Systematic review of the associations between prenatal sleep behaviours and components of energy balance for regulating weight gain.

This systematic review aimed to examine the magnitude and direction of the associations between prenatal sleep behaviours (i.e. nighttime sleep duration, sleep quality, night awakenings and daytime nap duration) and eating behaviours, physical activity and gestational weight gain. A systematic search was conducted using Medline/PubMed, PsychINFO, CINAHL Complete, ProQuest Dissertations and Thesis A&I, and Web of Science to identify studies with at least one sleep measure, and either eating behaviours, physical activity and/or gestational weight gain. In summary, 11 studies met the review criteria and generated 11 total effect size across 10,900 participants. The majority of the studies were conducted after 2010, which highlights the infancy of this research. Overall, the strengths of the effect size were small: sleep-gestational weight gain (effect size = 0.29), sleep-eating behaviours (effect size = 0.13) and sleep-physical activity (effect size = 0.13). The only effect size that emerged as significant was for the pooled sleep behaviours-physical activity association; good sleep behaviours were positively associated with higher levels of physical activity. These findings summarize and provide insight on how sleep behaviours are related to prenatal gestational weight gain, eating behaviours and physical activity by identifying the strength and direction of the associations that have been previously unknown. Results support the rationale for future longitudinal and randomized control trials to examine the effects of sleep behaviours on gestational weight gain, eating behaviours and physical activity over the course of pregnancy.

Variation in urine osmolality throughout pregnancy: a longitudinal, randomized-control trial among women with overweight and obesity.

PURPOSE: Water needs increase during pregnancy, and proper hydration is critical for maternal and fetal health. This study characterized weekly hydration status changes throughout pregnancy and examined change in response to a randomized, behavioral intervention. An exploratory analysis tested how underhydration during pregnancy was associated with birth outcomes. METHODS: The Healthy Mom Zone Study is a longitudinal, randomized-control trial intervention aiming to regulate gestational weight gain (GWG) in pregnant women with overweight/obesity (n = 27). Fourteen women received standard of care; 13 women additionally received weekly guidance on nutrition, physical activity, water intake, and health-promoting behaviors. Hydration status was measured weekly via overnight urine osmolality (Uosm) from ~ 8-36 weeks gestation; underhydration was dichotomized (Uosm ≥ 500 mOsm/kg). Gestational age- and sex-standardized birth weight and length z scores and percentiles were calculated. We used mixed-effect and linear regression models to test covariate-adjusted relationships. RESULTS: No differences existed in Uosm or other characteristics between control and intervention women at baseline. Significant interactions (p = 0.01) between intervention and week of pregnancy on Uosm indicated intervention women maintained lower Uosm, whereas control women had a significant quadratic (inverse-U) relationship and greater Uosm in the second and early third trimesters. Results were consistent across robustness and sensitivity checks. Exploratory analyses suggest underhydration was associated with birth weight, but not length, in opposite ways in the second vs. third trimester. CONCLUSION: A multi-component behavioral intervention helped women with overweight/obesity maintain better hydration throughout pregnancy. Future studies should confirm birth outcome results as they have important implications for early life nutrition. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03945266; registered May 10, 2019 retrospectively.

Optimizing Behavioral Interventions to Regulate Gestational Weight Gain With Sequential Decision Policies Using Hybrid Model Predictive Control.

Excessive gestational weight gain is a significant public health concern that has been the recent focus of control systems-based interventions. Healthy Mom Zone (HMZ) is an intervention study that aims to develop and validate an individually-tailored and "intensively adaptive" intervention to manage weight gain for pregnant women with overweight or obesity using control engineering approaches. This paper presents how Hybrid Model Predictive Control (HMPC) can be used to assign intervention dosages and consequently generate a prescribed intervention with dosages unique to each individuals needs. A Mixed Logical Dynamical (MLD) model enforces the requirements for categorical (discrete-level) doses of intervention components and their sequential assignment into mixed-integer linear constraints. A comprehensive system model that integrates energy balance and behavior change theory, using data from one HMZ participant, is used to illustrate the workings of the HMPC-based control system for the HMZ intervention. Simulations demonstrate the utility of HMPC as a means for enabling optimized complex interventions in behavioral medicine, and the benefits of a HMPC framework in contrast to conventional interventions relying on "IF-THEN" decision rules.

