Background
Methods
Study inclusion criteria
Study design
Participants
Independent variables (exposures)
Psychological construct
|
Themes
$$
|
---|---|
1. Affect
| Stress |
Distress | |
Adaptation/coping behavior | |
Depression | |
Anxiety | |
Mood/Affect | |
Emotions/Feelings | |
2. Cognitions
| |
Related to weight gain
| Self-esteem |
Self-efficacy | |
Locus of control | |
Body image | |
Attitude | |
Motivation | |
Related to dietary behavior
| Eating attitudes |
Feeding behavior | |
Knowledge | |
Personality
| Personality traits related to Five Factor Model and Eysenck’s personality model |
Resilience | |
Impulsivity |
Outcome measures
Study selection process
Assessment of risk of bias
Data abstraction
Data synthesis
Results
Study characteristics
Author, year (
years study span
)
|
Sample size
|
Setting
|
Population
|
---|---|---|---|
Allison 2012 [34] (NR)
| 105 | University-based hospital in USA for women on community-based health insurance | African-American English speaking women, who were ≥ 18 years with a pre-gravid BMI of ≥25 kg/m2, had a singleton pregnancy; no pre-existing diabetes mellitus or autoimmune disorder, or regular use of steroid treatment |
Brawarsky 2005 [9] (NR)
| 1100 | Project WISH (Women and Infants Starting Healthy) cohort participants received prenatal care and planned to deliver at participating hospitals in San-Francisco, USA | Women who had a singleton, full-term birth (>37 weeks), identified their race as white, ‘black’, Latina, or Asian, and had complete pregnancy weight gain information, including a weight measured within four weeks of delivery |
Chasan-Taber 2008 [36] (2000–2003)
| 770 | Latina Gestational Diabetes Mellitus (GDM) cohort study based in public obstetrics/gynecology clinic and midwifery practice of a large tertiary care facility in Western Massachusetts, USA | Women who were Hispanic, 16–40 years old, <24 weeks, had a singleton pregnancy; no history of type 2 diabetes, hypertension or heart disease, chronic renal disease; treatment with medications thought to influence glucose tolerance adversely |
Cogswell 1999 [37] (1993) | 1661 | Identified through a consumer mail panel (of 500, 000 households), representative of USA population in terms of geographic region, annual income, population density, household size and age | Women who had a singleton pregnancy, and were expecting to deliver within 3 months |
Copper 1995 [39] (1985–1988)
| 1000 | Data obtained from a prospective study of risk factors for fetal growth restriction that included pregnant women who delivered at the University of Alabama hospital, USA | Multiparous women, who had a live singleton birth at full term, predominantly ‘black’, and medically indigent; last available weight was within 2 weeks before delivery; oversampled women with one or more risk factors for Fetal Growth Restriction, including, but not limited to, smoking, a history of an low birth weight infant, and small stature |
Herring 2008 [41] (1999–2002)
| 1537 | Women recruited from project Viva having their first prenatal visit in one of eight urban and suburban obstetric clinics associated with multispecialty group practice in eastern Massachusetts, USA | Women with a fluency in English, <22 weeks, with a singleton; excluded: underweight women |
Hill 2013 [42] (NR)
| 104 | Participants recruited from Australian pregnancy online forum and in pregnancy and parenting magazines distributed at state and national level | Pregnant women >18 years and between 10 and 16 weeks |
Laraia 2013 [43] (2001–2005)
| 1041 for univariate, 922 for multivariate | Pregnancy, Infection and Nutrition (PIN3) prospective cohort study recruited through the University of North Carolina Hospital and private physician obstetrics clinics in USA | Women ≥16 years, English speaking, planning to continue care or deliver at the study site and having a singleton pregnancy |
Loris 1985 [44] (1979–1982)
| 46 | Teen obstetric clinic of the University of Carolina Davis Medical Centre, USA | Teenagers delivering a singleton |
McAnarney 1992 [45] (1986–1989)
| 116 | Participants recruited from Rochester Study of Adolescent Pregnancy in New York, USA | Participants of a cohort of poor, ‘black’, 12 to 19 years |
Mehta 2011 [46] (2001–2005)
| 1192 | Pregnancy, Infection and Nutrition (PIN) cohort study delivering at the University of North Carolina Hospital, USA | Participants of a cohort who were >16 years, spoke English, were ≤20 weeks on their second prenatal visit, were planning to continue care or deliver at the study site, had access to a phone for telephone interviews, and were having singleton pregnancies |
Mehta-Lee 2013 [63] (2008–2010)
