Die Entwicklung von Figur- und Gewichtssorgen während und nach der Schwangerschaft: Der Einfluss von Übergewicht und Adipositas

Zusammenfassung

Ziele Übergewicht und Adipositas in der Schwangerschaft sowie Figur- und Gewichtssorgen sind mit erhöhter physischer und psychischer Belastung assoziiert. Bisher ist allerdings wenig über die Entwicklung von Figur- und Gewichtssorgen bei schwangeren Frauen mit Übergewicht und Adipositas sowie Zusammenhänge mit der psychischen Gesundheit bekannt.

Methodik Die Studienteilnehmerinnen (N = 218) füllten validierte Fragebögen zu Figur- und Gewichtssorgen (Eating Disorder Examination-Questionnaire), Depression (Edinburgh Postnatal Depression Scale) und Stress (Perceived Stress Scale) in der 18.–22. Schwangerschaftswoche (SSW) (T1), der 28.–32. SSW (T2) und 12 bis 16 Wochen nach der Geburt (T3) aus. Der Einfluss von Body Mass Index (BMI) auf Figur- und Gewichtssorgen wurde mittels ANCOVAs mit Messwiederholungen untersucht. Korrelationen und multiple Regressionsmodelle wurden angewandt, um Zusammenhänge zwischen Figur- und Gewichtssorgen und der Depressions- und Stresssymptomatik zu explorieren.

Ergebnisse Frauen mit Übergewicht berichteten zwischen der 28.–32. SSW und der 12.–16. Woche nach der Geburt eine stärkere Zunahme von Figur- und Gewichtssorgen als normalgewichtige Frauen. In adjustieren Analysen sagten Figur- und Gewichtssorgen zu T1 über alle BMI-Kategorien hinweg Depressions- und Stresssymptome zu T3 vorher.

Schlussfolgerungen Die Ergebnisse dieser Studie zeigen, dass vor allem die Zeit nach der Entbindung eine Risikoperiode für die Entwicklung von Figur- und Gewichtssorgen bei Frauen mit erhöhtem BMI ist. Köperbildspezifische Interventionen vor und nach der Geburt könnten dazu beitragen, die psychische Belastung von Frauen mit Übergewicht und Adipositas zu verringern.

Abstract

Aim Overweight and obesity during pregnancy and shape/weight concerns are associated with psychological distress. To date, there is a paucity of research on the evolution of shape/weight concerns of pregnant women with overweight and obesity.

Methods Participants (N = 218) completed validated questionnaires assessing shape/weight concerns (Eating Disorder Examination-Questionnaire), depression (Edinburgh Postnatal Depression Scale) and stress (Perceived Stress Scale) at 18 to 22 weeks of gestation (T1), 28 to 32 weeks of gestation (T2) and 12 to 16 weeks postpartum (T3). Repeated measures ANCOVAs were used to investigate the effect of body mass index (BMI) on shape/weight concerns. Correlations and multiple regressions models were applied to explore associations between shape/weight concerns and symptoms of depression and stress.

Results Overweight women reported a stronger increase in shape/weight concerns between T2 and T3 than normal weight women. Shape/weight concerns at T1 predicted symptoms of depression and stress across all BMI categories after adjusting for covariates.

Conclusions Results show that women with an increased BMI are at risk of developing weight/shape concerns in the period after birth. Intervention targeting women’s body image before and after birth might prove effective in promoting mental health among women with overweight and obesity.

