Weight gain attitudes among pregnant adolescents

Abstract

Maternal weight gain is the most important, manageable determinant of infant birth weight among adolescents. Negative attitudes toward weight gain may adversely affect maternal weight gain. We hypothesized that (a) negative attitudes toward pregnancy weight gain are more common among younger pregnant adolescents, and (b) negative attitudes toward pregnancy weight gain adversely affect adolescent maternal weight gain. The study subjects, 99, radially diverse, pregnant 13 through 18 year olds, completed the 18-item, Likert-format, Pregnancy and Weight Gain Attitude Scale. Responses to the questionnaire indicated that most (83.8%) of the adolescents we interviewed had a positive attitude toward pregnancy weight gain when they entered prenatal care. Univariate analyses revealed that attitudes toward weight gain were unrelated to the respondents' ages but inversely related to their prepregnant weights (-0.16; p = 0.06) and the severity of their symptoms of depression (r = -0.26; p = 0.004). Attitudes toward weight gain were also directly related to their family support (r = 0.17; p = 0.06). Weight gain was significantly related to 4 of the 18 scale items but not to the total attitude scale score. We conclude that (a) the developmental task of formulating a positive body image does not foster more negative attitudes toward pregnancy weight gain among younger adolescents; (b) negative weight gain attitudes are most common among heavier adolescents, depressed adolescents, and adolescents who do not perceive their families as supportive; and (c) negative weight gain attitudes could adversely affect pregnancy weight gain.

PIP: Since maternal weight gain affects infant birth weight and is significantly correlated with attitudes toward weight gain, pregnant adolescents were studied to determine whether negative attitudes towards weight gain were more common among younger pregnant adolescents and whether negative attitudes adversely affect adolescent maternal weight gain. 99 pregnant adolescents (aged 13-18 years), who were enrolled in the Colorado Adolescent Maternity Program at the University Hospital in Denver, Colorado, took part in the study. The subjects were from a variety of ethnic groups, were mostly poor, and 86% were primigravidas (92% nulliparas). Attitudes toward weight gain were gleaned at the time the adolescents entered prenatal care from the self-administered Pregnancy and Weight Gain Attitude Scale (PWGAS), which rates a very negative attitude as 1, a positive attitude as 3 or above, and a very positive attitude as 5. Gestational weight gain was recorded to the nearest tenth of a kilogram at every visit. Weight gain was described as slow (0.23k/week), average (0.23-0.4k/week), or rapid (0.4k/week). Additional data collected as possible determinants of weight gain attitudes and weight gain were 1) maternal age at conception, 2) self-reported pre-pregnant weight, 3) dietary habits, 4) health habits, and 5) social history. The Statistical Package for the Social Sciences was used to perform data analyses. It was found that the PWGAS scores ranged from 2.39 to 4.61, with 83 of the 99 respondents having a score or=3. These positive attitudes were unrelated to age, race, medicaid status, gravidity, parity, dietary habits, health habits, or stress scale, but were less positive among adolescents with higher prepregnancy weights. PWGAS scores were inversely related to scores on the depression scale and positively related to scores on the Family Apgar Scale. Actual gestational weight gain correlated significantly with 4 of the 18 PWGAS items: enjoying wearing maternity clothes, feeling unattractive because of weight gained, being embarrassed when being weighted, and being bothered by not being able to wear current fashions. Rate of weight gain, however, was unrelated to 1) total scale score, since mean attitude scores were similar for all 3 weight-gain groups; 2) self-reports about number of meals and snacks consumed daily; and 3) efforts to limit weight during gestation. Thus, the common hypothesis that younger pregnant adolescents may be more concerned about pregnancy weight gain than older adolescents or women is not supported by these findings. Having depressive symptoms was the only characteristic studied which was significantly associated with weight gain attitudes. This analysis indicated that family support may mitigate against the adverse effect of depression on pregnancy weight gain. Since the rate of weight gain correlated significantly with 4 items on the PWGAS, it was concluded that certain negative attitudes can adversely affect adolescent maternal weight gain.