Weight-related distress in the early months after childbirth

Self-Oriented Body Comparison and Self-Compassion: Interactive Models of Disordered Eating Behaviors Among Postpartum Women

Evidence suggests self-oriented body comparison (comparison of one's postpartum body shape and weight to one's prepregnant body shape and weight) is a critical factor associated with increased levels of disordered eating during the postpartum period. However, some postpartum women adopt a self-compassionate and acceptance-based perspective toward their body shape and weight changes. It is unclear whether self-compassion may buffer the associations between self-comparisons and disordered eating behaviors among postpartum women, which is the aim of the current study. A total of 306 postpartum women who gave birth in the past year completed an online survey asking about self-compassion, social comparison, broad eating pathology, dietary restraint, and binge eating. Results indicated that self-compassion appeared to buffer the associations between self-comparison and broad eating pathology and binge eating among postpartum women, such that for women with above-average levels of self-compassion, the associations between self-comparison and disordered eating was weaker than for women with average or below-average levels of self-compassion. Findings suggest self-compassion could be a potential target for intervention programs.

The Reproductive Impact of Eating Disorders in Adolescents

Eating disorders are common, chronic illnesses that frequently arise during adolescence. Because of the impact on nutrition, individuals with eating disorders have significant health consequences, including effects on reproductive health. Adolescent women with eating disorders frequently have menstrual irregularities, though the causes of these abnormalities are complex and vary depending on the type of eating disorder. Teens with eating disorders may have changes in current and future fertility, and eating disorders during pregnancy can have medical and psychologic impacts for both mother and child. Though not well researched, eating disorders in men can affect reproductive health and potentially impact fertility. Lastly, eating disorders in adolescents can have significantly deleterious, irreversible effects on bone health.

Predictors of mothers' postpartum body dissatisfaction based on demographic and fertility factors

Background

There are fundamental and rapid changes in body shape during pregnancy, some of which persist for an extended time after delivery and may cause dissatisfaction with body shape. Therefore, we conducted this study to determine predictors of body dissatisfaction at six months postpartum based on demographic and fertility factors.

Methods

This cross-sectional study was conducted on 300 women who referred to seven health centers affiliated with Iran University of Medical Sciences, Tehran, Iran. The sampling was multistage and we collected data from a demographic and fertility questionnaire and Cooper’s Body Shape Questionnaire (BSQ-34). The independent t-test, Mann-Whitney U test, chi-square test, one-way ANOVA, Kruskal-Wallis, Pearson correlation coefficient, and multiple linear regression were used for data analysis. The level of significance was set at P < 0.05.

Results

The mean age of participating women was 29.77 (standard deviation: 5.9) years. Body dissatisfaction had a statistically significant association with variables such as body mass index (BMI) at six months postpartum, gestational age, the receipt of information about body shape, spouse’s views on the shape of a woman’s body, and mode of delivery. These variables predicted 34% of body dissatisfaction based on multiple linear regression.

Conclusion

Postpartum body dissatisfaction is related to a several variables. Paying attention to these variables will help to plan and improve postpartum counseling and educational programs.

An application of psychosocial frameworks for eating disorder risk during the postpartum period: A review and future directions

The postpartum period may be a particular window of vulnerability for eating disorder symptoms given changes to body shape and weight that women experience. However, no quantitative studies have identified risk factors for postpartum eating disorder symptoms, and current psychosocial frameworks of risk may be missing key elements unique to this period. This manuscript reviews existing quantitative and qualitative literature regarding the developmental trajectory of eating disorder symptoms during the perinatal period and proposes an application of three psychosocial models of eating disorder risk (objectification theory, the tripartite influence model of body image and eating disturbances, and social comparison theory) to the postpartum period. Drawing on quantitative and qualitative literature, this paper identifies novel postpartum-specific factors that should be included for consideration in psychosocial models (e.g., self-oriented body comparison and pressure to achieve a prepregnancy weight and shape). This review is the first to theorize potential postpartum-specific risk factors for postpartum eating disorder symptoms. Prior models of eating disorder risk omit key psychosocial factors that are unique to the postpartum period. Other limitations of prior research relate to measurement and methodology. This critical window of vulnerability has been largely ignored in the quantitative literature and necessitates further research.