Schlüsselwörter

Übergewicht - Adipositas - Schwangerschaft - Körperbild - psychische Gesundheit

Key words

overweight - obesity - pregnancy - body image - mental health

• Literatur

• 1 Mensink GBM, Schienkiewitz A, Haftenberger M. et al. Übergewicht und Adipositas in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56: 786-794 doi:10.1007/s00103–012–1656–3
• 2 Euro-Peristat project with SCPE and Eurocat. European Perinatal Health Report. The health and care of pregnant women and babies in Europe in 2010. 2013
• 3 Sebire NJ, Jolly M, Harris JP. et al. Maternal obesity and pregnancy outcome. A study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25: 1175-1182 doi:10.1038/sj.ijo.0801670
• 4 Rasmussen SA, Chu SY, Kim SY. et al. Maternal obesity and risk of neural tube defects. A metaanalysis. Am J Obstet Gynecol 2008; 198: 611-619 doi:10.1016/j.ajog.2008.04.021
• 5 Nohr EA, Vaeth M, Baker JL. et al. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr 2008; 87: 1750-1759 doi:10.1093/ajcn/87.6.1750
• 6 Deputy NP, Sharma AJ, Kim SY. et al. Prevalence and characteristics associated with gestational weight gain adequacy. Obstet Gynecol 2015; 125: 773-781 doi:10.1097/AOG.0000000000000739
• 7 Molyneaux E, Poston L, Ashurst-Williams S. et al. Obesity and mental disorders during pregnancy and postpartum. A systematic review and meta-analysis. Obstet Gynecol 2014; 123: 857-867 doi:10.1097/AOG.0000000000000170
• 8 Preiss K, Brennan L, Clarke D. A systematic review of variables associated with the relationship between obesity and depression. Obes Rev 2013; 14: 906-918 doi:10.1111/obr.12052
• 9 Luppino FS, Wit LM de, Bouvy PF. et al. Overweight, obesity, and depression. A systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67: 220-229 doi:10.1001/archgenpsychiatry.2010.2
• 10 Thompson JK. Exacting beauty: Theory, assessment, and treatment of body image disturbance. 2nd ed.. Washington ,DC: American Psychological Association; 2002
• 11 Weinberger N-A, Kersting A, Riedel-Heller SG. et al. Body Dissatisfaction in Individuals with Obesity Compared to Normal-Weight Individuals. A Systematic Review and Meta-Analysis. Obes Facts 2016; 9: 424-441 doi:10.1159/000454837
• 12 Markowitz S, Friedman MA, Arent SM. Understanding the Relation Between Obesity and Depression. Causal Mechanisms and Implications for Treatment. Clin Psychol Sci & Pract 2008; 15: 1-20 doi:10.1111/j.1468–2850.2008.00106.x
• 13 Brechan I, Kvalem IL. Relationship between body dissatisfaction and disordered eating. Mediating role of self-esteem and depression. Eat Behav 2015; 17: 49-58 doi:10.1016/j.eatbeh.2014.12.008
• 14 Fuller-Tyszkiewicz M, Skouteris H, Watson BE. et al. Body dissatisfaction during pregnancy. A systematic review of cross-sectional and prospective correlates. J Health Psychol 2013; 18: 1411-1421 doi:10.1177/1359105312462437
• 15 Wrotniak BH, Shults J, Butts S. et al. Gestational weight gain and risk of overweight in the offspring at age 7 y in a multicenter, multiethnic cohort study. Am J Clin Nutr 2008; 87: 1818-1824 doi:10.1093/ajcn/87.6.1818
• 16 Hodgkinson EL, Smith DM, Wittkowski A. Women’s experiences of their pregnancy and postpartum body image. A systematic review and meta-synthesis. BMC Pregnancy Childbirth 2014; 14: 330 doi:10.1186/1471–2393–14–330
• 17 Fox P, Yamaguchi C. Body Image Change in Pregnancy. A Comparison of Normal Weight and Overweight Primigravidas. Birth 1997; 24: 35-40 doi:10.1111/j.1523–536X.1997.00035.pp.x
• 18 Sui Z, Turnbull D, Dodd J. Effect of body image on gestational weight gain in overweight and obese women. Women Birth 2013; 26: 267-272 doi:10.1016/j.wombi.2013.07.001
• 19 Rallis S, Skouteris H, Wertheim EH. et al. Predictors of body image during the first year postpartum:a prospective study. Women Health 2007; 45: 87-104 doi:10.1300/J013v45n01_06
• 20 Clark A, Skouteris H, Wertheim EH. et al. The relationship between depression and body dissatisfaction across pregnancy and the postpartum. A prospective study. J Health Psychol 2009; 14: 27-35 doi:10.1177/1359105308097940
• 21 Leddy MA, Jones C, Morgan MA. et al. Eating disorders and obstetric-gynecologic care. J Womens Health (Larchmt) 2009; 18: 1395-1401 doi:10.1089/jwh.2008.1183.
• 22 World Health Organization. http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi Stand: 08.10.2018
• 23 Hilbert A, Tuschen-Caffier B, Karwautz A. et al. Eating Disorder Examination-Questionnaire. Diagnostica 2007; 53: 144-154 doi:10.1026/0012–1924.53.3.144
• 24 Bergant AM, Nguyen T, Heim K. et al. Deutschsprachige Fassung und Validierung der „Edinburgh postnatal depression scale“. Dtsch Med Wochenschr 1998; 123: 35-40 doi:10.1055/s-2007–1023895
• 25 Matthey S, Henshaw C, Elliott S. et al. Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale. Implications for clinical and research practice. Arch Womens Ment Health 2006; 9: 309-315 doi:10.1007/s00737–006–0152-x
• 26 Klein EM, Brähler E, Dreier M. et al. 2016; The German version of the Perceived Stress Scale - psychometric characteristics in a representative German community sample. BMC psychiatry 16: 159
• 27 Mamun AA, Kinarivala M, O’Callaghan MJ. et al. Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity. Evidence from 21 y postpartum follow-up. Am J Clin Nutr 2010; 91: 1336-1341 doi:10.3945/ajcn.2009.28950
• 28 Lovering ME, Rodgers RF, George JE. et al. Exploring the Tripartite Influence Model of body dissatisfaction in postpartum women. Body Image 2018; 24: 44-54 doi:10.1016/j.bodyim.2017.12.001
• 29 Tofani AA, Lamarca GdA, Sheiham A. et al. The different effects of neighbourhood and individual social capital on health-compromising behaviours in women during pregnancy. A multi-level analysis. BMC Public Health 2015; 15: 890 doi:10.1186/s12889–015–2213–4
• 30 Heslehurst N, Rankin J, Wilkinson JR. et al. A nationally representative study of maternal obesity in England, UK. Trends in incidence and demographic inequalities in 619 323 births, 1989–2007. Int J Obes (Lond) 2010; 34: 420-428 doi:10.1038/ijo.2009.250
• 31 Connor Gorber S, Tremblay M, Moher D. et al. A comparison of direct vs. self-report measures for assessing height, weight and body mass index. A systematic review. Obes Rev 2007; 8: 307-326 doi:10.1111/j.1467–789X.2007.00347.x
• 32 Johnson M, Campbell F, Messina J. et al. Weight management during pregnancy. A systematic review of qualitative evidence. Midwifery 2013; 29: 1287-1296 doi:10.1016/j.midw.2012.11.016
• 33 Lindhardt CL, Rubak S, Mogensen O. et al. The experience of pregnant women with a body mass index 30 kg/m² of their encounters with healthcare professionals. Acta Obstet Gynecol Scand 2013; 92: 1101-1107 doi:10.1111/aogs.12186
• 34 Simpson CC, Griffin BJ, Mazzeo SE. Psychological and behavioral effects of obesity prevention campaigns. J Health Psychol. 2017 1359105317693913 DOI: doi:10.1177/1359105317693913