The relationship between social determinants of health and postpartum weight retention based on the World Health Organization model: path analysis

Abstract

Background Postpartum weight retention (PPWR) causes obesity, chronic diseases, and occurring adverse maternal-fetal and neonatal outcomes. Given the social factors’ effect on health and disease and considering the lack of information on social determinants of health (SDH) effects on PPWR, this study was conducted to survey the relationship between SDH and PPWR based on the World Health Organization (WHO) model. Methods A cross-sectional study was performed on 400 women six months after delivery in 2020. Twelve health centers were randomly selected from the three universities of Medical Sciences in the city of Tehran, Iran. Participants were selected by convenience method and based on eligibility. Questionnaires used included: Lifestyle Profile Health Promoting II, Short Form Postpartum Quality of Life Questionnaire, Multidimensional Scale of Perceived Social Support, Postpartum Social Support, Depression Anxiety Stress Scales, and questionnaires designed by reviewing the literature about breastfeeding, sleep, contraceptive, child health, unhealthy behaviors, postpartum nutritional awareness/beliefs, body satisfaction, access to postpartum care, socioeconomic status, demographic, and obstetric questionnaire. Data analysis was performed in SPSS-23, and the relationship model was examined using the path analysis method in LISREL-8.8. Results Path analysis indicated the direct effect of six intermediate factors on PPWR including: gestational weight gain (β = 0.42), access to postpartum care (β = 0.11), postpartum nutritional awareness/beliefs (β=-0.17), anxiety (β = 0.09), sleep duration (β=-0.09), pre-pregnancy body mass index (β = 0.09). Among the structural factors, woman’s education and socioeconomic status had an indirect negative effect on PPWR. The model fit indices showed good fit (RMSE = 0/05, GFI = 0.92, CFI = 0.92, χ2/df = 2.17). Conclusion The results indicate the effect of structural and intermediate determinants of health on PPWR. It is recommended to use the proposed model as an appropriate framework in the research, design, and implementation of programs to prevent and control PPWR.

Relationships among Postpartum Weight Retention, Stress, and Disinhibited Eating: A Scoping Review

“…A recent systematic review examined the relationships between depression, stress, and anxiety and PPWR. 35 Six articles were reviewed relating specifically to stress and PPWR and of those articles, 4 found statistically significant, although mixed, findings. 17,[36][37][38] These 4 papers were also included in database findings for this review, as well as 4 others that give further context to the concepts of PPWR and stress.…”

Adverse perinatal events and maternal interpregnancy weight change: A population‐based observational study

“…The birth of a sick child or the death of a newborn can profoundly affect a mother's well‐being. Mothers of sick children are prone to high chronic mental stress and sleeplessness, each of which is a risk factor for self‐neglect and greater weight 7 . Preliminary Danish registry data reported a 0.26 kg (95% confidence interval [CI]: 0.10 to 0.42) higher net interpregnancy weight gain in women who gave birth to an infant with a congenital anomaly than in women with an unaffected infant 8 .…”

“…Mothers of sick children are prone to high chronic mental stress and sleeplessness, each of which is a risk factor for self-neglect and greater weight. 7 Preliminary Danish registry data reported a 0.26 kg (95% confidence interval [CI]: 0.10 to 0.42) higher net interpregnancy weight gain in women who gave birth to an infant with a congenital anomaly than in women with an unaffected infant. 8 However, whether that finding was confounded by genetic or environmental factors associated with both the development of a congenital anomaly and poor maternal health is unclear.…”