Gestational weight gain, physical activity, sleep problems, substance use, and food intake as proximal risk factors of stress and depressive symptoms during pregnancy

Background

Because maternal depressive symptoms and stress during pregnancy are strongly associated with poor health of the mother and the developing child, understanding the predictors of women’s mental health problems is important to prevent complications in the perinatal period. Therefore, this study sought to examine the association between six risk factors – gestational weight gain (GWG), low physical activity, sleep problems, alcohol use, cigarette smoking and snack food intake – and mental health problems during pregnancy. We hypothesized that risk factors would predict mental health problems while adjusting for socio-demographic characteristics and pregnancy intention, both cross-sectionally and longitudinally.

Methods

Hierarchical linear regression analyses were conducted in a population-based sample of N = 463 pregnant women during their 2^nd trimester (gestational age: 23 to 28 weeks) of whom n = 349 were reassessed during their 3^rd trimester (gestational age: 33 to 38 weeks). Women had a mean age of 29.8 ± 4.2 years and a mean pregravid body mass index of 23.5 ± 4.3 kg/m². Data were collected by the ‘Leipzig Research Center for Civilization Diseases’ via the Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Food Frequency Questionnaire, self-report items on physical activity and substance use, and objectively measured anthropometrics.

Results

Cross-sectionally, while a higher snack food intake and sleep problems predicted depressive symptoms and stress during the 2^nd trimester, gestational weight gain predicted stress only. Longitudinally, sleep problems positively predicted depressive symptoms during the 3^rd trimester. All results remained significant after controlling for age, pregravid body mass index, and pregnancy intention. GWG and significant longitudinal effects became insignificant when controlling for gestational age or baseline depressive symptoms and stress, respectively.

Conclusions

The results showed that sleep problems were associated with maternal mental health problems during pregnancy. Longitudinal studies using standardized measures, particularly diagnostic interviews and physiological or biochemical markers, are warranted to confirm patterns of risk factors, their association with depressive symptoms and stress during the course of pregnancy, and their effects on mother’s and child’s health.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2328-1) contains supplementary material, which is available to authorized users.

Prepregnancy Body Mass Index shift across gestation: primary evidence of an association with eating disorders

Objective: Previous studies indicated that gestational weight gain-related disorders share many similarities with feeding and eating disorders (EDs).Design: To examine the association of prepregnancy Body Mass Index (BMI), defined according to 2009 Institute of Medicine (IOM), and its shift across gestation with symptoms of feeding and EDs, defined by EDE-Q.Setting: This prospective cohort study took place at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy, from Jannuary 2015 to October 2015.Population and sample: The sample included 655 healthy at term puerperae.Main outcomes measures: We correlated gestational BMI in different women categories to EDE-Q Global score and Restrain, Eating concern, Shape concern, and Weight concern subscales, by Spearman's correlation test.Results: Among 655 women, 59 (9.0%) were categorized as underweight, 463 (70.7%) normal weight, 98 (15.0%) overweight, and 35 (5.3%) as obese in prepregnancy period. At the end of gestation, underweight women category disappeared, normal weight women lightened to one third, overweight women tripled, and obese women doubled. At the same time, EDE-Q global scores increased from normal weight (0.25 ± 0.41), to overweight (0.47 ± 0.58), and to obese (0.72 ± 0.70) puerperae. In addition, EDE-Q global scores were significantly correlated with gestational BMI increase in Global score (rho = 0.326; p < .001) and in the four subscales: Restrain (rho = 0.161; p < .001), Eating concern (rho = 0.193; p < .001), Shape concern (rho = 0.335; p < .001), and Weight concern (rho = 0.365; p < .001), respectively.Conclusions: It was found that the shift of woman BMI across an uncomplicated pregnancy is a warning indicator of unhealthy eating and feeding symptoms.

