1
|
Tarchi L, Merola GP, Selvi G, Caprara E, Pecoraro V, Cassioli E, Rossi E, Petraglia F, Ricca V, Castellini G. Pregorexia: a systematic review and meta-analysis on the constructs of body image dissatisfaction and eating disturbances by gestational age in the peripartum. Eat Weight Disord 2023; 28:64. [PMID: 37526698 PMCID: PMC10393903 DOI: 10.1007/s40519-023-01595-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giuseppe Pierpaolo Merola
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giulia Selvi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Eleonora Caprara
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Vincenzo Pecoraro
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy.
| |
Collapse
|
2
|
Bigman G, Homedes N, Wilkinson AV. A commentary on 'A systematic review examining the association between body image and infant feeding methods (breastfeeding vs. bottle-feeding)'. J Health Psychol 2019; 26:1126-1131. [PMID: 31448629 DOI: 10.1177/1359105319869800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A systematic review is a valuable and influential research method that aims to identify and synthesize all literature relevant to the research question at hand. A well-conducted systematic review benefits the scientific community by providing a summary of all the existing evidence as well as generating new hypotheses and highlighting gaps in the literature. However, when a systematic review does not adhere to the recommended guidelines, it may introduce selection bias and generate false conclusions. Here, we present a commentary on a systematic review by the scholars Morley-Hewitt and Owen titled 'A systematic review examining the association between female body image and the intention, initiation, and duration of postpartum infant feeding methods (breastfeeding vs. bottle-feeding)' that included nine peer-reviewed articles but missed at least eight other peer-reviewed articles that aligned with their study aim, and therefore introduced selection bias in the review. To complete the missing piece, we provide a short summary of these additional articles and describe how they align with this systematic review.
Collapse
Affiliation(s)
- Galya Bigman
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Nuria Homedes
- School of Public Health, Management Policy and Community Health, The University of Texas at El Paso, USA
| | - Anna V Wilkinson
- School of Public Health in Austin, The University of Texas Health Science Center, Houston, USA
| |
Collapse
|
3
|
Johnson-Young EA. Predicting Intentions to Breastfeed for Three Months, Six Months, and One Year Using the Theory of Planned Behavior and Body Satisfaction. HEALTH COMMUNICATION 2019; 34:789-800. [PMID: 29485299 DOI: 10.1080/10410236.2018.1437523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Breastfeeding is one of the top maternal priorities for many organizations, including the World Health Organization (WHO), The American Academy of Pediatrics (AAP), and the Center for Disease Control (CDC). Focusing on the goals of Healthy People 2020, as well as the recommendations of other organizations, this paper investigates the impacts on women's intentions to breastfeed newborns for 3 months, 6 months, and 1 year. This research used the theory of planned behavior (TPB) as a model to predict intentions for each duration of time. Body satisfaction was included as a moderating variable given research demonstrating a possible connection of body satisfaction to breastfeeding. A survey of 156 pregnant women was conducted. Results demonstrated the importance of the three TPB measures in predicting intentions. Further, significant interactions between body satisfaction and attitudes, as well as body satisfaction and subjective norms were present in predicting intentions to exclusively breastfeed one's baby from infant to 6 months of age. Theoretical implications are discussed, as well as practical implications for breastfeeding interventions and campaigns.
Collapse
|
4
|
Lovering ME, Rodgers RF, George JE, Franko DL. Exploring the Tripartite Influence Model of body dissatisfaction in postpartum women. Body Image 2018; 24:44-54. [PMID: 29258016 DOI: 10.1016/j.bodyim.2017.12.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/26/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Abstract
Pregnancy and childbirth result in dramatic changes in a woman's body shape, which can be associated with body image concerns. To date, however, little is known about how sociocultural factors may influence body dissatisfaction in postpartum women. This study aimed to test a sociocultural model of body image and eating concerns among a sample of postpartum women. A sample of N=474 women, mean (SD) age=30.6 (4.8), having given birth during the last year, completed an online survey and reported on sociocultural pressures from media, peers, family and partners, thin-ideal internalization, appearance comparison, body dissatisfaction, and psychological functioning. Structural equation modeling analyses revealed a good fit to the data, χ2 (49)=220.20, p<.001, RMSEA=.086, CFI=.93. Findings suggest that women experience strong sociocultural pressures to attain unrealistic body shapes/sizes during the post-pregnancy period, contributing to their body image concerns.
Collapse
Affiliation(s)
- Meghan E Lovering
- Northeastern University, Department of Applied Psychology, 360 Huntington Avenue, Boston, MA 02115, United States.
| | - Rachel F Rodgers
- Northeastern University, Department of Applied Psychology, 360 Huntington Avenue, Boston, MA 02115, United States
| | - Jessica Edwards George
- Northeastern University, Department of Applied Psychology, 360 Huntington Avenue, Boston, MA 02115, United States
| | - Debra L Franko
- Northeastern University, Department of Applied Psychology, 360 Huntington Avenue, Boston, MA 02115, United States
| |
Collapse
|
5
|
Hartley E, Hill B, McPhie S, Skouteris H. The associations between depressive and anxiety symptoms, body image, and weight in the first year postpartum: a rapid systematic review. J Reprod Infant Psychol 2017. [PMID: 29517302 DOI: 10.1080/02646838.2017.1396301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to conduct a rapid systematic review of the evidence of associations between postpartum depressive symptoms, anxiety symptoms, body image and weight status in the first 12 months post birth. BACKGROUND The postpartum period places the mother and infant at risk of a number of negative health outcomes. Mental health conditions such as depression and anxiety are common in the postpartum, as are poor body image and excessive weight retention as women adjust to their post pregnancy body. However, the associations between body image, weight status and psychological distress are not currently well understood. METHODS Articles in English, published between 2006 and 2017, involving singleton pregnancies of normally developing infants and maternal depression or anxiety were eligible for this systematic review. RESULTS From the total of 1805 articles located, 12 were identified as relevant and were subsequently reviewed in full. In the nine studies of depressive symptoms, body image or weight status, four found a significant relationship. Significant associations were not found in the three studies investigating postpartum anxiety symptoms, body image or weight. Body dissatisfaction was associated significantly with poorer postpartum weight status in all nine studies. CONCLUSIONS Further research is needed to determine the nature of the relationships between body image, weight status and depressive and anxiety symptoms across the first year after birth. This information will assist health professionals to promote healthy lifestyle behaviours in the postpartum, as well as inform clinical interventions that target behaviour change to prevent the worsening of these issues and related negative outcomes.