Adaptive, behavioral intervention impact on weight gain, physical activity, energy intake, and motivational determinants: results of a feasibility trial in pregnant women with overweight/obesity.

Interventions have modest impact on reducing excessive gestational weight gain (GWG) in pregnant women with overweight/obesity. This two-arm feasibility randomized control trial tested delivery of and compliance with an intervention using adapted dosages to regulate GWG, and examined pre-post change in GWG and secondary outcomes (physical activity: PA, energy intake: EI, theories of planned behavior/self-regulation constructs) compared to a usual care group. Pregnant women with overweight/obesity (N = 31) were randomized to a usual care control group or usual care + intervention group from 8 to 2 weeks gestation and completed the intervention through 36 weeks gestation. Intervention women received weekly evidence-based education/counseling (e.g., GWG, PA, EI) delivered by a registered dietitian in a 60-min face-to-face session. GWG was monitored weekly; women within weight goals continued with education while women exceeding goals received more intensive dosages (e.g., additional hands-on EI/PA sessions). All participants used mHealth tools to complete daily measures of weight (Wi-Fi scale) and PA (activity monitor), weekly evaluation of diet quality (MyFitnessPal app), and weekly/monthly online surveys of motivational determinants/self-regulation. Daily EI was estimated with a validated back-calculation method as a function of maternal weight, PA, and resting metabolic rate. Sixty-five percent of eligible women were randomized; study completion was 87%; 10% partially completed the study and drop-out was 3%. Compliance with using the mHealth tools for intensive data collection ranged from 77 to 97%; intervention women attended > 90% education/counseling sessions, and 68-93% dosage step-up sessions. The intervention group (6.9 kg) had 21% lower GWG than controls (8.8 kg) although this difference was not significant. Exploratory analyses also showed the intervention group had significantly lower EI kcals at post-intervention than controls. A theoretical, adaptive intervention with varied dosages to regulate GWG is feasible to deliver to pregnant women with overweight/obesity.

System Identification Approaches For Energy Intake Estimation: Enhancing Interventions For Managing Gestational Weight Gain.

Excessive maternal weight gain during pregnancy represents a major public health concern that calls for novel and effective gestational weight management interventions. In Healthy Mom Zone (HMZ), an on-going intervention study, energy intake underreporting has been found to be an important consideration that interferes with accurate weight control assessment, and the effective use of energy balance models in an intervention setting. In this paper, a series of estimation approaches that address measurement noise and measurement losses are developed to better understand the extent of energy intake underreporting. These include back-calculating energy intake from an energy balance model developed for gestational weight gain prediction, a Kalman filtering-based approach to recursively estimate energy intake from intermittent measurements in real-time, and an approach based on semi-physical identification principles which features the capability of adjusting future self-reported energy intake by parameterizing the extent of underreporting. The three approaches are illustrated by evaluating with participant data obtained through the HMZ intervention study, with the results demonstrating the potential of these methods to promote the success of weight control. The pros and cons of the presented approaches are discussed to generate insights for users in future applications.

Breastfeeding initiation and duration and child health outcomes in the first baby study.

