Body image mediates the depressive effects of weight gain in new mothers, particularly for women already obese: evidence from the Norwegian Mother and Child Cohort Study

The Relationship between Body Mass Index, Body Dissatisfaction and Mood Symptoms in Pregnant Women

Background: High body mass and adiposity during pregnancy can contribute to psychological distress, and body dissatisfaction may be a potential underlying mechanism of this association. Objective. This study aimed to evaluate the mediational role of body dissatisfaction in the relationship between body mass index (BMI) and depressive and anxious symptoms, respectively. Methods: Given the cross-sectional design of this study, two alternative models were investigated, positing that BMI was related to depressive (Model 1a) and anxious symptoms (Model 2a), which, in turn, predicted body dissatisfaction. Seventy-two pregnant women in the third trimester of pregnancy completed the Body Image Disturbance Questionnaire, the Beck Depression Inventory-II and the State-Trait Anxiety Inventory, as well as a demographic form assessing their BMI. Results: As hypothesized, body dissatisfaction mediated the relationship between BMI and psychopathological symptoms. Moreover, the alternative models of reverse mediation were also significant, suggesting that psychopathological symptoms mediated the relationship between BMI and body dissatisfaction. Findings from both the hypothesized and alternative models suggested that, on the one hand, higher distress symptoms associated with body dissatisfaction would result from high BMI and, on the other hand, that body dissatisfaction may result from the effect of BMI on distress symptoms. Conclusions: The present study suggests that body image theory and practice should be implemented by the inclusion of evidence-based clinical interventions for promoting psychological well-being during the antenatal period.

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

Background

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

Material and methods

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

Results

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

Conclusion

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

Systematic review registration

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

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.

Investigating the Relationship between Self-Compassion and Body Image with Postpartum Depression in Women Referring to Health Centres in Iran

Background

Depression is the most important postpartum mental disorder that can lead to irreversible damage to family health if not addressed, including inability to provide maternal care, impaired mother-child relationship, impaired growth, and development of the child, to marital problems, and sometimes the risk of suicide and infant death. The aim of this study was to investigate the relationship between self-compassion and body image with postpartum depression.

Material and Method

In this study, 150 pregnant women in the third trimester and 6 weeks postpartum completed the Short Form Self-Compassion Questionnaire (SCS-SF), Multidimensional Self-Body Relationships (MBSRQ), and Edinburgh Postpartum Depression Inventory (EPDS). Depending on the type of study, descriptive statistics such as mean, median, and standard deviation were calculated for quantitative, frequency, and relative frequency variables. Kolmogorov-Smirnov test was used to evaluate the normality of the distribution of scores in each questionnaire. Data were analyzed using parametric proportional statistical tests (paired t-test, Pearson correlation, and linear regression) at the level of significance less than 0.05.

Results

Based on the findings, the relationship between self-compassion and postpartum depression was not significant. Self-kindness had a significant positive relationship, and self-judgement had a significant negative relationship with depression (p < 0.01). Body image had a significant predictive effect on postpartum depression (p < 0.05).

Conclusions

Negative body image as a risk factor for postpartum depression should be considered by healthcare providers and used in the prevention and treatment of postpartum depression.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Maternal Metabolites Indicative of Mental Health Status during Pregnancy

Approximately 25% of individuals report poor mental health during their pregnancy or postpartum period, which may impact fetal neurodevelopment, birth outcomes, and maternal behaviors. In the present study, maternal serum samples were collected from pregnancies at 28-32 weeks gestation from the All Our Families (Alberta, Canada) cohort and assessed using nuclear magnetic resonance spectroscopy (¹H-NMR) and inductively coupled plasma-mass spectrometry (ICP-MS). Individuals with poor mental health at 34-36 weeks gestation were age-matched with mentally healthy pregnant controls. Metabolites were examined against validated self-reported mental health questionnaires for associations with depressive symptoms (Edinburgh Perinatal Depression Scale) and anxiety symptoms (Spielberger State-Trait Anxiety Inventory). ¹H-NMR metabolites were identified for depression (alanine, leucine, valine, methionine, phenylalanine, glucose, lactate, 3-hydroxybutyrate, and pyruvate) and anxiety (3-hydroxybutyrate). For ICP-MS, antimony and zinc were significant for depression and anxiety, respectively. Upon false discovery rate (FDR) correction at 10%, five ¹H-NMR metabolites (alanine, leucine, lactate, glucose, and phenylalanine) for depression remained significantly increased. Although results warrant further validation, the identified metabolites may serve as a predictive tool for assessing mental health during pregnancy as earlier identification has the potential to aid intervention and management of poor mental health symptomology, thus avoiding harmful consequences to both mother and offspring.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

Nursing diagnoses of the self-perception domain in women in the puerperium

PURPOSE

During puerperium, women experience changes that may be responsible for disorders in the phenomenon of self-perception. Thus, the present study aims to analyze the nursing diagnoses of the self-perception domain of NANDA International Taxonomy II in puerperal women.

