Abstract
BackgroundExcess 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.MethodsEight 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.ResultsA 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.ConclusionIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0535-y) contains supplementary material, which is available to authorized users.
Highlights
Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children
The considerable heterogeneity in the scales used to assess each psychological construct and the failure of many studies to report comprehensive data precluded us from computing a pooled effect estimate with meta-analytic techniques. This is the first systematic review to our knowledge to examine the relation between excess GWG and psychological antecedents, answering the call from other systematic reviews of generally non-successful interventions for preventing excess GWG to study the antecedents
Based on the studies included in this review, affective symptomatology was unrelated to excess GWG, except for severe symptoms of depression
Summary
Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children. Previous systematic reviews on GWG interventions have called for the need for a clearer understanding of psychological factors affecting weight gain. Kramer and colleagues suggested that whereas dietary modifications during pregnancy lowered GWG [16], interventions that focused on increasing physical activity through aerobic exercise were ineffective in reducing GWG [17] These conclusions suggest that dietary modifications are critical in a pathway of behavioral modifications to GWG. These findings are further supported by systematic reviews of clinical trials that suggest that physical activity plus dietary interventions [18,19] are most effective in reducing GWG. Personality’s role in preventive health care was deemed so pivotal that the American Psychological Association issued a recent Press Release entitled “Personality May be Key Risk Factor in Preventive Health Care” [28]
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