Skye McPhie

Maternal correlates of maternal child feeding practices: a systematic review.

Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 and June 2012. Only studies with mothers of normally developing children between the ages of 2 and 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or socioeconomic status (SES). Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and SES and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.

Attentional biases for food cues in overweight and individuals with obesity: a systematic review of the literature

Obesity rates have increased dramatically in recent decades, and it has proven difficult to treat. An attentional bias towards food cues may be implicated in the aetiology of obesity and influence cravings and food consumption. This review systematically investigated whether attentional biases to food cues exist in overweight/obese compared with healthy weight individuals. Electronic database were searched for relevant papers from inception to October 2014. Only studies reporting food‐related attentional bias between either overweight (body mass index [BMI] 25.0–29.9 kg m−2) or obese (BMI ≥ 30) participants and healthy weight participants (BMI 18.5–24.9) were included. The findings of 19 studies were reported in this review. Results of the literature are suggestive of differences in attentional bias, with all but four studies supporting the notion of enhanced reactivity to food stimuli in overweight individuals and individuals with obesity. This support for attentional bias was observed primarily in studies that employed psychophysiological techniques (i.e. electroencephalogram, eye‐tracking and functional magnetic resonance imaging). Despite the heterogeneous methodology within the featured studies, all measures of attentional bias demonstrated altered cue‐reactivity in individuals with obesity. Considering the theorized implications of attentional biases on obesity pathology, researchers are encouraged to replicate flagship studies to strengthen these inferences.

Health coaching to prevent excessive gestational weight gain: A randomized-controlled trial

OBJECTIVES The objectives of this study were to evaluate the efficacy of a health coaching (HC) intervention designed to prevent excessive gestational weight gain (GWG), and promote positive psychosocial and motivational outcomes in comparison with an Education Alone (EA) group. DESIGN Randomized-controlled trial. METHODS Two hundred and sixty-one women who were <18 weeks pregnant consented to take part. Those allocated to the HC group received a tailored HC intervention delivered by a Health Coach, whilst those in the EA group attended two education sessions. Women completed measures, including motivation, psychosocial variables, sleep quality, and knowledge, beliefs and expectations concerning GWG, at 15 weeks of gestation (Time 1) and 33 weeks of gestation (Time 2). Post-birth data were also collected at 2 months post-partum (Time 3). RESULTS There was no intervention effect in relation to weight gained during pregnancy, rate of excessive GWG or birth outcomes. The only differences between HC and EA women were higher readiness (b = 0.29, 95% CIs = 0.03-0.55, p < .05) and the importance to achieve a healthy GWG (b = 0.27, 95% CIs = 0.02-0.52, p < .05), improved sleep quality (b = -0.22, 95% CIs = -0.44 to -0.03, p < .05), and increased knowledge for an appropriate amount of GWG that would be best for their babys health (b = -1.75, 95% CI = -3.26 to -0.24, p < .05) reported by the HC at Time 2. CONCLUSIONS Whilst the HC intervention was not successful in preventing excessive GWG, several implications for the design of future GWG interventions were identified, including the burden of the intervention commitment and the use of weight monitoring. STATEMENT OF CONTRIBUTION What is already known on the subject? Designing interventions to address gestational weight gain (GWG) continues to be a challenge. To date, health behaviour change factors have not been the focus of GWG interventions. What does this study add? Our health coaching (HC) intervention did not reduce GWG more so than education alone (EA). There was an intervention effect on readiness and importance to achieve healthy GWG. Yet there were no group differences regarding confidence to achieve healthy GWG post-intervention.

Psychosocial risk factors for excessive gestational weight gain: A systematic review.

BACKGROUND Excessive weight gain during pregnancy can have adverse health outcomes for mother and infant throughout pregnancy. However, few studies have identified the psychosocial factors that contribute to women gaining excessive weight during pregnancy. AIM To review the existing literature that explores the impact of psychosocial risk factors (psychological distress, body image dissatisfaction, social support, self-efficacy and self-esteem) on excessive gestational weight gain. METHODS A systematic review of peer-reviewed English articles using Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO, Informit, Web of Science, and Scopus was conducted. Quantitative studies that investigated psychosocial factors of excessive GWG, published between 2000 and 2014 were included. Studies investigating mothers with a low risk of mental health issues and normally-developing foetuses were eligible for inclusion. From the total of 474 articles located, 12 articles were identified as relevant and were subsequently reviewed in full. FINDINGS Significant associations were found between depression, body image dissatisfaction, and social support with excessive gestational weight gain. No significant relationships were reported between anxiety, stress, self-efficacy, or self-esteem and excessive gestational weight gain. CONCLUSION The relationship between psychosocial factors and weight gain in pregnancy is complex; however depression, body dissatisfaction and social support appear to have a direct relationship with excessive gestational weight gain. Further research is needed to identify how screening for, and responding to, psychosocial risk factors for excessive gestational weight gain can be successfully incorporated into current antenatal care.

