Post-partum weight retention in women in Asia: a systematic review

Obesity is a health issue for people in Asia, and many studies support that childbearing may contribute to women's obesity. However, most studies of post-partum weight retention (PWR) focus on Western countries. This paper aimed to review recent data on PWR and discuss the related factors of PWR for women in Asia. Three electronic databases - MEDLINE, CINAHL and PsycINFO - were searched for data from January 1990 to August 2010. Twelve studies were identified as containing information related to PWR. Chinese, Taiwanese and Korean women tend to have higher gestational weight gain and PWR than women in other Asian countries in this review. The average reported gestational weight gain in these studies ranged from 8.3 kg to 18.0 kg, and the average weight retention at 6 months post partum in various countries ranged from 1.56 kg to 4.1 kg. Gestational weight gain had a positive effect on PWR, but there were no consistent conclusions for other factors. Only a few psychosocial and behavioural factors have been studied. Moreover, no one has assessed changes in waist circumference and waist-to-hip ratio for measuring central obesity and ensuring risk of chronic disease. Focusing on changes in maternal weight and body composition, and considering the impact of psychological and behavioural factors are suggested for future studies in Asia.

Rediscovering the "M" in "MCH": maternal health promotion after childbirth

Although maternal mortality is not a major health concern in the United States, evidence is accruing that after 6 weeks postpartum mothers continue to face mental and physical health, lifestyle, and parenting concerns. Exemplar areas for enhanced maternal health promotion after childbirth include (a) lifestyle changes in exercise, nutrition, and smoking, and (b) psychosocial well-being, particularly mood and body image. Research on health of women after childbirth supports rethinking the scope and duration of maternal health promotion.

Psychosocial and demographic factors related to health behaviors in the 1st trimester

OBJECTIVE

To explore the relationship of psychosocial and demographic variables to health behaviors in early pregnancy.

DESIGN

First trimester findings presented from a prospective study of weight gain in pregnancy.

SETTING

A comprehensive health care system in central Texas.

PARTICIPANTS

114 pregnant women (75% white, 13% African American, 10% Hispanic, 2% Asian) of 12 weeks gestation or less.

OUTCOME MEASURE

Self-Care Inventory, which includes diet/eating, substance abuse, recklessness, hygiene-related practices, sleep/rest, and exercise behaviors.

RESULTS

In regression analysis the final model of demographic and psychosocial variables showed that higher depressive symptoms, lower internal locus of control for fetal health, and lower family income were related to poorer health behaviors in the 1st trimester of pregnancy.

CONCLUSIONS

Health behaviors in early pregnancy may be affected by psychosocial factors such as depressive symptoms. Greater emphasis should be given to such factors in research and prenatal assessments.

The construct of thriving in pregnancy and postpartum

This article explores the construct of thriving as an integration of nutritional (manifested in weight), psychosocial, and lifestyle concerns of childbearing within the context of Orem's self-care deficit theory. Provisional definitions of thriving in pregnancy and postpartum are proposed. Preliminary dimensions of thriving in postpartum are based on factor analysis of weight, lifestyle, and psychosocial data from 145 women after childbirth. Four dimensions emerged: psychosocial distress, lifestyle patterns, a weight factor, and a body image factor. Although the dimensionality of postpartal thriving reported is preliminary, it provides a beginning foundation for assessment and intervention for postpartal women.

Is a healthy lifestyle related to stress, parenting confidence, and health symptoms among new fathers?

A healthy lifestyle is widely recognized as important in preventing disease and disability. This study examined whether in the transition to fatherhood a healthy lifestyle was related to perceived stress, parenting confidence, and physical health symptoms. Survey data from 87 fathers were examined for relationships between lifestyle, measured by 6 subscales of the Health Promoting Lifestyle Profile (HPLP), and perceived stress, parenting confidence, and health symptoms. In general, a healthier lifestyle, especially HPLP self-actualization and stress-management subscales, was related to less perceived stress, more parenting confidence, and fewer health symptoms. Higher HPLP nutrition and exercise scores were related to fewer health symptoms; higher exercise and seeking-interpersonal-support scores were related to higher parenting confidence. Also, higher social desirability scores, a confounding influence, were related to less perceived stress. The authors conclude that health-promotion behaviours may be an important personal resource in maintaining health and promoting well-being among new fathers.

Is integrative science necessary to improve nursing practice?