| 775 | Secondary analysis of data collected for two randomized-controlled trials of routine provider, primary care based breastfeeding promotion interventions in the Bronx, New York United States | English or Spanish speaking women >18 years, 1st or 2nd trimester of a singleton pregnancy without known risk factors for premature birth, medical contraindications to breastfeed, or infant conditions that prevent breastfeeding. Inclusion criteria for this study: medical record data for height, self-reported pre-pregnancy weight or a pregnancy weight <22 weeks, and a weight > 12 weeks later; exclusion: underweight |
McPhie 2015 [62] (NR)
| 183 | Participants were recruited via advertising on online mother, child and baby forums, in parenting magazines, at baby and children’s markets, and at obstetrician clinic waiting rooms in Geelong/Melbourne in the state of Vicotria, Australia | Women over the age of 18 years |
Morling 2003 [47] (NR)
| 56 American women; 94 Japanese women | American women recruited from four obstetric clinics in the city of Schenectady, New York; Japanese women were recruited from the Centre of Obstetrics at the Central Hospital of Ethime | Women who were middle class, recruited during second trimester |
Mumford 2008 [48] (2001 to 2005)
| 1223 | PIN cohort study participant recruited from both public and private prenatal clinics at the University of North Carolina Hospital, USA | Participants who were ≥16 years, spoke English, ≤20 weeks on their second prenatal visit, planning to continue care or deliver at the study site and had a singleton pregnancy |
Olson 2003 [49] (NR)
| 622 | Women registered for prenatal care in a hospital and primary care clinic system serving a 10 county area of Upstate New York, USA | Women who entered prenatal care < third trimester, were ≥ 18 years at the time of delivery, planned to deliver within the local hospital and keep the baby, were healthy and mentally competent and gave birth to live singleton infants |
Pomerleau$2000 [50] (NR)
| 68 | Participants from studies at the Nicotine Research Laboratory, recruited from the general community in Michigan, USA | Women who had a first-born child age ≤10 years, singleton pregnancy, delivered at ≥ 37 weeks, smoked at least five cigarettes/day prior to first pregnancy, were smokers at the time of their first pregnancy (regardless of whether they quit during pregnancy or of their current smoking status); participants with a wide range of weight concerns and oversampled those who scored high on measures of dieting and bingeing severity |
Steven-Simon 1993 [53] (1986–1989)
| 99 | Participants were enrolled in the Colorado Adolescent maternity program at the University Hospital, USA | Participants who were 13 to 18 year old from diverse ethnic backgrounds |
Steven-Simon 1995 [52] (1986–1989)
| 122 | Participants of Rochester study of Adolescent pregnancy in New York, USA | Participants who were poor, ‘black’ and 12 to 19 years |
Strychar$ 2000 [54] (NR)
| 115 | Prenatal clinics at 3 university teaching hospitals in Montreal, Canada | Primiparous women with singleton pregnancies, ≥ 19 years; excluded: high-risk pregnancies, gestational diabetes, edema, preeclampsia, ‘black’ women and women of Asiatic and Hispanic origin |
Sui 2013 [64] (2010–2012)
| 442 | Prospective cohort study nested within the LIMIT (LIMITing weight gain in overweight an dobese women during pregnancy to improve health outcomes) randomized trial, evaluating the effect of an antenatal dietary and lifestyle intervention for women who are overweight or obese; public maternity hospitals in South Australian metropolitan area | Women with BMI >25 kg/m2 were recruited with a live singleton pregnancy form 10–20 weeks’ gestation at the time of their 1st antenatal appointment |
Tovar 2012 [55] (2006–2011)
| 952 | Proyecto Buena Salud Cohort based in the public obstetrics and gynecology clinic and midwifery practice at a large tertiary care facility in Western Massachusetts, USA | Hispanic 16 to 40 year old women of Puerto Rican or Dominican Republic heritage (Caribbean Islanders), who were either themselves, or one of their a parent, or at least 2 of their grandparents born in the Caribbean Islands; women who had a full-term, live singleton birth; excluded: women with current use of medications that could influence glucose tolerance, history of diagnosis of diabetes prior to pregnancy, hypertension, heart disease or chronic renal disease |
van der Wijden 2014 [66] (2005–2006)
| 161 | Pregnant women from eight midwifery practices in The Netherlands were invited to participate in a randomized control trial on the New Life(style) intervention program consisting of five individual counselling session by one of two trained counsellors with the aim of preventing excess GWG. (Secondary analysis) | Women were eligible if <14 weeks pregnant (1st ongoing pregnancy) and fluent in Dutch. Exclusion criteria for current study: pre-pregnancy BMI or objectively measured pregnancy weight gain could not be established, or if >/=2 items per scale missing in the Dutch Eating Behaviour Questionnaire or >/=3 items on other scales. |
Walker$2002 [57] (NR)