Maternal predictors of preschool child-eating behaviours, food intake and body mass index: a prospective study

This study extends McPhie et al. (2011)s [Maternal correlates of preschool child eating behaviours and body mass index: A cross-sectional study. International Journal of Pediatric Obesity, Early Online, 1–5.] McPhie et al. (2011)’s cross-sectional research, by prospectively evaluating maternal child-feeding practices, parenting style and mother–child interactions as predictors of child-eating behaviours, food habits and weight. A sample of 117 mothers of preschoolers (63 girls, 54 boys) participated at two time-points, Time 1 (T1) and Time 2 (T2), 12 months apart. Results from the two path models revealed maternal pressure to eat at T1 positively predicted change in child enjoyment of food. Maternal warmth at T1 negatively predicted child unhealthy food habits at T2. At T1, family income and maternal control negatively predicted change in child body mass index z-scores (BMIz); maternal pressure to eat at T1 also positively predicted change in child BMIz. There were significant results specific to each model. Both final path models provided an adequate fit. Our findings suggest childhood obesity is predicted by a complex interplay of demographic, maternal and child variables.

A longitudinal study of the effect of psychosocial factors on exclusive breastfeeding duration

OBJECTIVE to examine the effect of psychosocial factors on exclusive breastfeeding duration to six months postpartum DESIGN longitudinal, prospective questionnaire based study. SETTING participants were recruited from a publically funded antenatal clinic located in the western metropolitan region of Melbourne, Victoria, Australia and asked to complete questionnaires at three time points; 32 weeks pregnancy, two months postpartum and six months postpartum. PARTICIPANTS the participants were 125 pregnant women aged 22-44 years. MEASUREMENTS AND FINDINGS psychosocial variables such as breastfeeding self-efficacy, body attitude, psychological adjustment, attitude towards pregnancy, intention, confidence and motivation to exclusively breastfeed and importance of exclusive breastfeeding were assessed using a range of psychometrically validated tools. Exclusive breastfeeding behaviour up to six months postpartum was also measured. At 32 weeks gestation a womans confidence to achieve exclusive breastfeeding was a direct predictor of exclusive breastfeeding duration to six months postpartum. At two months postpartum, psychological adjustment and breastfeeding self-efficacy were predictive of exclusive breastfeeding duration. Finally, at six months postpartum, psychological adjustment, breastfeeding self-efficacy, confidence to maintain and feeling fat were directly predictive of exclusive breastfeeding duration. KEY CONCLUSIONS psychosocial factors are significantly predictive of exclusive breastfeeding duration. Self-efficacy, psychological adjustment, body image, motivation and confidence are all important psychosocial factors implicated in a womans ability to maintain exclusive breastfeeding over time. IMPLICATIONS FOR PRACTICE Individualised antenatal breastfeeding education and support may be strengthened by strategies that build a womans confidence to exclusive breastfeeding. Implementing psychosocial supports and methods providing positive feedback that increase a womans self-efficacy to exclusively breastfeed to six months are also important two months postpartum.

Understanding gestational weight gain: The role of weight-related expectations and knowledge

Health behaviour theories acknowledge that beliefs, attitudes and knowledge contribute to health behaviours, yet the role of these cognitions in predicting weight gain during pregnancy has not been widely researched.

Relationships between mental health symptoms and body mass index in women with and without excessive weight gain during pregnancy

