Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany.
Department of Obstetrics, University of Leipzig, Leipzig, Germany.
PLoS One. 2024 Aug 26;19(8):e0309396. doi: 10.1371/journal.pone.0309396. eCollection 2024.
During pregnancy, women's bodies undergo rapid body weight and size changes within a relatively short period. Pregnancy may therefore, be associated with an increased vulnerability for developing body image dissatisfaction linked to adverse health outcomes for the mother (e.g., depression, eating disorders) and child (e.g., impaired self-regulation, childhood obesity). The present study aims to examine the prevalence and trajectories of body image dissatisfaction during pregnancy and postpartum and its relationship to pre-pregnancy BMI. This is the first study that investigates prevalence rates of body image dissatisfaction not only ante- but also postpartum, and that compares trajectories of women with normal weight and overweight.
A prospective longitudinal design with a quantitative approach was applied. Healthy pregnant women (N = 136) answered paper-pencil or online questionnaires at four time points (18th-22nd and 33rd-37th week of gestation, 3 and 6 months postpartum). Body image dissatisfaction was assessed using the German version of the Body Shape Questionnaire (BSQ) and the Eating Disorder Examination Questionnaire (EDE-Q). Both questionnaires are considered reliable and valid measures of several aspects of body image, and the BSQ allows for calculating prevalence rates by providing cut-off values. Using not just one but two body image questionnaires, trajectories of body image dissatisfaction can be compared. Pre-pregnancy BMI was assessed retrospectively via self-reported weight and height.
The proportion of women reporting elevated levels of body image dissatisfaction was 6.6% (n = 9) in the second trimester, 2.9% (n = 4) in the third trimester, 11.0% (n = 15) three months postpartum, and 10.3% (n = 14) six months postpartum. Repeated measures ANOVA revealed that body image dissatisfaction significantly decreased from pre-pregnancy to pregnancy, remained stable during pregnancy, and returned to pre-pregnancy levels three to six months postpartum. Mixed between-within ANOVA showed that the overweight/obese group reported significantly higher levels of body image dissatisfaction at each measurement point except during the third trimester than women in the normal weight group. Significant but small interaction effects between time and pre-pregnancy BMI were found.
The results revealed that approximately every tenth woman is affected by body image dissatisfaction after childbirth. Women with a higher BMI level before pregnancy are particularly at risk of experiencing body image dissatisfaction. Healthcare providers should screen for body image dissatisfaction, in particular after childbirth, and inform affected women about possible adverse health outcomes and treatment options. Study limitations concern the drop-out rate of 51.4% and the retrospective and self-reported assessment of pre-pregnancy BMI. Future studies should include additional assessment points in the first trimester and more than six months postpartum and try to include a matched control group of non-pregnant women to compare prevalence rates and trajectory of body image dissatisfaction.
怀孕期间，女性的身体在相对较短的时间内经历快速的体重和体型变化。因此，怀孕可能会增加与母亲（例如抑郁、饮食失调）和儿童（例如自我调节受损、儿童肥胖）不良健康后果相关的身体形象不满的脆弱性。本研究旨在检查怀孕期间和产后身体形象不满的发生率和轨迹及其与孕前 BMI 的关系。这是第一项不仅在产前而且在产后调查身体形象不满发生率的研究，并且比较了正常体重和超重女性的轨迹。
采用前瞻性纵向设计和定量方法。健康孕妇（N=136）在四个时间点（妊娠 18-22 周和 33-37 周，产后 3 个月和 6 个月）回答纸笔或在线问卷。使用德国版身体形状问卷（BSQ）和饮食失调检查问卷（EDE-Q）评估身体形象不满。这两个问卷都是评估身体形象的多个方面的可靠和有效的测量工具，BSQ 通过提供截断值来计算患病率。使用不只是一个而是两个身体形象问卷，可以比较身体形象不满的轨迹。通过自我报告的体重和身高回顾性评估孕前 BMI。
在第二个三个月报告身体形象不满水平升高的女性比例为 6.6%（n=9），第三个三个月为 2.9%（n=4），产后三个月为 11.0%（n=15），产后六个月为 10.3%（n=14）。重复测量方差分析显示，从孕前到孕期，身体形象不满显著下降，孕期保持稳定，产后 3-6 个月恢复到孕前水平。混合组内和组间方差分析显示，除了第三个三个月之外，超重/肥胖组在每个测量点的身体形象不满水平显著高于正常体重组。发现时间和孕前 BMI 之间存在显著但较小的交互作用。
结果表明，大约每十分之一的女性在产后会受到身体形象不满的影响。孕前 BMI 水平较高的女性特别容易出现身体形象不满。医疗保健提供者应筛查产后身体形象不满，并告知受影响的女性可能的不良健康后果和治疗选择。研究局限性在于 51.4%的脱落率以及孕前 BMI 的回顾性和自我报告评估。未来的研究应包括在第一个三个月增加额外的评估点，并在产后超过六个月进行研究，并尝试纳入非孕妇的匹配对照组以比较身体形象不满的患病率和轨迹。
