Body image concerns during pregnancy are associated with a shorter breast feeding duration

The relationship between body image, depression, and breastfeeding attitudes in women with 0-24-month-old infants: a cross-sectional study

OBJECTIVE

The aim of this study was to determine the relationship between body image, depression, and breastfeeding attitudes in women who had infants aged 0-24 months.

METHODS

The study was cross-sectional and correlational in nature, conducted in Turkey between November 2023 and July 2024, with 282 women who had infants aged 0-24 months (n=282).

RESULTS

Of the women who participated in the study, 46.1% received breastfeeding training during the postpartum period, and 46.2% received breastfeeding training between 7 and 12 months. It was determined that women stopped breastfeeding between months, with the main reason being the perception of insufficient milk (51.2%). The total mean score of the Women's Breastfeeding Attitude Evaluation Scale was found to be 99.53±13.48, the Body Perception Scale was 132.19±28.84, and the Beck Depression Scale was 16.19±10.97. Additionally, if there was a high-level, positive linear relationship between the Breastfeeding Attitude Evaluation Scale and the Body Image Scale total scores (r=0.340, p<0.01), then there was a high-level, negative relationship between the Breastfeeding Attitude Evaluation Scale and the Beck Depression Inventory total score (r=-0.503, p<0.01), and a highly negative relationship was found between the Body Image Scale and the Beck Depression Scale (r=-0.526, p<0.01).

CONCLUSION

It has been concluded that low body image and depression in women who had infants aged 0-24 months negatively affect breastfeeding attitudes. It is recommended to investigate the factors affecting breastfeeding attitudes in postpartum women and to provide support and training that can positively affect breastfeeding attitudes.

Body understanding measure for pregnancy scale (BUMPS): Psychometric properties and predictive validity with postpartum anxiety, depression and body appreciation among Italian peripartum women

Pregnancy is a unique phase in a woman's life marked by profound physical transformations, including changes in body shape and weight. The Body Understanding Measure for Pregnancy Scale (BUMPs) was designed to assess body image during pregnancy. Despite its increasing use, the scale has not yet been adapted into Italian, and evidence regarding its predictive validity with respect to anxiety, depression, and body appreciation is lacking. This study aimed to address these gaps to validate the Italian BUMPs and test its predictive validity. A community sample of 726 Italian pregnant women was recruited (age range 18-48, Mage= 31.3 ± 4.79). Participants completed a translated BUMPs and other self-report questionnaires assessing anxiety, depression, and body appreciation. Confirmatory factor analysis supported a three-factor structure for the BUMPs, with dimensions assessing Satisfaction with Appearing Pregnant, Weight Gain Concerns, and Physical Burdens of Pregnancy. BUMPs subscales demonstrated satisfactory internal consistency (ω = 0.765-0.866). Cross-sectional analysis revealed that BUMPs scores correlated with anxiety (r range from 0.25 to 0.32), depression (r range from 0.31 to 0.34), and gestational body mass index (r range from 0.18 to 0.37). Longitudinal analysis associated BUMPs with anxiety, depression, and body appreciation measured after childbirth, providing evidence of predictive validity. Overall, the present study supports the BUMPs as a valid and reliable tool for assessing body image during pregnancy within the Italian context. Additionally, it provides the first evidence of the BUMPs' predictive validity for postpartum mental health outcomes and body appreciation after childbirth.

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.

Sexual and reproductive health in overweight and obesity: Aims and visions for integrated research approaches

Overweight and obesity increasingly affect women in their reproductive phase, during family planning, pregnancy, breastfeeding and the postpartum period. Overweight and obesity are associated with impaired sexual and reproductive health, including increased rates of infertility, pregnancy complications, and reduced breastfeeding rates. Furthermore, maternal overweight and obesity are associated with long-term negative health consequences for the child, such as an increased risk for respiratory and metabolic disease. With the Junior Research Center for Reproduction: Sexual and Reproductive Health in Overweight and Obesity (SRHOO Center), we aim to address the effects of overweight and obesity on sexual and reproductive health in an interdisciplinary approach, combining the areas of obstetrics and midwifery, sexual health research, basic research in feto-maternal medicine and glycoimmunology, pediatrics, as well as endocrinology, metabolism and bariatric surgery. Combining these areas of expertise, we seek (1) to understand the effects of overweight and obesity on sexual and reproductive health in different patient groups, focusing on their specific needs in order to provide appropriate counselling and access to healthcare; (2) to improve reproductive health in different groups of overweight and obese patients; and (3) to create interdisciplinary, comprehensive scientific and clinical training regarding sexual and reproductive health in overweight and obese patients. In this short introduction to the SRHOO Center, we provide information on its structure, aims and individual projects as well as its presumed long-term implications for clinical care and public health.

Mothers' Body Appreciation and Postpartum Self-Esteem in Relation to Body Changes and Breastfeeding Difficulties: A Cross-Sectional Survey in Cyprus

Objectives: This study explores the effect of pregnancy weight gain, acceptance of body changes, and breastfeeding difficulties on mothers' self-esteem and body appreciation during the postpartum period. Methods: A cross-sectional survey was conducted among 100 puerperae (at 2nd day postpartum), during August 2022-March 2023 in Paralimni/Cyprus, with exclusion criteria being the presence of postpartum depression. The Body Appreciation Scale-BAS-was administrated in order to investigate the level of body appreciation, and the Rosenberg Self-Esteem Scale-RSES-10-was used for assessing self-esteem. Results: Findings indicated that the higher the pregnancy weight gain (r = -0.293), the lower the measured levels of the mothers' self-esteem and body appreciation are (r = -0.292). Mothers whose level of acceptance of body changes was low to moderate appeared to demonstrate lower self-esteem (p = 0.027) and lower body appreciation (p < 0.001) at two days postpartum. Also, mothers who had breastfeeding difficulties at two days postpartum seem to demonstrate lower self-esteem (p = 0.032), and increased support from their husbands in terms of breastfeeding is associated with higher levels of mothers' self-esteem (r = 0.235). Additionally, greater support for breastfeeding, both in the clinic (r = 0.314) and from their husbands (r = 0.290), appears to be linked to higher levels of body appreciation. The psychological influence of pregnancy weight gain (β = -0.236, p = 0.04) and breastfeeding difficulties (β = -0.284, p = 0.008) appeared to be predictors of mothers' self-esteem at two days postpartum. Conclusions: The findings highlight the need for further research in areas including mothers' body image and self-esteem and breastfeeding difficulties and further longitudinal studies to determine the exact nature of the pathways involved.