This article explores integrative science as a perspective for overcoming intellectual barriers between nurses' valuing of the holistic person and the science and technology that drives advances in health care. Several meanings of integrative science are reflected in health science literature. One use of integrative science refers to comprehensive and unifying theories (or viewpoints) that draw together interrelated aspects of a field. Another use of integrative science pertains to efforts to formulate models that accommodate the special dualities that exist in studying humans. Integrative science as a perspective addresses overcoming intellectual separation of knowledge relevant to understanding of persons or populations by an open-ended sharing and juxtaposing of knowledge relevant to solving that problem. For nursing, integrative science may pose a threat to nursing knowledge. Failure to thrive, a nutritional and psychosocial phenomenon, is presented as an example of a topic manifesting the need for an integrative science perspective.

Lifestyle factors related to postpartum weight gain and body image in bottle- and breastfeeding women

OBJECTIVE

To explore the relationship of lifestyle variables to postpartum weight gain and body image attitudes of bottle- and breastfeeding women.

DESIGN

Mail survey of new mothers at approximately 4 months postpartum.

SETTING

Southwestern community.

PARTICIPANTS

One hundred one bottle-feeding women (69% white, 20% Hispanic, 11% other) and 106 breastfeeding women (76% white, 19% Hispanic, 5% other) without diabetes. Bottle- and breast-feeding women did not differ on gestational weight gain or weight gain sustained postpartum.

MAIN OUTCOME MEASURES

Postpartum weight gain (relative to prepregnancy weight) and body image attitudes.

RESULTS

Feeding method (breast or bottle) was not associated with postpartum weight gain in the sample as a whole. Bottle-feeding mothers with higher postpartum gains exercised less, had higher fat intake habits, and were more dissatisfied with body image than mothers with lower gains. Breast-feeding mothers with higher and lower gains did not differ on any lifestyle factors. Overall lifestyle and psychologic skill in managing emotions were related negatively to postpartum body image dissatisfaction in both groups of women.

CONCLUSIONS

Breastfeeding women did not differ from bottle-feeding women in sustained postpartum weight gain. In bottle-feeding women, lifestyle factors were associated with levels of weight gain. Lifestyle-focused programs for weight management would potentially benefit these women.

Weight-related distress in the early months after childbirth

The purpose of this study was to assess the extent of weight-related distress reported by new mothers and to explore associations of anthropometric and psychosocial variables with feelings about weight. New mothers' (N = 227) written descriptions of feelings about their weight were categorized using content analysis. More than 40% were somewhat satisfied with their weight, another 40% were mildly dissatisfied, and 8% experienced weight-related distress. Higher prepregnancy body mass index, larger gestational weight gain, higher current postpartum body mass index, less healthy lifestyle, and greater body image dissatisfaction were associated significantly with more dissatisfied/distressed feelings about weight. Results support the need for greater attention to the psychosocial significance of weight after childbirth.

Weight and weight-related distress after childbirth: relationships to stress, social support, and depressive symptoms

The aim of this study was to explore whether women's psychosocial context was related to weight status 1 year after childbirth. A survey sample of 149 women provided data on life-event stress, social support, and depressive symptoms; and three weight variables: body mass index, weight gain, and weight-related distress. Of the women, 32 (22%) reported gains of > or = 5 kg and 50 (34%) met the criterion for high depressive symptoms. Low social support, low income, and high depressive symptoms were related to higher weight gain. Women with gains > or = 5 kg reported high depressive symptoms (53% vs. 28%) more often than women with lesser gains. Women who reported lowered self-esteem because of weight also had higher depressive symptoms, body mass indexes, and weight gains than women with increased or unaffected self-esteem. This study points to the importance of incorporating women's psychosocial context into counseling about weight management after childbirth.

Contributions of maternal identity and lifestyle to young children's adjustment

Early child behavior problems have been related to later child adjustment. Therefore, it is important to study factors, such as maternal characteristics, which may affect early child behavior. Existing science stresses the import of maternal identity formation as a key aspect of the early mother-child relationship; however, recent evidence also shows that mothers' health-related lifestyles are salient to preschool children's healthy adjustment. The relative contributions of these two influences on children's behavioral adjustment were compared in a longitudinal mail study of new mothers. The sample consisted of two cohorts of mothers (6 or 12 months postpartum at recruitment) systematically selected (every third name) from published birth announcements in a midwestern newspaper. Maternal identity and lifestyle were both measured when children were 6 to 12 months and were used to predict child behavioral problems 2 years later (N = 122). Using path analysis, the influence of maternal identity and lifestyle on child behavior problems was tested within one model with maternal age, education, family income, and social desirability statistically controlled. The model provided an acceptable fit to the data. The hypothesis that maternal identity would be related to child behavior problems was not supported; however, maternal lifestyle was significantly related to child behavior problems. These findings support the relationship between the mother's health-related lifestyle and her young child's adjustment.

Toward an integrative science of women's health

For too long, the health care of women has separated childbearing from health promotion and management of chronic health problems. A critical dimension of an integrative science of women's health is bringing together childbearing with women's health during the life span. This integration is needed in areas such as preconception care, reproductive weight management, and gestational diabetes. An integrative science enhances research promoting women's health and patterns of care aimed at disease prevention.