Despite the known benefits of breastmilk, associations between breastfeeding and child overall health outcomes remain unclear. We aimed to understand associations between breastfeeding and health outcomes, including child weight, through age 3. Analysis included women (N = 3006) in the longitudinal, prospective First Baby Study from 2009 to 2014. For this analysis, breastfeeding initiation and duration were measured using self-reported data from the 1-, 6- and 12-month surveys; child illnesses were analyzed from the 6-, 12-, and 24-month interviews; height and weight at age 3 were used to determine overweight/obese (≥85th percentile) and obese (≥95th percentile). Adjusted logistic regressions were utilized to determine significance. Greater duration of breastfeeding was associated with fewer reported acute illnesses at 6 months (p < 0.001) and fewer diarrheal illness/constipation episodes at 6, 12, and 24 months (p = 0.05) in adjusted analyses. Fewer breastfed children, compared to non-breastfed children, were overweight/obese (23.5% vs. 37.8%; p = 0.032) or obese (9.1% vs. 21.6%; p = 0.012) at age 3. Breastfeeding duration was negatively associated with overweight/obese (never breastfed: 37.8%, 0-6 months: 26.9%, >6 months: 20.2%; p = 0.020) and obesity (never breastfed: 21.6%, 0-6 months: 11.0%, >6 months: 7.3%; p = 0.012). Overall, our findings support the hypothesis that duration of breastfeeding is associated with fewer reported acute illnesses at 6 months of age and diarrheal illness and/or constipation episodes at 6, 12, and 24 months. Additionally, results from our study suggest a protective effect of breastfeeding from childhood overweight/obesity, as children who received breastmilk for 6 months or longer had lower odds of overweight/obesity at age 3 years.

A Dynamical Systems Model of Intrauterine Fetal Growth.

The underlying mechanisms for how maternal perinatal obesity and intrauterine environment influence fetal development are not well understood and thus require further understanding. In this paper, energy balance concepts are used to develop a comprehensive dynamical systems model for fetal growth that illustrates how maternal factors (energy intake and physical activity) influence fetal weight and related components (fat mass, fat-free mass, and placental volume) over time. The model is estimated from intensive measurements of fetal weight and placental volume obtained as part of Healthy Mom Zone (HMZ), a novel intervention for managing gestational weight gain in obese/overweight women. The overall result of the modeling procedure is a parsimonious system of equations that reliably predicts fetal weight gain and birth weight based on a sensible number of assessments. This model can inform clinical care recommendations as well as how adaptive interventions, such as HMZ, can influence fetal growth and birth outcomes.

Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes.

OBJECTIVES: Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM). DESIGN: Randomized control trial with two intervention arms and control (standard care). METHOD: Participants (N=65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records. RESULTS: At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < .05) and significantly higher exercise min and subjective norm than the Home group (p's < .05); these effect sizes were medium-large (η2 = .11-.23). There was a medium effect (η2 = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups. CONCLUSION: A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.

Control systems engineering for optimizing a prenatal weight gain intervention to regulate infant birth weight.

OBJECTIVES: We used dynamical systems modeling to describe how a prenatal behavioral intervention that adapts to the needs of each pregnant woman may help manage gestational weight gain and alter the obesogenic intrauterine environment to regulate infant birth weight. METHODS: This approach relies on integrating mechanistic energy balance, theory of planned behavior, and self-regulation models to describe how internal processes can be impacted by intervention dosages, and reinforce positive outcomes (e.g., healthy eating and physical activity) to moderate gestational weight gain and affect birth weight. RESULTS: A simulated hypothetical case study from MATLAB with Simulink showed how, in response to our adaptive intervention, self-regulation helps adjust perceived behavioral control. This, in turn, changes the woman's intention and behavior with respect to healthy eating and physical activity during pregnancy, affecting gestational weight gain and infant birth weight. CONCLUSIONS: This article demonstrates the potential for real-world applications of an adaptive intervention to manage gestational weight gain and moderate infant birth weight. This model could be expanded to examine the long-term sustainable impacts of an intervention that varies according to the participant's needs on maternal postpartum weight retention and child postnatal eating behavior.

Every sip counts: Understanding hydration behaviors and user-acceptability of digital tools to promote adequate intake during early and late pregnancy.