Pregnancy Eating Attitudes-Questionnaire (PEA-Q): Exploratory factor analysis and psychometric performance in a pregnant community sample with body mass index ≥ 25

Pregnancy is characterized by biopsychosocial changes that impact appetite, eating and weight. Understanding pregnant individuals' attitudes toward eating and weight can provide insight into prenatal health behavior. Accordingly, we developed and performed initial psychometric testing of a self-report measure, the Pregnancy Eating Attitudes-Questionnaire (PEA-Q), among individuals with pre-pregnancy BMI≥25. Pregnant participants with pre-pregnancy BMI≥25 (N = 213), who predominantly identified as racially minoritized (51% Black/African American) and lower income (66% ≤$30,000/year), enrolled in a longitudinal study. Participants completed 25 candidate PEA-Q items and eating- and weight-related measures. We conducted exploratory factor analysis to determine PEA-Q factor structure, calculated internal consistency coefficients of the extracted factors, and assessed convergent and discriminant validity. An 11-item, three-factor solution produced excellent model fit. Factors were interpreted as Permissive Eating and Weight Attitudes (e.g., "Pregnancy is a 'free pass' to eat any type of food that I want; " α = .82), Intentional Eating Changes (e.g., "I need to eat more food each day because I am pregnant; " α = .81), and Lack of Worry about Eating and Weight (e.g., "I am not concerned about eating too much now that I am pregnant; " α = .83). Each factor showed small-to-moderate correlations with measures of gestational weight gain and/or dietary intake and was not correlated with eating pathology measures, demonstrating adequate convergent and discriminant validity, respectively. This novel self-report measure seems to adequately capture pregnancy-related attitudes toward eating and weight among pregnant individuals with BMI≥25. Further testing is required to confirm these preliminary findings and determine generalizability.

Psychometric properties of the Turkish version of BUMPs and its relationship with prenatal attachment

OBJECTIVE

The present research aims to adapt the Body Understanding Measure for Pregnancy Scale (BUMPs) to Turkish, determine its psychometric properties, and examine the correlation between prenatal attachment and body image perception of pregnant women.

METHODS

Three hundred seventy-one pregnant women were enrolled in the research. The original English version of the BUMPs was translated into Turkish using forward-backward translation logic. The scale's reliability was evaluated with item analysis, internal consistency analysis, and test-retest reliability. Turkish version of the BUMPs and Prenatal Attachment Inventory (PAI) were filled out by pregnant women. The relationship between them was evaluated by correlation analysis.

RESULTS

The mean week of gestation was 25.25 ± 8.26 (min: 12, max: 41). The Turkish version of the BUMPs exhibited satisfactory psychometric properties. The t-values, factor loadings, and fit indices of the scale items of the Turkish version were at an acceptable and excellent level. As a result of confirmatory factor analysis, the 18-item, three-factor construct was confirmed for the Turkish version of the scale. In the Turkish version of the scale, there are three subscales, including satisfaction with appearing pregnant, weight gain concerns, and physical burdens of pregnancy. Cronbach's alpha internal consistency coefficient of the overall scale was 0.84. A significant correlation was determined between the scores of the Turkish version of the BUMPs and the PAI (r = -0.263; p < 0.001).

CONCLUSION

The Turkish version of the BUMPs is a valid and reliable measurement tool for determining pregnant women's body image perception. Prenatal attachment increases with the increasing body image perception of pregnant women.

Measurement and decomposition of education-related inequality in exclusive breastfeeding practice among Ethiopian mothers: applying Wagstaff decomposition analysis

Background

Human breast milk, a naturally balanced source of infant nutrition, promotes optimal growth and health when exclusively fed for 6 months. Exclusive breastfeeding reduces common childhood infections, provides protection against some chronic illnesses, and contributes to achieving several Sustainable Development Goals. Despite its benefits, only 58% of Ethiopian women practice it, and the associated education-related inequality is not well documented. Thus, this study aims to quantify and decompose the education-related inequality in exclusive breastfeeding practice among Ethiopian mothers.

Methods

A total of 1,504 weighted samples were studied using a Performance Monitoring for Action Ethiopia longitudinal panel survey dataset (2021-2023). Wagstaff normalized concentration index and its concentration curve were used to assess education-related inequality in exclusive breastfeeding practice. Wagstaff decomposition analysis was performed to decompose the concentration index and identify factors contributing to the observed education-related inequality. Significance was declared at p-value <0.05.

Results

The overall prevalence of exclusive breastfeeding among Ethiopian women was 57.29% (95% CI: 54.79, 59.80%), with a greater concentration found among women with lower levels of education. This indicates an inequality that favors less educated women (pro-less educated inequality), as demonstrated by the Wagstaff normalized concentration index of -0.058 (95% CI: -0.113, -0.002). Factors that made a significant contribution to the observed education-related inequality in exclusive breastfeeding practice were residence (18.80%), region (29.31%), place of birth (-7.38%), and the wantedness status of the indexed pregnancy (82.58%). The indexed pregnancy's wantedness was made a more elastic (elasticity = 0.282) contribution.