Collapse
Affiliation(s)
- Eliza Hartley
- a School of Psychology , Deakin University , Geelong , Australia
| | - Briony Hill
- a School of Psychology , Deakin University , Geelong , Australia
| | - Skye McPhie
- a School of Psychology , Deakin University , Geelong , Australia
| | - Helen Skouteris
- a School of Psychology , Deakin University , Geelong , Australia
| |
Collapse
|
6
|
Jawed-Wessel S, Herbenick D, Schick V. The Relationship Between Body Image, Female Genital Self-Image, and Sexual Function Among First-Time Mothers. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:618-632. [PMID: 27420566 DOI: 10.1080/0092623x.2016.1212443] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this cross-sectional study was to examine the extent to which perceived changes in weight, body satisfaction, body-image self-consciousness, and genital self-image could be used to predict sexual function scores. A total of 168 primiparous women completed the cross-sectional, web-based survey. Significant correlations were found between body satisfaction, body-image self-consciousness, and female genital self-image and sexual function. Multivariate regression analysis suggests body image and genital self-image combined account for 14.1% of the variance in overall sexual function. Women should have opportunities to discuss body changes throughout pregnancy.
Collapse
Affiliation(s)
- Sofia Jawed-Wessel
- a School of Health, Physical Education, and Recreation, University of Nebraska at Omaha , Omaha , Nebraska , USA
| | - Debby Herbenick
- b Center for Sexual Health Promotion, Indiana University , Bloomington , Indiana , USA
| | - Vanessa Schick
- c School of Public Health, The University of Texas Health Science Center at Houston , Houston , Texas , USA
| |
Collapse
|
7
|
Jiang M, Gao H, Vinyes-Pares G, Yu K, Ma D, Qin X, Wang P. Association between breastfeeding duration and postpartum weight retention of lactating mothers: A meta-analysis of cohort studies. Clin Nutr 2017; 37:1224-1231. [PMID: 28606701 DOI: 10.1016/j.clnu.2017.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/23/2017] [Accepted: 05/12/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND & AIMS To clarify the relationship between different breastfeeding duration and postpartum weight retention through meta-analysis. METHODS In this study, all relevant studies that described the effect of breastfeeding duration on postpartum weight retention were identified from Pubmed, Cochrane, and WANGFANG databases and so on (1960-2016). This meta-analysis had been registered in International Prospective Register of Systematic Reviews (CRD42016038409). RESULTS Fourteen cohort studies involving 66 comparisons were included. Compared with bottle-feeding mothers, breastfeeding mothers had significantly lower postpartum weight retention of -0.38 kg (95% confidence interval: -0.64, -0.11 kg). Subgroup analysis showed that, mothers who were primipara, less than 30 years old or normal pre-pregnancy body mass index had lower postpartum weight retention. When breastfeeding duration were stratified into <12 weeks, 12 weeks-24 weeks, 24 weeks-48 weeks, and ≥48 weeks, postpartum weight retention in breastfeeding women presented a U-shaped trend: a decline during early breastfeeding duration (year 1) (from 0.23 kg at < 12 weeks to -1.58 kg at 24-48 weeks) and then an increase in the follow-up duration (from -1.58 kg at 24-48 weeks to -0.97 kg at more than 48 weeks). CONCLUSIONS Our results indicated that breastfeeding including exclusive breastfeeding and mixed breastfeeding were inversely related to postpartum weight retention. The decreasing influence of breastfeeding was more significant when the lactating mothers were less than 30 years old, primipara, normal pre-pregnant body mass index, or breastfeeding duration for 6-12 months.
Collapse
Affiliation(s)
| | - Haer Gao
- School of Public Health, Peking University Health Science Center, Beijing, China
| | | | - Kai Yu
- Nestlé Research Center, Beijing, China
| | - Defu Ma
- School of Public Health, Peking University Health Science Center, Beijing, China.
| | - Xueying Qin
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Peiyu Wang
- School of Public Health, Peking University Health Science Center, Beijing, China
| |
Collapse
|
8
|
Reifsnider E, Flowers J, Todd M, Bever Babendure J, Moramarco M. The Relationship Among Breastfeeding, Postpartum Depression, and Postpartum Weight in Mexican American Women. J Obstet Gynecol Neonatal Nurs 2016; 45:760-771. [PMID: 27632434 DOI: 10.1016/j.jogn.2016.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine if symptoms of postpartum depression and postpartum weight varied according to the level of breastfeeding among women of Mexican origin at 1 month and 6 months postpartum. DESIGN Secondary quantitative analysis to study the differences in postpartum weight and depression among the mothers in the study who breastfed and those who did not. SETTING A heavily Hispanic community located in a major Southwestern U.S. city. PARTICIPANTS Women of Mexican origin (N = 150) who enrolled during their third trimesters in a local Special Supplemental Nutrition Program for Women, Infants, and Children clinic and were followed for 6 months. METHODS Weight was measured at 1 month and at 6 months postpartum at home visits with validated digital scales. Breastfeeding was measured according to World Health Organization criteria and recorded after monthly phone calls. Depression was measured at home visits at 1 month and 6 months with the Edinburgh Postnatal Depression Scale. RESULTS At 6 months postpartum, participants who did not breastfeed had the highest scores on the Edinburgh Postnatal Depression Scale; participants who breastfed nonexclusively had the lowest scores (p = .067). At both time points, there was a significant difference in weight (p = .017) between women who were doing any breastfeeding and women who were not breastfeeding. CONCLUSION Breastfeeding, even if not exclusive, contributed to lower depression scores and significantly lower postpartum weight among this sample of Mexican American women.
Collapse
|
9
|
Abstract
This study presents an integrative review of published research articles on positive health practices (PHP) as defined by Muhlenkamp and Brown. Using Cooper's guidelines for accomplishing an integrative review, 29 relevant studies concerning PHP were located, reviewed, and critiqued; theoretical and methodological issues emerging from the studies were identified. Directions for future research on PHP are specified. Implications for nursing practice derived from the research findings are addressed.
Collapse
|
10
|
Fallon V, Halford JCG, Bennett KM, Harrold JA. The Postpartum Specific Anxiety Scale: development and preliminary validation. Arch Womens Ment Health 2016; 19:1079-1090. [PMID: 27571782 PMCID: PMC5102940 DOI: 10.1007/s00737-016-0658-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/12/2016] [Indexed: 12/04/2022]
Abstract
Perinatal symptoms of anxiety are increasingly recognised due to their high prevalence and impact. Studies using pregnancy-specific anxiety measures have found that they may predict perinatal outcomes more effectively than general measures. However, no such measure exists to assess anxieties specific to the postpartum. This study aimed to develop and validate a measure (Postpartum Specific Anxiety Scale; PSAS) that accurately represents the specific anxieties faced by postpartum women, using a four-stage methodology: (1) 51 items were generated from interviews conducted with a group of 19 postpartum women at two time points, (2) the scale was reviewed and refined by a diverse expert panel, (3) an online pilot study (n = 146) was conducted to assess comprehensibility and acceptability and (4) an online sample of 1282 mothers of infants up to 6 months old completed the PSAS against a battery of convergent measures. A subsample (n = 262) repeated the PSAS 2 weeks later. The PSAS possessed good face and content validity and was comprehensible and acceptable to postpartum women. PSAS scores were significantly correlated with other measures indicating good convergent validity. Principal component analyses (PCA) revealed a simple four-factor structure. Reliability of the overall scale and individual PSAS factors proved to be good to excellent. A preliminary receiver operating characteristic (ROC) analysis also suggested that the PSAS may be a useful screening tool. The psychometric evidence suggests that the PSAS is an acceptable, valid, and reliable research tool to assess anxieties, which are specific to the postpartum period. Next steps in the iterative validation process are considered for both research and screening purposes.
