The Past Influencing The Present? examining How Prior Pregnancy Loss and Prepregnancy Weight Status Effect Psychological Well-being and Exercise Motivation and Behavior During a Subsequent Pregnancy

Open Access
Devlin, Courtenay A
Graduate Program:
Master of Science
Document Type:
Master Thesis
Date of Defense:
March 31, 2015
Committee Members:
  • Danielle Symons Downs, Thesis Advisor
  • Exercise
  • Pregnancy
  • Theory of Planned Behavior
  • Pregnancy loss
  • Miscarriage
  • Psychological Well-Being
  • Physical Activity
One-third of American women will experience a pregnancy loss (i.e., miscarriage or stillbirth) during the reproductive years and the majority of these women will become pregnant again. Pregnancy loss is associated with significant psychological distress which can persist during subsequent pregnancies. The risk of pregnancy loss is increased for overweight and obese women, with rates of miscarriage and stillbirth currently rising along with rates of obesity in the United States. Exercise behavior (EXB) is associated with positive health outcomes among pregnant women and their offspring. Scant research, however, has examined the extent to which psychological well-being and motivational determinants influence EXB in pregnant women who have experienced a prior pregnancy loss. Purpose: To examine the extent to which a history of pregnancy loss, prepregnancy weight status, and psychological well-being are associated with and explain pregnant women’s EXB and its motivational determinants during a subsequent pregnancy using the framework of the Theory of Planned Behavior (TPB). Methods: 204 pregnant women (41 with a history of pregnancy loss; 72 overweight/obese) prospectively reported their depressive and anxiety symptoms, TPB motivational determinants, and EXB during the first, second, and third pregnancy trimesters via mailed surveys. Results: During early pregnancy, women with a history of pregnancy loss had higher levels of depressive and anxiety symptoms and lower levels of EXB motivation than women without a history of pregnancy loss. Overweight and obese (OW/OB) women had lower levels of EXB motivation throughout pregnancy and lower prepregnancy EXB than normal weight (NW) women. A smaller proportion of women with a history of pregnancy loss endorsed beliefs positively related to EXB than women without a history of pregnancy loss. A larger proportion of OW/OB women recorded experiencing barriers to EXB than NW women. Pregnancy loss moderated the late pregnancy associations between anxiety and intention, and anxiety and EXB, respectively, in NW women such that highly motivated and active women with a history of pregnancy loss had higher levels of anxiety than highly motivated and active NW women without a history of pregnancy loss. Among OW/OB women, pregnancy loss moderated the association between early pregnancy intention and EXB such that first trimester intention more strongly influenced the EXB of women without a history of pregnancy loss compared to women who had previously experienced pregnancy loss. Conclusion: Both pregnancy loss and prepregnancy weight status contribute individual and combined influences on psychological well-being, TPB motivational determinants and EXB of pregnant women. Practitioners and interventions aimed at promoting EXB in pregnant women should target both prepregnancy weight status and pregnancy loss history and adapt as necessary to meet the unique needs of women.