Abstract
Background
Women’s rate of personal and cosmetic care product use have increased with the societal increases in social appearance anxiety, fear of negative evaluation, and body image concerns.
Aims
The purpose of this study is to determine social appearance anxiety, fear of negative evaluation and body image and the use of personal care and cosmetic products during pregnancy.
Methods
This study used a cross-sectional, correlational and descriptive design. It was conducted with pregnant women who sought treatment in the gynecology outpatient clinics of a state hospital. The sample of the study consisted of 378 pregnant women. Data were collected through the Personal Information Form, the Social Appearance Anxiety Scale (SAAS), the Fear of Negative Evaluation Scale (FNES), and the Body Image Concerns during Pregnancy Scale (BICDPS).
Results
One out of every five pregnant women in this study changed the personal care/cosmetic product they used after learning about their pregnancy. The number of personal care and cosmetic products used was found to increase with the increase in the BICDPS avoidance and social concerns, concerns about weight gain, and concerns about the future sub-scales mean scores (p < 0.05). In addition, the increase in BICDPS concerns about weight gain and concerns about the future sub-scale mean scores and the increase in FNES mean scores indicated an increase in the number of cosmetic products (p < 0.05). SAAS mean score was found to increase with the increase in the number of personal care products used (p < 0.05).
Conclusion
This study found that pregnant women’s rate of personal and cosmetic care product use increased with the increase in social appearance anxiety, fear of negative evaluation, and body image concerns.
Implication for the profession and/or patient care
Gynecology nurses can identify the use of cosmetics and personal care products during pregnancy and reduce the use of these products.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s12884-026-09543-x.
Keywords: Body image concerns during pregnancy scale, Cosmetic products, Fear of negative evaluation scale, Personal care products, Social appearance anxiety scale
Introduction
The pregnancy period may involve physiological symptoms affecting body image as a result of vascular, hormonal, and metabolic changes, such as hair loss, facial hair growth, brittle nails, itching, bloating, weight gain, darkening of the nipples, telangiectasia, striae, and linea nigra formation [1, 2]. Although pregnancy is considered a sacred period of motherhood, these changes change women’s social appearance and perception of body image [3–5]. Changing perceptions of body image and social media use expose women to cultural pressures regarding body image and may cause them to use chemical products even during pregnancy, despite knowing about their harmful effects [6].
A cosmetic product refers to any substance intended to be placed in contact with the external parts of the human body such as epidermis, hair system, nails, lips, and external genital organs or with the teeth and the mucous membranes of the oral cavity with a view exclusively or mainly to cleaning them, perfuming them, changing their appearance, protecting them, keeping them in good condition, or correcting body odors [7]. Cosmetic products contain chemicals such as phthalates, parabens, benzophenone (ultraviolet filter), triclosan (antimicrobial), toxic metals, colorants, emollients, and preservatives [8–11]. Personal care products frequently used in our daily lives to maintain personal cleanliness or cosmetic products used to give an aesthetic appearance contain these chemicals in large amounts. For instance, hair care products, which are among the most widely used products, contain chemicals such as parabens, phthalates, and benzophenone, and they threaten health substantially [12–17].
Due to cultural pressures on women’s body image, women continue to use personal care and cosmetic products containing potentially harmful chemicals even during pregnancy despite awareness that some of the chemicals contained in these products may have adverse health effects for both the mother and the fetus [6]. Although the potential risks associated with exposure to these chemicals are increasingly recognized, many women continue to use cosmetic products during pregnancy [18]. When the physiological changes during pregnancy are taken into consideration, women’s exposure to chemicals and teratogens during this period poses a risk to the health of the mother and the baby [19]. Fruh et al. [20] found that more than 90% of pregnant women had phthalates and derivatives in their urine due to the use of personal care products/cosmetic products [20]. The pregnancy period is highly sensitive to endocrine changes, so the effects of cosmetic products on the mother and fetus are significant [10, 21, 22]. Chemicals in many used cosmetic and personal care products during pregnancy have effects on the fetus and cause disruptions in the release of estrogen, FSH, LH, testosterone, thyroid, and glucocorticoid hormones by exerting anti-androgenic effects [14, 16]. These harmful chemicals in personal/cosmetic products used during pregnancy cause adverse conditions such as abortion, preeclampsia, gestational diabetes, increased oxidative stress, pregnancy-related hypertensive diseases, intrauterine growth retardation, preterm birth, low birth weight, and stillbirth [19, 23]. The literature also reports that harmful chemicals in personal/cosmetic products could cause problems such as myeloid leukemia, lymphoblastic leukemia, asthma, obesity, hyperactivity disorder in the baby, and depression and anxiety in the mother [15, 19, 21, 24].