Exploring the Tripartite Influence Model of body dissatisfaction in postpartum women

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.

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

Background During the first postpartum year 20% of women retain excessive weight from pregnancy (postpartum weight retention; PPWR), which predicts long-term overweight/obesity. Objective The aim of this study was to explore the associations between psychological factors (depression, anxiety and stress symptoms and body attitudes) in late gestation and at 12-months postpartum with PPWR one-year post-birth. Methods Pregnant women (N = 176) completed questionnaires in early-mid pregnancy (Time 1; mean (SD) = 16.97 (1.35) weeks), late pregnancy (Time 2; mean (SD) = 33.33 (2.05) weeks), and one year postpartum (Time 3; mean (SD) = 53.12 (3.34) weeks). Women provided demographic characteristics, height and pre-pregnancy weight at Time 1. At Times 2 and 3, weight, depressive, anxiety and stress symptoms and body attitudes (salience of weight and shape, attractiveness, feeling fat, and strength and fitness) were assessed in addition to physiological, socio-contextual and lifestyle factors. Gestational weight gain and PPWR were calculated. Hierarchical linear regression models were conducted to explore variance in 12-month PPWR. Results Overall, models explained 26-39% variance in PPWR. Gestational weight gain in late pregnancy and low attractiveness at 12 months postpartum were the only variables associated significantly with 12-month PPWR. Conclusion While psychological factors did not appear to be important direct contributors to PPWR at 12 months, the overall contribution of all variables suggests that such factors may be implicated in a small and incremental way. Exploration of the interactions between variables will help unpack potential mechanisms of the development of PPWR at 12 months post-birth.

A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study

BACKGROUND

Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour.

METHODS

A subsample of first-time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n = 28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n = 48; n = 43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self-reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum.

RESULTS

Mean PPWR decreased in the (I) group (-1.2 kg) and the C2 group (-1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (-6.4 cm) compared to C1 (-1.1 cm; P = 0.002) and C2 (-3.3 cm; P = 0.001). Changes in diet, physical activity or sedentary behaviour were not significant.

CONCLUSIONS

The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

An Integrative Review of Positive Health Practices

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.

Changes in satisfaction with body in pregnant women participating in physical exercise classes and childbirth classes

<b>Background</b><br /> During pregnancy, a woman’s body undergoes major transformation contrary to the present ideal image of a slim body shape. Satisfaction with the body is important for a pregnant woman because it is one of the factors that determine her physical and mental well-being. The aim of this study was to compare the changes in the satisfaction with the body in women who regularly participated in physical exercise classes (experimental group) and in women who attended traditional childbirth classes (control group).<br /> <br /> <b>Participants and procedure</b><br /> The research included 74 women aged 22-37 years in the second and third trimesters of their first pregnancy. The experimental group consisted of 39 pregnant women who participated in physical exercise classes from the Active Nine Months program for pregnant women. The control group consisted of 36 pregnant women who participated in typical childbirth classes twice a week. The Body Shape Test for Pregnant Women and the modified version of the Body Satisfaction Scale were used.<br /> <br /> <b>Results</b><br /> After two months, women in both groups perceived their body shape as significantly bigger; the ideal figure became plumper, and the disparity between the actual and the ideal figure increased. Dissatisfaction with torso, motor skills, and appearance did not change in the experimental group; a significant increase of dissatisfaction with appearance and motor skills was observed in the control group.<br /> <br /> <b>Conclusions</b><br /> Regular physical exercise helps pregnant women to maintain positive attitudes towards their body.

Reproductive issues in anorexia nervosa

Despite a high prevalence of menstrual irregularities, women with anorexia nervosa are becoming pregnant. The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article summarizes key issues related to reproduction in women with anorexia nervosa, highlighting the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety are also discussed.

Obesity and postpartum depression: does prenatal care utilization make a difference?