METHODS

Descriptive, cross-sectional, and quantitative study. The sample consisted of 153 women on puerperium followed in a University Hospital in a Brazilian capital. Data were collected through interviews with the application of an instrument. Data analysis was performed using descriptive and inferential statistics. The study was approved by the Research Ethics Committee (CAAE: 02849818.0. 0000.5208).

FINDINGS

The most prevalent Nursing Diagnosis of the self-concept class was Readiness for enhanced self-concept, which presented statistically significant associations with two defining characteristics. The risk for situational low self-esteem was the most prevalent Nursing Diagnosis in the Self-esteem class and presented associations to two risk factors. The Nursing Diagnosis Disrupted body image, present in the Body Image class, showed associations with 11 significant defining characteristics.

CONCLUSIONS

The analysis of the Nursing Diagnosis of the Self-Perception domain can assist in planning interventions directed to the specific needs of women in the puerperium.

IMPLICATIONS FOR NURSING PRACTICE

This study may contribute to the development of specific interventions to the reality of the puerperal, encouraging the nursing professional to implement the Nursing Process in the clinical practice. It may also contribute to the refinement of the NANDA-II taxonomy and the advancement of nursing research, in addition to providing safe clinical practice grounded in scientific knowledge for planning educational actions in puerperal women in order to minimize the negative perceptions experienced by them.

Maternal Obesity and Perinatal Depression: An Updated Literature Review

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

Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care

OBJECTIVE

This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team Planning for Delivery and Postpartum Care.

INTENDED USERS

All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity.

TARGET POPULATION

Women with obesity who are pregnant or planning pregnancies.

EVIDENCE

Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

VALIDATION METHODS

The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care.

BENEFITS, HARMS, AND COSTS

Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affecting pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity.

GUIDELINE UPDATE

SOGC guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter.

SPONSORS

This guideline was developed with resources funded by the SOGC.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Lifestyle information and access to a commercial weight management group to promote maternal postnatal weight management and positive lifestyle behaviour: the SWAN feasibility RCT

Background

Increasing numbers of UK women have overweight or obese body mass index scores when they become pregnant, or gain excessive weight in pregnancy, increasing their risk of adverse outcomes. Failure to manage postnatal weight is linked to smoking, non-healthy dietary choices, lack of regular exercise and poorer longer-term health. Women living in areas of higher social deprivation are more likely to experience weight management problems postnatally.

Objectives

The objectives were to assess the feasibility of conducting a definitive randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of lifestyle information and access to a commercial weight management group focusing on self-monitoring, goal-setting and motivation to achieve dietary change commencing 8–16 weeks postnatally to achieve and maintain weight management and positive lifestyle behaviour.

Design

The design was a randomised two-arm feasibility trial with a nested mixed-methods process evaluation.

Setting

The setting was a single centre in an inner city setting in the south of England.

Participants

Participants were women with body mass index scores of > 25 kg/m2 at antenatal ‘booking’ and women with normal body mass index scores (18.0–24.9 kg/m2) at antenatal booking who developed excessive gestational weight gain as assessed at 36 weeks’ gestation.

Main outcome measures

Recruitment, retention, acceptability of trial processes and identification of relevant economic data were the feasibility objectives. The proposed primary outcome was difference between groups in weight at 12 months postnatally, expressed as percentage weight change and weight loss from antenatal booking. Other proposed outcomes included assessment of diet, physical activity, smoking, alcohol consumption, body image, maternal esteem, mental health, infant feeding and NHS costs.

Results

Most objectives were achieved. A total of 193 women were recruited, 98 allocated to the intervention arm and 95 to the control arm. High follow-up rates (> 80%) were achieved to 12 months. There was an 8.8% difference in weight loss at 12 months between women allocated to the intervention arm and women allocated to the control arm (13.0% vs. 4.2%, respectively; p = 0.062); 47% of women in the intervention arm attended at least one weight management session, with low risk of contamination between arms. The greatest benefit was among women who attended ≥ 10 sessions. Barriers to attending sessions included capability, opportunity and motivation issues. Data collection tools were appropriate to support economic evaluation in a definitive trial, and economic modelling is feasible to quantify resource impacts and outcomes not directly measurable within a trial.