Women’s changing social position and sociodemographic features cause an increase in the frequency and risk of exposure to chemicals in personal care products and cosmetic products due to the increase in the variety of cosmetic products, purchasing power, and easy accessibility [20, 25, 26]. The price range of the products decreases, which changes the chemicals in their content and increases their diversity [3]. Changing beauty perception is becoming a global issue with women’s increased use of social networks [20, 25, 26]. This situation can be explained by Social Comparison Theory [27], Body Image Theory [28] and the Absorption and Addiction Model [29]. Social Comparison Theory posits that when evaluating themselves, individuals refer to the value judgments of other individuals and society rather than objective thoughts, feelings, and value standards [27]. This approach causes women to compare themselves to the sociocultural environment they live in, social media, and the people they look up to as role models. As noted in Body Image Theory, the use of idealized beauty standards promoted by society or social media as a reference point during this comparison causes women’s body image, attitudes, and judgments to be determined by social media, norms, and cultural values [28]. The Absorption and Addiction Model, which explains why women on social media take famous people as role models and imitate them, demonstrates that social media significantly influences women’s lives [29]. These theories suggest that women who have an idealized beauty perception on social media or who compare themselves to celebrities may engage in behaviors such as photo editing, makeup, disordered eating, cosmetic procedures, or attempts to resemble other women/celebrities [30–32]. These behaviors carry risks such as dissatisfaction with one’s own body, perceiving oneself less attractive, increased use of cosmetic products, a tendency toward cosmetic surgery, fear of negative evaluation, and social appearance anxiety [28, 33, 34]. Women’s increased time spent on social media is reported to be associated with increased body dissatisfaction and behaviours associated with comparing themselves to other women with idealized body types on social media and altering their bodies [31, 35]. This situation may continue during pregnancy and affect the use of personal care and cosmetic products [3, 16, 32].
The high visibility of women on social networks may cause social appearance anxiety and fear of negative evaluation, which can change women’s body image perceptions negatively [4, 5]. This condition continues during pregnancy as well [32]. Pregnancy involves a period when motherhood is considered sacred, yet the women’s body image perception of the changing physiological status during pregnancy also changes over time [3]. Changing body image perception during pregnancy may also affect cosmetic product use during pregnancy [4]. No studies were found to have examined the use of cosmetic and personal care products by pregnant women in relation to these three variables. Therefore, this study aims to evaluate the relationship between body image, social appearance anxiety, and fear of negative evaluation with cosmetic and personal care product use during pregnancy.
Research questions:
What is the status of personal care and cosmetic product use among pregnant women?
What are the levels of social appearance anxiety, fear of negative evaluation, and body image among pregnant women?
How do social appearance anxiety, fear of negative evaluation, and body image perception affect personal care and cosmetic product use during pregnancy?
Is there a significant relationship between pregnant women’s social appearance anxiety, fear of negative evaluation, and body image?
Do pregnant women’s social appearance anxiety, fear of negative evaluation, and body image predict their personal care and use of cosmetic product behaviors?
Methods
Design
This study used a descriptive, correlational and cross-sectional design. It was conducted with women who sought treatment in the gynecology outpatient clinics of a state hospital between April and July, 2022.
Sample
The target population of the study consisted of pregnant women who sought treatment in the gynecology outpatient clinics of the hospital when the study was conducted. With a 23% effect size, 98% power, and a 5% bias level, the sample size of the study was calculated as 369 in the power analysis using the G*Power 3.1.9.6 program [4]. Considering possible losses in the study, 10% more participants than the sample size were invited to participate in the study (n = 406). However, the study was completed with 378 pregnant women as some invited pregnant women filled out the data collection forms incompletely (n = 13), withdrew from the study (n = 6) and women declined participation (n = 9). Data were collected through face-to-face interviews. For participants who reported being illiterate, the researcher read the questions aloud and recorded their responses. The study included pregnant women who were aged 18 and over, who did not have any health problems in themselves and their babies, and who did not have any skin disease. Pregnant women with high-risk pregnancies and those who did not complete the research forms were excluded from the study.
Data collection tools
Data were collected through the Participant Information Form, the Body Image Concerns during Pregnancy Scale (BICDPS), the Fear of Negative Evaluation Scale (FNES), and the Social Appearance Anxiety Scale (SAAS).
Participant information form
The Participant Information form developed by the researchers in line with the literature consists of questions about the pregnant women’s socio-demographic characteristics (age, BMI, marital status, education status, employment status, economic status), obstetric characteristics (number of pregnancies, gestational week, weight gain during pregnancy), and personal care (shampoo, toothpaste, soap, wet wipes, deodorant/perfume, moisturizers, sunscreen, oils, mouthwash, herbal products, acne cream, shower gel, hair care cream, wax, hair removal cream, disinfectant, sunscreen, oils, mouthwash, herbal products) and cosmetic products (eye makeup, lip makeup, foundation, face mask, nail makeup, nail polish/acetone, anti-wrinkle cream, hair spray, hair dye) and cosmetic product use. The number of personal care and cosmetic products used by pregnant women was calculated considering the weekly period [4, 10, 16, 32].