To identify (1) the association between pre-pregnancy BMI (PP-BMI) and PPD symptoms, and (2) the association between PP-BMI and PPD symptoms after considering PNC utilization as a moderating variable. Data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed from 15 states. The study design utilized two risk-adjustment approaches. One approach included all women in the dataset and used statistical analyses to risk-adjust for pregnancy risk status, and the other approach, through a sensitivity analysis, modified the design of the study by truncating the sample to include only women with healthy pregnancies. An initial association was seen between obesity and PPD symptoms, and PNC and PPD symptoms in the multivariate analyses. However, the inclusion of case-mix variables into the multivariate models removed these associations. Overall, for both approaches, there was no indication of a moderating effect of PNC utilization. Results also revealed that many of the women were significantly affected by a variety of high-risk maternal morbidity (case-mix) variables. Although PNC is important for the health of mothers and babies, it does not appear to moderate the association of PP-BMI and PPD symptoms. However, since this study revealed associations between several high-risk maternal morbidities (included as case-mix variables), and PPD symptoms, it is recommended that future research further investigate the possible association of these morbidities with PPD symptoms. For practice, it is suggested that PNC providers focus on their patients, and establish suitable interventions accordingly.

Representations of celebrities' weight and shape during pregnancy and postpartum: a content analysis of three entertainment magazine websites

Entertainment magazine websites provide a continuous stream of celebrity news accessed by over 13 million unique viewers each month. Celebrities' experiences of pregnancy and new motherhood appear to be popular topics within these media outlets; however, little research has investigated the content of this coverage. In this study, investigators coded articles (N=387) published between August 1, 2007 and August 1, 2008 on three popular entertainment magazine websites. Relatively few articles about celebrities' pregnancies discussed weight (13%) or shape (30%), and an even smaller proportion (6.2%) included any discussion of postpartum body dissatisfaction. This suggests a gap between portrayal of celebrities' pregnancies and postpartum experiences and those of non-celebrity women. This disparity is concerning as it might lead to unrealistic expectations about pregnancy and postpartum for both pregnant readers and a more general audience. This study provides important initial information about the messages these media provide regarding pregnancy-related appearance.

Determinants of pregnancy and postpartum depression: prospective influences of depressive symptoms, body image satisfaction, and exercise behavior

BACKGROUND

Limited research has prospectively examined women's exercise and psychological health behaviors before, during, and after pregnancy.

PURPOSE

The purpose of this study was to examine the associations between and the extent to which depressive symptoms (DS), body image satisfaction (BIS), and exercise behavior (EB) prospectively explained trimester-specific and postpartum depression.

METHODS

Participants (N = 230 pregnant women) completed self-reported measures midway through their first, second, and third trimesters and at 6-weeks postpartum from 2005 to 2007. Women were also classified based on current activity guidelines as active and somewhat active to examine the moderating influence of pre-pregnancy EB on the contributions of the study variables for explaining DS.

RESULTS

We found that : (a) DS, BIS, and EB were associated across the three pregnancy time points and postpartum, (b) DS and BIS were main determinants of later depression in pregnancy and postpartum, and (c) the moderating influence of pre-pregnancy EB was evident in early pregnancy.

CONCLUSIONS

These preliminary findings suggest that DS and BIS are important psychological factors for intervention to improve women's pregnancy and postpartum psychological health and that EB in the pre-pregnancy period may offer women protective effects against DS in early pregnancy.

Breast or bottle? Eating disordered childbearing women and infant-feeding decisions

Debates about infant-feeding methods have intensified in recent years with increasing pressures on women living in industrialized nations to breastfeed their infants. This paper, based on a qualitative study of 16 childbearing women with a pre-existing eating disorder living in the north of England, examines participants' motivations for, and understandings of, infant-feeding decisions and practices. In this study, a small number of participants reported being 'desperate' to formula feed in order to resume practices underpinning their eating disorder and thereby to shed the weight accumulated during pregnancy. These participants anticipated an early return to restrictive eating, heavy exercise regimes and/or bingeing/purging behaviours. Most participants, however, reported being 'desperate' to breastfeed because this implied 'good' mothering and prolonged the time during which they could consume 'naughty' treats. Women who opted to breastfeed generally believed this would accelerate weight loss. This study contributes to research on the subjective experiences of a particular group of women living with chronic illnesses and problematic relationships with their bodies. Negotiating individual transitions to motherhood required participants to confront their own, often longstanding, disrupted eating patterns and to make important decisions about infant-feeding methods. Findings from this study raise questions about some of the assumptions underpinning infant-feeding activities and articulate some of the complexities surrounding these issues. By highlighting ways in which women may compromise their own well-being by prioritizing their baby's needs, for example by persisting with breastfeeding when they were 'desperate' to re-engage with their disordered eating practices, an individualized cost-benefit framing is outlined.

