited eating. In total, 16 articles met the inclusion criteria. Findings were inconsistent related to PPWR and stress. PPWR and disinhibited eating were not significantly correlated; however, disinhibition scores were higher during the postpartum period compared to prenatally. Stress and disinhibited eating were directly correlated in 4 studies. Our findings suggest these concepts, particularly disinhibited eating, have not been robustly examined during the postpartum period. Additionally, instruments used to measure maternal stress vary widely and should be further studied and refined.

Coparenting-focused preventive intervention reduces postnatal maternal BMI and buffers impact of cortisol

OBJECTIVE

The postpartum period is a key life stage, contributing to increased maternal obesity risk. Current lifestyle interventions do not consider the role of a woman's partner in reducing stress and supporting lifestyle change. The objective of this study was to assess the effect of an intervention that seeks to enhance coparenting relationship quality on maternal BMI from before conception to 12 months post partum and whether the intervention moderated the association of changes in cortisol and BMI.

METHODS

A randomized controlled trial was used to assess an intervention (eight classes: four during and four following pregnancy) focusing on enhancing couple coparenting relationships during pregnancy and post partum (n = 57) compared with standard care (n = 53).

RESULTS

The main outcome measures were changes in maternal BMI and cortisol. There was a smaller increase in BMI for mothers in intervention compared with control groups (mean [SE], -1.03 [0.42] kg/m2 , p = 0.015). There was an interaction between intervention status and cortisol change predicting BMI change (p = 0.026), such that cortisol change significantly predicted BMI change among mothers in the control (p = 0.049) but not the intervention groups (p = 0.204).

CONCLUSIONS

A coparenting intervention improved maternal postpartum BMI, with this effect potentially related to ameliorating the negative effect of stress, as measured by cortisol, on BMI. The role of enhanced coparenting in improving maternal anthropometry warrants urgent attention.

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.

The Use of Social Media for Preconception Information and Pregnancy Planning among Young Women

Young women of reproductive age (18–25 years) often seek and engage with health-related information via social media. However, the extent to which this population group seek preconception and pregnancy-related information has not been explored. Therefore, this study aimed to: (1) examine the proportion, type, and frequency of social media use to seek general health, preconception, and pregnancy-related information or advice among young women; and (2) explore the relationship between age, education status, relationship status, and planning a pregnancy on social media use for preconception and pregnancy-related health information. Ninety-one Australian women aged 18–25 years completed an online survey about their patterns and preferences of social media use for this information. Forty percent of women used social media for general health information (most often daily), 32% for preconception health advice (most commonly weekly), and 20% for pregnancy-related information (most often weekly), with Facebook the most frequently used platform. Planning a pregnancy within the next 5 years and younger age were associated with greater likelihood of using social media for such information. It is necessary that social media platforms are leveraged to disseminate preconception and pregnancy planning health advice, support, and education to provide better health promotion and preventive care to young women.

Combined analysis of gestational diabetes and maternal weight status from pre-pregnancy through post-delivery in future development of type 2 diabetes

We examined the associations of gestational diabetes mellitus (GDM) and women’s weight status from pre-pregnancy through post-delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4–6 years post-delivery. Using Poisson regression with confounder adjustments, we assessed associations of standard categorisations of prospectively ascertained pre-pregnancy overweight and obesity (OWOB), gestational weight gain (GWG) and substantial post-delivery weight retention (PDWR) with post-delivery dysglycaemia (n = 692). Women with GDM had a higher risk of later T2D [relative risk (95% CI) 12.07 (4.55, 32.02)] and dysglycaemia [3.02 (2.19, 4.16)] compared with non-GDM women. Independent of GDM, women with pre-pregnancy OWOB also had a higher risk of post-delivery dysglycaemia. Women with GDM who were OWOB pre-pregnancy and had subsequent PDWR (≥ 5 kg) had 2.38 times (1.29, 4.41) the risk of post-delivery dysglycaemia compared with pre-pregnancy lean GDM women without PDWR. No consistent associations were observed between GWG and later dysglycaemia risk. In conclusion, women with GDM have a higher risk of T2D 4–6 years after the index pregnancy. Pre-pregnancy OWOB and PDWR exacerbate the risk of post-delivery dysglycaemia. Weight management during preconception and post-delivery represent early windows of opportunity for improving long-term health, especially in those with GDM.

The influence of sleep quality on weight retention in the postpartum period

Poor sleep in the postpartum is often treated as an unavoidable consequence of childbirth. This study aims to compare objective and subjective measures of sleep, explore the relationship between sleep and postpartum weight retention (PPWR), and investigate factors that may contribute to sleep quality in the postpartum period. In this cross-sectional cohort, PPWR, sleep quality (Pittsburgh Sleep Quality Index (PSQI)), and objective sleep and physical activity (accelerometry) were assessed in 109 women 0–52 weeks postpartum. Anthropometric and demographic data were collected. Gestational weight gain (GWG) was classified as inadequate, appropriate, or excessive according to Institute of Medicine guidelines. Average GWG (33.7 lbs) and PPWR (5.39 lbs) were not different between “good” (PSQI < 6) and “bad” (PSQI ≥ 6) sleepers. Following adjustment, mothers with excessive GWG who were “bad” sleepers had 5.26 higher odds of PPWR ≥ 10 lbs compared with all other combinations of GWG and PSQI. PSQI was not correlated with total sleep time (accelerometer-derived). Light activity and moderate-to-vigorous physical activity (MVPA) were associated with reduced odds of being a “bad” sleeper. The influence of GWG on PPWR was modified by postpartum sleep quality. Both light activity and meeting the MVPA guidelines in the postpartum were associated with higher sleep quality.