Collapse
Affiliation(s)
- Victoria Fallon
- Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Jason Christian Grovenor Halford
- Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
| | - Kate Mary Bennett
- Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
| | - Joanne Allison Harrold
- Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK
| |
Collapse
|
11
|
Watson B, Fuller-Tyszkiewicz M, Broadbent J, Skouteris H. The meaning of body image experiences during the perinatal period: A systematic review of the qualitative literature. Body Image 2015; 14:102-13. [PMID: 25950953 DOI: 10.1016/j.bodyim.2015.04.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
Literature reporting body image disturbances across the perinatal period has produced inconsistent findings, owing to the complexity of body image experiences during pregnancy and the first year postpartum. Existing qualitative data might provide potential avenues to advance understanding of pregnancy-related body image experiences and guide future quantitative research. The present systematic review synthesised the findings of 10 qualitative studies exploring the body image experiences of women through the perinatal period, albeit the majority focused only on pregnancy. Themes emerging included malleability of body image ideals across pregnancy (including the shift from aesthetic to functional concerns about one's appearance), the salience of stomach and breasts for self-rated body satisfaction, and perceived pressure to limit weight gain across pregnancy in order to return quickly to pre-pregnancy figure following birth. These qualitative findings suggest greater complexity of body image experiences during perinatal period than can be captured by typically used self-report measures.
Collapse
|
12
|
Abstract
OBJECTIVE Weight gained during pregnancy and postpartum weight retention might contribute to obesity in women of childbearing age. Whether breast-feeding (BF) may decrease postpartum weight retention (PPWR) is still controversial. The purpose of our systematic review and meta-analysis was to investigate the relationship between BF and PPWR. DESIGN Three databases were systematically reviewed and the reference lists of relevant articles were checked. Meta-analysis was performed to quantify the pooled standardized mean differences (SMD) of BF on PPWR by using a random-effect model. Heterogeneity was tested using the χ 2 test and I 2 statistics. Publication bias was estimated from Egger's test (linear regression method) or Begg's test (rank correlation method). RESULTS Among 349 search hits, eleven studies met the inclusion criteria for the meta-analysis. Seven studies were conducted in the USA, one in Brazil, one in France, one in Georgia and one in Croatia. Compared with formula-feeding, BF for 3 to ≤6 months seemed to have a negative influence on PPWR and if BF continued for >6 months had little or no influence on PPWR. In a subgroup meta-analysis, the results did not change substantially after the analysis had been classified by available confounding factors. There was no indication of a publication bias from the result of either Egger's test or Begg's test. CONCLUSIONS Although the available evidence held belief that BF decreases PPWR, more robust studies are needed to reliably assess the impact of patterns and duration of BF on PPWR.
Collapse
|
13
|
Adjusting to motherhood. The importance of BMI in predicting maternal well-being, eating behaviour and feeding practice within a cross cultural setting. Appetite 2014; 81:261-8. [PMID: 24933685 DOI: 10.1016/j.appet.2014.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/13/2014] [Accepted: 06/10/2014] [Indexed: 11/23/2022]
Abstract
Maternal body mass index (BMI) is associated with negative body image and restrained eating which are experienced differently across cultures. The present study aimed to: 1) examine if self-esteem, eating behaviours and body satisfaction changed from early pregnancy to 2-6 months after giving birth; 2) explore changes according to country (Israel vs. UK) and BMI; and 3) determine any relationship between these measurements and infant feeding. Participants completed questionnaires assessing self-esteem, body image and eating/feeding behaviours. Multilevel linear modelling was used to account for change and to assess the independent impact of BMI on outcomes. Seventy-three women and infants participated in the study in early pregnancy and again 16 (9) weeks following birth. Women gained 1.5 kg (range -12 + 23) and UK mothers reported significantly greater body dissatisfaction, but self-esteem and eating behaviours remained stable. BMI was the main predictor of self-esteem, eating behaviours and body satisfaction. Mothers' perceptions of infant's eating did not vary according to BMI or country; however, heavier mothers reported feeding their infants according to a schedule. The first months after giving birth are a key time to assess adjustment to motherhood but later assessments are necessary in order to track changes beyond the early period post-pregnancy.
Collapse
|
14
|
Ferrari RM, Siega-Riz AM, Evenson KR, Moos MK, Melvin CL, Herring AH. Provider advice about weight loss and physical activity in the postpartum period. J Womens Health (Larchmt) 2013; 19:397-406. [PMID: 20156083 DOI: 10.1089/jwh.2008.1332] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore the association between healthcare provider advice about weight loss and physical activity in the postpartum period and weight retention and activity levels in women assessed at 3 months postpartum. METHODS Using data from a prospective cohort study, we explored the association of advice with postpartum weight retention and activity levels in 688 women at 3 months postpartum. Data from home visits included anthropometric measurements and information collected from sociodemographic, health behavior, and psychosocial questionnaires. Weight retention was calculated as weight at 3 months postpartum minus prepregnancy weight; activity levels and advice were based on maternal self-report. Linear regression and Poisson regression were used to explore associations. RESULTS The majority of the population was white (76%), had a greater than high school education (83%), and had an income >185% of the federal poverty level (81%). Women ranged in age from 17 to 48 years. Most women reported receiving no weight loss (89.1%) and no physical activity advice (77.4%) from a healthcare provider during the 3-month postpartum period. After adjustment, we found no association between provider advice and weight retention. When compared with those who reported no advice, following provider advice showed an association with recreational activity above the median (RR 1.50, 95% confidence interval [CI] 1.24, 1.80). CONCLUSIONS Provider advice may influence physical activity but may not be enough to help postpartum women lose pregnancy weight. Instead, women may benefit more from individualized counseling and follow-up beyond the usual 6-week postpartum visit.
