188 - Psychological and behavioral factors during pregnancy associated with gestational weight gain: A cross-sectional study using a digital pregnancy cohort in Japan

Publication Number: 2181.188

Kazuma Shinno, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Tomoko Aoyama, National Center for Child Health and Development, Setagaya, Tokyo, Japan; Kohei Ogawa, National Center for Child Health and Development, Tokyo, Tokyo, Japan; Naho Morisaki, National Center for Child Health and Development, Tokyo, Tokyo, Japan

Background: Gestational weight gain (GWG) represents an important factor potentially affecting maternal and neonatal outcomes. However, the roles of psychological and behavioral factors during pregnancy in GWG have not been well established. Clarifying these associations is essential for developing effective interventions for healthy pregnancy weight management.

Objective: We examined the associations between psychological and behavioral factors during pregnancy-attitudes toward GWG, disordered eating tendencies, and physical activity-and GWG among pregnant women in Japan.

Design/Methods: We used data from a digital cohort of users of a commercial smartphone app for pregnancy. Eligible users were those aged ≥18 years, enrolled between 12 and 36 weeks' gestation without complications or lifestyle restrictions. We analyzed data from 4,016 users who had weight-log entries in the app. At recruitment, psychological factors were assessed using the Japanese versions of the Pregnancy Weight Gain Attitude Scale (J-PWGAS) and the Eating Disorder Examination Questionnaire 7-item version (EDE-Q7). Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) and categorized into tertiles (low, moderate, high). GWG was calculated as the difference between pre-pregnancy and final pre-delivery weights recorded in the app's logs. Associations were examined using multivariable linear and ordinal logistic regressions for continuous and categorical GWG, adjusting for age, parity, smoking, height, pre-pregnancy body mass index, and gestational week at weight measurement.

Results: Participants had a median age of 31 years, pre-pregnancy body mass index of 20.7 kg/m², and GWG of 9.0 kg. In multivariable regression, higher EDE-Q7 scores were significantly associated with greater GWG (β = 0.02 kg per point, p < 0.05). Both high and low physical activity levels were associated with lower GWG compared with moderate (β = −0.35 kg and −0.32 kg, respectively; p < 0.05). J-PWGAS scores were not associated with GWG (β = 0.05, p = 0.67). In categorical analyses of GWG (inadequate, adequate, excessive), none of the psychological or behavioral factors showed statistically significant associations after adjustment. However, EDE-Q7 demonstrated a modest, albeit non-significant, tendency toward higher GWG (OR = 1.01, p = 0.06).

Conclusion(s): Psychological and behavioral factors, particularly disordered eating and physical activity, may influence GWG. These findings suggest the importance of incorporating behavioral and mental health perspectives into pregnancy weight management.

Table 1. Demographic characteristics of the study participants (n = 4,016)
IQR: interquartile range; BMI: body mass index; J-PWGAS: Japanese version of the Pregnancy Weight Gain Attitude Scale; EDE-Q7: Eating Disorder Examination Questionnaire 7-item version; IPAQ: International Physical Activity Questionnaire; GWG: gestational weight gain

Table 2. The effect of psychological and behavioral factors during pregnancy on gestational weight gain
Multivariable analyses were adjusted for maternal age, parity, smoking, height, pre-pregnancy BMI, and gestational week at weight measurement. In the models for J-PWGAS and IPAQ, EDE-Q7 was additionally included as a covariate.
BMI: body mass index; J-PWGAS: Japanese version of the Pregnancy Weight Gain Attitude Scale; EDE-Q7: Eating Disorder Examination Questionnaire 7-item version; IPAQ: International Physical Activity Questionnaire; 95% CI: 95% confidence interval

Table 3. The effect of psychological and behavioral factors during pregnancy on gestational weight gain category
Multivariable analyses were adjusted for maternal age, parity, smoking, height, pre-pregnancy BMI, and gestational week at weight measurement. In the models for J-PWGAS and IPAQ, EDE-Q7 was additionally included as a covariate. Women with pre-pregnancy BMI >= 30 kg/m² were excluded. GWG was categorized as Inadequate (below), Adequate (within), or Excessive (above) according to pre-pregnancy BMI (kg/m²): 12-15 kg for BMI < 18.5, 10-13 kg for BMI 18.5-24.9, and 7-10 kg for BMI 25.0-29.9.
BMI: body mass index; J-PWGAS: Japanese version of the Pregnancy Weight Gain Attitude Scale; EDE-Q7: Eating Disorder Examination Questionnaire 7-item version; IPAQ: International Physical Activity Questionnaire; 95% CI: 95% confidence interval