Helen Skouteris

Parental influence and obesity prevention in pre‐schoolers: a systematic review of interventions

Obesity is difficult to reverse in older children and adults and calls have been made to implement obesity prevention strategies during the formative pre‐school years. Childhood obesity experts suggest that prevention of overweight in the pre‐school years should focus on parents, because parental beliefs, attitudes, perceptions and behaviours appear to contribute to childrens development of excessive weight gain. While evidence suggests that parental variables may be instrumental in the development of obesity, there has been no systematic evaluation of whether intervening to change such variables will positively influence the development of excess adiposity during the pre‐school years. This paper is a conceptual and methodological review of the literature on the parental variables targeted in interventions designed to modify risk factors for obesity by promoting healthy eating and/or physical activity and/or reducing sedentary behaviours in families of children aged 2–6 years. There were significant methodological limitations of existing studies and the scientific study of this area is in its infancy. However, the results suggest that the modification of parental variables known to be associated with obesity‐promoting behaviours in pre‐school children may show promise as an obesity prevention strategy; further research is needed.

Maternal feeding practices predict weight gain and obesogenic eating behaviors in young children: a prospective study

BackgroundMaternal feeding practices have been proposed to play an important role in early child weight gain and obesogenic eating behaviors. However, to date longitudinal investigations in young children exploring these relationships have been lacking. The aim of the present study was to explore prospective relationships between maternal feeding practices, child weight gain and obesogenic eating behaviors in 2-year-old children. The competing hypothesis that child eating behaviors predict changes in maternal feeding practices was also examined.MethodsA sample of 323 mother (mean age = 35 years, ± 0.37) and child dyads (mean age = 2.03 years, ± 0.37 at recruitment) were participants. Mothers completed a questionnaire assessing parental feeding practices and child eating behaviors at baseline and again one year later. Child BMI (predominantly objectively measured) was obtained at both time points.ResultsIncreases in child BMI z-scores over the follow-up period were predicted by maternal instrumental feeding practices. Furthermore, restriction, emotional feeding, encouragement to eat, weight-based restriction and fat restriction were associated prospectively with the development of obesogenic eating behaviors in children including emotional eating, tendency to overeat and food approach behaviors (such as enjoyment of food and good appetite). Maternal monitoring, however, predicted decreases in food approach eating behaviors. Partial support was also observed for child eating behaviors predicting maternal feeding practices.ConclusionsMaternal feeding practices play an important role in the development of weight gain and obesogenic eating behaviors in young children and are potential targets for effective prevention interventions aiming to decrease child obesity.

Preventing excessive gestational weight gain: a systematic review of interventions

Women who gain excessive weight during pregnancy have an increased risk of post‐partum obesity, and retention of gestational weight gain (GWG) post birth is a strong predictor of maternal overweight/obesity a decade or more after the birth. The aim of the current review was to identify, and evaluate the effect of key variables designed to modify risk factors for excessive weight gain in pregnant women that have been targeted in interventions over the last decade. The 10 interventions focused primarily on behavioural changes in relation to physical activity and/or to eating. While six studies reported significantly less weight gain in the intervention women, only three showed that women in the intervention were significantly more likely to gain within recommended guidelines. GWG was reduced in only normal‐weight, low‐income, obese, or overweight women, or not at all. Only one study reported a reduction in GWG in women with body mass indexes spanning the normal, overweight and obese categories. The findings were inconsistent in relation to what factors need to be targeted in intervention programmes to reduce GWG. Consideration of psychological factors relevant to pregnancy, in addition to behavioural changes in relation to eating and physical activity, is suggested for future intervention studies.

Depression and anxiety through pregnancy and the early postpartum: An examination of prospective relationships

BACKGROUND The aim of this study was to explore the prospective relationship between depressive symptoms and anxiety across pregnancy and the early postpartum. METHODS Participants (N=207) completed the State-Trait Anxiety Inventory Trait subscale, Beck Depression Inventory, and social support and sleep quality measures at two time points during pregnancy and once in the early postpartum period. RESULTS After accounting for the relative stability of anxiety and depression over time, depressive symptoms earlier in pregnancy predicted higher levels of anxiety in late pregnancy and anxiety in late pregnancy predicted higher depressive symptomatology in the early postpartum. A bi-directional model of depression and anxiety in pregnancy was supported. LIMITATIONS Data were based on self-reports and participating women were predominantly tertiary educated with high family incomes. CONCLUSION Our findings suggest that depressive symptoms precede the development of higher levels of anxiety and that anxiety, even at non-clinical levels, can predict higher depressive symptoms. Clinicians are advised to screen for anxiety and depression concurrently during pregnancy.

