Postpartum weight retention (PPWR) is a significant contributor to maternal cardiometabolic disease risk. The transition to motherhood is a stressful time period in which women report consuming food to cope, an eating behavior that is associated with PPWR. In this scoping review, we identified original research and review articles published since 2010 that examined relationships among PPWR, maternal stress, and disinhibited eating. In total, 16 articles met the inclusion criteria. Findings were inconsistent related to PPWR and stress. PPWR and disinhibited eating were not significantly correlated; however, disinhibition scores were higher during the postpartum period compared to prenatally. Stress and disinhibited eating were directly correlated in 4 studies. Our findings suggest these concepts, particularly disinhibited eating, have not been robustly examined during the postpartum period. Additionally, instruments used to measure maternal stress vary widely and should be further studied and refined.
KassebaumNJBertozzi-VillaACoggeshallMS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. Sep132014;384(9947):980-1004. doi:10.1016/s0140-6736(14)60696-6.
2.
PetersenEEDavisNLGoodmanD, et al. Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017. MMWR Morb Mortal Wkly Rep. May102019;68(18):423-429. doi:10.15585/mmwr.mm6818e1.
HirshbergASrinivasSK.Epidemiology of maternal morbidity and mortality. Semin Perinatol. Oct2017;41(6):332-337. doi:10.1053/j.semperi.2017.07.007.
6.
KilpatrickSKEckerJL.Severe maternal morbidity: screening and review. Am J Obstet Gynecol. 2016;215(3):B17-B22.
7.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Obstetrics. Obesity in pregnancy: ACOG practice bulletin, number 230. Obstet Gynecol. 2021;137(6):e128-e144. doi:10.1097/AOG.0000000000004395.
8.
SaucedoMEsteves-PereiraAPPencoléL, et al. Understanding maternal mortality in women with obesity and the role of care they receive: a national case-control study. Int J Obes. 2021;45(1):258-265. doi:10.1038/s41366-020-00691-4.
9.
CatalanoPdeMouzonSH.Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes. Int J Obes. 2015;39(4):642-649. doi:10.1038/ijo.2015.15.
10.
PostonLCaleyachettyRCnattingiusS, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. Dec2016;4(12):1025-1036. doi:10.1016/s2213-8587(16)30217-0.
Rich-EdwardsJWFraserALawlorDACatovJM.Pregnancy characteristics and women’s future cardiovascular health: an underused opportunity to improve women’s health?Epidemiol Rev. 2014;36(1):57-70. doi:10.1093/epirev/mxt006.
13.
OgdenCLCarrollMDCurtinLRMcDowellMATabakCJFlegalKM.Prevalence of overweight and obesity in the United States, 1999-2004. Jama. Apr52006;295(13):1549-1555. doi:10.1001/jama.295.13.1549.
RasmussenKMYaktineAL, eds. Weight Gain during Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press (US); 2009.
16.
LinnéYDyeLBarkelingBRössnerS.Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res. Jul2004;12(7):1166-1178. doi:10.1038/oby.2004.146.
17.
WhitakerKYoung-HymanDVernonMWilcoxS.Maternal stress predicts postpartum weight retention. Matern Child Health J. Nov2014;18(9):2209-2217. doi:10.1007/s10995-014-1470-7
18.
EndresLKStraubHMcKinneyC, et al. Postpartum weight retention risk factors and relationship to obesity at 1 year. Obstet Gynecol. Jan2015;125(1):144-152. doi:10.1097/aog.0000000000000565.
19.
ChristensonAJohanssonEReynisdottirSTorgersonJHemmingssonE.Women’s perceived reasons for their excessive postpartum weight retention: a qualitative interview study. PLoS One. 2016;11(12):e0167731. doi:10.1371/journal.pone.0167731.
20.
PedersenPBakerJLHenriksenTB, et al. Influence of psychosocial factors on postpartum weight retention. Obesity (Silver Spring). Mar2011;19(3):639-646. doi:10.1038/oby.2010.175.
21.
BaumA.Stress, intrusive imagery, and chronic distress. Health Psychol. 1990;9(6):653-675. doi:10.1037//0278-6133.9.6.653.
22.
Dunkel SchetterC. Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annu Rev Psychol. 2011;62:531-558. doi:10.1146/annurev.psych.031809.130727.
23.
KumarRRizviMRSaraswatS.Obesity and stress: a contingent paralysis. Int J Prev Med. 2022;13:95. doi:10.4103/ijpvm.IJPVM_427_20.
24.
ChaoAMJastreboffAMWhiteMAGriloCMSinhaR.Stress, cortisol, and other appetite-related hormones: prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring). Apr2017;25(4):713-720. doi:10.1002/oby.21790.
25.
SchellekensHFingerBCDinanTGCryanJF.Ghrelin signalling and obesity: at the interface of stress, mood and food reward. Pharmacol Ther. Sep2012;135(3):316-326. doi:10.1016/j.pharmthera.2012.06.004.