Predictors of weight loss in low-income mothers of young children

OBJECTIVE

To identify predictors of weight loss in a tri-ethnic population of low-income mothers.

DESIGN

An 8-week dietary and physical activity program was tested. Demographic data were collected at baseline; anthropometric, dietary, physical activity, and psychosocial data were measured at baseline and week 8.

SUBJECTS/SETTING

A convenience sample of 114 Hispanic, African-American, and white, low-income mothers with a body mass index > or = 25 (calculated as kg/m2) participated in the intervention.

INTERVENTION

Weight-loss classes that incorporated nutrition, physical activity, and behavior modification were administered for 8 weeks.

MAIN OUTCOME MEASURES

Anthropometry (body weight, weight loss).

STATISTICAL ANALYSES PERFORMED

Analysis of variance, chi2 tests, and Spearman and Pearson correlations were used to test for associations between baseline and change data and total weight loss. Hierarchical regression was employed to assess the marginal importance of factors beyond socioeconomic influences.

RESULTS

Correlates of weight loss included less satisfaction with appearance (r=0.24), greater percentage of energy from protein (r=-0.22), enhanced nutrition knowledge (r=-0.23), and higher scores for benefits of weight loss (r =-0.20) at baseline; and the change in healthful eating attitudes (r=-0.28) and social support (r=-0.21) at 8 weeks. The predictive models of baseline and change variables represented 11.4% and 13.8% of the variance, respectively.

CONCLUSIONS

Weight-management programs serving low-income mothers should provide techniques to enhance social support, attitudes toward healthful eating, benefits of weight loss, and nutrition knowledge.

The psychosocial consequences for primiparas and multiparas

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.

A Pilot Study on the Effects of Aquatic Exercises on Discomforts of Pregnancy

OBJECTIVES

To estimate the impact of an aquatic exercise program on perception of body image, participation in health-promoting behaviors, barriers to health-promoting participation, level of physical discomfort, and mobility.

DESIGN

A two-group, quasi-experimental, pretest/posttest design.

SAMPLE AND SETTING

A convenience sample of 40 nonexercising pregnant women who were at least 19 weeks gestation were recruited. Sixty percent of the sample was African American. Participants self-selected assignment to either the exercise or nonexercise group. Both groups completed self-report measures and underwent a mobility assessment. The exercise group participated in a 60-minute, 6-week aquatic exercise program three sessions per week. The control group was instructed to continue their normal activities of daily living.

RESULTS

Women who had participated in the aquatic exercise program reported significantly less physical discomfort, improved mobility, and improved body image and health-promoting behaviors as compared to control subjects.

CONCLUSIONS

Aquatic exercise during pregnancy may enhance physical functioning, decreasing maternal discomfort, improving maternal body image, and improving health-promoting behaviors.

Effects of pregnancy on eating attitudes and disorders: a prospective study

The aim of this prospective study was to investigate the effects of pregnancy on eating disorders (ED), dietary habits and body image perception. One hundred and fifty pregnant women were interviewed between the period January 2001 and May 2003. Ninety-seven women completed the study and were divided in three subgroups: pregnant women with a positive history of dieting (n=37), pregnant women with a positive history of dieting with a complete diagnosis of a current ED (n=11) and pregnant women with a negative history either of dieting or ED (control group; n=49). Age, education and parity were equally distributed in all three groups. To verify if pregnancy exerts a specific protective effect, a battery of psychometric tests was administered to women at 12 degrees (T0), 22 degrees (T1), and 34 degrees pregnancy weeks (T2), and 2 days (T3) and 4 months (T4) after delivery, respectively. The study showed a quadratic trend for ED, subthreshold ED and body satisfaction, with a general improvement in the middle of pregnancy and a return to previous levels after delivery. Some interesting significant differences came out among the groups.

Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum

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.

Adolescent Motherhood and Postpartum Depression

Adolescent mothers undergo unique personal and social challenges that may contribute to postpartum functioning. In this exploratory investigation completed within a risk and resilience framework, 149 adolescent mothers, ages 15 to 19, who participated in school-based teen parents' programs, completed measures of parental stress (social isolation and role restriction), maternal competence, weight/shape concerns, and depression. The sample was quite diverse, and no ethnic differences in base rate levels of the variables were detected. Regression analyses indicated that social isolation, maternal competence, and weight/shape concerns predicted unique variance associated with depression level. The findings are discussed in light of future work and the continued need to inform prevention and treatment programs for young mothers.

Weight and behavioral and psychosocial factors among ethnically diverse, low-income women after childbirth: II. Trends and correlates

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.

Pregnancy-related weight gain--a link to obesity?

Past research on maternal weight gain during pregnancy has focused on determinants and consequences of inadequate weight gain with concerns for the health of the infant. However, with the rising prevalence of obesity among women of childbearing ages and the high proportion of women who are gaining in excess of recommendations, a shift in research focus must occur to include consideration of the mother's long-term health status. The few studies that have examined determinants of excessive weight gain and postpartum weight retention in this country were not comprehensive in assessing diet, physical activity and psychosocial factors and suffer from small sample sizes. Information is lacking concerning pregnant women's perceptions about eating and gaining weight, what they actually eat, how consumption and exercise relate to weight gain, and how psychosocial factors influence these behaviors during pregnancy. Likewise, little is known concerning these same attitudes and behaviors during the postpartum period that may contribute to weight retention.

A meta-analysis of predictors of positive health practices

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.

Body image across the adult life span: stability and change

By far, the majority of studies investigating body image in adults have drawn samples from college populations within a very narrow age range. The purpose of the present paper is to review empirical research on the body image of adults older than the typical college student. There are marked changes in appearance across the adult life span, especially for women, which lead to the expectation of concomitant changes in body image. In fact, the review found that body dissatisfaction was remarkably stable across the adult life span for women, at least until they are quite elderly. In contrast, the importance of body shape, weight and appearance decreased as women aged, underscoring an important distinction between evaluation and importance of the body. However, there are many large gaps and limitations in the current literature that will need to be addressed before a more complete understanding of the development of body image across the adult life span is achieved.

Relationships between body image and depressive symptoms during postpartum in ethnically diverse, low income women

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.

Changes in body image satisfaction during pregnancy: a comparison of high exercising and low exercising women

OBJECTIVE

This study aimed to compare ratings of body image satisfaction (BIS) from 6 months prepregnancy to 23-30 weeks' gestation for high exercising and low exercising pregnant women. The authors also aimed to assess and compare expectations of BIS for the post-partum period in high and low exercising women.

DESIGN

A partial prospective approach was implemented.

SAMPLE

A total of 71 healthy pregnant women (40 high exercisers and 31 low exercisers) participated.

METHODS

Participants completed a series of questionnaires at 15-22 weeks' gestation and 23-30 weeks' gestation.

MAIN OUTCOME MEASURES

There were two main outcome measures. At 15-22 weeks' gestation there was an exercise inventory and two versions of the Body Cathexis Scale (BCS) (retrospective prepregnancy BIS and current BIS). At 23-30 weeks' gestation there was an exercise inventory and two versions of the BCS (current BIS and projected post-partum BIS).

RESULTS

At 15-22 weeks' gestation, high exercisers demonstrated significantly higher levels of BIS compared to low exercisers. There were no other significant differences between groups. Within groups, high exercisers were significantly more satisfied with their bodies at 15-22 weeks' gestation compared to 6 months prepregnancy, and expected to be less satisfied with their bodies at 6 weeks' post-partum than they were during pregnancy. Low exercisers demonstrated no significant changes over time.

