Psychological factors and trimester-specific gestational weight gain: a systematic review

Abstract

Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with numerous adverse pregnancy outcomes. Early pregnancy provides a unique opportunity for counseling pregnant women since many women are motivated to engage in healthy behaviors. A systematic review was conducted to summarize the relation between psychological factors and trimester-specific GWG, i.e. GWG measured at the end of each trimester. Eight databases were searched for affect, cognition and personality factors. The guidelines on meta-analysis of Observational Studies in Epidemiology were followed. The methodological quality of each study was assessed using a modified Newcastle–Ottawa Scale. Of 3620 non-duplicate titles and abstracts, 74 articles underwent full-text review. Two cohort studies met the inclusion criteria. Distress was negatively associated with first trimester GWG among both adolescents and non-adolescents. Body image dissatisfaction was associated with second trimester GWG only among non-adolescents. No association emerged between perceived stress, state and trait anxiety and body image dissatisfaction among adolescents and trimester-specific GWG. The relation between trimester-specific GWG and a number of weight-related and dietary-related cognitions, affective states and personality traits remain unexplored. Given the limited number of studies, further high-quality evidence is required to examine the association between psychological factors and trimester-specific GWG, especially for cognitive and personality factors.

• Gestational weight gain
• pregnancy
• psychological factors
• systematic review
• trimester

Current knowledge of this subject

• Excess gestational weight gain (GWG), that is, gain above the amount recommended in national guidelines has reached epidemic proportions and associated with numerous adverse pregnancy outcomes.

• Early identification of increased risk of excess GWG is important to allow sufficient time for potential interventions to improve adherence to recommendations for total GWG.

• A number of previous systematic reviews have shown limited effectiveness of interventions aimed at improving adherence to GWG guidelines by modifying behaviors directly related to dietary and physical activity. However, none of the previous systematic reviews have investigated the psychological antecedents of these behaviors.

What this study adds

• We found that body image dissatisfaction among pregnant non-adolescents and distress among all pregnant women were associated with GWG in early pregnancy.

• State and trait anxiety were not related to trimester-specific GWG. However, the number of included studies was limited and precludes definitive conclusion.

• We identified important areas for future study, such as the lack of available information on the association of trimester-specific GWG with a number of weight-related and dietary-related cognitions, affective states and personality traits.

Declaration of interest

None of the authors have any financial or other conflicts of interest.

This work was supported by a Canadian Institute of Health Research (CIHR) operating grant number 124594, S. D. M. is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Salary Award and J. B. is supported John D. Cameron Chair in the Genetic Determinants of Chronic Disease at McMaster University. CIHR and McMaster University had no role in the conduct of analyses, writing of the report, interpretation of data or decision to submit this manuscript.