Body image concerns during pregnancy scale (BICDPS)
The scale measuring body image concerns during pregnancy was developed by Uçar et al. [36], who also performed its Turkish validity and reliability [36]. The scale is responded on a five-point Likert scale and consists of 23 questions. It consists of four sub-scales including avoidance and social concerns, concerns about weight gain, concerns about the future, and concerns about physical appearance. Items 5, 6, 7, 8 and 15 are scored reversely. The scores to be obtained from the scale range from 23 to 115, with higher scores indicating higher levels of concern about body image during pregnancy and lower scores indicating lower levels of concern about body image during pregnancy. Cronbach’s alpha value was reported as 0.88 in the Turkish validity and reliability study of the scale. In this study, Cronbach’s alpha value was found 0.86.
Social appearance anxiety scale (SAAS)
The scale aims to determine social appearance anxiety. The Social Appearance Anxiety Scale was developed by Hart et al. (2008) [37] and adapted to Turkish culture by Doğan (2010) [38]. The scale is responded on a five-point Likert scale and consists of 16 items. The first item in the scale is scored reversely. The scores to be obtained from the scale range from 16 to 80, and the total score is obtained by summing the scores obtained from the scale items. Higher scores obtained from the scale indicate the person’s increased social appearance anxiety. Cronbach’s alpha value of the scale was calculated as 0.93 in the Turkish validity and reliability study. Cronbach’s alpha value was found 0.95 in this study.
Fear of negative evaluation scale (FNES)
The scale aims to determine the level of fear of negative evaluation. The Turkish validity and reliability study of the scale developed by Leary (1983) was conducted by Çetin, Doğan and Sapman [39]. The scale is responded on a five-point Likert scale and consists of 11 items. Items 2, 7, and 11 are scored reversely, and the scores to be obtained from the scale range from 12 to 60. The total score is obtained by summing the scores obtained from the scale items, with higher scores indicating an increase in the level of fear of negative evaluation and lower scores indicating a decrease in the level of fear of negative evaluation. Cronbach’s alpha value was found to be 0.96 in the Turkish validity and reliability study of the scale. Cronbach’s alpha value was found 0.67 in this study.
Data collection
The study data were collected between April and July 2022 by the researchers by meeting the participants face-to-face on Tuesdays using a simple random sampling method. Data were collected through the Personal Information Form, the Body Image Concerns during Pregnancy Scale (BICDPS), the Social Appearance Anxiety Scale (SAAS), and the Fear of Negative Evaluation Scale-Short Form (FNES-SF).
Data analysis
Data were analyzed on a computer using SPSS (Statistical Package for Social Science) 22.0 statistical package program. Data analyses included descriptive statistics such as numbers, percentages, means, standard deviations and One-way ANOVA, Bonferroni, T-test, Kruskal Wallis, Tamhane, and Mann Whitney U tests. Additionally, Pearson correlation analysis and multiple linear regression analysis were used.
Results
The average age of the pregnant women in this study was 27.53 ± 5.29 years, the average gestational age was 31.74 ± 7.43 weeks, the average weight gain during pregnancy was 9.08 ± 6.97, and the average body mass index (BMI) before pregnancy was 23.99 ± 23.00. While 38.1% of the pregnant women were high school graduates, 62.5% of them had income equal to expenses (Table 1).
Table 1.
Distribution of Pregnant Women’s Descriptive Characteristics
| Variables | n (%)/ X ± SD |
|---|---|
| Age | 27.53 ± 5.29 |
| ≤ 20 years | 30 (7.9) |
| 20–34 years | 309 (81.8) |
| ≥ 35 years | 39 (10.3) |
| Education Level | |
| Illiterate | 11 (2.9) |
| Primary school / secondary school graduate | 114 (30.2) |
| High school graduate | 144 (38.1) |
| University and above | 109 (28.8) |
| Employment Status | |
| Employed | 115(30.4) |
| Unemployed | 263(69.6) |
| Income Status | |
| Income less than expenses | 98 (25.9) |
| Income equal to expenses | 236(62.5) |
| Income more than expenses | 44(11.6) |
| Number of pregnancies | 2.10 ± 1.49 |
| 1 | 152 (40.2) |
| 2 | 116(30.7) |
| ≥ 3 | 110 (29.1) |
| Gestational week | 31.74 ± 7.43 |
| Weight gained during pregnancy | 9.08 ± 6.97 |
| Pre-pregnancy BMI | 23.99 ± 23.00 |
This study found the BICDPS total score as 59.15 ± 14.75, the SAAS total score as 35.78 ± 14.32, and the FNES total score as 28.97 ± 3.41 (Table 2). A significant positive correlation was found between the BICDPS total and sub-scale scores and the SAAS (p < 0.001). No significant relationship was found between the BICDPS and the FNES total scores (p > 0.05). However, the FNES total score was found to have a small positive correlation with the BICDPS avoidance sub-scale score and a moderate negative correlation with the concerns about physical appearance sub-scale (p < 0.05). A moderate positive correlation was found between the SAAS total score and the FNES total score (p < 0.05).