Maintaining adequate hydration over the course of pregnancy is critical for maternal and fetal health and reducing risks for adverse pregnancy outcomes (e.g., preeclampsia, low placental and amniotic fluid volume). Recent evidence suggests that women may be at risk for under-hydration in the second and third trimesters when water needs begin to increase. Scant research has examined pregnant women's knowledge of hydration recommendations, water intake behaviors, and willingness to use digital tools to promote water intake. This study aimed to: 1) describe hydration recommendation knowledge and behaviors by the overall sample and early vs late pregnancy, and 2) identify habits and barriers of using digital tools. Pregnant women (N = 137; M age = 30.9 years; M gestational age = 20.9) completed a one-time, 45-minute online survey. Descriptive statistics quantified women's knowledge of hydration recommendations, behaviors, and attitudes about utilizing digital tools to promote adequate intake, and Mann-Whitney U and chi-squared tests were used to determine group differences. Most women lacked knowledge of and were not meeting hydration recommendations (63%, 67%, respectively) and were not tracking their fluid consumption (59%). Knowledge of hydration recommendations differed by time of pregnancy, such that women in later pregnancy reported 82 ounces compared to women in early pregnancy (49 ounces). Common barriers included: forgetting to drink (47%), not feeling thirsty (47%), and increased urination (33%). Most were willing to use digital tools (69%) and believed a smart water bottle would help them achieve daily fluid recommendations (67%). These initial findings suggest that pregnant women may benefit from useful strategies to increase knowledge, decrease barriers, and maintain adequate hydration, specifically earlier in pregnancy. These findings will inform the design of a behavioral intervention incorporating smart connected water bottles, wearables for gesture detection, and behavior modification strategies to overcome barriers, promote proper hydration and examine its impact on maternal and infant health outcomes.

Feasibility and user acceptability of Breezing™, a mobile indirect calorimetry device, in pregnant women with overweight or obesity.

Emerging evidence has suggested that prenatal resting energy expenditure (REE) may be an important determinant of gestational weight gain. Advancements in technology such as the real-time, mobile indirect calorimetry device (Breezing™) have offered the novel opportunity to continuously assess prenatal REE while also potentially capturing fluctuations in REE. The purpose of this study was to examine feasibility and user acceptability of Breezing™ to assess weekly REE from 8-36 weeks gestation in pregnant women with overweight or obesity participating in the Healthy Mom Zone intervention study. Participants (N=27) completed REE assessments once per week from 8-36 gestation using Breezing™. Feasibility of the device was calculated as compliance (# of weeks used/total # of weeks). User acceptability was measured by asking women to report on the device's enjoyability and barriers. Median compliance was 68%. However, when weeks women experienced technical difficulties (11 of 702 total events) and the device was unavailable were removed (13 of 702 total events), median compliance increased to 71%. Over half (56%) of the women reported that the device was enjoyable or they had neutral feelings about it whereas the remaining 44% reported that it was not enjoyable. The most common barrier reported (44%) was the experience of technical issues. Study compliance data suggest the feasibility of using Breezing™ to assess prenatal REE is promising. However, acceptability data suggest future interventionists should develop transparent and informative protocols to address any barriers prior to implementing the device to increase use.

Women's beliefs of pain after childbirth: Critical insight for promoting behavioral strategies to regulate pain and reduce risks for maternal mortality.

OBJECTIVE: Promoting behavioral strategies to better regulate pain and decrease the use of prescription pain medications immediately after childbirth is an attractive approach to reduce risks for adverse outcomes associated with the maternal mortality crisis. This study aimed to understand women's beliefs and experiences about pain management to identify important insights for promoting behavioral strategies to control postpartum pain. METHODS: N = 32 postpartum women participated in a semi-structured interview about beliefs/experiences with managing postpartum pain. Higher- and lower-order themes were coded; descriptive statistics were used to summarize results. RESULTS: Major trends emerging from the data were: (1) most women used a combination of medications (e.g., oxycodone and acetaminophen) and behavioral strategies (e.g., physical activity) in the hospital (94 %) and at discharge (83 %); (2) some women reported disadvantages like negative side effects of medications and fatigue from physical activity; and (3) some women reported they would have preferred to receive more evidence-based education on behavioral strategies during prenatal visits. CONCLUSION: Our findings showed that most women were prescribed medications while in the hospital and at discharge, and used non-prescription, behavioral strategies. PRACTICAL IMPLICATIONS: Future research is needed to test behavioral strategies in randomized clinical trials and clinical care settings to identify impact on reducing adverse maternal health outcomes.