Predictors of weight gain at 6 and 18 months after childbirth: a pilot study

OBJECTIVE

To test the contributions of life-style and stress to postpartum weight gain after controlling for sociodemographic and reproductive influences.

DESIGN

Longitudinal mail survey with retrospective data on gestational weight gain and prospective data on postpartum weight gain.

SETTING

Multicounty community in the midwestern United States.

PARTICIPANTS

After deleting from the sample women who became pregnant again, had confounding medical conditions, or had missing weight data, the sample consisted of 88 predominantly white mothers at 6 months after childbirth and 75 predominantly white mothers at 18 months after childbirth.

MAIN OUTCOME MEASURES

Weight gain at 6 and 18 months after childbirth.

RESULTS

Maternal race and gestational weight gain accounted for significant amounts of variance in 6-month and 18-month postpartum weight gain. Neither life-style nor perceived stress contributed significantly to predicting postpartum weight gains. Gestational weight gain was the most important predictor of postpartum weight gain.

CONCLUSIONS

Given the contribution of gestational weight gain to postpartum weight gain, further study is needed of high gestational weight gain.

Are maternal health behaviors related to preschool children's adjustment? A preliminary report

Little is known about how parental health behaviors affect others within the family. This study examined the relationship of mothers' health behaviors to mothers' reports of their preschool children's mental health. Mothers (n = 89) of 2 and 3 year olds completed a mail survey assessing a variety of health related measures. Children's adjustment was assessed by the Child Behavior Checklist, a well established measure of child adjustment. The Personal Lifestyle Questionnaire and Perceived Stress Scale were also contained in the survey. Most mothers were white, married, and had attended college. After entering control variables (income, work status, and perceived stress) in regression analyses, mothers' overall health behaviors were significantly related to total child behavioral/emotional problems. These preliminary findings suggest that the health behaviors of mothers may be related to children's mental health, but the direction of the relationship should be tested further in longitudinal research.

Competence-building in adolescents, Part II: Community intervention for survivors of peer suicide

Nurses often encounter situations in which they are called upon to assist in post-suicide community interventions with teachers, church youth group leaders, and mental health professionals. Controlled studies of interventions to aid adolescents coping with the loss of a peer are lacking. The purpose of this study, conditioned by an unanticipated suicide in an ongoing research study, was to document changes in psychosocial competence of adolescent peer suicide survivors. Following a supportive community intervention, the peer survivor group was compared with a similar group of adolescents who did not experience peer suicide. Both groups were in the control condition of a larger nursing study of social competence-building. The survivor group had significantly greater self-efficacy immediately after the community intervention and 2 months later when contrasted with the comparison group. In addition, the survivor group reported greater social acceptance and job competence immediately after the community intervention. Correlated t-tests showed the survivor group had significant gains in problem-solving appraisal and global self-worth after the community intervention, but significant declines in global self-worth and scholastic competence 2 months after the intervention. The findings support the belief that community interventions are initially worthwhile in helping adolescents to cope with peer suicide, but continued supportive intervention may be needed to offset declines noted over time in areas such as self-worth and academics.

Competence-building in adolescents, Part I: A self-help nursing intervention

The purpose of this study was to test the effects of a self-help nursing intervention on adolescent psychosocial competence. A community sample of 139 adolescents was assigned to three conditions (intervention, delayed intervention, and control) within a pretest-posttest design. The self-help nursing intervention was a 9-page, 14-step self-help workbook for use by adolescents in dealing with upsetting situations in day-to-day living. After a self-assessment of coping, subsequent workbook steps aided adolescents in developing alternate coping responses and generating other ways to deal with the upsetting situation. Adolescents in the three conditions did not differ on pretest measures of psychosocial competence: problem-solving appraisal, adolescent self-perception, and general self-efficacy. After statistically controlling for pretest scores, gender, and age, the intervention group showed more favorable self-perceptions in scholastic competence, social acceptance, and conduct/morality compared with the control group. However, expected differences in the delayed intervention group failed to appear. Thus, anticipated benefits in psychosocial competence were found inconsistently. Although not predicted, significant reductions in the prevalence of negative affect occurred among adolescents in both intervention groups. Overall, the self-help format for delivering psychosocial competence training lacked the power needed to bring about consistent benefits for adolescents. Testing the self-help workbook in a group context is recommended in future nursing intervention research.

Health and Well-Being of Childbearing Women in Rural and Urban Contexts

As part of the national focus on women's health issues, it is important to identify those health-related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health-related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty-five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self-actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women.