| 305 | Austin New Mothers Study cohort who completed the post-delivery panel in USA | White, African-American, and Hispanic low income women who could read and speak in English, were ≥ 18 years, had full term delivery (between 37 and 42 weeks based on medical records), singleton birth, no medical risks such as diabetes or hypertension during pregnancy, parity of ≤3, and who had Medicaid coverage for prenatal care |
Webb 2009 [2] (2001–2005)
| 1605 | PIN cohort study conducted in central North Carolina, USA | Women who were >16 years, had a singleton pregnancy, were <20 weeks at their second prenatal visit, had a live birth, and had GWG data |
Wells 2006 [58] (2000–2002)
| 4528 | Data from the Centre for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS) for Colorado, USA | Women with live births, were ≥ 15 years |
Wright$ 2013 [59] (NR)
| 101 | Participants from Pennsylvania, USA. Details about the study setting not reported | Low income, English or Spanish speaking women who delivered a single live infant |
Zhu 2013 [65] (2008)
| 1800 | Women at Hefei Maternal and Child Health Hospital, Hefei, China | Women >32 weeks (retrospectively assessed stress in 1st and 2nd trimesters), singleton gestations. Exclusion criteria: >35 years, medically indicated preterm birth, birth defects, stillbirth, assisted reproductive technology, mental disorders, complications of pregnancy including diabetes, hypertension, heart failure, thyroid disease, intrahepatic cholestasis of pregnancy, moderate or severe anemia, history of abnormal pregnancy outcome including premature birth, spontaneous abortion, fetal death, stillbirth, birth defect, neonatal death |
Zuckerman 1989 [60] (1984–1987)
| 1014 | Prenatal clinic at Boston City Hospital, USA | Women who had the ability to communicate in English or Spanish, who gave informed consent |
Author, year
(Years study span)
|
Sample size
|
Setting
|
Population
|
---|---|---|---|
Bagheri 2013 [35] (2010)
| 362 | Women referred for prenatal care to a large women’s hospital in the south of Tehran, Iran | Fifteen to forty-six year-old pregnant women who were referred for prenatal care in a women’s hospital; >34 weeks and had a singleton pregnancy; cases were defined as pregnant women who gained weight in excess of Institute of Medicine guidelines and controls as women who gained weight within the guidelines; excluded: pregnant women with abnormal fetuses and those who received hormonal treatment during pregnancy or had diabetes, hypertension, thyroid or, renal chronic diseases |
Conway$ 1999 [38] (1995–1996)
| 62 | A large London hospital in United Kingdom | Caucasian women, who were expecting their first or second singleton baby, >18 years and free from known medical conditions which might affect nutrition or fetal outcomes |
Dipietro$ 2003 [40] (NR)
| 130 | Obstetric clinic in Baltimore, USA | Women with low risk, normal, singleton pregnancies, delivered at term, and with no history of smoking; predominantly well-educated, middle class women |
McDonald$ 2013 [61] (2012)
| 330 | Seven obstetrical and two midwifery clinics in southwestern Ontario, Canada | Women who had had at least one prenatal visit, could read English sufficiently well to complete the survey, and had a live singleton pregnancy |
Sangi-haghpeykar$ 2013 [51] (2011)
| 282 | Women delivering at a general hospital in Houston, USA | Women who were Hispanic, recruited immediately post-partum before leaving the hospital |
Walker 2009 [56] (2000–2003)
| 1988 | Pregnancy Risk Assessment Monitoring System (PRAMS) study data in New Mexico, USA | Hispanic mothers, ≥ 18 years, who had a singleton live birth during their most recent pregnancy, and had a full term (≤37 weeks) delivery |
Quality assessment
Cohort studies
Case–control and cross-sectional studies
Psychological factors and excess GWG
Author, Year (Study reference number)*
|
Scale used**, Validation
|
Outcome
|
Crude (unadjusted) results
|
Adjusted results
|
Confounders adjusted for
|
Summary of results
|
---|---|---|---|---|---|---|
Exposure: Depression
| ||||||
McAnarney 1992 [45] | Centre for Epidemiological Studies-Depression Scale (CES-D), validated | Rate of weight gain categorized as slow, average and rapid | Mean (SD) CES-D in each weight gain category: 22 (±9); 20 (±7); 24 (±8) (p <0.05) | OR (95% CI ) of rapid weight gain: | Covariates used but not reported | Only 1 item was significant on multivariate analysis ➔ |
Item: Suicidal thoughts and attempts | Item: ‘Suicidal thoughts and attempts’ 5.0 (1.28 to 19.57) | |||||
Proportion within each weight gain category 13%; 4.6%; 19.4% (p <0.05) | ||||||
McPhie 2015 [62] | Depression, Anxiety, and Stress Scale-21 (DASS-21), validated | Excess GWG | In 1st trimester, mild depression in 8.5% of those who gained in excess and 8.9% who gained within guidelines (for moderate depression, 2.8% and 0.9%, respectively); mild anxiety in 9.9% and 11.6%, respectively (for moderate anxiety, 7.0% and 0.9%, respectively) | NA | NA | NS on univariate analysis |