26.
TorresSJNowsonCA.Relationship between stress, eating behavior, and obesity. Nutrition. Nov-Dec2007;23(11-12):887-894. doi:10.1016/j.nut.2007.08.008.
27.
BijlholtMVan UytselHAmeyeLDevliegerRBogaertsA.Eating behaviors in relation to gestational weight gain and postpartum weight retention: a systematic review. Obes Rev. Oct2020;21(10):e13047. doi:10.1111/obr.13047.
28.
StunkardAJMessickS.The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29(1):71-83. doi:10.1016/0022-3999(85)90010-8.
29.
ProvencherVDrapeauVTremblayADesprésJPLemieuxS.Eating behaviors and indexes of body composition in men and women from the Québec family study. Obes Res. Jun2003;11(6):783-792. doi:10.1038/oby.2003.109.
30.
ZellnerDALoaizaSGonzalezZ, et al. Food selection changes under stress. Physiol Behav. Apr152006;87(4):789-793. doi:10.1016/j.physbeh.2006.01.014.
31.
BellisleFClémentKLe BarzicMLe GallAGuy-GrandBBasdevantA.The Eating Inventory and body adiposity from leanness to massive obesity: a study of 2509 adults. Obes Res. Dec2004;12(12):2023-2030. doi:10.1038/oby.2004.253.
32.
KrugerRDe BrayJGBeckKLConlonCAStonehouseW.Exploring the relationship between body composition and eating behavior using the Three Factor Eating Questionnaire (TFEQ) in young New Zealand women. Nutrients. 2016;8(7):386. doi:10.3390/nu8070386.
33.
TriccoACLillieEZarinW, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. Oct22018;169(7):467-473. doi:10.7326/m18-0850.
34.
DangDDearholtSLBissettKAscenziJWhalenM.Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model and Guidelines. Sigma Theta Tau; 2021.
35.
BazzazianSRiaziHVafaM, et al. The relationship between depression, stress, anxiety, and postpartum weight retention: a systematic review. J Educ Health Promot. 2021;10:230. doi:10.4103/jehp.jehp_1409_20.
36.
GoldsteinNDRogersSEhrenthalDB.The impact of psychosocial stressors on postpartum weight retention. Arch Womens Ment Health. Aug2016;19(4):691-694. doi:10.1007/s00737-016-0613-9
37.
PhillipsJKingRSkouterisH.The influence of psychological factors on post-partum weight retention at 9 months. Br J Health Psychol. Nov2014;19(4):751-766. doi:10.1111/bjhp.12074.
38.
StraubHSimonCPlunkettBA, et al. Evidence for a complex relationship among weight retention, cortisol and breastfeeding in postpartum women. Matern Child Health J. Jul2016;20(7):1375-1383. doi:10.1007/s10995-016-1934-z.
39.
CollingsRHillBSkouterisH.The influence of psychological factors on postpartum weight retention 12 months post-birth. J Reprod Infant Psychol. Apr2018;36(2):177-191. doi:10.1080/02646838.2018.1424323.
40.
LeonardKSAdamsELSavageJS, et al. Influence of prenatal perceived stress on postpartum weight retention is mediated by high gestational weight gain in women with overweight. Clin Obes. Jun2021;11(3):e12446. doi:10.1111/cob.12446.
41.
MagriplesUBoyntonMHKershawTS, et al. The impact of group prenatal care on pregnancy and postpartum weight trajectories. Am J Obstet Gynecol. Nov2015;213(5):688.e1-e9. doi:10.1016/j.ajog.2015.06.066.
42.
LobelM.The revised pregnancy distress questionnaire (NUPDQ). Stony Brook (NY): State University of New York at Stony Brook; 1996.
LovibondPFLovibondSH.The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. Mar1995;33(3):335-343. doi:10.1016/0005-7967(94)00075-u.
45.
WilliamsPGoldbergD.A User’s Guide to the General Health Questionnaire. Berkshire: NFER, Nelson. 1988;1988
46.
CohenSKamarckTMermelsteinR.A global measure of perceived stress. J Health Soc Behav. Dec1983;24(4):385-396.
47.
MostJAltazanADSt AmantMBeylRARavussinERedmanLM.Increased energy intake after pregnancy determines postpartum weight retention in women with obesity. J Clin Endocrinol Metab. Apr12020;105(4):e1601-e1611. doi:10.1210/clinem/dgz330.
48.
PhelanSPhippsMGAbramsB, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Am J Clin Nutr. Feb2014;99(2):302-311. doi:10.3945/ajcn.113.070151.
49.
PhelanSWingRRBrannenA, et al. Does partial meal replacement during pregnancy reduce 12-month postpartum weight retention?Obesity (Silver Spring). Feb2019;27(2):226-236. doi:10.1002/oby.22361.