Collapse
Affiliation(s)
- Renée M Ferrari
- Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | | |
Collapse
|
15
|
Phillips J, King R, Skouteris H. A conceptual model of psychological predictors of postpartum weight retention. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.717265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joanne Phillips
- a School of Psychology , Deakin University , Victoria , Australia
| | - Ross King
- a School of Psychology , Deakin University , Victoria , Australia
| | - Helen Skouteris
- a School of Psychology , Deakin University , Victoria , Australia
| |
Collapse
|
16
|
Caire-Juvera G, Casanueva E, Bolaños-Villar AV, De Regil LM, De la barca AMC. No changes in weight and body fat in lactating adolescent and adult women from Mexico. Am J Hum Biol 2012; 24:425-31. [DOI: 10.1002/ajhb.22234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 11/25/2011] [Accepted: 12/17/2011] [Indexed: 11/06/2022] Open
|
17
|
Hauff LE, Demerath EW. Body image concerns and reduced breastfeeding duration in primiparous overweight and obese women. Am J Hum Biol 2012; 24:339-49. [DOI: 10.1002/ajhb.22238] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/19/2011] [Accepted: 12/21/2011] [Indexed: 12/31/2022] Open
|
18
|
Huang TT, Yeh CY, Tsai YC. A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Midwifery 2011; 27:257-64. [DOI: 10.1016/j.midw.2009.06.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 12/18/2008] [Accepted: 06/07/2009] [Indexed: 10/20/2022]
|
19
|
Althuizen E, van Poppel MN, de Vries JH, Seidell JC, van Mechelen W. Postpartum behaviour as predictor of weight change from before pregnancy to one year postpartum. BMC Public Health 2011; 11:165. [PMID: 21410953 PMCID: PMC3068095 DOI: 10.1186/1471-2458-11-165] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 03/16/2011] [Indexed: 01/12/2023] Open
Abstract
Background Postpartum weight retention affects many women and increases the risk of becoming overweight. The research objective was to study modifiable factors contributing to weight change at one year postpartum. Methods In this prospective cohort, postpartum behavior, such as physical activity, sedentary behavior, sleep, and intake of total energy, total fat and saturated fatty acids of 118 Dutch women were assessed in 2003/2004 by self-report at 6 weeks, 6 and 12 months postpartum. Mean postpartum scores were computed for the behavioral measures. In linear regression models it was determined which factors were associated with average weight change from before pregnancy to one year postpartum. Furthermore, factors associated with substantial postpartum weight retention (≥ 5 kg) were also studied in logistic regression models. Results At one year postpartum, the average weight of participants had increased by 0.9 kg (SD 4.4). Moreover, 20% of the women retained ≥ 5 kg. Women who perceived themselves more physically active than others were almost ten times less likely to retain ≥ 5 kg than women who perceived themselves equally active (OR = 0.11, 95%CI: 0.02 - 0.66). Exceeding the guideline for saturated fatty acid intake (OR = 3.40, 95%CI: 1.04 - 11.11), total gestational weight gain (OR = 1.14/kg, 95%CI: 1.01 - 1.27), and not having completed post high school education (OR = 5.13, 95%CI: 1.66 - 15.90) increased the odds of retaining ≥ 5 kg. Conclusions Since one in five women had substantial weight retention postpartum, effective interventions for the prevention of weight retention are much needed. Future studies should evaluate whether interventions focusing on the identified modifiable postpartum factors are successful in reducing weight retention after childbirth.
Collapse
Affiliation(s)
- Ellen Althuizen
- Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | | | | | | |
Collapse
|
20
|
Durham HA, Lovelady CA, Brouwer RJN, Krause KM, Østbye T. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2011; 111:67-74. [PMID: 21185967 PMCID: PMC3035946 DOI: 10.1016/j.jada.2010.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 07/09/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Weight gain in the postpartum period is a risk factor for long-term obesity. Investigations of dietary intake among lactating and nonlactating overweight women might identify nutritional concerns specific to this population. OBJECTIVE To compare nutrient, meal, and snack intakes, food-group servings and prevalence of dieting among fully breastfeeding (BF), mixed breast and formula feeding (MF), and formula feeding (FF) overweight and obese women. The second aim was to compare nutrient intakes and food-group servings to the Dietary Reference Intake and MyPyramid recommendations, respectively. DESIGN Data were collected from September 2004 through April 2006 in Durham, NC. Infant feeding practices and dietary information were collected on 450 women between 6 and 9 weeks postpartum. Two 24-hour dietary recalls were completed by phone, using Nutrition Data Systems for Research. Analysis of covariance was used to compare infant feeding groups in dietary quality (nutrient intake per 1,000 kcal) and food-group servings, controlling for prepregnancy body mass index, race, age, education, income, and marital status. χ² analysis was performed to determine differences in meal and snack intake and dieting among infant feeding groups. RESULTS BF women consumed more energy (2,107 ± 50 kcal) than MF (1,866 ± 56 kcal) or FF (1,657 ± 50 kcal) women (P < 0.001). Adjusted nutrient intake did not differ between groups. All groups were at risk for inadequate intakes of vitamins A, E, C, and folate and did not meet recommended servings of all food groups. BF women consumed lunch and snacks more frequently, were less likely to diet, and reported higher intakes of grains and desserts than MF and FF women. CONCLUSIONS To help increase intakes of nutrients lacking in the diet and prevent postpartum weight gain, overweight women should be encouraged to increase fruits, vegetables, low-fat dairy, whole grains, legumes, and healthy types of fat, while decreasing refined grains, regular soda, sweetened beverages, and desserts.
Collapse
Affiliation(s)
- Holiday A. Durham
- Department of Nutrition, University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC 27402-6170
| | - Cheryl A. Lovelady
- Department of Nutrition, University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC 27402-6170, Office: 336-256-0310 Fax: 336-334-4129
| | - Rebecca J. N. Brouwer
- Duke University Medical Center, Department of Community and Family Medicine, DUMC Box 104006 Durham, NC 27710, Office: (919) 681-0858, FAX: (919) 684-5108
| | - Katrina M. Krause
- Duke University Medical Center, Department of Community and Family Medicine, DUMC Box 104006, Durham, NC 27710, Office: (919) 681-3030, FAX: 919-684-5108
| | - Truls Østbye
- Duke University Medical Center, Department of Community and Family Medicine, DUMC Box 104006, Durham, NC 27710, Office: (919) 660 0331, FAX: (919) 684-5108
| |
Collapse
|
21
|
A preliminary study on the pattern of weight change from pregnancy to 6 months postpartum: a latent growth model approach. Int J Obes (Lond) 2010; 35:1079-86. [PMID: 21042322 DOI: 10.1038/ijo.2010.225] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There is a lack of comprehensive understanding about patterns of weight change from pregnancy to childbirth and beyond. We describe the trajectory of weight change pattern from pre-pregnancy to 6 months postpartum and examine demographical and perinatal variables that predict the weight change using the latent growth model (LGM). DESIGN AND SUBJECTS This study used a longitudinal design. The study participants were 120 women whose body weights were measured at eight time points. RESULTS The adjusted mean pre-pregnancy weight was 52.57 kg. When the weight growth rate for 10-13 weeks of pregnancy and pre-pregnancy weight was set to 1, the body-weight change rate was 2.20 during the second trimester, 2.14 during the third trimester, -2.90 during the period from the third trimester to 2-3 weeks postpartum, -0.08 during the period from 2-3 weeks to 4-5 weeks postpartum, -0.37 during the period from 4-5 weeks to 11-12 weeks postpartum, and -0.65 during the period from 11-12 weeks to 24-25 weeks postpartum. On average, body weight increased 26.54% (13.95 kg) from pre-pregnancy to 36-39 weeks of pregnancy and body weight remained 6.26% (3.29 kg) higher at 24-25 weeks postpartum compare with pre-pregnancy. In terms of factors related to body weight, age was positively associated with pre-pregnancy body weight. Parity had a negative effect on the change of body weight. Women who had an increased change rate in body weight had higher newborn birth weights. CONCLUSIONS We found that weight change from pregnancy to postpartum followed a pattern that could be specified using the LGM approach. The women retained more than 6% of weight at 6 months postpartum compared with their pre-pregnancy weight.