Limitations

The trial recruited from only one site. It was not possible to recruit women with normal body mass index scores who developed excessive pregnancy weight gain.

Conclusions

It was feasible to recruit and retain women with overweight or obese body mass index scores at antenatal booking to a trial comparing postnatal weight management plus standard care with standard care only and collect relevant data to assess outcomes. Approaches to recruit women with normal body mass index scores who gain excessive gestational weight need to be considered. Commercial weight management groups could support women’s weight management as assessed at 12 months postnatally, with probable greater benefit from attending ≥ 10 sessions. Process evaluation findings highlighted the importance of providing more information about the intervention on trial allocation, extended duration of time to commence sessions following birth and extended number of sessions offered to enhance uptake and retention. Results support the conduct of a future randomised controlled trial.

Trial registration

Current Controlled Trials ISRCTN39186148.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.

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.

Weight Changes and Body Image in Pregnant Women: A Challenge for Health Care Professionals

Body changes concerns and body image dissatisfaction are common during pregnancy. We aimed to examine whether health care professionals (HCPs): (i) believe that women are concerned about body image during pregnancy; (ii) consider it important to question, support, and intervene when pregnant women express body image concerns; (iii) feel comfortable enough in their abilities to question pregnant women with concerns; and (iv) have sufficient knowledge and skills to provide adequate support. A 36-item e-survey, developed by ÉquiLibre in collaboration with an expert committee, was sent to HCPs via email. HCPs believe that some situations are associated with body image concerns: postpregnancy weight loss (74.0%), perceived changes in their appearance (65.9%), excessive weight gain (65.3%), and feeling less in control of their body (36.8%). Among 321 responders, 60% considered it important to question pregnant women's concerns. One in four (25.4%) considered themselves "totally comfortable" asking about weight and body image concerns. Our study showed that HCPs need to be better supported in developing their abilities to help weight-preoccupied pregnant women. There is an urgent need to clarify HCPs' roles and to delineate the referral process as well as to ensure staff availability, in terms of time and personnel.

Directive clinique No 392 - Grossesse et obésité maternelle Partie 2 : Planification en équipe de l'accouchement et soins post-partum

OBJECTIF

La présente directive clinique aborde les aspects essentiels des soins prénataux chez les femmes atteintes d'obésité. La partie 1 porte sur la préconception et les soins prénataux. La partie 2 porte sur la planification en équipe de l'accouchement et les soins post-partum. UTILISATEURS CONCERNéS: Tous les fournisseurs de soins de santé (obstétriciens, médecins de famille, sages-femmes, infirmières, anesthésiologistes) qui prodiguent des soins relatifs à la grossesse auprès de femmes atteintes d'obésité.

POPULATION CIBLE

Femmes atteintes d'obésité qui sont enceintes ou prévoient le devenir. DONNéES PROBANTES: Des recherches ont été menées en consultant les ressources de Statistique Canada, de Medline et de Cochrane Library en vue d'en tirer la littérature relativement aux effets de l'obésité durant la grossesse sur les soins prénataux et intrapartum, la morbidité et la mortalité maternelles, l'anesthésie obstétricale ainsi que sur la morbidité et la mortalité périnatales. Seuls les résultats de revues systématiques, d'essais cliniques randomisés ou comparatifs et d'études observationnelles ont été retenus. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été mises à jour régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en septembre 2018. Nous avons également tenu compte de la littérature grise (non publiée) obtenue sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes pertinents, dans des collections de directives cliniques et des registres d'essais cliniques, et auprès d'associations nationales et internationales de médecins spécialistes. MéTHODES DE VALIDATION: Le contenu et les recommandations ont été rédigés et acceptés par les auteurs. Les membres du comité de médecine fœto-maternelle ont ensuite passé en revue le contenu et formulé des commentaires aux fins d'examen. Enfin, le conseil d'administration de la Société des obstétriciens et gynécologues du Canada (SOGC) a approuvé la publication de la version définitive de la directive. Les points de désaccord ont été abordés lors de réunions pour enfin arriver à un consensus. La qualité des données et des recommandations a été déterminée à l'aide des critères d'évaluation décrits par le Groupe d'étude canadien sur les soins de santé préventifs. AVANTAGES, PRéJUDICE ET COûTS: La mise en place des recommandations des présentes directives peut améliorer la reconnaissance des fournisseurs de soins obstétricaux relativement aux problèmes qui touchent les personnes enceintes atteintes d'obésité, notamment au moyen de stratégies de prévention clinique; de la communication entre l'équipe de soins de santé, la patiente et la famille; et de la planification de l'équipement et des ressources humaines. Il est à espérer que les organismes régionaux, provinciaux et fédéraux participeront à la formation et au soutien en matière de soins coordonnés pour les personnes enceintes atteintes d'obésité. MISE à JOUR DE LA DIRECTIVE CLINIQUE: Les directives de la SOGC sont automatiquement passées en revue 5 ans après leur publication. Les auteurs peuvent toutefois proposer une autre date de réévaluation s'ils croient qu'une période de 5 ans est trop courte ou trop longue en fonction de leurs connaissances du sujet à titre d'experts en la matière.

