Predictors of maternal 6-week postpartum weight retention: Influences of exercise determinants and psychological well-being

Open Access
Author:
Leonard, Krista Sue
Graduate Program:
Kinesiology
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
June 29, 2017
Committee Members:
  • Danielle Symons Downs, Thesis Advisor
  • Blair Evans, Committee Member
  • Kristen H. Kjerulff, Committee Member
Keywords:
  • Postpartum Depression
  • Postpartum Stress
  • Pre-pregnancy Weight
  • Postpartum Weight Retention
  • Psychobehavioral Determinants
Abstract:
Women with higher pre-pregnancy weight status and postpartum weight retention are at increased risk for postpartum depression and stress. Psychobehavioral determinants (e.g., low self-esteem, social support, and exercise) may also put women at additional risk for poor postpartum well-being. However, there is a lack of research focusing on the collective influence of these psychobehavioral factors and the extent to which they impact depression and stress across the postpartum period. Purpose: To prospectively examine the extent to which pre-pregnancy weight status, postpartum weight retention, and postpartum psychobehavioral variables (i.e., depression, stress, self-esteem, social support, and exercise) in early postpartum (i.e., 6-, 12- and 18-months) were associated with and explained depression and stress in later postpartum (i.e., 12-, 18- and 24-months) within a cohort of first-time mothers who were prospectively followed from 6- to 24-months postpartum. Methods: Women (N = 903) were categorized by their pre-pregnancy weight (i.e., normal weight vs. overweight/obese) and postpartum weight retention (i.e., low vs. high at 6-months) status. Women prospectively reported depressive symptoms, stress, self-esteem, social support, and exercise at 6-, 12-, 18-, and 24-months postpartum via telephone interviews. Results: Lower early (i.e., 6-, 12-, and 18-months) postpartum social support and self-esteem and higher depression and stress were associated with higher later (i.e., 12-, 18-, and 24-months) postpartum depression and stress. Lower early (i.e., 6- and 18-months) postpartum exercise was associated with higher later (i.e., 12- and 24-months) postpartum depression and stress among overweight/obese women with low 6-month postpartum weight retention. Normal weight women with low 6-month postpartum weight retention reported: (1) significantly lower 12-month postpartum depression, and 18- and 24-month postpartum stress compared to normal weight women with higher 6-month postpartum weight retention, (2) significantly higher 12-month postpartum exercise compared to overweight/obese women with low 6-month postpartum weight retention, and (3) higher 18-month postpartum self-esteem compared to overweight/obese women with high 6-month postpartum weight retention. Among all categories of women, early (i.e., 6-, 12-, and 18-months) postpartum depression mediated the relationship between early postpartum stress, self-esteem, and social support and later (i.e., 12-, 18-, and 24-months) postpartum depression. Also, early postpartum stress mediated the relationship between early postpartum depression, self-esteem, and social support and later postpartum stress. Conclusion: Women may experience postpartum psychobehavioral constructs differently based on their pre-pregnancy weight and 6-month postpartum weight retention status. However, among all women and regardless of weight status, poorer psychobehavioral constructs lead to early postpartum depression and stress, and in turn, a continued trajectory of postpartum depression and stress as far out as 24-months postpartum. Intervention efforts are warranted during pregnancy or earlier postpartum to increase self-esteem, strengthen social support, and managing early postpartum depressive and stress symptoms in an effort to prevent a long-term trajectory of postpartum depression and stress and directly improve maternal (and therefore indirectly infant) health and well-being.