Collapse
|
22
|
|
23
|
Gjerdingen D, Fontaine P, Crow S, McGovern P, Center B, Miner M. Predictors of mothers' postpartum body dissatisfaction. Women Health 2010; 49:491-504. [PMID: 20013517 DOI: 10.1080/03630240903423998] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate changes in mothers' body dissatisfaction from delivery to 9 months postpartum, and the relationship of postpartum body dissatisfaction to weight, other health, and social characteristics. METHODS In this prospective longitudinal study, 506 mothers completed surveys at 0-1 and 9 months postpartum. Postpartum changes in body dissatisfaction and weight were evaluated by paired t-tests, and predictors of postpartum body dissatisfaction were identified by stepwise multiple regression analysis. RESULTS Mothers' body dissatisfaction increased significantly from 0-1 to 9 months postpartum (mean scores of 15.2 and 18.2, respectively, p < .001). Although women lost an average of 10.1 pounds (sd = 16.3) or 4.6 kg. (sd = 7.4) between 0-1 and 9 months postpartum (p < .001), their weight at 9 months postpartum remained an average of 5.4 pounds (sd = 15.6) or 2.5 kg (sd = 7.1) above their pre-pregnancy weights (p < .001). Body dissatisfaction at 9 months postpartum was associated with overeating or poor appetite, higher current weight, worse mental health (SF-36 Mental Health scale), race other than black, bottle-feeding (vs. breastfeeding), being single (vs. married), and having fewer children. CONCLUSIONS Mothers' body satisfaction worsened from 1 to 9 months postpartum, and 9-month body dissatisfaction was associated with eating/appetite abnormalities, greater weight, worse mental health, non-black race, non-breastfeeding status, and fewer immediate family relationships. Given these relationships, it is important to educate women about expected postpartum weight and body changes, and to find ways to enhance mothers' postpartum self-esteem and body satisfaction.
Collapse
Affiliation(s)
- Dwenda Gjerdingen
- Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Records K, Keller C, Ainsworth B, Permana PA. Overweight and obesity in postpartum Hispanic women. Health Care Women Int 2008; 29:649-67. [PMID: 18569049 DOI: 10.1080/07399330802089214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Overweight and obesity vary in prevalence among particular groups, and are especially problematic for childbearing Hispanic women. The complex interaction between physical changes associated with pregnancy, role changes accompanying birth, and family and cultural values related to childbearing are superimposed upon the underlying mechanisms that create or perpetuate obesity. In this article we review biological and behavioral research on obesity in postpartum Hispanic women to identify critical components for intervention studies focused on weight management. Recommendations are offered for health care providers and researchers.
Collapse
Affiliation(s)
- Kathie Records
- Arizona State University College of Nursing and Healthcare Innovation, Phoenix, Arizona, USA.
| | | | | | | |
Collapse
|
25
|
Abstract
OBJECTIVES To examine physiologic and psychological outcomes associated with maternal obesity in pregnancy and patterns of pregnancy weight gain. To identify effective interventions for maternal obesity. DATA SOURCES AND STUDY SELECTION Search of obesity and pregnancy research conducted over the past 10 years using CIHAHL, Medline ERIC, and PyscInfo databases. Studies including the following keywords were included in the review: obesity, weight gain, body image, pregnancy weight gain, pregnancy obesity complications, preeclampsia and gestational diabetes. Articles were included based on scientific merit and research outcomes. DATA SYNTHESIS AND CONCLUSIONS Maternal obesity is a serious condition that significantly impacts not only mothers' health but also the health and future of their children. It is paramount that all levels of health care providers be aware of consequences of obesity and be knowledgeable of effective interventions. No effective long-term interventions have been demonstrated to prevent or control obesity during pregnancy. The paucity of published results of pregnancy and postpartum interventions to address weight gain in pregnancy suggests the need for more community and individualized based intervention studies, especially focusing on long-term effects.
Collapse
Affiliation(s)
- Shelia A Smith
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | | | |
Collapse
|
26
|
Chen CM, Kuo SF, Chou YH, Chen HC. Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles. J Clin Nurs 2007; 16:1550-60. [PMID: 17655544 DOI: 10.1111/j.1365-2702.2006.01837.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND To reach the Millennium Development Goals, maternal health-promoting behaviours need to be encouraged after childbirth; little is known about the health-promoting behaviour among first-time mothers during their postpartum period. AIM To examine levels of engagement in health-promoting behaviours and related factors among postpartum women in Taiwan. METHODS This cross-sectional study was conducted through a convenience sample of 122 qualified women. Participants self-completed a questionnaire and mailed it back using a stamped, self-addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert-type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self-developed social support scale. RESULTS The average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD 1.35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers-in-law, mothers and husbands. An astonishing 42.6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health-promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self-actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model. CONCLUSIONS This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles. RELEVANCE TO CLINICAL PRACTICE This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.
Collapse
Affiliation(s)
- Ching-Min Chen
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | | | | | | |
Collapse
|
27
|
Abstract
The purpose of the study was to differentiate among various postpartum stressors and to compare women's postpartum stress, social support, and mental health status in relation to parity differences. A non-experimental quantitative study with cross-sectional design was carried out. A total of 435 primiparas and 426 multiparas from clinics and hospitals in southern Taiwan were recruited for the study. The Hung Postpartum Stress Scale, the Social Support Scale, and the 12-item Chinese Health Questionnaire were used to compare the postpartum stress, social support, and mental health status of primiparous and multiparous women. Compared with multiparas, the mean scores of primiparas were higher for postpartum stress, concerns about negative body changes, concerns about maternal role attainment, as well as for measures of social support, family support, and friend support. However, multiparas had higher scores than primiparas regarding concerns about lack of social support. The mental health status of the two groups did not differ significantly by parity. The primiparous women and multiparous women experienced unique postpartum stressors. The results suggest that it is important to identify specific postpartum stressors for primiparas and multiparas when providing supportive interventions. Specifically tailored nursing interventions based on differences in parity may help reduce postpartum stress and help prevent the development of more severe mental health problems among postpartum women.
Collapse
Affiliation(s)
- Chich-Hsiu Hung
- College of Nursing, Kaohsiung Medical University and Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
28
|
Walker LO. Managing Excessive Weight Gain During Pregnancy and the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2007; 36:490-500. [PMID: 17880322 DOI: 10.1111/j.1552-6909.2007.00179.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Childbearing is a period in the life cycle during which some women may gain weight, become overweight, or become obese. Despite guidelines issued in 1990 for gestational weight gain, many women exceed them. Women who are overweight before pregnancy are most vulnerable to excessive gestational weight gain. Prenatal interventions to prevent excessive gain have had mixed results. During the postpartum period, 14% to 20% of women may retain weight from pregnancy, which elevates risk of later health problems. Although postpartum weight loss interventions have been shown to have efficacy, these have been tested primarily with White women. Continued efforts are needed in practice and research to develop effective approaches for managing weight during pregnancy and postpartum, especially for low-income and ethnic minority women.