Maternal identity and role attainment: long-term relations to children's development

Mother-infant pairs were assessed during postpartum for maternal role and identity and a variety of infant and sociodemographic characteristics. When children were school age (8 to 10 years), 77 of the original 124 mothers returned a mail survey that assessed children's social competence and behavioral problems. After controlling for socioeconomic status, neither perceived nor demonstrated role attainment predicted child outcomes. Only a subset of the maternal identity indicators predicted children's social competence and behavior problems at 9 years, and these relationships were few and modest in magnitude. Overall, little support was found for the long-term predictive power of maternal role indicators measured during postpartum.

Well-being of mothers with infant children: a preliminary comparison of employed women and homemakers

In general, research has demonstrated that employment has positive or neutral effects on women's mental and physical health. Stressors unique to full-time employed mothers of infants, however, may diminish their well-being. This study compared perceived stress levels and health-promotive lifestyles in a sample of full-time employed mothers and homemaking mothers. As expected, full-time employed mothers of infants reported greater perceived stress in their lives and less healthy lifestyles when they were compared with homemakers. The most frequently reported sources of stress for employed mothers of infants were conflicts or problems about returning to work. Findings support the hypothesis that full-time employed mothers of infants may adopt a pattern of self-neglect to cope with work overload.

A longitudinal analysis of stress process among mothers of infants

A model of stress process among mothers of infants was retested. In that model, stressors (work status or infant difficultness) influence maternal identity through perception of stress. Also, maternal identity may be buffered from stressor effects by health-promotive lifestyle. This model previously received partial support in a one-panel mail survey. The present study reports maternal outcomes from a 6-month follow-up of the original sample. One hundred nineteen (69%) mothers of infants aged 8-20 months participated in the follow-up study. Despite subject attrition, most findings from the original study were replicated in this study. As before, work status and perceived stress each contributed to predicting identity. Health-promotive lifestyle acted directly, not as a buffer, on maternal identity. When extraneous influences were controlled, neither perceived stress nor health-promotive lifestyle was significantly correlated across a 6-month period.

Stress process among mothers of infants: preliminary model testing

Maternal employment, cesarean birth, and infant difficultness were used to test the mediating effect of perceived stress and the stress-buffering role of health practices on maternal identity. One hundred seventy-three mothers returned a parenting survey that focused on: stressors, perceived stress, health practices, maternal identity, and a demographic profile. Work status and infant difficultness were related to perceived stress. Neither had direct effects on maternal identity, but were related to it through the mediating effects of perceived stress. While health practices did not show buffering effects between stressors and perceived stress, these did contribute additively to the prediction of stress perception. Also, health practices contributed additively to the prediction of identity. Notable among the health practices predicting identity were self-actualizing expression, nutrition, interpersonal support, and stress management. These findings support a stress process model of parenting in which: (a) effects of stressors on maternal identity are mediated by perception of stress, and (b) health practices contribute positively and directly to maternal identity.

Mothering behavior and maternal role attainment during the postpartum period

Relationships among subjective and behavioral components of maternal role attainment were investigated separately for 64 primiparous and 60 multiparous mothers. The influence of contextual variables on maternal behavior was also examined. Subjects were medically low risk with normal infants. Attitudes toward themselves and their infants and feelings of self-confidence were measured at 1 to 2 days and 4 to 6 weeks after delivery. At 4 to 6 weeks mothers were also videotaped performing an infant feeding at home. Tapes were rated for maternal sensitivity and responsivity. For primiparas, self-confidence was related to maternal feeding behavior as were maternal age, education, and socioeconomic class. For multiparas, only initial attitude toward self was related to maternal behavior; however, maternal age and infant size were contextual factors related to behavior. Distinctions proposed among subjective and behavioral components are in part supported by the findings of the study.

Maternal role attainment and identity in the postpartum period: stability and change

Stability and change in maternal identity and maternal role attainment were examined in 64 medically normal, middle-class primiparous and 58 multiparous women. Using two semantic differential scales, "Myself as Mother" and "My Baby", for maternal identity and the Pharis (1978) Self-Confidence Scale for role attainment, subjects were tested at 1 to 3 days and 4 to 6 weeks postpartum. Main effects for parity and testing occasions were found for both semantic differential scales. While mothers' attitudes toward themselves became more positive over time, those toward their babies became less positive. Self-confidence showed main effects for both time of testing and parity as well as interaction effects. Although attitudes and self-confidence were stable across testing occasions, self-confidence was less related to indicators of maternal identity for multiparas than for primiparas. Sociodemographic variables demonstrated only low correlations with indicators of maternal identity and role attainment. Testing the relationship of maternal identity and role attainment to actual parenting behaviors is needed to determine the empirical and practical import of these two concepts in nursing practice.