Table 4.
Summary table of the relationship of affect and excess gestational weight gain during pregnancy in systematic review of psychological antecedents of excess gestational weight gain
| 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 $$ | Proportion of exposure within Excess GWG category: | NA | NA | NS on univariate analysis; variable not entered in a multivariate model |
| Low 43.8%; | ||||||
| Medium 37.1% | ||||||
| High 41.9% | ||||||
| Exposure: Coping behavior | ||||||
| Tovar 2012 [55] | Psychological Acculturation Scale, validated | Excess GWG $ | Proportions within GWG categories: | OR (95% CI ): | Pre-pregnancy weight, age, parity, perceived stress, gestational age and physical activity | NS on univariate or multivariate analysis; NS association with other weight gain outcomes (rate of weight gain, weight gain as continuous) |
| Low acculturation | Continuous acculturation score | |||||
| 49.3%, 30.6%; | 1.0 (0.8 to 1.3) | |||||
| Medium acculturation | ||||||
| 42.2%, 31.1%; | ||||||
| High acculturation | ||||||
| 47%, 31.5% | ||||||
| (p = 0.4) | ||||||
*Study reference number correspond to those cited in a pinwheel and web plot; **Scale details can be found in Additional file 1: Table S1; $2009 IOM GWG guidelines; $$ GWG measured in pounds (lb); ➔Positive association (Risk factor); 
Negative association (Protective factor); BMI: Body Mass Index; CES-D: Centre for Epidemiological Studies-Depression Scale; GWG: Gestational Weight Gain; NA: Not Applicable; NR: Not Reported; NS: Not Significant; PHQ: Patient Health Questionnaire; PRAMS: Pregnancy Risk Assessment Monitoring System; PSS: Perceived Stress Scale; STAI-S: State and Trait Anxiety Inventory-State; STAI-T: State and Trait Anxiety Inventory-Trait.