Table 2.
Relationship between the of BICDPS, SAAS, and FNES total and sub-scale scores among pregnant women
| Scales | X̄ ± SD | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
|---|---|---|---|---|---|---|---|---|
| 1. BICDPS | 59.15 ± 14.75 | 1 | ||||||
| 2. Avoidance and social concerns | 21.30 ± 8.04 |
0.954 0.000 |
1 | |||||
| 3. Concerns about weight gain | 13.31 ± 3.16 |
0.853 0.000 |
0.613 0.000 |
1 | ||||
| 4. Concerns about the future | 7.78 ± 3.85 |
0.882 0.000 |
0.664 0.000 |
0.485 0.000 |
1 | |||
| 5. Concerns about physical appearance | 17.02 ± 2.34 |
-0.258 0.014 |
-0.436 0.000 |
-0.278 0.008 |
-0.363 0.000 |
1 | ||
| 6. SAAS | 35.78 ± 14.32 |
0.685 0.000 |
0.622 0.000 |
0.436 0.000 |
0.541 0.000 |
-0.337 0.010 |
1 | |
| 7. FNES | 28.97 ± 3.41 |
0.119 0.561 |
0.249 0.013 |
0.157 0.271 |
0.154 0.129 |
-0.479 0.002 |
0.384 0.017 |
1 |
Pearson correlation note X̄ Mean, SD Standart deviation
Of all the participating pregnant women, 22.8% made changes in the cosmetic/personal care products they used due to pregnancy, 58.1% changed the product they used, and 41.9% reduced the amount of the product they used. While 57.7% used five or fewer personal care products weekly, 50% reported one or fewer routinely used cosmetic product weekly (Table 3).
Table 3.
Distribution of pregnant women’s use of and changes in personal care products during pregnancy and the frequency of the use of personal care/cosmetic products
| Variables | n (%) |
|---|---|
| Making changes in cosmetic/personal care products due to pregnancy | |
| Yes | 86 (22.8) |
| No | 292 (77.2) |
| Type of changes made (n = 86) | |
| Changing the product | 50 (58.1) |
| Reducing the amount of use | 36 (41.9) |
| Continuing to use cosmetics/personal care products despite knowing their harm to pregnancy | |
| Yes | 15 (4.0) |
| No | 363 (96.0) |
| Number of Routinely Used Personal Care Products /Week | |
| ≤ 5 | 218 (57.7) |
| 6–13 | 138 (36.5) |
| 14–16 | 22 (5.8) |
| Number of Routinely Used Cosmetic Products /Week | |
| ≤ 1 | 189 (50.0) |
| 2–6 | 167 (44.2) |
| ≥ 7 | 22 (5.8) |
The BICDPS total score and sub-scale scores were found not to correlate with changes to the cosmetic/personal care products used during pregnancy and the changes made (decreasing the amount of product, decreasing the amount of use) (p > 0.05). A significant difference was found in the BICDPS Avoidance and Social Concerns sub-scale scores according to whether pregnant women continued to use cosmetic and personal care products despite knowing their potential harm during pregnancy, with higher scores observed among those who reported continued use (p = 0.034). BICDPS avoidance and social concerns, concerns about weight gain, and concerns about the future mean scores were lower in pregnant women who routinely used 6–13 personal care products compared to pregnant women who used 5 or fewer personal care products during their pregnancy (p = 0.005; p = 0.030; p = 0.005). No significant correlation was found between the BICDPS total score, concerns about weight gain, and concerns about physical appearance sub-scale scores and the use of make-up products (p = 0.141; p = 0.510; p = 0.669). BICDPS avoidance and social concerns and concerns about the future sub-scale scores were lower in pregnant women who used 2–6 make-up products compared to pregnant women who used one or fewer make-up products during their pregnancy (p = 0.024; p = 0.035; Table 4).
Table 4.