OBJECTIVE This study investigated the prospective relationships between mental health symptoms (depressive and anxiety symptoms) and body mass index (BMI) in women with and without excessive weight gain during pregnancy. The secondary aim was to examine whether mental health symptoms and BMI were predictive of one another. Two models were tested: the first depicted depressive or anxiety symptoms predicting BMI, and the second model depicted BMI predicting depressive or anxiety symptoms. DESIGN AND PARTICIPANTS Women completed questionnaires at three time points throughout pregnancy, which comprised of the Depression, Anxiety and Stress Scale-21 and self-reported weight. Height and weight were also reported retrospectively at T1 to calculate pre-pregancy BMI category. To calculate total gestational weight gain (GWG), pre-pregnancy weight was substracted from weight at 36 weeks gestation. METHODS 183 women were tracked during pregnancy; Time (T)1 (mean=16.50 weeks of gestation, SD=.92), T2 (mean=24.40 weeks of gestation, SD=.92), and T3 (mean=32.61 weeks gestation, SD=.88). The sample was divided into those for whom weight gain exceeded the guidelines for GWG (excessive gestational weight gain; EGWG), and those who for whom it did not. Multigroup path analyses compared the longitudinal relationships between depressive or anxiety symptoms and BMI during pregnancy for women with and without EGWG. FINDINGS BMI did not predict depressive or anxiety symptoms. Depressive symptoms at T1, did however predict higher BMI at T2 for women without EGWG. Anxiety symptoms and BMI were not related, regardless of GWG status. CONCLUSION These findings suggest that depressive symptoms may precede increased BMI during pregnancy in women who do not gain weight excessively. There may be longitudinal relationships between depressive symptoms and BMI during pregnancy; however, further research is required to identify the mechanisms that link these health outcomes and inform the focus of intervention design.

The inter-relationship between depressive, anxiety and stress symptoms in fathers during the antenatal period

Objective: The aim of this study was to examine whether depressive symptoms predict anxiety and stress or whether anxiety and stress precede depressive symptoms in fathers during the antenatal period. Background: The findings of previous studies suggest that there is an association between paternal depression, anxiety and stress during the antenatal period. However, the temporal inter-relationship between these variables has yet to be investigated. Method: Data were collected from 150 expectant couples at approximately 18, 25 and 33 weeks’ gestation. Results: After accounting for the relative stability of depression, anxiety and stress over time, for men higher levels of anxiety earlier in pregnancy predicted higher levels of depression and stress in middle pregnancy, which predicted higher depression during late pregnancy. A similar relationship remained after partialling out the effects of partner’s depression, perceived social support and sleep quality. Further analyses also revealed significant differences in the manifestation of distress symptoms between men and women, but not between first-time and non-first-time fathers. Conclusion: Our findings indicated a possible inter-relationship between depression, anxiety and stress for men antenatally. Our findings also showed that men who reported elevated depression, anxiety and stress earlier in the antenatal period also reported elevated symptomology at later time points. Finally, the current findings revealed that antenatal paternal stress may play a key role in the development of depression and anxiety later in pregnancy. Therefore, it may be important to screen for early levels of antenatal stress in men, as well as depression and anxiety.

A path model of psychosocial and health behaviour change predictors of excessive gestational weight gain

Abstract Objective: This study aimed to evaluate a conceptual model of psychosocial, behaviour change, and behavioural predictors of excessive gestational weight gain (GWG). Background: Excessive GWG can place women and their babies at risk of poor health outcomes, including obesity. Models of psychosocial and behaviour change predictors of excessive GWG have not been extensively explored; understanding the mechanisms leading to excess GWG will provide crucial evidence towards the development of effective interventions. Method: Two hundred and eighty-eight pregnant women (≤18 weeks gestation) were recruited to a prospective study. Demographic, psychosocial, health behaviour change, and behavioural factors were assessed at 17 (Time 1, T1) and 33 weeks (Time 2, T2) gestation. Pre-pregnancy and final pregnancy weight were obtained and women were classified with/without excessive GWG. Logistic regressions refined the list of predictors of excessive GWG; variables with p < .1 were included in a path analysis. Results: Age, family income, T2 depression, T2 pregnancy-specific coping, T1 buttocks dissatisfaction, T2 GWG-specific self-efficacy, T1 dietary readiness, T1 dietary importance, and T1 vegetable intake predicted excessive GWG in the logistic regressions and were included in the path model. The baseline path model demonstrated poor fit. Once statistically and theoretically plausible paths were added, adequate model fit was achieved (χ² = 21.61(9), p < .05; RMSEA = .07; CFI = .93); this revised model explained 19.5% of the variance in excessive GWG. Women with high T1 buttocks dissatisfaction were more likely to exhibit low levels of dietary readiness. Women with low dietary readiness were more likely to have a lower vegetable intake, which predicted excessive GWG. Women with higher T2 depressive symptoms were more likely to report lower GWG self-efficacy and gain excessively. Conclusion: Future behavioural GWG trials should consider combining psychosocial and health behaviour change factors to optimise GWG.