Collapse
Affiliation(s)
- Lorraine O Walker
- The University of Texas at Austin School of Nursing, Austin, TX 78701-1499, USA.
| |
Collapse
|
29
|
Keller C, Allan J, Tinkle MB. Stages of change, processes of change, and social support for exercise and weight gain in postpartum women. J Obstet Gynecol Neonatal Nurs 2006; 35:232-40. [PMID: 16620249 DOI: 10.1111/j.1552-6909.2006.00030.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To test the extent to which social support and variables included in the Transtheoretical Model were explanatory for exercise initiation and weight maintenance in postpartum women. DESIGN A cross-sectional descriptive design. SETTING Data were collected in the participant's homes. PARTICIPANTS Postpartum women who had normal pregnancies were interviewed and measured on body fat, physical activity, and psychosocial scales. MAIN OUTCOME MEASURE (a) Stages of exercise change measure, (b) Seven Day Recall, (c) Friend and Family Support for Exercise Scale, (d) Processes of Change Questionnaire, and (e) body fat measures including body mass index and percent body fat. RESULTS Forty percent reported engaging in vigorous activity less than 1 hour daily, 55% walked less than four city blocks daily, and 52% engaged in less than 2 hours of vigorous weekend activity. Multilinear regression showed that the processes of change contributed 36% to the body mass index, and 21% of the variance in waist-thigh ratio. Of the processes of change, environmental reevaluation correlated significantly with body mass index. CONCLUSION The impact of a woman's weight on others as well as information concerning the health effects of obesity and physical activity could enhance the initiation of exercise in the postpartum woman.
Collapse
Affiliation(s)
- Colleen Keller
- Center for Improving Healthy Outcomes in Aging, Arizona State University, College of Nursing, Tempe, AZ, USA.
| | | | | |
Collapse
|
30
|
George GC, Hanss-Nuss H, Milani TJ, Freeland-Graves JH. Food choices of low-income women during pregnancy and postpartum. ACTA ACUST UNITED AC 2005; 105:899-907. [PMID: 15942539 DOI: 10.1016/j.jada.2005.03.028] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this study was to examine dietary behavior during pregnancy and postpartum in a multiethnic sample of low-income women. SUBJECTS Participants were 149 Medicaid-qualified women (30% white, 24% African American, and 46% Hispanic; median age, 22 years). DESIGN Subjects were recruited into a longitudinal cohort design 0 to 1 days following delivery. Dietary choices during pregnancy and the first 6 months postpartum were assessed via validated food frequency questionnaires administered at 6 weeks and 6 months postpartum, respectively. STATISTICAL ANALYSES PERFORMED Frequencies and means were used for descriptive purposes. Paired and independent sample t tests were used for continuous variables; chi 2 and McNemar tests were used for categorical variables. RESULTS In all subjects, mean daily servings of grains (7.4 vs 6.2, P <.004), vegetables (2.5 vs 2.0, P <.002), and fruit (3.4 vs 1.7, P <.001) declined following childbirth, while the percentage of energy from fat (37.3% vs 38.4%, P <.023) and added sugar (14.4% vs 16.4%, P <.019) increased. Women who breastfed their infants at 6 months postpartum reported lower intakes of total fat (34.2% vs 37.9%, P <.005) during pregnancy and higher fruit (2.2 vs 1.6, P <.05) and vegetable (2.6 vs 1.8, P <.02) intakes in postpartum than those who bottle-fed. Also, a greater proportion of lactating than nonlactating women (66.7% vs 36.9%, P <.05) met recommendations for fruit intake during pregnancy. CONCLUSIONS The findings suggest that the transition from pregnancy to postpartum may be associated with a negative impact on dietary behavior that could compromise nutritional status in low-income women.
Collapse
Affiliation(s)
- Goldy C George
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center, Houston, USA
| | | | | | | |
Collapse
|
31
|
George GC, Milani TJ, Hanss-Nuss H, Freeland-Graves JH. Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum. ACTA ACUST UNITED AC 2005; 105:916-26. [PMID: 15942541 DOI: 10.1016/j.jada.2005.03.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance. SUBJECTS/SETTING Participants were 146 triethnic, low-income women who were recruited 0 to 1 days after childbirth and who visited a clinic site at 1 year postpartum. DESIGN At 1 year postpartum, multiple psychosocial characteristics were measured, and food choices and nutrient intakes were assessed via a validated food frequency questionnaire. Dietary guidelines index scores and measures of adherence to dietary recommendations were computed. STATISTICAL ANALYSES PERFORMED Descriptive statistics, analysis of variance with post-hoc Scheffe tests, chi 2 with follow-up tests of independent proportions, and Pearson correlation coefficients were utilized. RESULTS For dietary compliance, 60% had adequate intakes of meat, but less than 30% met recommendations for grains, vegetables, fruits, dairy foods, total fat, and added sugar. Healthful weights (body mass index <25) were observed in 37% of women. Those in the highest tertile of dietary compliance had a more positive body image than those in the lowest tertile, and less neglect of self-care, weight-related distress, stress, depressive symptoms, and perceived barriers to weight loss ( P <.05). Dietary compliance and psychosocial scale scores did not vary by ethnicity. CONCLUSIONS Adherence to dietary guidelines was limited in the low-income, postpartum women. Psychosocial variables, such as neglect of self-care, weight-related distress, negative body image, stress, and depressive symptoms were associated with less healthful diets and lifestyle in late postpartum. Programs that target diet-related behavior change in low-income women might be improved by inclusion of psychosocial assessment and counseling components.
Collapse
Affiliation(s)
- Goldy C George
- Center for Health Promotion and Prevention Research, The University of Texas School of Public Health at Houston, USA
| | | | | | | |
Collapse
|
32
|
Walker L, Freeland-Graves JH, Milani T, George G, Hanss-Nuss H, Kim M, Sterling BS, Timmerman GM, Wilkinson S, Arheart KL, Stuifbergen A. Weight and behavioral and psychosocial factors among ethnically diverse, low-income women after childbirth: II. Trends and correlates. Women Health 2005; 40:19-34. [PMID: 15778136 DOI: 10.1300/j013v40n02_02] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This paper presents a longitudinal analysis of behavioral and psychosocial correlates of weight trends during the first postpartum year. Data are derived from the Austin New Mothers Study (ANMS), a longitudinal study of a low-income, tri-ethnic sample of postpartum women that incorporated serial assessment of weight and behavioral and psychosocial variables. METHOD Postpartum body mass index (BMI) was measured prospectively (post-delivery, 6 weeks, and 3, 6, and 12 months postpartum). The analytic sample consisted of 382 White, African American, and Hispanic women receiving maternity care funded by Medicaid who had at least three measured postpartum weights. Behavioral and psychosocial variables included energy intakes, fat intakes, physical activity, health related lifestyle, smoking, breastfeeding, contraception, depressive symptoms, emotional eating, body image, and weight-related distress. RESULTS Using hierarchical linear modeling to incorporate baseline only and time-varying effects, significant associations with postpartum BMI were found for the following variables: ethnicity (p = .001), time of weight measurement (p < .001), the interaction of ethnicity and time (p = .005), pre-pregnant BMI (p < .001), gestational weight gain (p < .001), weight-related distress (p < .001), and energy intakes (p = .005). After adjusting for covariates, ethnic groups displayed differing trends in postpartum BMI resulting in White women having significantly lower BMIs at 12 months postpartum compared to ethnic minority women (p's < .01). CONCLUSION Behavioral and psychosocial variables contribute to a fuller understanding of BMI status of low-income women during the first postpartum year.