Sangi-Haghpeykar 2013 [51] | Patient Health Questionnaire (PHQ), validated | Excess GWG | Proportion with GWG categories: 9%, 9% (p-value NS) | NA | NA | NS on univariate analysis; variable not entered in the multivariate study |
Steven-Simon 1995 [52] | CES-D, validated | Effect estimate not reported; (p-value NS) | NA | NA | NS on univariate analysis | |
Multivariate analysis was not done | ||||||
Walker 2002 [57] | CES-D, validated | Excess GWG | Correlation co-efficient (p-value): r = 0.02 (p-value NS) | β (SE): 0.0 (0.1) | Pre-pregnancy BMI, age, parity, ethnicity, newborn gender, maternal height, food habits | NS on univariate or multivariate analyses |
Webb 2009 [2] | CES-D, validated | Excess GWG; Adequacy Ratio | RR (95% CI ): | RR (95% CI ): | Pre-gravid BMI, other socio-demographic, dietary and physical activity covariates | NS on univariate or multivariate analyses; Adequacy ratio outcome was significant only on univariate analysis |
CES-D score (<20 weeks)
|
CES-D score (<20 weeks)
| |||||
Low 1.0 (Reference); Moderate 1.06 (1.0 to 1.2); High 1.03 (0.9 to 1.1) | Low 1.0 (Reference); Moderate 1.01 (0.9 to 1.1); High 0.98 (0.9 to 1.1) (p = 0.91) | |||||
CES-D score (24–29 weeks)
|
CES-D score (24–29 weeks)
| |||||
Low 1.0 (Reference); Moderate 1.08 (1.0 to 1.2); High 1.12 (1.0 to 1.1) | Low 1.0 (Reference); Moderate 1.02 (0.9 to 1.1); High 1.02 (0.9 to 1.1) (p = 0.76) | |||||
Wright 2013 [59] | Edinburgh Postnatal Depression Scale (EPDS), validated | Excess GWG $; GWG (continuous)$$; | β (95% CI ): 0.88 (0.1 to 1.7) | Effect estimate not reported for excess GWG | Pre-pregnancy BMI, age, race | Results were reported to be similar to secondary outcome but estimates were not reported, hence considered non-significant on univariate or multivariate analysis |
β (95% CI) for secondary outcome: 0.3 (−1.0 to 1.5) | ||||||
Exposure: Anxiety
| ||||||
McPhie 2015 [62] | Depression, Anxiety, and Stress Scale-21 (DASS-21), validated | Excess GWG | In 1st trimester, mild anxiety in 9.9% of those who gained in excess and 11.6% who gained within guidelines, respectively (for moderate anxiety, 7.0% and 0.9%, respectively) | NA | NA | NS on univariate analysis |
Webb 2009 [2] | State and Trait Anxiety Inventory (STAI), validated | Excess GWG; Adequacy Ratio | RR (95% CI): | RR (95% CI): | Pre-gravid BMI, other socio-demographic, dietary and physical activity covariates | NS on univariate or multivariate analyses; adequacy ratio was also NS on univariate or multivariate analyses |
STAI-T (<20 weeks)
|
STAI-T (<20 weeks)
| |||||
Low 1.0 (Reference); Moderate 1.04 (1.0 to 1.1); High 0.98 (0.9 to 1.1) | Low 1.0 (Reference); Moderate 1.02 (1.0 to 1.1); High 1.01 (1.0 to 1.1) | |||||
STAI-S (<20 weeks)
|
STAI-S (<20 weeks)
| |||||
Low 1.0 (Reference); Moderate 0.94 (0.9 to 1.0); High 0.94 (0.9 to 1.0) | Low 1.0 (Reference); Moderate 1.06 (1.0 to 1.1); High 1.00 (0.9 to 1.1) | |||||
STAI-S (24–29 weeks)
|
STAI-S (24 to29 weeks)
| |||||
Low 1.0 (Reference); Moderate 1.00 (0.9 to 1.1); High 0.95 (0.9 to 1.0) | Low 1.0 (Reference); Moderate 1.01 (0.9 to 1.1); High 0.99 (0.9 to 1.1) | |||||
Exposure: Stress
| ||||||
Brawarsky 2005 [9] | Perceived Stress Scale-PSS (short form), validated | Excess GWG | Proportion within GWG categories: | NA | NA | NS on univariate or multivariate analyses |
Stress categorised as: | ||||||
Yes: 46.4%, 32.2% | ||||||
No: 55.4%, 32.2% | ||||||
Chasan-Taber 2008 [36] | Perceived Stress Scale-PSS (short form), validated | Excess GWG | OR (95% CI ): | Pre-pregnancy BMI, parity, age, generation in USA, prenatal care, caloric intake, household activity | NS on univariate or multivariate analyses | |
Proportion within GWG categories: | Maternal stress categorised as: | |||||
0-2: 51.5%, 25.0%; | 0-2: 1.0 (Reference); | |||||
3-5: 39.5%, 38.4%; | 3-5: 0.5 (0.3 to 0.9); | |||||
6-8: 43.4%, 34.4%; | 6-8: 0.6 (0.4 to 1.1); | |||||
≥9: 51.3%, 28.6%; | ≥9: 0.9 (0.5 to 1.6); | |||||
(p for trend = .75 and .82, respectively) | Missing: 1.1 (0.4 to 3.2) | |||||
Chasan-Taber 2008 [36] | PRAMS standard questions – based on modified Life Event Inventory, validated | Excess GWG | Proportions within GWG categories: | NA | NA | NS on univariate analysis; variable not entered in a multivariate model |
Number of life events categorised as: | ||||||
None: 46.4%, 33.6%; | ||||||
1: 46.0%, 35.4% | ||||||
2: 50.0%, 28.8; | ||||||
≥3: 42.6%, 31.1% | ||||||
(p for trend = .51 and .37 respectively) | ||||||
Sangi-haghpeykar 2013 [51] | Prenatal Psychosocial Profile Hassles Scale, validated | Excess GWG $ and $$
| Mean (±SD): | NA | NA | NS on univariate analysis; Variable not entered in the multivariate model |
13.7 (±2.8), 14.4 (±4.0) | ||||||