The Effect of Pregnant Women’s Use of and Changes in Personal Care Products during Pregnancy and the Use of Personal Care/Cosmetic Products on the BICDPS
| Variables | BICDPS Total |
Avoidance and social concerns | Concerns about weight gain | Concerns about the future | Concerns about physical appearance |
|---|---|---|---|---|---|
| Making changes in cosmetic/personal care products due to pregnancy | |||||
| Yes | 59.95 ± 14.23 | 22.03 ± 8.58 | 13.50 ± 2.74 | 8.26 ± 3.68 | 16.78 ± 2.09 |
| No | 58.94 ± 14.97 | 21.09 ± 7.88 | 13.26 ± 3.26 | 7.63 ± 3.89 | 17.10 ± 2.43 |
| Test/p value | &0.262/0.694 | &0.962/0.376 | &0.419/0.676 | &1.320/0.188 | &-0.712/0.478 |
| Type of changes made | |||||
| Changing the product | |||||
| Yes | 59.36 ± 10.28 | 21.56 ± 8.06 | 13.45 ± 2.67 | 8.52 ± 3.68 | 16.43 ± 2.23 |
| No | 59.13 ± 15.31 | 21.26 ± 8.05 | 13.29 ± 3.22 | 7.66 ± 3.86 | 17.13 ± 2.36 |
| Test/p value | &0.050/0.960 | &0.244/0.808 | &0.232/0.817 | &1.472/0.142 | &-0.255/0.212 |
| Reducing the amount of use | |||||
| Yes | 62.63 ± 18.42 | 22.94 ± 9.95 | 13.35 ± 3.24 | 8.11 ± 4.18 | 16.54 ± 2.64 |
| No | 58.82 ± 14.44 | 21.13 ± 7.81 | 13.30 ± 3.16 | 7.74 ± 3.82 | 17.07 ± 2.31 |
| Test/p value | &0.695/0.489 | &1.290/0.198 | &0.062/0.950 | &0.550/0.582 | &−0.772/0.441 |
| Continuing to use cosmetics/personal care products despite knowing their harm to pregnancy | |||||
| Yes | 54.00 ± 2.83 | 25.60 ± 7.03 | 13.38 ± 2.13 | 9.67 ± 3.79 | 17.33 ± 2.31 |
| No | 59.27 ± 14.89 | 21.12 ± 8.04 | 13.30 ± 3.20 | 7.70 ± 3.83 | 17.01 ± 2.35 |
| Test/p value | &-0.498/0.620 | &2.123/0.034 | &0.062/0.951 | &1.950/0.052 | &0.237/0.813 |
| Number of Routinely Used Personal Care Products /Week | |||||
| ≤ 5 | 57.49 ± 14.20 | 20.16 ± 7.57 | 12.75 ± 3.01 | 7.26 ± 3.70 | 17.16 ± 2.44 |
| 6–13 | 61.89 ± 16.29 | 22.88 ± 8.03 | 13.95 ± 3.30 | 8.34 ± 3.80 | 16.98 ± 2.29 |
| 14–16 | 56.22 ± 9.12 | 22.77 ± 10.74 | 14.00 ± 2.80 | 9.36 ± 4.72 | 16.27 ± 2.00 |
| Test/p value | +1.105/0.336 |
+5.349/0.005 1 < 2 |
+3.586/0.03 1 < 2 |
+5.471/0.005 1 < 2, 1 < 3 |
+0.691/0.503 |
| Number of Routinely Used Cosmetic Products /Week | |||||
| ≤ 1 | 57.13 ± 14.10 | 20.26 ± 7.81 | 13.06 ± 3.41 | 7.27 ± 3.57 | 17.19 ± 2.51 |
| 2–6 | 63.06 ± 16.38 | 22.56 ± 8.08 | 13.57 ± 2.83 | 8.24 ± 4.06 | 16.81 ± 2.19 |
| ≥ 7 | 55.40 ± 8.98 | 20.64 ± 8.72 | 13.67 ± 2.99 | 8.59 ± 4.05 | 17.08 ± 2.23 |
| Test/p value | +2.003/0.141 |
±3.756/0.024 1 < 2 |
±0.677/0.510 |
±3.384/0.035 1 < 2, 1 < 3 |
±0.403/0.669 |
Abbreviations:BICDPS Body Image Concerns during Pregnancy Scale,SAAS Social Appearance Anxiety Scale, FNES Fear of Negative Evaluation Scale, +F One-Way Anova test post hoc,Bonferroni test &t Independent t-test
The SAAS total score was found to demonstrate no changes according to the status of making changes in the cosmetics/personal care products used during pregnancy, the type of change made (changing the product, reducing the amount of use), the status of continuing to use cosmetics/personal care products despite knowing their harm to pregnancy, and the frequency of cosmetic product use (p < 0.05). On the other hand, the SAAS total score was lower in pregnant women who used 6–13 personal care products compared to pregnant women who used 5 or fewer and 14–16 personal care products during their pregnancy (KW = 7.786, p = 0.020, Table 5).
Table 5.