Conclusion

The study identified a small yet significant education-related inequality in exclusive breastfeeding, favoring less educated women. Hence, emphasis should be placed not only on educating women but also on healthy habits that they can leave behind when they learn. Residence, region, place of birth, and indexed pregnancy's wantedness significantly contributed to the observed education-related inequality. The elasticity value for each factor suggests that policy changes addressing these factors could readily reduce the observed inequality.

Breastfeeding self-efficacy in mothers: The body image and emotional intelligence perspective

BACKGROUND

Breastfeeding is a dynamic and complex process. Due to its complex nature, many reasons affect one another. Recent studies have focused on breastfeeding rates and factors that affect the early termination of breastfeeding. However, studies evaluating the relationship of body image and emotional intelligence concepts with breastfeeding self-efficacy have remained limited to date, resulting in a significant gap in the literature.

AIM

The present study was carried out to determine the relationship between breastfeeding self-efficacy, body image, and emotional intelligence of postpartum mothers.

METHODS

The descriptive and cross-sectional study was conducted with 400 mothers. The data were collected using the Descriptive Information Form, the Body Image Scale (BIS), Schutte Emotional Intelligence Scale (SEIS), and the Breastfeeding Self-Efficacy Scale (BSES). The data were evaluated with the SPSS program, using percentages, mean values, independent t-test,One-Way ANOVA, and Pearson's correlation and regression.

RESULTS

The mothers' mean age was 29.99±5.46 years. The mean total scores that mothers obtained from the scales were found to be 123.47±23.45 for the BIS, 144.46±13.11 for the SEIS, 51.81±9.46 for the BSES-SF. In the correlation analysis results, there was no correlation between the BSES-SF and SEIS. A statistically significant positive correlation was determined between the BIS and BSES-SF. Considering the regression analysis, it is seen that 7.4% of the change in mothers' breastfeeding self-efficacy is explained by body image (R^2 = 0.074) CONCLUSION: The study found that positive body image increases breastfeeding self-efficacy. There is a need for additional longitudinal research examining the body image and emotional intelligence perspective of breastfeeding self-efficacy.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

PROSPERO registry: CRD42024531531.

Maternal Breast Growth and Body Mass Index Are Associated with Low Milk Production in Women

BACKGROUND

Maternal breast volume is determined by the quantity of glandular and adipose tissue, and it undergoes significant changes during pregnancy. These changes are intricately linked to the development of glandular tissue, which most likely reflects lactation capacity. Evidence indicates that women with overweight or obesity exhibit larger breast volume compared to those with a normal body mass index (BMI), emphasizing the close relationship between breast volume and maternal adiposity. Hence, we aim to investigate breast volume growth and maternal BMI as potential risk factors for low milk production.

METHODS

Lactating women (n = 609) from the Perth metropolitan area in Western Australia between 2011 and 2023 were included in the analysis. Twenty-four-hour milk production measurements were conducted using the test weighing method, and milk removal frequencies were recorded. Mothers completed questionnaires regarding demographic, obstetric and infant details. Linear and logistic regression models were used to determine maternal and infant factors associated with milk production.

RESULTS

Here we show that increasing maternal age and BMI are associated with low milk production. Moreover, larger pre-pregnancy breast volume and breast growth are associated with both higher BMI and milk production.

CONCLUSIONS

Women who are older, have an obese BMI and who have minimal pre-pregnancy breast volume and breast growth should be provided with antenatal screening and breastfeeding support as they are more likely to experience low milk production.

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.

Developing a new measure of retrospective body dissatisfaction: links to postnatal bonding and psychological well-being

BACKGROUND

Pregnancy is a transformative time for women and their bodies, and therefore thoughts and feelings about the body understandably change during this period. While previous research has established the impact of body dissatisfaction on factors like antenatal attachment and maternal mental health, there is a notable gap in understanding its long-term effects on postnatal factors. This is often due to high attrition rates in longitudinal studies. Using retrospective measures could address this issue, however a measure of retrospective pregnant body dissatisfaction has not yet been identified.

AIMS

This paper aimed to create a retrospective measure of pregnancy body dissatisfaction by adapting a previously validated measure. It also aimed to investigate the relationship between retrospective accounts of body dissatisfaction during pregnancy and postnatal anxiety, depression, and bonding.

METHOD

Cross-sectional online survey data was collected from women postnatally (N = 404).

FINDINGS

An exploratory and confirmatory factor analysis identified a two-factor model of retrospective body dissatisfaction, adapted from the Body Understanding Measure for Pregnancy Scale, which was equivalent to two of the original subscales. Using this factor structure, linear regressions demonstrated that higher levels of retrospective pregnant body dissatisfaction were associated with elevated rates of postnatal anxiety and depression and lower bonding scores.

CONCLUSIONS

This study successfully established a measure for assessing retrospective pregnant body dissatisfaction, potentially aiding future research. Additionally, it has highlighted the link between pregnant body dissatisfaction and postnatal levels of depression, anxiety, and bonding. Thus, improving the pregnant bodily experience may have the potential to enhance the postnatal experience.

Importance Assigned to Breastfeeding by Spanish Pregnant Women and Associated Factors: A Survey-Based Multivariate Linear Correlation Study

Breastfeeding education, across all disciplines, is often inconsistent and lacking in expertise and confidence. However, recommendations from health professionals, the sociocultural environment, and previous knowledge and experiences significantly influence women's decision to breastfeed. This study aimed to identify factors that promote the assignment of greater importance to breastfeeding and associated practical benefits. This retrospective cross-sectional study included 276 participants who completed a self-administered questionnaire. Descriptive and bivariate analyses were performed, and multivariate linear models were applied to identify factors influencing the importance assigned to breastfeeding. Most participants were married or in a relationship, were native Spaniards, had secondary or higher education, and had an average age of 32.6 years. Seventy percent met the physical activity recommendations, and 91% felt comfortable with their body image during pregnancy. The importance assigned to breastfeeding was high across various aspects, except for postpartum weight loss and body image. Group prenatal care was only significantly associated with the importance assigned to the breastfeeding technique (how to breastfeed). The obesogenic environment and the importance assigned to nutritional aspects and physical activity also turned out to be predictors, although not for all models. In our region, the educational strategy of antenatal care groups could contain gaps regarding the mother's health, which should be addressed in the future to improve results regarding the initiation and continuation of breastfeeding.