Walker 2009 [56] | PRAMS standard questions – based on modified Life Event Inventory, validated (18 items were used) | Excess GWG | Proportions within GWG categories: | NA | NA | NS on univariate analysis; Variable not entered in the multivariate model |
Maternal stress categorised as: | ||||||
None: 20.93%, 18.48% | ||||||
1-2: 38.76%, 40.65%; | ||||||
3-5: 32.11%, 31.49%; | ||||||
6-18: 8.20%, 9.39% | ||||||
Webb 2009 [2] | Perceived Stress Scale (PSS), validated | Excess GWG | RR (95% CI ): | RR (95% CI ): | Pre-gravid BMI, other socio-demographic, dietary and physical activity covariates | NS on univariate or multivariate analyses; NS results for adequacy ratio outcome |
PSS 17–22 weeks
|
PSS 17–22 weeks
| |||||
Low 1.0 (Reference); | Low 1.0 (Reference); | |||||
Moderate 0.99 (0.9 to 1.0); | Moderate 0.99 (0.9 to 1.0); | |||||
High 1.03 (1.0 to 1.1) ; | High 0.99 (0.9 to 1.1) | |||||
PSS 27–30 weeks
|
PSS 27–30 weeks
| |||||
Low 1.0 (Reference); | Low 1.0 (Reference); | |||||
Moderate 1.04 (1.0 to 1.1); | Moderate 1.01 (1.0 to 1.1); | |||||
High 1.07 (1.0 to 1.2) | High 1.01 (1.0 to 1.1) | |||||
Wells 2006 [58] | PRAMS standard question – based on modified Life Event Inventory, validated (13 items were used) | Excess GWG | Proportions within GWG categories: | OR (95% CI ): | NS on univariate level or multivariate analyses | |
Maternal stress categorised as: | 0 Stressor: 1.0 (Reference); | |||||
0 Stressors: 41.3%, 36.4%; | 1-2 stressors: 1.03 | |||||
1-2 Stressors: 41.7%, 36.2%; | (0.84 to 1.26); | |||||
3 or more stressors: 39.9%, 32.5% | ≥3 stressors: 1.04 (0.82 to 1.32) | |||||
Exposure: Feelings
| ||||||
Olson 2003 [49] | Investigator developed series of statement on Feelings about motherhood, Not validated | Excess GWG $$
| Proportion of exposure within Excess GWG category: | NA | NA | NS on univariate analysis; variable not entered in a multivariate model |
Low 43.8%; | ||||||
Medium 37.1% | ||||||
High 41.9% | ||||||
Exposure: Coping behavior
| ||||||
Tovar 2012 [55] | Psychological Acculturation Scale, validated | Excess GWG $
| Proportions within GWG categories: | OR (95% CI ): | Pre-pregnancy weight, age, parity, perceived stress, gestational age and physical activity | NS on univariate or multivariate analysis; NS association with other weight gain outcomes (rate of weight gain, weight gain as continuous) |
Low acculturation | Continuous acculturation score | |||||
49.3%, 30.6%; | 1.0 (0.8 to 1.3) | |||||
Medium acculturation | ||||||
42.2%, 31.1%; | ||||||
High acculturation | ||||||
47%, 31.5% | ||||||
(p = 0.4) |
Author, year (Study reference number)*
|
Scale used**, Validation
|
Outcomes
|
Crude(unadjusted) results
|
Adjusted results
|
Confounders adjusted for
|
Summary of results
|
---|---|---|---|---|---|---|
Exposure: Negative attitude towards weight gain
| ||||||
DiPietro 2003 [40] | Pregnancy and Weight Gain Attitude Scale, validated | Excess GWG | Proportions within GWG categories (p-value): | NA | Pre-pregnancy BMI | Only 1 item and two sub-scales were significant on univariate analyses ➔ |
Individual items:
| ||||||
-Embarrassed about weight | ||||||
28%, 8% ( p <0.05) | ||||||
-Worried will get fat | ||||||
43%, 37% (p-value NS) | ||||||
Feel unattractive | ||||||
28%, 14% (p-value NS) | ||||||
-Embarrassed when nurse weight me | ||||||
21%, 21% (p-value NS) | ||||||
-Cannot wear what is in style | ||||||
18%, 27% (p-value NS) | ||||||
Subscales:
| ||||||
Negative pregnancy body image r = 0.28 (p < 0.001) | ||||||
Pregnancy experience scale r = 0.20 (p < 0.001) | ||||||
McDonald 2013 [61] | Pregnancy and Weight Gain Attitude Scale, validated (Attitude towards weight gain scale) | Excess GWG | Mean (SD) in those gaining above 17.4 (3.4) vs within 17.9 (2.8); OR 0.95 (0.86 to 1.05) | NA | NA | NS on univariate therefore not included in multivariate |
Olson 2003 [49] | Pregnancy and Weight Gain Attitude Scale, validated | Excess GWG $$
| Effect estimate not reported; (p-value NS) | NA | NA | NS on univariate analysis |
($$$modified 1990 Institute of Medicine guidelines) | Variable not entered in the multivariate model | |||||
Sangi-haghpeykar 2013 [51] | Pregnancy and Weight Gain Attitude Scale, validated | Excess GWG $
| Proportions within GWG categories (p-value): | OR (95% CI ) | Pre-pregnancy BMI, USA born, unmarried | Only a few items were significant on univariate or multivariate analyses ➔ |
Individual items
| ||||||
-Worried will get fat: 28%, 15% ( p <0.05) | -Embarrassed when nurse weighed me: 4.61 (1.18 to 29.80) | |||||
-Embarrassed when nurse weighed me: 14%, 3% ( p <0.05) | -Don’t care how much I gain: 3.80 (1.47 to 11.36) | |||||
-Don’t care how much I gain: 23%, 9% (p <0.05) | ||||||
Stevens-Simon 1993 [53] | Pregnancy and Weight Gain Attitude Scale, validated | Rate of weight gain categorised into slow (<0.23 kg/wk), average (0.23 – 0.4 kg/wk), rapid (>0.4 kg/wk) | Correlation co-efficient (p-value): | NA | NA | Only a few items were significant on univariate analyses ➔ |