PROMOTEURS

La présente directive a été élaborée à l'aide de ressources financées par la SOGC. DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.

Evaluation of Maternal Functioning in Mothers of Infants Admitted to the Neonatal Intensive Care Unit

Objective: Factors associated with maternal functioning in biological mothers whose infants were admitted to a Neonatal Intensive Care Unit (NICU) were identified as measured by a modified version of the Barkin Index of Maternal Functioning. Materials and Methods: This multivariable regression analysis explored sociodemographic and clinical data from 146 mother-infant dyads admitted to a Level III NICU between February 2015 and May 2016. Eligible dyads included: (1) adult biological mothers with singleton infants discharged home alive after NICU admission meeting criteria and (2) infants discharged home alive from the NICU with adult, biological mothers after a minimum 6-day admission. Results: Lower scores on the Edinburgh Postnatal Depression Scale (p < 0.0001), and an infant admission diagnosis of hypoglycemia (p = 0.0295) were significantly associated with higher levels of maternal functioning. Conclusions: The significant association between maternal functioning and depressive symptom score is corroborated by the literature. Results relative to a diagnosis of infant hypoglycemia and higher levels of maternal functioning are intriguing, considering current literature linking increased postpartum depression to gestational diabetes. The severity of other possible admission diagnoses may provide a partial explanation. We believe this is the first study suggesting a potential role between infant admission diagnosis and the level of maternal functioning.

Weight Shame, Social Connection, and Depressive Symptoms in Late Adolescence

Child and adolescent obesity is increasingly the focus of interventions, because it predicts serious disease morbidity later in life. However, social environments that permit weight-related stigma and body shame may make weight control and loss more difficult. Rarely do youth obesity interventions address these complexities. Drawing on repeated measures in a large sample (N = 1443) of first-year (freshman), campus-resident university students across a nine-month period, we model how weight-related shame predicts depressive symptom levels, how being overweight (assessed by anthropometric measures) shapes that risk, and how social connection (openness to friendship) might mediate/moderate. Body shame directly, clearly, and repeatedly predicts depression symptom levels across the whole school year for all students, but overweight youth have significantly elevated risk. Social connections mediate earlier in the school year, and in all phases moderate, body shame effects on depression. Youth obesity interventions would be well-served recognizing and incorporating the influential roles of social-environmental factors like weight stigma and friendship in program design.

Psychosocial Predictors of Change in Depressive Symptoms Following Gastric Banding Surgery

OBJECTIVE

The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery.

METHODS

Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery.

RESULTS

Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery.

CONCLUSIONS

Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.

The associations between depressive and anxiety symptoms, body image, and weight in the first year postpartum: a rapid systematic review

OBJECTIVE

The aim of this study was to conduct a rapid systematic review of the evidence of associations between postpartum depressive symptoms, anxiety symptoms, body image and weight status in the first 12 months post birth.

BACKGROUND

The postpartum period places the mother and infant at risk of a number of negative health outcomes. Mental health conditions such as depression and anxiety are common in the postpartum, as are poor body image and excessive weight retention as women adjust to their post pregnancy body. However, the associations between body image, weight status and psychological distress are not currently well understood.

METHODS

Articles in English, published between 2006 and 2017, involving singleton pregnancies of normally developing infants and maternal depression or anxiety were eligible for this systematic review.

RESULTS

From the total of 1805 articles located, 12 were identified as relevant and were subsequently reviewed in full. In the nine studies of depressive symptoms, body image or weight status, four found a significant relationship. Significant associations were not found in the three studies investigating postpartum anxiety symptoms, body image or weight. Body dissatisfaction was associated significantly with poorer postpartum weight status in all nine studies.

CONCLUSIONS

Further research is needed to determine the nature of the relationships between body image, weight status and depressive and anxiety symptoms across the first year after birth. This information will assist health professionals to promote healthy lifestyle behaviours in the postpartum, as well as inform clinical interventions that target behaviour change to prevent the worsening of these issues and related negative outcomes.