Maternal interoceptive focus is associated with greater reported engagement in mother-infant stroking and rocking

Parental caregiving during infancy is primarily aimed at the regulation of infants' physiological and emotional states. Recent models of embodied cognition propose that interoception, i.e., the perception of internal bodily states, may influence the quality and quantity of parent-infant caregiving. Yet, empirical investigations into this relationship remain scarce. Across two online studies of mothers with 6- to 18-month-old infants during Covid-19 lockdowns, we examined whether mothers' self-reported engagement in stroking and rocking their infant was related to self-reported interoceptive abilities. Additional measures included retrospective accounts of pregnancy and postnatal body satisfaction, and mothers' reports of their infant's understanding of vocabulary relating to body parts. In Study 1 (N = 151) and Study 2 (N = 111), mothers reported their engagement in caregiving behaviours and their tendency to focus on and regulate bodily states. In a subsample from Study 2 (N = 49), we also obtained an objective measure of cardiac interoceptive accuracy using an online heartbeat counting task. Across both studies, the tendency to focus on and regulate interoceptive states was associated with greater mother-infant stroking and rocking. Conversely, we found no evidence for a relationship between objective interoceptive accuracy and caregiving. The findings suggest that interoception may play a role in parental engagement in stroking and rocking, however, in-person dyadic studies are warranted to further investigate this relationship.

Body understanding measure for pregnancy scale (BUMPs): Cross-cultural adaptation and psychometric properties among Brazilian pregnant women

The Body Understanding Measure for Pregnancy Scale (BUMPs) is a scale developed and validated for British pregnant women to assess body satisfaction during pregnancy. The aim of this study was to perform a cross-cultural adaptation and verify the psychometric properties of BUMPs for Brazilian adult pregnant women. The cross-cultural adaptation was performed using translation, back-translation, expert committee, expert analysis, and pre-testing, which showed easy comprehension by pregnant women. Psychometric analyses were evaluated in a sample of 618 pregnant women (31.08 ± 4.94 years old). Exploratory and confirmatory factor analyses resulted in 19 items and three factors, with satisfactory fit indices. BUMPs presented an invariant measurement across white vs. nonwhite women and across the three gestational trimesters. BUMPs showed good indicators of convergent, internal consistency, and test-retest reproducibility validity. It was concluded that the Brazilian version of BUMPs has adequate psychometric properties for Brazilian pregnant women, being an excellent instrument for analyzing body satisfaction in this population, facilitating additional investigations into these constructs.

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.

Validation and psychometric testing of the Chinese version of the prenatal body image questionnaire

BACKGROUND

The body image during pregnancy potentially affects both short- and long-term maternal and child health outcomes, including pregnancy mood, postpartum weight recovery, and the quality of mother-child interactions. However, research on the impact of body changes during pregnancy in the Chinese population is scarce. A comprehensive, practical, and reliable tool for assessing pregnant women is needed to detect, intervene in, and implement the reduction of physical dissatisfaction risk. This study translated the Prenatal Body Image Questionnaire (PBIQ) into the Chinese version (PBIQ-C) to assess the body image of pregnant women and evaluated its reliability and validity.

METHODS

An improved Brislin translation model was used for the translation. A panel of experts determined the content validity. A convenience sample of 429 pregnant women was chosen from three third-class hospitals in different regions of Fujian Province, China. Factor analysis, Pearson's correlation, retest reliability, and Cronbach's alpha were employed to evaluate structural validity and reliability.

RESULTS

The final PBIQ-C had five dimensions with 21 items. Exploratory factor analysis obtained a five-factor solution, which accounted for a total of 60.34%. Confirmatory factor analysis showed that the model fit of the five-factor model also reached a satisfactory model fit after modifying: The Comparative Fit Index was 0.93, and the Tucker-Lewis Index was 0.92; the Root Mean Square Error of Approximation was 0.079. The content validity index of the scale ranged from 0.63 ~ 1.00. The Cronbach's alpha coefficient was 0.95 for the total scale, and the test-retest reliability was 0.80.

CONCLUSIONS

The findings indicated that the PBIQ-C is a valid and reliable instrument for assessing women's body image during pregnancy, which helps in the early identification of body dissatisfaction during pregnancy and enables the early prevention of postpartum depression.

Australian, Irish, and Swedish women's comfort levels when breastfeeding in public

BACKGROUND

Despite a flux of global initiatives to increase and sustain breastfeeding rates, challenges persist. The decision to commence and sustain breastfeeding is influenced by multiple, complex factors. Feelings of social embarrassment, shame, fear of judgement, and lack of confidence when breastfeeding in public, compound women's decisions to breastfeed and may result in formula feeding or early cessation of breastfeeding. A greater understanding of where and how women feel most comfortable when breastfeeding in public can assist in designing interventions to support the initiation and continuation of breastfeeding.

METHODS

A cross-sectional survey was conducted with women living in Australia (n = 10,910), Sweden (n = 1,520), and Ireland (n = 1,835), who were currently breastfeeding or who had breastfed within the previous two years. Our aim was to explore where, and how often women breastfeed in public and to compare their levels of comfort when breastfeeding in public. Data were collected in 2018 using an anonymous online survey over a four-week period in Ireland, Australia, and Sweden, and were analyzed using SPSS Version 25.