Total scale score | Multivariate analysis was not done | |||||
r = 0.12 (p <0.14) | ||||||
Mean (± SD) attitude score among three outcome categories
| ||||||
3.4(±0.6), 3.5(±0.5), 3.5(±0.6) (p >0.05) | ||||||
Individual items (Correlation co-efficient not reported): | ||||||
-Liked wearing maternity clothes: (p <0.05) | ||||||
-Felt unattractive: (p <0.05) | ||||||
-Embarrassed when nurse weighed me: (p <0.05) | ||||||
-Cannot wear what is in style: (p <0.05) | ||||||
Strychar 2000 [54] | Investigator developed, Not validated | Excess GWG | NR |
Sub-scale – less favourable attitude towards weight gain led to excess weight gain | Pre-pregnancy BMI, age, marital status, education, smoking, and alcohol | Only a sub-scale was significant on multivariate analysis ➔ |
Effect estimate not reported (p <0.05 | ||||||
Exposure: Concerns and beliefs about weight gain
| ||||||
Strychar 2000 [54] | Investigator developed, Not validated | Excess GWG | NR |
Sub-scale: Perceived concern about their weight – more concerned leads to excess weight gain Effect estimate not reported; (p <0.05) | Pre-pregnancy BMI, age, marital status, education, smoking, and alcohol | Only a sub-scale, namely, ‘perceived concern’ was significant on multivariate analysis ➔ |
Exposure: Knowledge about weight gain
| ||||||
Strychar 2000 [54] | Investigator developed, Not validated | Excess GWG | NR |
Sub-scale: Importance of not gaining an excess amount of weight– Less knowledge leads to excess weight gain | Pre-pregnancy BMI, age, marital status, education, smoking, and alcohol | Only a sub-scale, namely, ‘ importance of not gaining an excess amount of weight’ was significant on multivariate analysis ➔ |
Effect estimate not reported; (p <0.05) | ||||||
Exposure: Target weight gain
| ||||||
Cogswell, 1999 [37] | Investigator developed single item; Not validated | Excess GWG | NR | OR (95% CI ) | Pre-pregnancy BMI, maternal height, age, race, education, marital status, parity, prenatal care, WIC participants,, income | Significant on multivariate analysis |
Target weight gain categories | ➔ (> recommended) | |||||
<Recommended 0.4 (0.2 to 0.6) |
(< recommended) | |||||
Recommended 1.0 (Reference) | ||||||
>Recommended 6.1 (4.1 to 8.9) | ||||||
McDonald 2013 [61] | Investigator developed single item; Investigator developed, not validated | Excess GWG | OR (95% CI ) | OR (95% CI ) | Pre-pregnancy BMI group, first birth, planned | Planned gain above the guidelines Significant on both univariate and multivariate analysis |
Planned gain above the guidelines 9.31 (3.86 to 22.42), planned gain below 0.78 (0.33 to 1.84) | Planned gain above the guidelines 11.18 (4.45 to 28.06); planned gain below 0.69 (0.26 to 1.80) | weight gain, daily soda or juice consumption, watching television before bedtime, locus of control to Eysenck’s neurotic scale of emotional instability, and satisfaction with pre-pregnancy weight | ➔ (> recommended) planned gain below NS on univariate or multivariate multivariate | |||
Exposure: Inaccuracy of perceived body weight
| ||||||
Herring 2008 [41] | Previously published single item adopted National Health and Nutrition Examination Survey, No reference to validation | Excess GWG | Proportion of Excess GWG within each exposure category: | OR (95% CI ): | Pre-pregnancy BMI, age, education, marital status, income, employment, ethnicity, parity, smoking, gestational length | Significant on univariate or multivariate analyses ➔ |
Normal weight, accurate assessor 47% | Normal weight, accurate assessor 1.0 (reference); | |||||
Normal weight, over-assessor 57% | Normal weight, over-assessor 2.0 (1.3 to 3.0); | |||||
Overweight, accurate assessor 62% | Overweight accurate assessor 2.9 (2.2 to 3.9); | |||||
Overweight under-assessor 81% (p <0.05) | Overweight under-assessor 7.6 (3.4 to 17.0) | |||||
Mehta-Lee 2013 [63] | Single item, Perceived weight status was defined as “accurate” or “inaccurate” based upon the level of concordance between BMI (derived from actual weight) and self reported overweight or obesity (no reference to validation) | Excess GWG | OR (95% CI ): Inaccurate reporters 1.2 (0.8, 1.8); | OR (95% CI ): Inaccurate reporters 1.1 (0.7, 1.7); | Stratified by BMI; adjusted for: WIC status, employment status, race, native born, smoking, parity and either pre-gestational or gestational diabetes | NS on univariate and on multivariate analyses |
Exposure: Body image dissatisfaction
| ||||||
Bagheri 2013 [35] | Body Image Assessment for Obesity (BIA-O), Validated | Excess (cases) vs. Adequate (controls) GWG | OR (95% CI ): | OR (95% CI ): | Pre-pregnancy BMI, age, parity, social class, energy intake | Significant on univariate or multivariate analyses ➔ |
Heavier body size preference 0.54 (0.27 to 1.04) | Heavier body size preference 0.44 (0.18 to 1.10) | |||||
Thinner Body Size Preference 2.17 (1.17 – 4.02) | Thinner body size preference 3.12 (1.97 to 4.95) | |||||