The effect of pregnant women’s use of and changes in personal care products during pregnancy and the use of personal care/cosmetic products on SAAS
| Variables | SAAS |
|---|---|
| Making changes in cosmetic/personal care products due to pregnancy | |
| Yes | 32.11 ± 14.01 |
| No | 35.44 ± 14.44 |
| Test/p value | &0.550/0.583 |
| Type of change | |
| Changing the product | |
| Yes | 36.00 ± 8.49 |
| No | 35.76 ± 14.74 |
| Test/p value | &0.054/0.957 |
| Reducing the amount of use | |
| Yes | 37.83 ± 18.17 |
| No | 35.58 ± 13.97 |
| Test/p value | &0.520/0.604 |
| Continuing to use cosmetics/personal care products despite knowing their harm to pregnancy | |
| Yes | 37.20 ± 12.05 |
| No | 35.72 ± 14.43 |
| Test/p value | &0.224/0.822 |
| Number of Routinely Used Personal Care Products /Week | |
| ≤ 5 | 33.69 ± 13.01 |
| 6–13 | 40.47 ± 16.15 |
| 14–16 | 28.78 ± 6.22 |
| Test/p value |
%7.786/0.020 1 < 2, 3 < 2 |
| ≤ 1 | 33.78 ± 14.17 |
| 2–6 | 37.58 ± 13.91 |
| ≥ 7 | 36.38 ± 18.49 |
| Test/p value | +1.156/0.318 |
Abbreviations:BICDPS Body Image Concerns during Pregnancy Scale,SAASSocial Appearance Anxiety Scale, FNESFear of Negative Evaluation Scale,+F One-Way Anova test post hoc,Bonferroni test&t Independent t-test%,KWKruskal Wallis Post Hoc Tamhane
The FNES total score was found not to be affected by the status of making changes in the cosmetics/personal care products used during pregnancy, the type of changes made (changing the product, reducing the amount of use), the status of continuing to use cosmetics/personal care products despite knowing their harm to pregnancy, and the frequency of personal care product used (p < 0.05). However, the FNES total score was found to be lower in pregnant women who reported 7 or fewer routinely used make-up products during their pregnancy compared to pregnant women who used 7 or more make-up products during their pregnancy (p = 0.020, Table 6).
Table 6.
The effect of pregnant women’s use of and changes in personal care products during pregnancy and the use of personal care/cosmetic products during pregnancy on FNES
| Variables | FNES |
|---|---|
| Changes in cosmetics/personal care products used during pregnancy | |
| Yes | 30.00 ± 2.61 |
| No | 28.60 ± 3.60 |
| Test/p value | ¥-1.947/0.051 |
| Type of change | |
| Changing the product | |
| Yes | 30.29 ± 4.07 |
| No | 28.87 ± 3.36 |
| Test/p value | &1.060/0.292 |
| Reducing the amount of use | |
| Yes | 29.75 ± 2.49 |
| No | 28.86 ± 3.51 |
| Test/p value | &0.845/0.400 |
| Continuing to use cosmetics/personal care products despite knowing their harm to pregnancy | |
| Yes | 30.00 ± 2.34 |
| No | 28.88 ± 3.49 |
| Test/p value | &0.891/0.375 |
| Number of Routinely Used Personal Care Products /Week | |
| ≤ 5 | 29.48 ± 3.25 |
| 6–13 | 28.58 ± 3.39 |
| 14–16 | 27.44 ± 4.10 |
| Test/p value | +1.768/0.176 |
| Number of Routinely Used Cosmetic Products /Week | |
| ≤ 1 | 29.11 ± 3.14 |
| 2–6 | 29.40 ± 3.53 |
| ≥ 7 | 26.00 ± 2.78 |
| Test/p value |
+4.077/0.020 3 > 2, 3 > 1 |
Abbreviations:BICDPSBody Image Concerns during Pregnancy Scale,SAASSocial Appearance Anxiety Scale, FNESFear of Negative Evaluation Scale,+F One-Way Anova test post hoc, Bonferroni test&t Independent t-test% ¥MU Mann Whitney U
A multiple regression model was created with variables identified as having significant differences between the BICDPS about Avoidance and Social Concerns, Concerns about Weight Gain, and Concerns about the Future sub-scales, SAAS and FNES total scores, and cosmetic and personal care product use variables (Table 7). Continuing to use cosmetic/personal care products despite knowing about their harm to pregnancy (β-coefficient = -0.106; p = 0.037) and routinely using personal care products (β-coefficient = 0.152; p = 0.003) BICDPS Avoidance and Social Concerns are significant predictors, explaining 0.03% of the total variance. Routinely used personal care products (β-coefficient = 0.177; p = 0.014) are a significant predictor of concerns about weight gain during pregnancy, explaining 0.02% of the total variance. Routinely used personal care products (β-coefficient = 0.142; p = 0.027) are a significant predictor of concerns about the future, explaining 0.04% of the total variance.
