Maternal health behaviours and gestational weight gain: relationships with and importance of body image and disordered eating during pregnancy

Approximately 30-40% of women gain the recommended amount of weight during pregnancy and most do not report eating and physical activity behaviours in accordance with health recommendations. This is concerning and is associated with poor pregnancy and health outcomes. Interventions that have attempted to promote healthy gestational weight gain (GWG) and positive health behaviours during pregnancy have had limited success. It was the aim of this thesis to investigate the relationship between body image and disordered eating during pregnancy and health behaviours and GWG.

A mixed methods approach was used and 126 Australian pregnant women completed the larger quantitative study. Participants completed a questionnaire at two stages of their pregnancy (within 20 weeks gestation and after 30 weeks gestation) assessing their body image, disordered eating, diet, physical activity, depression, stress, anxiety, self-esteem, social connectedness, fatigue, nausea and vomiting, feelings toward motherhood, and demographic characteristics including GWG. Seventy-seven women volunteered to participate in optional follow-up qualitative interviews and 19 women completed interviews at two stages of pregnancy.

The findings of the quantitative study indicated that experiencing negative body image and disordered eating during pregnancy was associated with poorer health behaviours and unhealthy levels of GWG. However, complex relationships were found with some types of body image distress and disordered eating also associated with healthy eating behaviours (i.e., unique predictors were negative attitudes toward GWG, high concern about GWG, negative appearance evaluation, and cognitive restraint) and healthier GWG (i.e., unique predictors were preoccupation with being overweight and high oral control). It was evident that assessing body image in a comprehensive and multidimensional manner was important to understanding the varying relationships. Furthermore, the observed relationships differed throughout pregnancy indicating how future research may need to consider tailoring treatment programs to the stage of pregnancy.

Thematic content analysis of the semi-structured interviews revealed that women believed body image, social support, and mood influenced their health behaviours during pregnancy. Complex experiences were revealed and women found each of these concepts had both positive and negative effects on their health behaviours. Other physiological, cognitive, behavioural, and environmental factors were also described as important influences on women’s eating and physical activity during pregnancy including feeling tired, powerless, and placing greater emphasis on ‘listening’ to what their body needs.

The findings of this thesis indicate that body image and disordered eating are associated with women’s health behaviours and GWG during pregnancy. Complex relationships were identified; some types of body image and disordered eating were associated with positive outcomes and other aspects with negative outcomes, and these relationships were not always consistent across the quantitative and qualitative studies. The relationships also differed according to the stage of pregnancy considered. Combined, these findings demonstrate the importance of further research to replicate and extend these findings particularly among women with greater disordered eating. The findings of this study provide support for a consideration of psychological variables, particularly body image and disordered eating, in research into the development of interventions aimed at improving GWG and health behaviours during pregnancy.