Hill 2013 [42] | Body Attitude Questionnaire (BAQ), Validated, modified | Excess GWG $
| NR | Effect estimates were not reported; p-value NS | Pre-pregnancy BMI, age, parity, education level | NS on multivariate analysis |
Mehta 2011 [46] | Body Image Assessment for Obesity (BIA-O), Validated | Excess GWG | RR (95% CI ): | RR (95% CI ): | Pre-pregnancy BMI | Significant on multivariate analysis ➔ |
Heavier body size preference 1.79 (0.52-9.58) | Thinner body size preference | |||||
Thinner body size preference 0.88 (0.82 to 0.94) | <16 years of education 1.11 (1.00 to 1.22) | |||||
≥16 years of education 0.92 (0.83 to 1.01) | ||||||
McDonald 2013 [61] | Satisfaction with pre-pregnancy weight , not stated if validated or not | Excess GWG | OR (95% CI ): | NA | NA | Significant on univariate analysis |
Not or not at all satisfied vs. satisfied or very satisfied 0.25 (0.10 to 0.60) | NS on multivariate analysis | |||||
Exposure: Weight Locus of Control
| ||||||
McDonald 2013 [61] | Locus of control score, validated | Excess GWG | OR (95% CI ) 1.12 (1 to 1.26) | NA | NA | NS on univariate analysis; Variable not entered in the multivariate model |
Olson 2003 [49] | Weight Locus of Control (WLOC), Validated | Excess GWG $$
| Effect estimate not reported; p-value NS | NA | NA | NS on univariate analysis; Variable not entered in the multivariate model |
Wright 2013 [59] | Single item from Attitude towards weigh gain scale by Palmer, Validated, modified | Excess GWG; | Effect estimate not reported for Adequacy ratio | Effect estimate not reported for Excess GWG | Pre-pregnancy BMI, age, race | Results were reported to be similar to secondary outcome , hence considered significant on univariate or multivariate analysis
|
GWG (continuous)$$
| β (95% CI ) for secondary outcome:-11.6 (−21.4 to −1.9) | β (95% CI ) for secondary outcome: −16.1 (−28.7 to −3.4) |
Author, year (Study reference number)*
|
Scale used**, Validation
|
Outcome(s)
|
Crude (unadjusted) results
|
Adjusted results
|
Confounders adjusted for
|
Summary of results
|
---|---|---|---|---|---|---|
Exposure: Knowledge about nutrition
| ||||||
Wright 2013 [59] | Investigator developed, Validated | Excess GWG; | β (95% CI ): | Effect estimate not reported for excess GWG | Pre-Pregnancy BMI, age, race | Results were reported to be similar to secondary outcome but estimates were not reported. Hence considered NS on univariate or multivariate analyses |
GWG (continuous)$$
| −1.2 (−3.2 to 0.69) | β (95% CI ) for secondary outcome: −0.14 (−2.8 to 2.5) | ||||
Exposure: Weight concerns
| ||||||
Pomerleau 2000 [50] | Dieting and Binge Eating Severity Scale (DBESS), Validated | Difference between actual and current maximum recommended weight gain (continuous) | Mean (± SD) excess GWG between two weight concern categories: | Effect estimates not reported | NR | Significant on multivariate analysis; weight gain (lb) as a continuous outcome also has a positive significant association with weight concern categories ➔ |
Low Weight Concern ;=2.9 (±12.7); | ANOVA F-test statistics = 7.614 (p <0.01) | |||||
High Weight Concern 15.6 (±21.9) (p <0.01) | ||||||
Cognitive dietary restraint
| ||||||
Conway 1999 [38] | Revised Restraint Scale (RRS), Validated | Excess GWG | Proportions with GWG categories (p-value): | NA | NA | NS on univariate analysis |
Dietary Restraint (Full scale) 48%, 30% (p = 0.07); | Multivariate analysis was not done | |||||
Weight Fluctuation subscale 46%, 31% (p = 0.054); | ||||||
Concern for dieting subscale 50%, 33% (p = 0.601) | ||||||
Laraia 2013 [43] | RRS, Validated | Excess GWG for univariate; | Proportion within GWG category: | β (95% CI ): | Pre-pregnancy BMI, maternal race, age, income, education, marital status, parity, gestational age, smoking, physical activity in 1st trimester | Full scale was significant on univariate or multivariate analyses; subscales were significant on multivariate analysis ➔ |
Adequacy Ratio for univariate and multivariate | Low dietary Restraint Food secure 52.7%, 35.4%; | Interaction between Marginally Food Insecure and: | ||||
Marginally food insecure 52.7%, 25.5% | High Restraint 0.53 (0.33 to 0.73) | |||||
High dietary Restraint Food secure 71.5%, | Dieters 0.50 (0.30 to 0.70) | |||||
16.8%; | Weight Cyclers 0.54 (0.34 to 0.74) | |||||
Marginally food insecure 74.0%, 11.0% | ||||||
Overall х2(p-value ) :57.3 (p <0.001) | ||||||
Mumford 2008 [48] | RRS, Validated | Adequacy Ratio | NR | OR (95% CI ): | Pre-pregnancy BMI, race, education, poverty, physical activity, weight gain attitude | Only subscales were significant on multivariate analyses ➔ |
Overall
| ||||||
Restrained eating 1.12 (0.94 to 1.31) | ||||||
Non-Restrained eating 0.95 (0.78 to 1.12) | ||||||
Dieters vs. Non-Dieters
| ||||||
Underweight 0.94 (0.68 to 1.19); 1.02 (0.89 to 1.16); | ||||||
Normal Weight 1.50 (1.40 to 1.60); 1.31 (1.23 to 1.40); Overweight 1.97 (1.80 to 2.15); 1.79 (1.54 to 2.03); | ||||||
