Abstract
Background
Prepregnancy body mass index and excessive gestational weight gain (GWG) are associated
with adverse maternal and infant outcomes. Because stress contributes to obesity and
eating behaviors, stress reduction interventions during pregnancy may be a novel way
to influence GWG, positively affect maternal and infant outcomes, and address the
obesity epidemic intergenerationally.
Methods
Our research team is developing a mindfulness-based stress reduction and nutrition
intervention for low-income, overweight and obese pregnant women, with healthy GWG
as the primary outcome measure. To inform development of the intervention, we conducted
focus groups with our target population. Focus group transcripts were analyzed for
themes related to sources and importance of stress, relationship between stress and
eating, and motivation for a stress reduction pregnancy intervention.
Findings
Fifty-nine low-income pregnant women from the San Francisco Bay Area participated
in focus groups and completed a questionnaire. The vast majority of women (80%) reported
experiencing significant stress from a variety of sources and most recognized a relationship
between stress and eating in their lives.
Conclusions
This at-risk population seems to be extremely interested in a stress reduction intervention
to support healthy GWG during pregnancy. The women in our groups described high levels
of stress and a desire for programs beyond basic dietary recommendations. These findings
inform practitioners and policymakers interested in pregnancy as a “window of opportunity”
for behavior change that can affect the metabolic and weight trajectory both for women
and their offspring.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women's Health IssuesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Stress, eating and the reward system.Physiology & Behavior. 2007; 91: 449-458
- Mind-body interventions during pregnancy.Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2008; 37: 165-175
- Metabolic syndrome in childhood: Association with birth weight, maternal obesity, and gestational diabetes mellitus.Pediatrics. 2005; 115: e290-e296
- The pattern of maternal weight gain in women with good pregnancy outcomes.American Journal of Public Health. 1997; 87: 1984-1988
- Social stressors associated with antepartum depressive symptoms in low-income African American women.Public Health Nursing. 2011; 28: 203-212
- Mindfulness intervention for stress eating to reduce cortisol and abdominal fat among overweight and obese women: An exploratory randomized controlled study.Journal of Obesity. 2011; 2011: 651936
- Childbearing, stress and obesity disparities in women: A public health perspective.Maternal and Child Health Journal. 2010; 2012: 109-118
- Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues.Annual Review of Psychology. 2011; 62: 531-558
- Prenatal stress and developmental programming of human health and disease risk: Concepts and integration of empirical findings.Current Opinion in Endocrinology, Diabetes, and Obesity. 2010; 17: 507-516
- Predictors of dietary quality in low-income pregnant women: A path analysis.Nursing Research. 2011; 60: 286-294
- Stress, depression, social support, and eating habits reduce diet quality in the first trimester in low-income women: A pilot study.Journal of the Academy of Nutrition and Dietetics. 2012; 112: 1619-1625
- A qualitative study of factors affecting pregnancy weight gain in African American women.Maternal and Child Health Journal. 2013; 17: 432-440
- Literature review: Considerations in undertaking focus group research with culturally and linguistically diverse groups.Journal of Clinical Nursing. 2007; 16: 1000-1011
- Gestational weight gain as a predictor of longitudinal body mass index transitions among socioeconomically disadvantaged women.Journal of Women's Health. 2012; 21: 1082-1090
- Seizing the 9-month moment: Addressing behavioral risks in prenatal patients.Patient Education and Counseling. 2006; 61: 228-235
- Risks and resources associated with antepartum risk for depression among rural southern women.Nursing Research. 2007; 56: 378-386
- The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women.BMC pregnancy and childbirth. 2008; 8: 22
- Kumanyika S. Parker L. Sim L. Bridging the evidence gap in obesity prevention: A framework to inform decision making. National Academies Press, Washington, DC2010
- Pregravid weight is associated with prior dietary restraint and psychosocial factors during pregnancy.Obesity. 2009; 17: 550-558
- Pregnancy-specific stress, prenatal health behaviors, and birth outcomes.Health Psychology. 2008; 27: 604-615
- Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay.BMC Pregnancy and Childbirth. 2011; 11: 62
- Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: Evidence from 21 y postpartum follow-up.American Journal of Clinical Nutrition. 2010; 91: 1336-1341
- Associations of gestational weight gain with offspring body mass index and blood pressure at 21 years of age: Evidence from a birth cohort study.Circulation. 2009; 119: 1720-1727
- Acceptability and feasibility of a multiple-behavior, computer-tailored intervention for underserved pregnant women.Journal of Midwifery & Women's Health. 2011; 56: 75-80