Table 7.
Regression analysis of BICDPS avoidance and social concerns, concerns about weight gain, and concerns about the future sub-scales, SAAS and FNES total scores
| BICDPS Avoidance and Social Concerns Sub-scale Risk Factors | B | SEa | β | t | p | 95% CI | |
|---|---|---|---|---|---|---|---|
| Lower | Upper | ||||||
| Constant | 24.864 | 4.465 | 5.568 | 0.000 | 16.084 | 33.645 | |
| Continuing to use cosmetic/personal care products despite knowing their harm to pregnancy | -4.367 | 2.087 | -0.106 | -2.092 | 0.037 | -8.471 | -0.263 |
| Routinely used personal care products | 2.014 | 0.673 | 0.152 | 2.991 | 0.003 | 0.690 | 3.338 |
| R = 0.187 R2= 0.035 AdjR2= 0.030 F = 6.773 p = 0.001 | |||||||
| BICDPS Concerns about Weight Gain Sub-Scale Risk Factors | |||||||
| Constant | 11.052 | 0.936 | 11.813 | 0.000 | 9.206 | 12.897 | |
| Routinely Used Personal Care Products | 0.889 | 0.358 | 0.177 | 2.483 | 0.014 | 0.183 | 1.595 |
| R = 0.177 R2= 0.031 AdjR2= 0.026 F = 6.167 p = 0.014 | |||||||
| BICDPS Concerns about the Future Sub-scale Risk Factors | |||||||
| Constant | 5.105 | 0.826 | 6.184 | 0.000 | 3.482 | 6.728 | |
| Routinely used personal care products | 0.901 | 0.406 | 0.142 | 2.219 | 0.027 | 0.103 | 1.699 |
| Routinely used cosmetic products | 0.279 | 0.408 | 0.044 | 0.685 | 0.494 | -0.522 | 1.081 |
| R = 0.172 R2= 0.030 AdjR2= 0.024 F = 5.711 p = 0.004 | |||||||
| SAAS risk factors | |||||||
| Constant | 30.847 | 5.061 | 6.095 | 0.000 | 20.838 | 40.855 | |
| Routinely used personal care products | 1.983 | 1.976 | 0.086 | 1.003 | 0.317 | -1.925 | 5.891 |
| R = 0.086 R2= 0.007 AdjR2= 0.000 F = 1.007 p = 0.317 | |||||||
| FNES risk factors | |||||||
| Constant | 30.327 | 0.946 | 32.041 | 0.000 | 28.448 | 32.205 | |
| Routinely used cosmetic products | -0.819 | 0.533 | -0.154 | -1.536 | 0.128 | -1.877 | 0.239 |
| R = 0.154 R2= 0.024 AdjR2= 0.014 F = 2.360 p = 0.128 | |||||||
Abbreviations: SE Standard Error, β Standard Beta, Adj. R2 Corrected R2, t F Test Statistic, p Significance Level, Cl Confidence Interval
Discussion
An analysis of the literature shows that pregnant women’s reasons for the use of cosmetic products require a holistic evaluation perspective [22, 40–42]. The purpose of this study was to determine social appearance anxiety, fear of negative evaluation, body image, and cosmetic product use in pregnant women.
The literature has documented that pregnancy brings with it psychosocial problems such as concerns about fetal health, fear of childbirth, body image concerns, anxiety, social appearance concerns, and sociocultural pressure [2, 40, 41, 43]. Therefore, several studies in the literature detected the use of non-invasive and aesthetic surgical procedures, such as the use of personal care and cosmetic products to reduce physiological changes during pregnancy [12, 16, 18, 20, 44, 45]. This study found that body image concerns during pregnancy were not affected by the use of personal care and cosmetic products. However, increased frequency of personal care product use increased avoidance and social anxiety levels. On the other hand, this study found that the increase in the concerns about weight gain and concerns about the future also increased the use of both cosmetic and personal care products.
In this study, the use of personal care and cosmetic products is generally not affected by body image concerns during pregnancy. However, the frequency of personal care and cosmetic product use increases as levels of social and weight gain concerns increase. Similar to our findings, Karhade et al. [42] found that the presence of stria increased pregnant women’s anxiety levels, and half of the pregnant women used cream/oil to prevent the formation of stria [42]. Kocaöz et al. [43] reported that one out of every three pregnant women used massage cream to prevent stria formation and that stria formation affected pregnant women’s body image negatively [43]. Boybay Koyuncu and Baydak Yılmaz [46] stated that pregnant women used cosmetic products to ensure hygiene, look beautiful, and reduce physiological changes that occur during pregnancy, respectively. The study found that pregnant women did not use cosmetic products that they thought could harm the fetus [46].