My Baby, My Move+: feasibility of a community prenatal wellbeing intervention.

BACKGROUND: Excessive gestational weight gain (EGWG), insufficient prenatal physical activity and sleep, and poor psychological wellbeing independently increase risks for adverse maternal and infant outcomes. A novel approach to mitigate these risks is utilizing peer support in a community-based prenatal intervention. This study assessed the feasibility (acceptability, demand, implementation, and practicality) of a remotely delivered prenatal physical activity intervention called My Baby, My Move + (MBMM +) that aims to increase prenatal physical activity, enhance mood and sleep hygiene, and reduce EGWG. METHODS: Participants were recruited through community organizations, local clinics, and social media platforms in the Fall of 2020 and Spring of 2021. Eligible pregnant women were randomized to either the MBMM + intervention or the control group. Each group met over Zoom for 16 sessions (twice weekly for 60 min over 8 weeks) to learn either behavioral change and wellbeing knowledge and skills (MBMM +) or knowledge and skills related to parenting (control group). Multiple methods of evaluation to better understand the feasibility of the intervention were conducted. RESULTS: A total of 49 women (25 MBMM + intervention, 24 control) completed both pre- and post-survey assessments and were included in the analyses. A subsample of 19 (39%) intervention participants completed a combination of semi-structured interviews/surveys to assess acceptability, demand, implementation, and practicality. Participants expressed positive feedback regarding acceptability (satisfaction and intent to continue use) and were extremely likely or likely to recommend the program to a friend (demand). Implementation metrics were assessed by observation and feedback forms completed by peer leaders and demonstrated high-quality control. Findings suggest that the intervention was practical due to remote sessions and cost-effectiveness. CONCLUSION: The MBMM + intervention was deemed to be a feasible intervention with high acceptability, demand, implementation, and practicality. These findings can be used to inform the scalability of the intervention and implementation of a larger efficacy trial. TRIAL REGISTRATION: 19-1366, initial date is on January 23, 2020.

Assessment of postural sway with a pendant-mounted wearable sensor.

BACKGROUND: Body-worn inertial measurement unit (IMU) sensors have been widely used in postural stability and balance studies because of their low cost and convenience. In most of these studies, a single IMU sensor is attached to a waist belt near the body's center of mass. Some populations such as pregnant women, however, may find a waist belt challenging in terms of fit and comfort. For this reason it may be useful to identify an alternative location for placement of an IMU and a more comfortable means for attaching the sensor to the body. Research question Does placing an IMU sensor in a pendant worn around the neck permit discrimination between conditions with varying postural stability? METHODS: Twenty-six healthy participants performed three standing tasks (double-leg, tandem, and single-leg standing) under eyes-open and eyes-closed vision conditions to preliminarily assess the ability of the pendant sensor to discriminate between balance conditions. Discrimination based upon data from a belt-mounted IMU was assessed in the same trials. Differences in standard deviation of acceleration components, sway area, and jerkiness due to trial condition and sensor were evaluated using analysis of variance followed by post hoc comparisons. These data were also incorporated into receiver-operator characteristic (ROC) curve analysis to assess the effectiveness of each sensor at discriminating between conditions. RESULTS: Stability was found to vary across conditions, but there was no interaction between stability and sensor location (all p ≥ 0.323). ROC curve analysis showed that sensors in both locations were good discriminators between conditions. Significance Placing an IMU in a pendant may be feasible for studying and monitoring postural instability. This approach may be especially valuable when considering populations for which wearing a belt is uncomfortable.

The influence of sleep and movement on mental health and life satisfaction during the transition to parenthood.