Collapse
Affiliation(s)
- Lorraine Walker
- University of Texas at Austin, School of Nursing, 1700 River Street, Austin, TX 78701-1499, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Walker LO, Freeland-Graves JH, Milani T, Hanss-Nuss H, George G, Sterling BS, Kim M, Timmerman GM, Wilkinson S, Arheart KL, Stuifbergen A. Weight and behavioral and psychosocial factors among ethnically diverse, low-income women after childbirth: I. Methods and context. Women Health 2005; 40:1-17. [PMID: 15778135 DOI: 10.1300/j013v40n02_01] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In this paper, we present the background, hypotheses, methods, and descriptive findings from the Austin New Mothers Study, a longitudinal series measuring weight and contextual variables across the first postpartum year. Among the distinguishing features of this study are its tri-ethnic sample of low-income women and its serial measurement of the behavioral and psychosocial context of postpartum weight changes post-delivery and at 6 weeks, and 3, 6, and 12 months postpartum. METHOD A prospective longitudinal design was used to assess body mass index (BMI), energy intake, fat intake, physical activity, health-related lifestyle, depressive symptoms, body image, and weight-related distress at each observation. SAMPLE The analytic sample consisted of 382 White, African American, and Hispanic women. FINDINGS For BMI, effects for ethnicity (p < .001), time (p < .001), and their interaction (p = .005) were significant. All ethnic groups had significant declines in BMI from delivery to 6 weeks postpartum. Thereafter, BMIs of White women declined during the second 6 months, whereas those of Hispanic and African American women either displayed small gains or plateaus between adjacent observations. Time-related effects were significant for behavioral and psychosocial variables except for body image and weight-related distress, whereas effects for ethnicity were significant on fat intake, depressive symptoms, and body image. Despite declines in depressive symptoms, women remained at risk of depression across the first postpartum year. CONCLUSIONS Low-income ethnic minority women have a higher vulnerability to postpartum weight gains or plateaus. High depressive symptoms occurred in all ethnic groups examined.
Collapse
Affiliation(s)
- Lorraine O Walker
- University of Texas at Austin, School of Nursing, 1700 River Street, Austin, TX 78701-1499, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Yarcheski A, Mahon NE, Yarcheski TJ, Cannella BL. A meta-analysis of predictors of positive health practices. J Nurs Scholarsh 2004; 36:102-8. [PMID: 15227755 DOI: 10.1111/j.1547-5069.2004.04021.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify predictors of positive health practices from empirical studies in which the Personal Lifestyle Questionnaire was used. METHODS Meta-analysis to determine the magnitude of the relationships between each of the predictors identified and positive health practices. Fourteen predictors of positive health practices were identified in 37 studies published since 1983; a meta-analysis was conducted on 14 predictors. RESULTS Eight predictors (loneliness, social support, perceived health status, self-efficacy, future time perspective, self-esteem, hope, and depression) had moderate effect sizes, and six (stress, education, marital status, age, income, and sex) had small effect sizes. CONCLUSIONS Findings enable health care professionals and researchers designing intervention studies to use the strongest predictors identified in this meta-analysis to promote positive health practices.
Collapse
Affiliation(s)
- Adela Yarcheski
- College of Nursing, Rutgers, State University of New Jersey, Newark, NJ, USA.
| | | | | | | |
Collapse
|
35
|
Abstract
PURPOSE To validate the 7-day physical activity recall (PAR), including alternative PAR scoring algorithms, using pedometer readings with low-income postpartum women, and to describe physical activity patterns of a low-income population of postpartum women. METHODS Forty-four women (13 African American, 19 Hispanic, and 12 White) from the Austin New Mothers Study (ANMS) were interviewed at 3 months postpartum. Data were scored alternatively according to the Blair (sitting treated as light activity) and Welk (sitting excluded from light activity and treated as rest) algorithms. Step counts based on 3 days of wearing pedometers served as the validation measure. FINDINGS Using the Welk algorithm, PAR components significantly correlated with step counts were: minutes spent in light activity, total activity (sum of light to very hard activity), and energy expenditure. Minutes spent in sitting were negatively correlated with step counts. No PAR component activities derived with the Blair algorithm were significantly related to step counts. The largest amount of active time was spent in light activity: 384.4 minutes with the Welk algorithm. Mothers averaged fewer than 16 minutes per day in moderate or high intensity activity. Step counts measured by pedometers averaged 6,262 (SD = 2,712) per day. CONCLUSIONS The findings indicate support for the validity of the PAR as a measure of physical activity with low-income postpartum mothers when scored according to the Welk algorithm. On average, low-income postpartum women in this study did not meet recommendations for amount of moderate or high intensity physical activity.
Collapse
Affiliation(s)
- Susan Wilkinson
- University of Texas at Austin, School of Nursing, 1700 Red River Street, Austin, TX 78701-1499, USA
| | | | | | | | | |
Collapse
|
36
|
Lacerda EMDA, Leal MDC. Fatores associados com a retenção e o ganho de peso pós-parto: uma revisão sistemática. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2004. [DOI: 10.1590/s1415-790x2004000200008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A retenção de peso após o parto é um dos determinantes da obesidade em mulheres. Seu desenvolvimento está relacionado com o ganho de peso gestacional, paridade, idade, situação marital, consumo energético, atividade física e lactação, mas as associações encontradas têm se mostrado inconclusivas e contraditórias. Objetivos: Avaliar estudos que identificaram fatores preditores da retenção e ganho de peso após o parto. MATERIAL E MÉTODOS: Foi realizada uma revisão de literatura na Base de Dados LILACS e MEDLINE, referente aos anos de 1993 a 2003. RESULTADOS: Vinte e oito artigos foram identificados, sendo 23 estudos de coorte, quatro estudos transversais e um estudo caso-controle. A maioria dos estudos foi realizada nos EUA e o tempo de acompanhamento após o parto ocorreu principalmente entre seis semanas e 24 meses. Cerca de 25% dos estudos apresentaram perdas superiores a 30%, 61% incluíram adolescentes na amostra e 75% não aferiram o peso pré-gestacional. Sete estudos foram considerados de melhor qualidade, pois utilizaram o peso pré-gestacional medido, incluíram grupo de comparação, excluíram adolescentes, apresentaram perdas de seguimento inferiores a 30% e controlaram para variáveis de confundimento. CONCLUSÃO: Ganho de peso gestacional, raça negra e paridade estão associados positivamente com a retenção de peso pós-parto. As evidências são contraditórias para a variável lactação e insuficientes para as variáveis consumo alimentar e atividade física. São necessários estudos cuidadosamente desenhados para esclarecer estas questões.