- Depressive disorders during pregnancy: Prevalence and risk factors in a large urban sample.Obstetrics and Gynecology. 2010; 116: 1064-1070
- Morgan D.L. Successful focus groups: Advancing the state of the art. Sage, Newberry Park, CA1993
- Gestational weight gain and long-term postpartum weight retention: A meta-analysis.American Journal of Clinical Nutrition. 2011; 94: 1225-1231
- Maternal metabolism and obesity: Modifiable determinants of pregnancy outcome.Human Reproduction Update. 2010; 16: 255-275
- The consequences of obesity and excess weight gain in pregnancy.Proceedings of the Nutrition Society. 2011; 70: 450-456
- The relationship between gestational weight gain and fetal growth: Time to take stock?.Journal of Perinatal Medicine. 2013; 21: 1-7
- Prevalence of overweight and obesity in the United States, 1999-2004.JAMA. 2006; 295: 1549-1555
- The web of risk factors for excessive gestational weight gain in low income women.Maternal and Child Health Journal. 2013; 17: 344-351
- Pregnancy: A “teachable moment” for weight control and obesity prevention.American Journal of Obstetrics and Gynecology. 2010; 202: 135.e131-135.e138
- Rasmussen K. Yaktine A.L. Weight gain during pregnancy: Reexamining the guidelines. The National Academies Press, Washington, DC2009
- A qualitative study of motivators and barriers to healthy eating in pregnancy for low-income, overweight, African-American mothers.Journal of the Academy of Nutrition and Dietetics. 2013; 113: 1175-1181
- Interventions during pregnancy to reduce excessive gestational weight gain: A systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.BJOG. 2010; 117: 1327-1334
- Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood.International Journal of Obesity. 2010; 34: 67-74
- Preventing excessive gestational weight gain: A systematic review of interventions.Obesity Reviews. 2010; 11: 757-768
- Focus groups: Theory and practice.Sage, Newberry Park, CA1994
- Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women.BMC Pregnancy and Childbirth. 2011; 11: 81
- Comfort food is comforting to those most stressed: Evidence of the chronic stress response network in high stress women.Psychoneuroendocrinology. 2011; 36: 1513-1519
- Impact of a prenatal cognitive-behavioral stress management intervention on salivary cortisol levels in low-income mothers and their infants.Psychoneuroendocrinology. 2011; 36: 1480-1494
- Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study.Archives of Women's Mental Health. 2008; 11: 67-74
- Psychoneuroendocrine processes in human pregnancy influence fetal development and health.Psychoneuroendocrinology. 2005; 30: 724-743
- Generation XL.International Journal of Epidemiology. 2008; 37: 963-965
- Psychosocial factors associated with gestational weight gain in a low-income cohort.Journal of Health Care for the Poor and Underserved. 2013; 24: 332-343
- Increasing prepregnancy body mass index: Analysis of trends and contributing variables.American Journal of Obstetrics and Gynecology. 2005; 193: 1994-1998
- Unique perspectives of women and their partners using the Prenatal Psychosocial Profile Scale.Journal of Advanced Nursing. 2011; 67: 1767-1778
Biography
Melanie Thomas, MD, MS, is a clinical researcher and psychiatrist at UCSF, San Francisco General Hospital. Her research focuses on interventions targeting the intersection of mental health, health-related behavior, and chronic disease among low-income women of reproductive age.
Biography
Cassandra Vieten, PhD, is a licensed clinical psychologist, Scientist at California Pacific Medical Center Research Institute, and President/CEO of the Institute of Noetic Sciences.
Biography
Ingrid Ammondson, PhD, is a psychologist who works currently as a researcher, instructor, and consultant in the topics of wellness, somatic and affect psychology, stress management, and meditation.
Biography
Nancy E. Adler, PhD, is the Vice-Chair of the Department of Psychiatry, and Director of the Center for Health and Community. Her current research examines social, psychological and biological mechanisms by which SES influences health.
Biography
Elissa Epel, PhD, is a health psychologist studying stress pathways and how stress processes may lead to early disease precursors, overeating, abdominal obesity, and immune cell aging. She also examines how maternal stress, weight, and health behaviors may affect offspring.
Biography
Kimberly Coleman-Phox, MPH, is project director of the MAMAS study at the UCSF Center for Health and Community. She is also currently pursuing her public health doctoral degree at the UCB School of Public Health.
Biography
Barbara Laraia, PhD, MPH, RD, is Associate Professor at the UCB School of Public Health. Her research program focuses on the influence of contextual level effects on dietary intake, cardiometabolic risk factors and pregnancy outcomes, especially among vulnerable populations.
Article info
Publication history
Accepted:
February 3,
2014
Received in revised form:
December 11,
2013
Received:
July 26,
2013
Footnotes
Author disclosure statement: No competing financial interests exist.
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