OBJECTIVES: This study assessed whether sleep and physical activity impact mental health and life satisfaction across the transition to parenthood. This study assessed the impact of parenthood on mental health of new parents and parents expecting their second child, and whether change in mental health occurred dyadically across couples. DESIGN: Longitudinal 12-month study. PARTICIPANTS: One hundred and fifty-seven couples (N = 314) between the ages of 25 and 40, who were not expecting to have a child (n = 102), expecting their first child (n = 136), or expecting their second child (n = 76) were recruited. MEASUREMENTS: Participants completed measures at baseline, 6 months, and 12 months. Sleep was assessed with how often participants met sleep guidelines (7-9 hours). Physical activity was measured objectively via accelerometers. Mental health was measured using 6 items from the short form-12 Quality of Life Survey. Life satisfaction was assessed with the Satisfaction with Life Scale (5 items). RESULTS: Mental health was not predicted by physical activity but was predicted by sleep. Sleep at 6 months was positively related to mental health at 6 months (ß = 0.156, p < .001), and sleep at 12 months was positively related to mental health at 12 months (ß = 0.170, p < .001). The change in mental health did not occur dyadically: mental health increased for women but not for men across groups. Mental health was positively related to life satisfaction at 6 months (ß = 0.338, p < .001) and 12-months (ß = 0.277, p < .001). CONCLUSIONS: For new and established parents, getting sufficient sleep plays an important role in mental health and, in turn, life satisfaction.

Fostering spirituality and psychosocial health through mind-body practices in underserved populations.

BACKGROUND: This study examined changes in spirituality and psychosocial outcomes among African American and rural adults participating in a culturally-adapted mind-body intervention. METHODS: African American (n = 22) and rural (n = 38) adults in Harmony & Health attended mind-body sessions twice a week for eight weeks and completed questionnaires on spirituality and psychosocial distress at baseline and post-intervention. Linear regression and repeated measures analyses were used to examine associations between intervention attendance and spirituality. RESULTS: Attendance was significantly associated with increased spirituality (ß=0.168, p = 013). Repeated measures analyses revealed a significant three-way interaction between attendance, spirituality, and study site (F(9,31)=2.891, p = 013). Urban African American participants who attended ≥75% of sessions reported greater increases in spirituality. CONCLUSION: Findings suggest that mind-body practices may foster spirituality in urban African American adults. Additional adaptations are needed to strengthen spirituality in rural residents and to improve psychosocial health and wellbeing in this underserved population.

Obstetricians' prescribing practices for pain management after delivery.

Aim: To examine postpartum opioid prescribing practices. Materials & methods: Obstetricians were interviewed about opioids: choice of opioid, clinical factors considered when prescribing, thoughts/beliefs about prescribing, and typical counseling provided. Inductive thematic analyses were used to identify themes. Results: A total of 38 interviews were analyzed. Several key points emerged. The choice of opioid, dosing and number of pills prescribed varied widely. The mode of delivery is the primary consideration for prescribing opioids. All providers would prescribe opioids to breastfeeding women. Some providers offered counseling on nonopioid treatment of pain. Discussion: At two large tertiary centers in Pennsylvania, the 38 physicians interviewed wrote 38 unique opioid prescriptions. Patient counseling addressed short-term pain management, but not the chronic overuse of opioids.

We wanted to look at the way opioid pain drugs are provided to mothers after the birth of their children and see what doctors tell mothers about the pain drugs. We interviewed doctors and asked which opioid pain drug they would choose, what made them prescribe the drug, the thoughts about giving mothers the drug and what they told the mothers about the drug. We then looked at all the responses to look for patterns in how doctors gave pain drugs to mothers. Our team interviewed 38 doctors. Some key points were seen; first is that the choice of opioid pain drug, dose and number of pills prescribed was different from doctor to doctor; second is that whether the baby was delivered vaginally or by cesarean was the main factor upon which doctors based their decisions for giving opioid pain drugs. Whether a mother was taking medications that help with addiction, the doctor's assessment of the mother's pain and the doctor's thoughts on the mother's risk of opioid addiction were also considered. All doctors would give opioid pain drugs to breastfeeding mothers. Finally, some doctors talked to mothers about using other medications for pain, but not about the overuse of opioid pain drugs. At our two hospital centers in Pennsylvania, the 38 doctors gave opioid pain drugs to mothers in 38 different ways. Doctors said that opioids are necessary after cesarean, but not after vaginal birth, unless there is a problem. A mother's history and social situation inform decision making. Doctors talk to mothers about short-term pain, but not about the overuse of opioid pain drugs.