CONCLUSIONS

The findings suggest that women are able to assimilate the bodily changes of pregnancy without a negative shift in BIS. However, women who exercise during pregnancy may respond more favourably to changes in their bodies at early pregnancy compared to women who remain sedentary.

Postpartum stress: current concepts and the possible protective role of breastfeeding

OBJECTIVE

To review stress during the postpartum and the research supporting that a unique, protective biology exists in breastfeeding mothers that may reduce reactivity to stress.

DATA SOURCES

Publications from nursing and biomedical literature.

STUDY SELECTION

Studies reviewed were those that have contributed to concurrent conceptualizations of postpartum stress. Additionally, studies with sufficient participants were analyzed for common findings. Animal literature was reviewed for studies on the stress response in lactating and nonlactating animal models.

DATA EXTRACTION

Stress during the postpartum may be conceptualized as physical, intrapersonal, and interpersonal. Animal data and a few recent human studies suggest that the neuroendocrinology of the lactating mother may down-regulate the magnitude of the stress response.

DATA SYNTHESIS

A diminished stress response may serve to protect the breastfeeding maternal-infant dyad from environmental stimuli and to direct the physiology of the mother toward milk production, energy conservation, and nurturance.

CONCLUSION

Nurses understand the benefits of breastfeeding for optimal infant health, but new research suggests that maternal health may also be benefited in a biologic and as yet unexplored way.

The children of mothers with eating disorders

There is good evidence that children of parents with psychological disorders are themselves at increased risk of disturbances in their development. Although there has been considerable research on a variety of disorders such as depression and alcohol, research on the children of parents with eating disorders has been relatively recent. This paper aims to review the evidence and covers a number of areas, including genetic factors, pregnancy, the perinatal and postpartum period, infancy, and the early years of life, focusing on feeding and mealtimes, general parenting functions, and growth. This is followed by a consideration of psychopathology in the children, parental attitudes to children's weight and shape, and adolescence. What is clear is that although there are numerous case reports and case series, the number of systematic controlled studies is relatively small, and almost nothing has been written about the children of fathers with eating disorders. What is evident from the available evidence is that children of mothers with eating disorders are at increased risk of disturbance, but that the risk depends on a variety of factors, and that difficulties in the children are far from invariable. The paper concludes by summarizing five broad categories of putative mechanisms, based on the evidence to date, by which eating disturbance in parents can influence child development.

Cholesterol and mood states at 3 days after delivery

The aim of this study was to investigate the relationship between cholesterol and mood states in the initial puerperal period. The Profile of Mood States (POMS) was administered to 72 women on the third day after normal pregnancy, uncomplicated vaginal delivery and healthy baby. Plasma cholesterol concentration was measured the same day. Our study indicates that reduced plasma cholesterol concentration is associated with major feelings of fatigue and depressed mood. The implications of these results are discussed.

Postpartum exercise and food intake: the importance of behavior-specific self-efficacy

OBJECTIVE

To examine the relationships between psychosocial characteristics and change in exercise and food intake of women during the first year postpartum.

DESIGN

A prospective cohort study following women from pregnancy until 1 year postpartum. Psychosocial variables, change in food intake, and exercise frequency were assessed using anonymous mailed questionnaires during pregnancy and at 1 year postpartum. Sociodemographic and anthropometric information was obtained from the medical record.

SUBJECTS/SETTING

Six hundred twenty-two women who enrolled for prenatal care in the Bassett Healthcare system between November 7, 1994, and November 15, 1996, and who met the eligibility criteria. The attrition rate for completing the questionnaire at 1 year postpartum was 20%.

STATISTICAL ANALYSES PERFORMED

Multivariate linear regression with exercise frequency at 1 year postpartum and change in food intake during the second 6 months postpartum as the dependent variables and psychosocial factors assessed at 1 year postpartum as the independent variables, controlling for sociodemographic variables, body mass index, and gestational weight gain.