RESULTS

Most respondents were highly educated, with over 70% in each country reporting having a university or college degree. Observing women breastfeeding in public was more commonly reported to be a weekly or daily occurrence in Sweden (24.5%) and Australia (28%), than in Ireland (13.3%). Women in the participating countries reported breastfeeding in public most commonly whenever their babies needed feeding. Very few women never or rarely breastfed publicly. Coffee shops/cafes, restaurants, and parks were the most popular locations. In all three countries, partners were reported to be very supportive of breastfeeding in public, which enhanced breastfeeding women's comfort levels. When asked to score out of a maximum comfort level of 10, women reported higher mean levels of comfort when breastfeeding in front of strangers (Ireland M = 7.33, Australia M = 6.58, Sweden M = 6.75) than with those known to them, particularly in front of their father-in-law (Ireland M = 5.44, Australia M = 5.76, Sweden M = 6.66 out of 10), who scored lowest in terms of women's comfort levels.

CONCLUSION

This study offers important insights into the experiences and comfort levels of women breastfeeding in public. Limitations include the anonymous nature of the surveys, thus preventing follow-up, and variances in terminology used to describe locations across the three settings. Recommendations are made for research to determine the relationships between the frequency of breastfeeding in public and breastfeeding women's perceived comfort levels, the influence of family members' perceptions of breastfeeding in public and women's experiences, and the experience of women who feel uncomfortable while breastfeeding in public, with a view to developing support measures.

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.

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.

Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action

Breast cancer is currently the most common cancer among women worldwide; in 15-25% of cases, patients are premenopausal at the time of diagnosis, and 50% of women desire pregnancy after cancer diagnosis. Motherhood after breast cancer involves complex psychological challenges with long-term consequences, though it is safely pursuable with adequate support. The purpose of this mini-review is to analyze the psychological implications surrounding pregnancy and motherhood after breast cancer and promote action in addressing the challenges that might affect women facing these life events.

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.

Body Image Assessment Tools in Pregnant Women: A Systematic Review

Pregnancy is a remarkable time and generates several changes in women in a short period. Body image is understood as the mental representation of the body itself, and, although bodily changes are considered healthy, they can impact pregnant women's body image. Problems related to body image during pregnancy can affect the health of the mother and fetus; thus, it is essential for health professionals to detect potential disorders as soon as possible. The objective of this systematic review was to identify instruments for assessing body image in pregnant women, highlighting their main characteristics. To this end, we applied the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to searches in the EMBASE, PubMed, and American Psychological Association databases from 5 January to 10 August 2021. We included studies on adult pregnant women without comorbidities in the validation and adaptation of (sub)scales that analyze components of body image. We excluded studies that considered nonpregnant, adolescent, postpartum, and/or clinical populations, as well as smoking/drug use studies that were not validation studies or did not assess any aspect of body image. We investigated the quality of the studies using the Quality Assessment Tool for Studies with Diverse Designs. In all, we examined 13 studies. The results point to a growing concern over body image during pregnancy, as there has been an increase in the number of validation and adaptation studies involving scales for different cultures that scrutinize different constructs. The findings suggest that the listed instruments be used in future research.

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.

Body Image Dissatisfaction, Breastfeeding Experiences, and Self-Efficacy in Postpartum Women with and Without Eating Disorder Symptoms

BACKGROUND

Women during the postpartum period undergo significant changes which affect body image, eating behaviors, and, potentially, breastfeeding. There is limited research about relationships among these variables, particularly related to breastfeeding experiences and self-efficacy.

RESEARCH AIMS

To determine: (1) the associations between eating disorder symptoms and body image, breastfeeding self-efficacy, and breastfeeding experiences; and (2) the differences in body image, breastfeeding self-efficacy, breastfeeding experiences, and breastfeeding status of postpartum women with and without clinically significant eating disorder symptoms.

METHODS

A secondary data analysis using a 2-group correlational, cross-sectional online survey design was used. Participants with infants 2-6 months old who had breastfed their infant at least once (N = 204) were recruited nationally to complete a cross-sectional survey assessing breastfeeding and postpartum physical and mental health using validated measures. Linear and logistic regression evaluated differences between participants with and without eating disorder symptoms regarding their body image, breastfeeding experience and self-efficacy, and breastfeeding status (continued vs. discontinued) at 2 months postpartum.

RESULTS

Clinical eating disorder symptoms were reported by 9.8% (n = 20). Participants with clinical eating disorder symptoms reported lower appearance evaluations (B = -0.53, 95% CI [-0.93, -0.14]) and body image satisfaction (B = -0.55, 95% CI [-0.87, -0.23]); reduced odds of breastfeeding at 2 months postpartum (AOR = 0.15, 95% CI [0.04, 0.56]); and lower breastfeeding self-efficacy (B = -7.70, 95% CI [-14.82, -0.58] relative to participants without clinical symptoms. No differences between groups were observed for breastfeeding experiences.

CONCLUSIONS

Participants with clinically significant eating disorder symptoms are at risk for early breastfeeding discontinuation and lower breastfeeding self-efficacy. Our findings have implications for future research and clinical care practices, including screening for body image concerns and eating disorder symptoms and supporting breastfeeding self-efficacy.

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.

A rare phenomenon of pregorexia in Pakistani women: need to understand the related behaviors

BACKGROUND

In Pakistan, for a decade or so, there has been a huge increase in body ideals, and thinness and eating disorders reported during pregnancy. The purpose of the present research was to study the lived experiences and behaviors characterized by pregorexia in Pakistani young women.

METHOD

A phenomenological approach was used to study eating disorder-related behaviors among pregnant women. A criterion sample of 15 women (22-34 years of age) having difficulty with their body image, the decline in caloric intake, skipping meals, and extensive exercise from a private gynae clinic of Islamabad was selected. The participants were screened on the DSM-5 criteria of anorexia nervosa. They were also asked questions about their diet intake, behaviors executed to lose or maintain weight, use of any medical or chemical substance to control weight, any social activities/behaviors, type of exercise if any, duration or frequency of exercise, and behaviors that made them feel better.