Correlates of ante- and postnatal depression in fathers: A systematic review

BACKGROUND Contemporary research findings suggest that depression during the ante- and postnatal periods is a significant problem not only for women but also for many men. This paper provides a conceptual and methodological review of the literature on cross-sectional and prospective correlates of depressive symptoms in men during both pregnancy and the postpartum period. METHODS The search, via several electronic databases, was limited to English papers published between January 1996 and August 2009, and identified 30 relevant articles. RESULTS The most common correlate of paternal depressive symptoms pre- and post birth was having a partner with elevated depressive symptoms or depression; poor relationship satisfaction was also frequently associated with elevated depressive symptoms or depression in men. LIMITATIONS There were significant methodological limitations of existing studies, including small sample sizes; the use of cross-sectional designs; varied measures of depression; focus on depression in the postpartum only; and in the few longitudinal gestational studies, the inclusion of only one assessment point. The limitations of the current systematic review include the inclusion of only papers written in English and potential publication bias, where studies with null findings are less likely to be published. CONCLUSION The scientific study of predictors of mens depressive symptoms pre and post birth remains in its infancy. Given the implications of clinical depression in men both during the gestational and postpartum periods, further systematic investigation of direct and indirect predictors of elevated depressive symptoms in men during this time is warranted.

Sleep quality and depression during pregnancy: a prospective study

For the first time, the relationship between depressive symptoms and sleep quality was explored prospectively during pregnancy. Participants (n = 273) completed the Pittsburgh Sleep Quality Index and Beck Depression Inventory at three 8‐week intervals, starting from 15–23 weeks gestation. In addition to sleep quality and depression remaining relatively stable during pregnancy, findings revealed that sleep quality earlier in pregnancy predicted higher levels of depressive symptoms at later stage in pregnancy (after controlling for prior depression levels). In contrast, there was no evidence to suggest that depressive symptoms earlier in pregnancy impacted on sleep quality later on. Given that depressive symptomatology can lead to major depression and given the prevalence of pre‐ and postnatal depression, our findings suggest that screening for sleep problems during pregnancy may be of clinical significance.

The relationship between depression and body dissatisfaction across pregnancy and the postpartum : a prospective study

The overall aim of this study was to examine the relationship between depression and body dissatisfaction across pregnancy and the first 12 months postpartum. During pregnancy, womens (N = 116) perceived attractiveness and strength/fitness remained stable, while feeling fat and salience of weight/shape decreased in late pregnancy. During the postpartum, feeling fat and salience of weight/shape increased. Depression and body dissatisfaction scores were correlated with each other concurrently and across multiple time points. However, in baseline-controlled prospective analyses, only a model of greater depression late in pregnancy predicting body dissatisfaction at six weeks postpartum and feeling fat throughout the postpartum was supported.

My baby body: A qualitative insight into women’s body‐related experiences and mood during pregnancy and the postpartum

An inductive qualitative approach was employed to explore women’s experiences of their body and mood during pregnancy and the postpartum. In‐depth interviews were conducted with 20 perinatal women (n at late pregnancy=10; n in the early postpartum period=10). While most of the sample reported adapting positively to body changes experienced during pregnancy, the postpartum period was often associated with body dissatisfaction. Women reported several events unique to pregnancy which helped them cope positively with bodily changes (e.g. increased perceived body functionality, new sense of meaning in life thus placing well‐being of developing foetus above body aesthetics, perceptual experiences such as feeling baby kick, increased sense of social connectedness due to pregnancy body shape, and positive social commentary); however, these events no longer protected against body dissatisfaction post‐birth. While women reported mood lability throughout the perinatal period, the postpartum was also a time of increased positive affect for most women, and overall most women did not associate body changes with their mood. Clinical implications of these findings included the need for education about normal postpartum body changes and their timing, and the development of more accurate measures of perinatal body image.

How well do women adapt to changes in their body size and shape across the course of pregnancy

This study examined body image across pregnancy. Pregnant women ( N = 158) completed measures of general attractiveness, feeling fat, fitness and strength, salience of weight and shape, and ideal and current body size at pre-pregnancy (retrospective), and in early, middle and late pregnancy. Body image was found to be fairly stable across pregnancy such that women who started with greater body concerns maintained them over time. Although women were least satisfied with their stomach size at late pregnancy, womens ideal body shape increased in parallel with increases in body size. Women with the most body concerns reported more depressive symptoms, tendency towards dieting, and smoking during pregnancy suggesting they were at greater risk in terms of health and well-being during pregnancy.

Psychosocial correlates of exclusive breastfeeding: A systematic review

BACKGROUND the World Health Organization recommends that all infants worldwide are exclusively breastfed for the first 6 months of life for optimal health and development. However, very few women worldwide are meeting this recommendation. Psychosocial factors have been identified as potentially modifiable factors implicated in a womans ability to successfully exclusively breastfeed, however there is very limited research examining these factors specifically for exclusive breastfeeding to 6 months duration. METHODS a search of psychological, nursing and medical databases was conducted in June 2011 for studies published from 2000 to 2011 examining psychological correlates of exclusive breastfeeding to four to 6 months duration. RESULTS nine papers from eight studies were found to be eligible for the review. Psychological factors have been reported to be highly predictive of exclusive breastfeeding outcomes. Research to date shows that psychosocial factors are not only importantly implicated in exclusive breastfeeding duration but they can also be changed through intervention and experiences. CONCLUSIONS while there is a wealth of literature on the role of psychosocial factors in breastfeeding, there is very limited research specifically examining the role of psychosocial factors of exclusive breastfeeding to 6 months duration. Interpreting the results of the available literature is difficult due to the various methodologies and definitions of exclusive breastfeeding and small sample sizes. Further research, specifically, longitudinal cohort studies are needed which examine psychological determinants of exclusive breastfeeding and infant feeding methods from pregnancy through to 6 months postpartum.