Mediating effects of body image satisfaction on exercise behavior, depressive symptoms, and gestational weight gain in pregnancy.

BACKGROUND: Body image satisfaction in pregnancy may have an important influence on maternal biopsychosocial outcomes. PURPOSE: This study aims to examine the mediating influence of trimesters 2 and 3 body image satisfaction on trimesters 2 and 3 depressive symptoms, exercise behavior, and gestational weight gain. METHODS: Pregnant women (N = 151; mean age = 30) prospectively completed study measures via mail during their 1st, 2nd, and 3rd trimesters. RESULTS: As predicted, trimesters 2 and 3 body image satisfaction mediated the relationship between trimester 1 body image satisfaction and trimester 2 depressive symptoms and the relationship between trimester 2 body image satisfaction and trimester 3 depressive symptoms. In contrast to the hypothesis, no mediation was observed for the relationship between body image satisfaction and exercise behavior or gestational weight gain. CONCLUSIONS: These preliminary findings demonstrate that body image satisfaction is an important psychological determinant of depressive symptoms in pregnancy. Promoting healthy body image may be a non-pharmacological strategy that offers protective effects against depressive symptoms during pregnancy.

Preconception predictors of birth outcomes: prospective findings from the central Pennsylvania women's health study.

OBJECTIVE: To examine maternal pre-pregnancy (preconception) predictors of birthweight and fetal growth for singleton live births occurring over a 2-year period in a prospective study. METHODS: Data are from a population-based cohort study of 1,420 women who were interviewed at baseline and 2-years later; self-report data and birth records were obtained for incident live births during the followup period. The analytic sample includes 116 singleton births. Baseline preconception maternal health status and health-related behaviors were examined as predictors of birthweight and fetal growth, controlling for prenatal and sociodemographic variables, using multiple regression analysis. RESULTS: Preconception BMI (overweight or obese) and vegetable consumption (at least one serving per day) had statistically significant independent and positive effects on birthweight and fetal growth. Maternal weight gain during pregnancy, a prenatal variable, was an additional independent predictor of birthweight and fetal growth. Sociodemographic variables were not significant predictors after controlling for preconception and prenatal maternal characteristics. CONCLUSIONS: Findings confirm that preconception maternal health status and health-related behaviors can affect birthweight and fetal growth independent of prenatal and socioeconomic variables. Implications for preconception care are discussed.

Obstetric Physicians' Beliefs and Knowledge on Guidelines and Screening Tools to Reduce Opioid Use After Childbirth.

OBJECTIVE: To examine obstetric physicians' beliefs about using professional or regulatory guidelines, opioid risk-screening tools, and preferences for recommending nonanalgesic therapies for postpartum pain management. METHODS: A qualitative study design was used to conduct semi-structured interviews with obstetric and maternal-fetal medicine physicians (N=38) from two large academic health care institutions in central Pennsylvania. An interview guide was used to direct the discussion about each physicians' beliefs in response to questions about pain management after childbirth. RESULTS: Three trends in the data emerged from physicians' responses: 1) 71% of physicians relied on their clinical insight rather than professional or regulatory guidelines to inform decisions about pain management after childbirth; 2) although many reported that a standard opioid patient screening tool would be useful to inform clinical decisions about pain management, nearly all (92%) physician respondents reported not currently using one; and 3) 63% thought that nonpharmacologic pain management therapies should be used whenever possible to manage pain after childbirth. Key physician barriers (eg, lack time and evidence, being unaware of how to implement) and patient barriers (eg, take away from other responsibilities, no time or patience) to implementation were also identified. CONCLUSION: These findings suggest that obstetric physicians' individual beliefs and clinical insight play a key role in pain management decisions for women after childbirth. Practical and scalable strategies are needed to: 1) encourage obstetric physicians to use professional or regulatory guidelines and standard opioid risk-screening tools to inform clinical decisions about pain management after childbirth, and 2) educate physicians and patients about nonopioid and nonpharmacologic pain management options to reduce exposure to prescription opioids after childbirth.