RESULTS

The findings revealed that 93.33% of women met the complete criteria of Anorexia nervosa. 86.6% had never been diagnosed or treated with anorexia nervosa, however, 13.33% were diagnosed with anorexia nervosa comorbid with depression. Results indicated a likelihood of having anorexic tendencies in 40% of women and the other 60% developed the symptoms during pregnancy only. Behaviors related to pregorexia were found to be: skipping meals, eating small portions, control on calorie intake, following diet plans available on YouTube, taking fat burn tea, avoiding the presence of elders of the family while taking meals, eating alone to limit food portion, taking laxatives or medicine to control weight, induced vomiting after eating, eating to match the norm of eating (supervised eating by elders) being pregnant and later self-induced vomiting, or eating slowly and consuming more time, pretending to eat the suitable amount of food. Women also engaged in fast walking, light exercise, and intensive cardio to control weight and stay in body shape. Around 86% reported that controlling weight, calorie intake, and exercising made them feel better.

CONCLUSION

There is a need to understand and differentiate pregorexia from other eating behaviors and problems among pregnant women with respect to cultural context.

Do Changes in Body Shape Due to Pregnancy Lead to Cosmetic Surgery? A Cross-Sectional Study

OBJECTIVE

Pregnants and puerperas show different perceptions of their body image and appearance, so authors investigated their perceptions related to pregnancy and puerperium, evaluating their views on cosmetic surgery, by a cross-sectional study.

MATERIALS AND METHODS

5-item questionnaires were administrated to women at first pregnancy and puerperas. Patients were submitted also to Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Body Image Inventory (BII) analysis, indicating the level of anxiety, depression and body dissatisfaction for somatic changes during pregnancy and after childbirth.

RESULTS

186 healthy women, aged between 25-35 years, equally divided in pregnancy and puerperium, were compared in terms of body image, with no significant difference between groups. Analyzing the item "cosmetic surgery is required after all pregnancies", there was a significant difference in puerperas and the item "cosmetic surgery is necessary for postpartum" was the principal. The comparison of BII, BDI, BAI values between pregnants and puerperas showed a significant difference between groups (p<0.00), with higher scores in postpartum patients.

CONCLUSION

Body shape and physical dissatisfaction during pregnancy is linked with increased risk of depression in pregnancy and puerperium, pushing women to opt for cosmetic surgery, especially in puerperium.

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.

Nurses' and midwives' perspectives on how the pursuit for the 'perfect' body image affects their own breastfeeding practices: a qualitative study in Ghana

Background

Body image concerns have been widely documented in the literature as one reason why most women shorten the breastfeeding duration of their infants. Negative body image concerns among breastfeeding mothers may lead to depressive symptoms. There is a paucity of literature on how body image affects the breastfeeding practices of nurses and midwives. Therefore, this study explored the perspectives of breastfeeding nurses and midwives on how their body image affected their breastfeeding practices.

Methods

A qualitative design was used in this study. Five focus group discussions were conducted with each group having five members. The study was conducted in the Greater Accra Region of Ghana between November and December of 2020. Participants were recruited into the study using a purposive sampling method. Focus group sessions were audiotaped and transcribed verbatim. Data were analyzed using a content analysis.

Results

Three main themes emerged from the data analysis: body image concerns and breastfeeding, sociocultural pressures and breastfeeding and coping strategies. Participants had concerns regarding weight gain due to the need to eat adequately while breastfeeding. Body image concerns included increase in abdominal size, sagging breasts and generalized weight gain. These concerns and pressures negatively affected the breastfeeding practices of participants. Body image concerns reflected sociocultural pressures such as negative comments from loved ones and in the social media. The coping strategies adopted by the mothers were self-motivation and the love they had for their children.

Conclusions

The perspectives of breastfeeding nurses and midwives on the ways their body image affected their breastfeeding practices identified the need for support in order to successfully breastfeed.

Breastfeeding, body image, and weight control behavior among postpartum women

The goal of this study was to examine breastfeeding behavior and attitudes as predictors of women's body image and weight control behavior. This study extends past research by focusing on positive body image variables including body appreciation and perceived body functionality. Women (N = 597) from the United States who had recently birthed biological babies ages 0-12 months participated in an online study. Current breastfeeding rates were high (86 %), and average breastfeeding duration was approximately 3 months. Women who were currently breastfeeding indicated more positive body images and less likelihood of engaging in maladaptive weight control behaviors than women who were no longer breastfeeding or had never breastfed their baby. Women's positive attitudes toward breastfeeding were associated with awareness and appreciation of body functionality and fewer maladaptive weight control behaviors. These findings extend research on the health benefits of positive body image and suggest that breastfeeding may occur within a constellation of beliefs and behaviors indicative of positive body image.

Social media use and postpartum body image dissatisfaction: The role of appearance-related social comparisons and thin-ideal internalization

OBJECTIVES

For many women, the postpartum period is a particularly vulnerable time to experience body image dissatisfaction. We aimed to examine the impact of social media usage frequency in the context of postpartum body image dissatisfaction and eating disorder psychopathology. We therefore empirically tested a hypothetical model assuming that social media usage influences postpartum body image dissatisfaction and eating disorder psychopathology via multiple mediation through appearance-related social comparisons and thin ideal internalization.

DESIGN

Cross-sectional online-survey.

SETTING

Online forums, social media groups, community groups PARTICIPANTS: Two-hundred-fifty-two new mothers who had given birth within the last 26 weeks prior to the assessment.

MEASUREMENTS

Social media use was assessed by the average frequency of using Facebook, Instagram, Youtube or other per week. Body image dissatisfaction was assessed with the Body Shape Questionnaire and eating disorder psychopathology with the Eating Disorder Examination-Questionnaire. Path analyses using SPSS Amos were conducted to examine whether the hypothetical model fitted our data.