RESULTS

Higher exercise self-efficacy and having the intention to exercise were associated with more frequent exercise at 1 year postpartum in the multivariate regression analysis (r2 = 20%). Food intake self-efficacy, body satisfaction, weight gain acceptance, and drive for thinness were all significant in the multivariate analysis (r2 = 7%) and higher scores on these variables were associated with reductions in food intake.

APPLICATIONS/CONCLUSIONS

Interventions that aim to help women get regular exercise and make appropriate reductions in food intake during the postpartum period should focus on self-efficacy specific to the targeted behaviors. For example, dietitians may strengthen exercise self-efficacy by providing postpartum women with mastery experiences of setting realistic exercise goals. Likewise, dietitians can focus on food intake self-efficacy by modeling strategies that women can use to avoid overeating in stressful situations.

Evaluation of psychosocial measures for understanding weight-related behaviors in pregnant women

The greatest weight gain for US. women occurs during the childbearing years of 25 to 34, and many obese women attribute their adult weight gain to childbearing. Few studies have examined psychosocial influences on women's behaviors during pregnancy, in part because of the lack of valid and reliable measures of psychosocial constructs relevant to pregnant women. Based on existing theory and an in-depth interview study, the psychosocial constructs of locus of control, self-efficacy, body image, feelings about motherhood, and career orientation were identified. Scales for each construct were constructed by drawing items from existing validated scales and writing items based on the in-depth interviews; their content validity assessed using factor analysis with oblique rotation and their reliability using Cronbach's alpha. Construct validity was assessed by examining the associations between scale scores and preexisting conditions of participants. Data for evaluating the scales came from a study of 622 pregnant women in a rural health care system who completed questionnaires and whose medical records were audited. Cronbach's alpha of the scales ranged from 0.73 to 0.89. Scale scores were strongly associated with lifestyle behaviors, body weight, and demographic characteristics of the participants. The analysis provides evidence of the validity of measures of psychosocial factors related to health behaviors of pregnant women. These measures should be useful in studying weight-related behaviors in pregnant women.

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

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

Continuity and change in women's weight orientations and lifestyle practices through pregnancy and the postpartum period: the influence of life course trajectories and transitional events

The life course perspective offers a framework for understanding continuity and change in health and health practices. Body weight, and the diet and physical activity strategies used to manage weight in pregnancy and the postpartum period, are a focus of much study because of an association between parity and body weight. The motherhood transition offers an opportunity to study weight concerns and weight management strategies during a period of weight fluctuation that is part of a life transition for many women. Our aim was to develop an in-depth understanding of women's experiences of pregnancy and postpartum weight changes, the strategies that women used to deal with weight changes, and patterns in their attitudes and strategies across pregnancy and the postpartum period. A longitudinal design, using multiple, in-depth, qualitative interviews with 36 women from pregnancy through the postpartum period, was chosen for data collection. Prepregnancy orientations towards body weight emerged as the primary influence on women's pregnancy and postpartum attitudes towards weight, on patterns of physical activity and diet, and on postpartum weight outcomes among most study participants. Four different trajectories ("relaxed maintenance", "exercise", "determined", and "unhurried"), characterized by differences in women's orientations towards their body weight and their diet and physical activity patterns across pregnancy and the postpartum period, emerged from the data. Only a few women diverged from prepregnancy trajectories in weight orientation and diet and physical activity patterns postpartum. Delayed resumption of prepregnancy physical activity and dietary patterns contributed to postpartum weight retention for a subset of "exercisers". Stress and age- or role-related changes in perspective interrupted the continuity of weight orientations and behavioral patterns for three other women. These findings highlight the direction and momentum provided by trajectories in health attitudes and strategies as processes shaping responses to a life transition.

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

OBJECTIVE

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

DESIGN

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

SETTING

A comprehensive health care system in central Texas.

PARTICIPANTS

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

OUTCOME MEASURE

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

RESULTS

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

CONCLUSIONS

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

The construct of thriving in pregnancy and postpartum

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

Is integrative science necessary to improve nursing practice?

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