Psychological antecedents of excess gestational weight gain: a systematic review

Abstract

Background: Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children. Psychological variables represent potentially modifiable factors. Moreover, previous systematic reviews on GWG interventions have called for the need for a clearer understanding of psychological factors affecting GWG. Hence, a systematic review was conducted to summarize the relation between psychological factors and GWG.

Methods: Eight databases were searched, and the guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality.

Results: A total of 6198 titles and abstracts were reviewed of which 90 full text articles were retrieved. Thirty-five studies (25 cohort, eight cross-sectional and two case-control) met the inclusion criteria, assessing 26 different psychological constructs in affect, cognitions and personality. Negative affective states such as depression, anxiety and stress were not related to excess GWG. Among weight-related and dietary-related cognitions, risk factors for excess GWG included concern about weight gain, negative body image and attitude towards weight gain, inaccurate perceptions regarding weight, higher than recommended target weight gain, less knowledge about weight gain, higher levels of cognitive dietary restraint, and perceived barriers to healthy eating. Protective factors included an internal locus of control for weight gain, lower than recommended target weight gain and higher self-efficacy for healthy eating. Only one study examined the relation between personality and excess GWG.

Conclusion: In this systematic review, a number of cognitive factors were identified that were associated with excess GWG. To address excess GWG, more high quality, adequately powered studies are required examining cognitions, motivation and personality factors.

Figure 1

Flow diagram of study selection process in systematic review of psychological antecedents of excess gestational weight gain.

Figure 2

Diagrammatic representation (pinwheel) of relation between affect, cognition and personality and excess gestational weight gain in systematic review of psychological antecedents of excess gestational weight gain. The results of the systematic review on the relation of affect, cognitions and personality with excess GWG are depicted in Figure 2. The major domains are positioned in the innermost circle. In the next circle, cognition is further divided into three sub-domains. These sub-domains are further divided to represent the individual exposures investigated. Boxes () have been used to represent adequately powered studies and diamonds () represent underpowered studies. The number within the boxes and diamonds corresponds to each study’s reference as listed in Tables 4, 5, 6 and 7. Boxes and diamonds are further coded as follows: Studies which performed multivariate analysis are shown with a thick border; studies which performed univariate analysis are shown with a thin border; Green = significant negative association (protective factor), red = significant positive association (risk factor) and yellow = non-significant association. Adjacent to the boxes and diamonds, symbols represent the following: = studies for which we were unable to determine power. * = significant only at subscale level of an exposure scale and △ = significant only at item level of an exposure scale. Exposures which were not investigated by any of the studies included in this systematic review are shown using crosshatching (). >: Greater than recommended target weight gain; <: Less than recommended target weight gain.