RESULTS

After minor modification, the final model revealed a good fit to the data, CFI = .977, TLI = .964, SRMR = .061, RMSEA = .056 (90%CI .027, .084), and as expected the indirect multiple mediation pathway via appearance-related social comparisons and thin ideal idealization was significant, IE = 4.395; 95%BCaCI 2.969, 7.394; p = .001. The number of target groups for appearance-related social comparisons did not moderate the results.

KEY CONCLUSIONS

Our results provide first evidence that social media use may play an important role in postpartum body dissatisfaction and eating disorder psychopathology. Mediational pathways proposed by socio-cultural theories of body image also hold for the postpartum period.

IMPLICATIONS FOR PRACTICE

Practitioners in the field should be aware of the association between social media use and body image dissatisfaction and mediating factors among new mothers and sensitive when directing new mothers to those media.

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.

The Associations Between Breastfeeding Duration and Body Dissatisfaction, Ethnicity, and Obesity Among Mexican Women, a Cross-Sectional Study, ENSANUT 2012

Introduction: Body image dissatisfaction (BID) has been inversely associated with breastfeeding initiation particularly among women with obesity. However, less is known on BID and the association with maintaining breastfeeding in Mexico, where breastfeeding rate is decreasing across ethnic subgroups. Therefore, we explore this gap of knowledge in diverse ethnic subgroups across levels of maternal weight status. Methods: Data were derived from the Mexican National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición [ENSANUT] 2012), and 10,466 women aged 20-49 years were included. Breastfeeding (<6 months versus ≥6 months) of the last child, BID (Stunkard Figure Rating Scale), anthropometric (body mass index, BMI), sociodemographics, and biological variables were collected. Crude and adjusted target associations and effect modifiers were assessed using weighted-logistic regression models. Results: Overall, 72.4% of ever breastfeeding mothers breastfed a minimum of 6 months, 22% were indigenous, 74% were dissatisfied with their body image (BID >0), and 37% had obesity (BMI ≥30 kg/m²). In the multivariable analysis, for each one-unit increase in the BID score, the adjusted odds of breastfeeding (≥6 months) decreased by 6% (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.89-0.99). After stratifications, only among women with obesity, a greater BID score was associated with lower odds of breastfeeding duration by 24% (OR = 0.76, 95% CI: 0.64-0.89) in indigenous and by 10% (OR = 0.90, 95% CI: 0.82-0.98) in non-indigenous women. Conclusions: Mexican women with a higher BID score reported lower odds of breastfeeding duration (≥6 months). Body image concerns should be integrated into a health promotion curriculum to mitigate their negative effect particularly in certain segments of the populations, such as women with obesity and among indigenous women.

Validation of the “Interactive Breastfeeding Scale”: theoretical and empirical analysis

ABSTRACT Objective: To conduct a theoretical and empirical analysis of the Interactive Breastfeeding Scale. Method: A methodological study that followed the measurement method by Pasquali and was carried out in two stages: theoretical analysis with 40 nurses as content's judges and a pilot survey with 68 mothers of a maternity hospital of a university hospital in southeastern Brazil. Results: The evaluation with judges showed that the items of the scale are accurate on the theoretical concept, semantic adequation, and pertinence. From 58 items on the scale, 33 had a Content Validity Index greater than or equal to 0.80. The pilot survey allowed us to evaluate the items in the social and cultural context of the target population. In the end, the scale remained with 30 items. Conclusion and implication for the practice: The validation with the judges showed that the items of the Interactive Breastfeeding Scale are accurate to the theoretical concept regarding semantics and relevance and proved to be a reliable and valid instrument to evaluate the factors that interfere in mother-child interaction during breastfeeding.

The Mood, Mother, and Infant Study: Associations Between Maternal Mood in Pregnancy and Breastfeeding Outcome

Purpose: We sought to determine the role of depression and anxiety in breastfeeding cessation. Materials and Methods: Participants underwent a baseline visit with a structured clinical interview in the third trimester of pregnancy. Monthly phone interviews assessed current mood symptoms and infant feeding status. We assessed the association between baseline mood and infant feeding outcomes using Cox proportional hazards regression, adjusting for infant feeding intention and sociodemographic confounders. Results: We enrolled 222 mother-infant dyads in late pregnancy, of whom 206 completed assessments through 12 months postpartum. We enriched our study with symptomatic women by enrolling 87 women with current depression or anxiety (Current), 64 women with a history of depression or anxiety (Past), and 71 women with no psychiatric history (Never). In multivariable-adjusted analyses, baseline diagnosis was not associated with breastfeeding outcome, but baseline symptoms of depression (Beck Depression Inventory ≥11) or anxiety (Spielberger State Anxiety ≥40) were associated with earlier introduction of formula (depression: adj hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.01-2.30; anxiety: 1.70, 95% CI 1.01-2.87); and any cessation of breastfeeding (depression: adj HR 2.02, 95% CI 1.23-3.31; anxiety: 1.83, 95% CI 1.00-3.33), as were depression symptoms among women who were being treated with antidepressants, compared with untreated asymptomatic women (formula: adj HR 2.27, 95% CI 1.29-4.02; cessation: 2.32, 95% CI 1.17-4.61). History of childhood trauma (adj HR 1.34, 95% CI 1.12-1.61), disordered eating symptoms (adj HR 1.22, 95% CI 1.02-1.46), and poor sleep quality in pregnancy (adj HR 1.32, 95% CI 1.09-1.60) were independently associated with earlier introduction of formula. Conclusions: Baseline mood symptoms were independently associated with earlier formula introduction and cessation of breastfeeding. History of childhood trauma, disordered eating symptoms and poor sleep quality were associated with earlier formula introduction. Targeted support may enable women with these symptoms to achieve their feeding goals.

