Table 5.
Summary table of the relationship between cognitions related to weight gain and excess gestational weight gain in systematic review of psychological antecedents of excess gestational weight gain
| 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) | ||||
*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; $$ GWG measured in pounds (lb); ➔ Positive association (Risk factor); 
Negative association (Protective factor); $$$ For obese women, upper limit of recommended weight gain was set as same as that of the overweight women; BAQ: Body Attitude Questionnaire; BIA-O: Body Image Assessment for Obesity; BMI: Body Mass Index; GWG: Gestational Weight Gain; NA: Not Applicable; NR: Not Reported; NS: Not Significant;