The findings of the present study are similar to the findings reported by Karhade et al. [42] and Kocaöz et al. [43]. This result is considered to be caused by the physiologic changes, the negative effects of the increase in body mass index on women’s body image perception, and pregnant women’s use of cosmetic products during pregnancy. Besides, our finding indicating that most pregnant women in our study did not continue to use cosmetic products while knowing about their harm to pregnancy supports our conclusion.
Participating pregnant women’s social appearance anxiety was found to be at a moderate level, and it was determined that women’s social appearance anxiety increased with the increase in the number of personal care products they used, but it did not affect the frequency of cosmetic product use. The literature includes several studies reporting an increase in the number of products used by women to improve their social appearance [4, 12, 25]. In their study conducted in France, Marie et al. [10] found that pregnant women frequently used personal care products to be satisfied with their appearance [10]. Our finding is similar to the finding of Marie et al. [10]. This study found no relationship between the increase in the number of cosmetic product use and social appearance anxiety. Different from the findings of the present study, Lang et al. [32] reported that the number of cosmetic products used by pregnant women increased with the increase in their perception of beauty [32]. The use of personal care and cosmetic products by pregnant women varies depending on age, education level, income level, and place of residence [10, 16, 20, 32]. The difference between our findings and those of Lang et al. is considered to stem from differences in cultural perspectives on pregnancy and variations in income levels.
This study found that pregnant women had a moderate level of fear of negative evaluation, and the fear of negative evaluation decreased with the increase in the number of cosmetic products used. Similar to the findings in our study, the study conducted by Kachambwa et al. [6] showed that 49.4% of women used cosmetic products to reduce the fear of negative evaluation [6]. The pregnant women in this study were in the middle-young adult age group, and the majority of them had their first pregnancy. The use of cosmetic products is considered to increase with the increase in the fear of negative evaluation with the change in the bodies of women who are still young and experiencing pregnancy for the first time.
This study was conducted at only one state hospital in western Turkey, which is a limitation. Since the majority of the pregnant women were young primiparous adults (average age 27.53), the findings of the study can be generalized to older and multiparous pregnant women in a limited way. Besides, since the majority of the pregnant women had an income level equal to their expenses, the generalizability to low- or high-income social groups is limited. Causality could not be fully established due to the cross-sectional nature of the study. Another limitation of this study is that data were collected between April and July 2022; therefore, seasonal variations in the use of certain cosmetic and personal care products, particularly sunscreen, were not evaluated. It should be noted that only 15 participants reported continuing to use cosmetic and personal care products despite awareness of their potential harm during pregnancy. Therefore, comparisons involving this subgroup should be interpreted with caution. A further limitation of this study is that cosmetic and personal care products were evaluated as a broad category. Because these products may differ considerably in their ingredients and potential risk profiles during pregnancy, the findings should be interpreted with caution.
Conclusion
This study found that the frequency of personal care products used increased as pregnant women’s social appearance anxiety increased, and the number of cosmetic products used increased as pregnant women’s fear of negative evaluation increased. It was found that an increase in the mean scores of avoidance and social concerns, concerns about weight gain, and concerns about the future sub-scales of the BICDPS increased the frequency of the use of personal care products. In addition, a correlation was found between the frequency of the use of cosmetic products and the increase in the mean scores of the avoidance and social concerns, and concerns about the future sub-scales of the BICDPS. It was also determined that women’s continuing to use cosmetic/personal care products despite knowing their harm to pregnancy increased as the mean score of the avoidance and social concerns sub-scale of the BICDPS increased. It is recommended that healthcare professionals evaluate pregnant women holistically, address their concerns about body image and social appearance, and question the relationship of these variables with personal care/cosmetic products used during pregnancy.
Supplementary Information
Acknowledgements
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectorsudy.
Authors’ contributions
S Öztürk: Conceptualization, Data Collection, Methodology, Formal analysis, Investigation, Writing - original draft, Supervision.G Nacar: Conceptualization, Methodology, Writing - original draft, Supervision.S Timur Taşhan: Conceptualization, Methodology, Writing - original draft, Supervision.All the authors agreed on the final draft of the manuscript.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability
All data generated or analyzed during this study are included in this published article and its additional information files.
Declarations
Ethics approval and consent to participate
Before the study was conducted, ethical approval (2022/3387) was obtained from Bartin University’s Social and Human Ethics Committee, and institutional permission was obtained from the hospital where the study was conducted. Pregnant women were informed about the study, and their written and/or verbal consent was obtained to indicate their agreement to participate in the study. Scale permission was obtained from the authors responsible for conducting the validity and reliability studies of the scales used in the study. The study was conducted following the principles of the Declaration of Helsinki 2008 (http://www.wma.net/en/30publications/10policies/b3/index.html). Clinical trial number: not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Supplementary Materials
Data Availability Statement
All data generated or analyzed during this study are included in this published article and its additional information files.