Collapse
|
37
|
Walker L, Timmerman GM, Kim M, Sterling B. Relationships between body image and depressive symptoms during postpartum in ethnically diverse, low income women. Women Health 2003; 36:101-21. [PMID: 12539795 DOI: 10.1300/j013v36n03_07] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to examine body image, depressive symptoms, and their interrelationship at post-delivery and at 6 weeks postpartum in a triethnic sample of low income new mothers. Data for this study were drawn from the Austin New Mothers Study. Participants were 76 Anglo/White, 72 African American, and 135 Hispanic new mothers who were participating in Medicaid, at least 18 years old, free of medical risk factors, and delivered at term. Body image was measured by the Body Cathexis Scale (BCS) and depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D). The leading areas of body dissatisfaction in postpartum were similar across ethnic groups. At 6 weeks postpartum Anglo women had the highest number of body image components perceived negatively, whereas African-American women had the least. In the overall sample, body image attitudes were significantly related to depressive symptoms in correlational (r's .19 to .34) and regression analyses. In addition, African American ethnicity was associated in regression analyses with higher depressive symptoms. Neither African American nor Hispanic ethnicity significantly moderated the relationship between body image attitudes and depressive symptoms in tests of interactions. Marital/partnered status and income level were related to depressive symptoms at both time points. In addition, being a woman with a parity of II was associated with higher depressive symptoms at 6 weeks postpartum. Although addition of these personal variables increased the percent of variance accounted for, body image attitudes continued to be significant predictors of depressive symptoms.
Collapse
Affiliation(s)
- Lorraine Walker
- University of Texas at Austin, School of Nursing, 1700 Red River Street, Austin, TX 78701-1499, USA
| | | | | | | |
Collapse
|
38
|
Larson-Meyer DE. Effect of postpartum exercise on mothers and their offspring: a review of the literature. OBESITY RESEARCH 2002; 10:841-53. [PMID: 12181395 DOI: 10.1038/oby.2002.114] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Epidemiological studies suggest that childbearing may contribute to the development of obesity. In the past 12 years, several cross-sectional and randomized trials have addressed the effect of postpartum exercise on weight loss and/or energy balance in mostly lactating women. These studies suggest that moderate exercise without specific calorie restriction does not promote greater weight or fat loss. This may be because exercise may promote greater energy intake and/or reduced energy expenditure from nonexercise physical activity (thus preventing negative energy balance), but further research is needed. Regular exercise, however, is likely to have other important health benefits after childbirth. A few published studies suggest that postpartum exercise improves aerobic fitness, high-density lipoprotein-cholesterol levels, and insulin sensitivity. Exercise may also enhance psychological well-being, but controlled clinical studies are needed. Although two published studies have addressed whether exercise training attenuates lactation-induced bone loss, better controlled studies are needed to determine whether postpartum weight-bearing exercise can improve bone mineral density in lactating and nonlactating women alike. In lactating women, several studies have collectively determined that neither acute nor regular exercise has adverse effects on a mother's ability to successfully breast-feed. It needs to be determined whether a woman's participation in regular exercise after childbirth will improve her ability to mother or instill lifetime habits of regular physical activity in either herself or her offspring. Overall, published studies have established the importance of regular exercise during the postpartum period. More research, however, is needed in this important area.
Collapse
Affiliation(s)
- Dawnine Enette Larson-Meyer
- Division of Health and Performance Enhancement, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana 80808-4124, USA.
| |
Collapse
|
39
|
Abstract
The postpartum period is an ideal time for clinicians to promote the importance of physical fitness, help patients incorporate exercise into lifestyle changes, and encourage them to overcome barriers to exercise. New responsibilities, physical changes, and competing demands for time may make exercise seem impossible. By emphasizing weight control, stress reduction, and other benefits, clinicians can help new mothers establish healthy exercise goals for the rest of their lives.
Collapse
Affiliation(s)
- Erika N Ringdahl
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, 65212, USA.
| |
Collapse
|
40
|
Gigante DP, Victora CG, Barros FC. Breast-feeding has a limited long-term effect on anthropometry and body composition of Brazilian mothers. J Nutr 2001; 131:78-84. [PMID: 11208942 DOI: 10.1093/jn/131.1.78] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The effect of lactation on maternal nutrition is controversial. Some studies have shown that breast-feeding reduces maternal weight, whereas some have not. All studies have been restricted to the first 2 y after delivery. We investigated the effect of lactation on maternal nutrition 5 y after delivery. All mothers giving birth in the city of Pelotas, Brazil, in 1993 were interviewed and weighed soon after delivery; information was also obtained on prepregnancy weight. In 1994, information on breast-feeding duration and pattern was collected for a 20% subsample. They were seen again in 1998, and those eligible (nonsmokers, no subsequent pregnancy, last birth weight > or = 2500 g) underwent measurements for weight, height, waist, hip and arm circumferences, triceps and subscapular skinfolds. The following indices were calculated in 312 women: body mass index, waist/hip ratio, arm fat area, the percentage of body fat assessed through skinfolds, and weight and body mass index change since before conception. The percentage of body fat was also measured through bioimpedance for half of the sample. After adjustment for confounding, all outcomes generally showed a similar pattern, i.e., mothers who breast-fed for 6-11.9 mo had lower measurements than those with shorter or longer durations. However, only the association with bioimpedance was significant (P < 0.03), and that for arm fat area tended to be significant (P = 0.06). Exclusive or predominant breastfeeding at 4 mo was associated with lower waist circumference (P = 0.05) and the percentage of body fat measured through skinfolds (P = 0.04). This study suggests that the relationship between breast-feeding and long-term changes in maternal weight is complex and, in this population, not particularly strong.
Collapse
Affiliation(s)
- D P Gigante
- Departamento de Nutrição, Universidade Federal de Pelotas, Pelotas, Brasil.
| | | | | |
Collapse
|
41
|
Abstract
Although the vast majority of pediatricians agree that breastfeeding is the preferred form of infant feeding, a large number of infants are still exclusively formula-fed or rarely breastfed for an extended period of time. This review explores focuses on data that speak to mothers' decisions to initiate and continue breastfeeding. Current research focuses on the immunomodulatory effects of breast milk, especially its protective benefits as relates to infection and allergy. The evidence clearly indicates that pediatricians must continue to play a critical role in the promotion of breastfeeding.
Collapse
Affiliation(s)
- C A Haller
- Department of Pediatrics, North Shore University Hospital, New York University School of Medicine, USA
| | | |
Collapse
|
42
|
Abstract
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.
Collapse
Affiliation(s)
- L O Walker
- University of Texas, Austin School of Nursing, USA
| | | |
Collapse
|