Obese 2.09 (1.98 to 2.21); 1.73 (1.53 to 1.93) | ||||||
Cyclers vs. Non-Cyclers
| ||||||
Underweight 0.88 (0.66 to 1.11); 0.94 (0.77 to 1.11); | ||||||
Normal Weight 1.38 (1.25 to 1.52); | ||||||
1.25 (1.12 to 1.37); Overweight 1.92 (1.72 to 2.12); 1.58 (1.35 to 1.80); | ||||||
Obese 2.11 (1.96 to 2.26); 1.73 (1.54 to 1.91) | ||||||
Exposure: Self-efficacy
| ||||||
McDonald 2013 [61] | Self-efficacy in achieving healthy weight, ii) towards controlling food Intake; iii) towards weight Management, not stated if validated | Excess GWG | OR (95% CI ): | NA | NA | NS on univariate Analysis; |
0.97 (0.92 to 1.02); ii) 0.91 (0.79 to 1.05); iii) 0.94 (0.86 to 1.03) | not entered in the multivariate model | |||||
Olson 2003 [49] | Investigator Developed, Not validated | Excess GWG $$
| Effect estimate not reported (p-value NS) | NA | NA | NS on univariate analysis; variable not entered in the multivariate model |
Wright 2013 [59] | Investigator developed, Not validated | Excess GWG; GWG (continuous)$$
| Effect estimate not reported for excess GWG | Effect estimate not reported for excess GWG | Pre-pregnancy BMI, age, race | Results were reported to be similar to secondary outcome but Estimates were not reported, hence considered significant on univariate or multivariate analysis
|
β (95% CI ) for secondary outcome: | β (95% CI ) for secondary outcome: −3.6 (−6.8 to −0.3) | |||||
β (95% CI ) -1.3 (−2.6 – 0.0) | ||||||
Exposure: Barriers to healthy eating
| ||||||
Wright 2013 [59] | Fowles’ Barriers to Health Eating Scale (BHES), Validated | Adequacy ratio; Excess GWG $$
| β (95% CI ): | β (95% CI ): | Pre-pregnancy BMI, age, race | Results were reported to be similar to secondary outcome but estimates were not reported, hence considered significant on multivariate analysis ➔ |
0.12 (−0.6 to 0.8) | 2.0 (0.3 to 3.7) |
Author, year (Study reference number)*
|
Scale used**, Validation
|
Outcome(s)
|
Crude (unadjusted) results
|
Adjusted results
|
Confounders adjusted for
|
Summary of results
|
---|---|---|---|---|---|---|
Exposure: Personality Traits
| ||||||
McDonald 2013 [61] | Eysenck’s Neurotic Scale of Emotional Instability (Personality trait), validated; | Excess GWG | OR 95% CI 1.24 (1.11 to 1.39) (per unit increase on scale) | OR 95% CI 1.26 (1.10 to 1.44) (per unit increase on scale) | pre-pregnancy BMI group, first birth, planned weight gain, daily soda or juice consumption, watching television before bedtime, locus of control to Eysenck’s neurotic scale of emotional instability, and satisfaction with pre-pregnancy weight | Neurotic Scale of Emotional Instability Significant on univariate analysis and multivariate ➔ |
Lie Scale of Social Desirability NS on univariate; not included in multivariate | ||||||
McDonald 2013 [61] | Eysenck’s Lie Scale of Social Desirability (Personality trait), validated | Excess GWG | OR 95% CI 1.24 | NA | NA | NS on univariate; Not entered into multivariate analyses |
0.95 (0.84 to 1.08) | ||||||
Exposure: ‘Other’ Cognitions (Fetal Health Locus of Control)
| ||||||
Webb 2009 [2] | Fetal Health Locus of Control (FHLC), Validated | Excess GWG; | RR (95% CI ): | RR (95% CI ): | Pre-pregnancy BMI and other identified maternal socio-demographic, dietary and physical activity variables (exact variables not reported) | NS on univariate or multivariate analyses; similar results for adequacy ratio outcome |
Adequacy ratio |
FHLC-(Internality scale)
|
FHLC--(Internality Scale)
| ||||
Low 1.07 (1.0 to 1.2) | Low 1.02 (1.0 to 1.1) | |||||
Moderate 1.03 | Moderate 1.01 (0.9 | |||||
(0.9 to 1.1) | to 1.1) | |||||
High 1.0 | High 1.0 | |||||
(Reference) | (Reference) | |||||
FHLC-(Powerful
|
FHLC-(Powerful
| |||||
others scale)
|
others scale)
| |||||
Low 1.0 (Reference) | Low 1.0 (Reference) | |||||
Moderate 1.10 (1.0 to 1.2) | Moderate 1.00 (0.9 to 1.1) | |||||
High 1.05 (1.0 to 1.1) | High 0.96 (0.9 to 1.0) | |||||
FHLC-(Chances scale)
|
FHLC-(Chances scale)
| |||||
Low 1.0 (Reference) | Low 1.0 (Reference) | |||||
Moderate 1.07 (1.0 to 1.2) | Moderate 1.00 (0.9 to 1.1) | |||||
High 1.08 (1.0 to 1.2) | High 1.01 (0.9 to 1.1) | |||||
Exposure: ‘Other’ Cognitions (Self-esteem)
| ||||||
McDonald 2013 [61] | Robins Self-esteem scale, validated | Excess GWG | OR (95% CI ) for “Not very true” vs. other in terms of positive self esteem 0.28 (0.04 to 2.19) | NA | NA | NS on univariate therefore not included in multivariate |
Webb 2009 [2] | Self-esteem scale, Previously published, no reference to validation | Excess GWG; | RR (95% CI ) | RR (95% CI ) | Pre-pregnancy BMI, other socio-demographic, dietary and physical activity covariates | NS on univariate or multivariate analyses; |
Adequacy Ratio | Low 1.01 (0.9 to 1.1); | Low 0.99 (0.9 to 1.1); | NS results for adequacy ratio outcome | |||
Moderate 1.03 (1.0 to 1.1); | Moderate 1.02 (0.9 to 1.1); | |||||
High 1.0 (Reference) | High 1.0 (Reference) |