A systematic review examining the association between female body image and the intention, initiation and duration of post-partum infant feeding methods (breastfeeding vs bottle-feeding)

A systematic review was conducted to examine female body image in relation to the intention, initiation and duration of post-partum infant feeding methods. A search of 10 databases was conducted to identify studies. A total of nine studies were included in the systematic review. All studies were of a non-randomised control design with a total of 13,046 participants. Findings suggest that exclusive breastfeeding is more likely in pregnant women with a higher body image, while those with body concerns had less intention to breastfeed or initiate, with those who start having a shorter duration.

Subconjunto terminológico da classificação internacional para a prática de enfermagem (CIPE®) para assistência à amamentação: estudo de validação de conteúdo

Resumo Objetivo: Realizar a validação de conteúdo dos enunciados de diagnósticos, resultados e intervenções de enfermagem contidos no subconjunto terminológico da Classificação Internacional para a Prática de Enfermagem (CIPE®) para assistência à mulher, à criança e à família em processo de amamentação. Métodos: Estudo de validação de conteúdo com 74 juízes que avaliaram 98 diagnósticos/resultados de enfermageme de 396 intervenções relacionadas aos diagnósticos/resultados validados. Resultados: Treze diagnósticos/resultados obtiveram IVC ≥ 0,8 (13,3%); 34 de 0,6 a 0,79 (34,7%) e; 51 menores que 0,6 (52%). Após a validação, para os diagnósticos “Falta de privacidade”, “Tomada de decisão pela amamentação, eficaz”, “Desempenho de papel de mãe, eficaz” e “Desempenho de papel de mãe, melhorado” foi necessário o estabelecimento de três enunciados de resultados de enfermagem. Na segunda etapa, 350 intervenções de enfermagem, obtiveram IVC ≥ 0,80. Conclusão: Foram validados 50 diagnósticos/resultados e 350 intervenções de enfermagem.

Self-objectification in the context of breastfeeding: A concept analysis

To increase the overall rate of breastfeeding initiation and duration, factors involved in a mother's decision to breastfeed must be identified. Self-objectification in the context of breastfeeding was a concept selected for exploring factors associated with negative views of breastfeeding. A concept analysis following the eight-step Walker & Avant method provides clarity and context to the concept of self-objectification in the context of breastfeeding. The antecedents of self-objectification in the context of breastfeeding include living in a culture of sexualization and objectification of women and the internalization of the values of objectification. Attributes of self-objectification in the context of breastfeeding are a prioritization of physical appearance attributes of the breast over the health benefits of breastfeeding and a preoccupation with physical appearance. Consequences include negative views toward breastfeeding initiation, duration, and public breastfeeding. A concept analysis on self-objectification in the context of breastfeeding will provide definition and clarity to this phenomenon, lend to theory and measurement, and add literature to the sociocultural factors impacting breastfeeding decisions.

"It's Just Not Very Realistic": Perceptions of Media Among Pregnant and Postpartum Women

Although research has documented a connection between media and body image for women, little research has explored this connection among pregnant or postpartum women. The purpose of this study was to explore women's perceptions of media and body image during the perinatal period. Fredrickson's objectification theory provided a theoretical framework for the study. Data collection involved semi-structured in-depth interviews with 50 pregnant or postpartum women in which they were asked to describe their perceptions of media depictions of pregnant or postpartum women and its impact on their body image. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Four major themes emerged: (1) participants questioned the realism of media depictions of pregnant and postpartum women, (2) participants described complex reactions to media messages including negative impacts on body image and strategies for mitigating negative impacts, (3) participants desired changes in media messages to be more realistic and to depict a more complex portrayal of the life stage, and (4) participants discussed the unique and complex role of social media including both negative and positive impacts. Implications of the findings for pregnant and postpartum women, communication scholars, and healthcare professionals are discussed.

The scale for body image concerns during pregnancy: Development and validation

PURPOSE

This study aimed to develop a scale that measures body image concerns during pregnancy.

DESIGN AND METHODS

The study administered draft of the scale for validity and reliability analysis to 320 pregnant women who visited the maternity polyclinic of a public hospital in eastern Turkey between February and May 2016.

FINDINGS

The Cronbach's alpha reliability coefficient of the entire scale was 0.88. Factor analysis determined that the 23 items that explained 58.578% of total variance were in four of the factors.

PRACTICE IMPLICATIONS

The scale for body image concerns during pregnancy was a valid and reliable scale.

Body image dissatisfaction in pregnant and non-pregnant females is strongly predicted by immune activation and mucosa-derived activation of the tryptophan catabolite (TRYCAT) pathway

OBJECTIVES

The aim of the present study is to delineate the associations between body image dissatisfaction in pregnant women and immune-inflammatory biomarkers, i.e., C-reactive protein (CRP), zinc and IgA/IgM responses to tryptophan and tryptophan catabolites (TRYCATs).

METHODS

We assessed 49 pregnant and 24 non-pregnant females and assessed Body Image Satisfaction (BIS) scores at the end of term (T1), and 2-4 days (T2) and 4-6 weeks (T3) after delivery. Subjects were divided in those with a lowered BIS score (≤ 3) versus those with a higher score.

RESULTS

Logistic regression analysis showed that a lowered T1 BIS score was predicted by CRP levels and IgA responses to tryptophan (negative) and TRYCATs (positive), perinatal depression, body mass index (BMI) and age. The sum of quinolinic acid, kynurenine, 3-OH-kynurenine and 3-OH-anthranilic acid (reflecting brain quinolinic acid contents) was the single best predictor. In addition, a large part of the variance in the T1, T2 and T3 BIS scores was explained by IgA responses to tryptophan and TRYCATs, especially quinolinic acid.

CONCLUSIONS

Body image dissatisfaction is strongly associated with inflammation and mucosa-derived IDO activation independently from depression, pregnancy, BMI and age. IgA responses to peripheral TRYCATs, which determine brain quinolinic acid concentrations, also predict body image dissatisfaction.