Novelty Subjectively rated poor sleep may represent the number of awakenings and wake after sleep onset in postpartum women. Poor postpartum sleep quality increases excessive postpartum weight retention in women with excessive GWG. Women doing light-to-vigorous physical activity in the postpartum are less likely to experience poor sleep quality.

Mothers' experiences of the relationship between body image and exercise, 0-5 years postpartum: A qualitative study

The relationship between body image and exercise in early motherhood is an important yet understudied determinant of mother and infant wellbeing. To address this, we report on a qualitative study of early mothers' lived experiences of the relationship between body image and exercise in the first five years post-birth. Twenty-one mothers (0-5 years postpartum) completed individual, semi-structured online/phone interviews (M interview time =47.25 min), to elicit narratives about peripartum body image and its relationship with exercise. Thematic analysis was conducted according to the Braun and Clarke framework. Three key themes, and several subthemes, were identified: 1.body image in early motherhood is diverse, dynamic and individual, 2.postpartum exercise forms part of early motherhood adjustment, and 3.body image and exercise form an important, intricate relationship in early motherhood. Women's narratives indicated three body image/exercise patterns, each characterised by different behaviours and motivations. Mothers who reported exercising, or avoiding exercising, for reasons related to body dissatisfaction appeared at greatest risk of negative outcomes from body-related distress and maladaptive exercise patterns. Conversely, mothers reporting higher body appreciation described more adaptive exercise behaviours. This research provides important information for the development of interventions to support positive body image and healthful exercise in early motherhood.

Validity and reliability of the Brazilian version of the Body Image in Pregnancy Scale

OBJECTIVES

To describe the translation and cultural adaptation, and evaluate the psychometric properties of the Body Image in Pregnancy Scale when applied to Brazilian pregnant women.

BACKGROUND

Poor body image of pregnant women is associated with negative outcomes for maternal and child health. However, there is a lack of psychometric studies aiming to evaluate the body image experiences during pregnancy.

METHODS

A methodological study was carried out with 187 Brazilian pregnant women. We performed translation and cross-cultural adaptation (evidence of content validity), and evaluated the psychometric properties (factorial validity through principal component analysis, discriminant validity, and estimated internal consistency) of the Brazilian version of the Body Image in Pregnancy Scale.

RESULTS

The scale items presented semantic, idiomatic, cultural, and conceptual equivalences, showing evidence of content validity. Principal component analysis resulted in a 6-factor structure with 35 items which showed an adequate adjustment of the scale among Brazilian pregnant women. Adequate estimated internal consistency (Cronbach's α = .88) was found. The Brazilian version was not able to discriminate pregnant women from different gestational age.

CONCLUSION

The Brazilian version of the Body Image in Pregnancy Scale showed evidence of content validity, factorial validity, and estimated internal consistency.

Phthalate exposure during pregnancy and long-term weight gain in women

BACKGROUND

Phthalates are known endocrine disruptors and peroxisome proliferator-activated receptor (PPAR) activators, potentially capable of promoting an obesogenic effect. Pregnant women are especially vulnerable to phthalate exposure due to physiological and metabolic changes during pregnancy, including those related to the metabolism of xenobiotics. Phthalate exposure during pregnancy has been associated with early gestational weight gain, however, its effect on long-term weight gain remains unclear. The aim of the present study was to evaluate the association between phthalate exposure during pregnancy and long-term changes in weight among women.

METHODS

Urinary phthalate concentrations, socioeconomic, anthropometry and information on diet and socioeconomic status were collected during pregnancy from 178 women from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort. Maternal body weight and diet information was also collected up to 5 times in the first year postpartum and twice during follow-up visits 5.2-10.7 years later. A path analysis was performed to assess associations between urinary phthalate metabolite levels during pregnancy and change in weight (kg) per year after delivery, including age, education, living with/without partner, parity, daily energy intake and breastfeeding duration.

RESULTS

The mean age at pregnancy was 27.3 ± 5.9 years and mean body mass index during the first postpartum year was 27.07 ± 4.22 kg/m². On average, women gained 3.48 kg (0.52 ± 0.84 kg/year). A unit increase in log-transformed mono-3-carboxypropyl phthalate (MCPP) was associated with 0.33 kg (95% CI: 0.09, 0.56) higher weight gain per year, and mono-benzyl phthalate (MBzP) with 0.21 kg (95% CI: -0.38, -0.03) lower weight gain per year.

CONCLUSION

Exposure to certain phthalates during pregnancy may be associated with long-term weight change in women. More studies on the effects of phthalate exposure during pregnancy on women's long-term health are required.

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

OBJECTIVES

The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

BACKGROUND

High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

METHODS

156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

RESULTS

Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

CONCLUSION

BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.