50.
GroeszLMMcCoySCarlJ, et al. What is eating you? Stress and the drive to eat. Appetite. Apr2012;58(2):717-721. doi:10.1016/j.appet.2011.11.028.
51.
JosephPVDavidsonHRBoulineauxCM, et al. Eating behavior, stress, and adiposity: discordance between perception and physiology. Biol Res Nurs. Oct2018;20(5):531-540. doi:10.1177/1099800418779460.
52.
O’NeillJKamper-DeMarcoKChenXOromH. Too stressed to self-regulate? Associations between stress, self-reported executive function, disinhibited eating, and BMI in women. Eat Behav. Dec2020;39:101417. doi:10.1016/j.eatbeh.2020.101417.
53.
RosenbaumDLRemmertJEFormanEMButrynML.Do participants with children age 18 and under have suboptimal weight loss?Eat Behav. Apr2018;29:68-74. doi:10.1016/j.eatbeh.2018.03.001.
54.
KozakATDavisJBrownRGrabowskiM.Are overeating and food addiction related to distress tolerance? An examination of residents with obesity from a U.S. metropolitan area. Obes Res Clin Pract. May-Jun2017;11(3):287-298. doi:10.1016/j.orcp.2016.09.010.
55.
SpacapanSOskampS.The Social Psychology of Health. MI, USA: Sage; 1988.
SimonsJSGaherRM.The Distress Tolerance Scale: development and validation of a self-report measure. Motiv Emot. June12005;29(2):83-102. doi:10.1007/s11031-005-7955-3.
58.
LynchTRMizonGA.Distress overtolerance and distress intolerance: a behavioral perspective. In: ZvolenskyMJBernsteinAVujanovicAA, eds. Distress Tolerance: Theory, Research, and Clinical Applications. New York, NY: The Guilford Press; 2011:52-79.
59.
KuczmarskiMFKuczmarskiRJNajjarM.Effects of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988-1994. J Am Diet Assoc. Jan2001;101(1):28-34; quiz 35-36. doi:10.1016/s0002-8223(01)00008-6.
60.
ParkERPsarosCTraegerL, et al. Development of a postpartum stressor measure. Matern Child Health J. Oct2015;19(10):2094-2101. doi:10.1007/s10995-015-1731-0.
61.
RemlerDKVan RyzinGG.Research Methods in Practice. 2nd ed.USA: Sage; 2015.
62.
AdamEKKumariM.Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology. Nov2009;34(10):1423-1436. doi:10.1016/j.psyneuen.2009.06.011.
63.
ChojnowskaSPtaszyńska-SarosiekIKępkaAKnaśMWaszkiewiczN.Salivary biomarkers of stress, anxiety and depression. J Clin Med. Feb12021;10(3):517. doi:10.3390/jcm10030517.
64.
Faria-SchützerDBSuritaFGRodriguesLTuratoER.Eating behaviors in postpartum: a qualitative study of women with obesity. Nutrients. Jul102018;10(7):885. doi:10.3390/nu10070885.
65.
XiaoRSKroll-DesrosiersARGoldbergRJPagotoSLPersonSDWaringME.The impact of sleep, stress, and depression on postpartum weight retention: a systematic review. J Psychosom Res. Nov2014;77(5):351-358. doi:10.1016/j.jpsychores.2014.09.016.
66.
RiemannDBergerMVoderholzerU.Sleep and depression—results from psychobiological studies: an overview. Biol Psychol. Jul-Aug2001;57(1-3):67-103. doi:10.1016/S0301-0511(01)00090-4.
67.
SilvaCSLimaMCSequeira-de-AndradeLAS, et al. Association between postpartum depression and the practice of exclusive breastfeeding in the first three months of life. J Pediatr (Rio J). Jul-Aug2017;93(4):356-364. doi:10.1016/j.jped.2016.08.005.
68.
Siega-RizAMHerringAHCarrierKEvensonKRDoleNDeierleinA.Sociodemographic, perinatal, behavioral, and psychosocial predictors of weight retention at 3 and 12 months postpartum. Obesity (Silver Spring). Oct2010;18(10):1996-2003. doi:10.1038/oby.2009.458.
69.
BlumfieldMLBeiBZimbergIZCainSW.Dietary disinhibition mediates the relationship between poor sleep quality and body weight. Appetite. Jan12018;120:602-608. doi:10.1016/j.appet.2017.10.022.
70.
EckKMSantiagoEMartin-BiggersJByrd-BredbennerC.Maternal sleep quality is associated with personal and parenting weight-related behaviors. Int J Environ Res Public Health. Jul232020;17(15):5312. doi:10.3390/ijerph17155312.
71.
Gila-DíazACarrilloGHLópez de PabloÁ LArribasSMRamiro-CortijoD.Association between maternal postpartum depression, stress, optimism, and breastfeeding pattern in the first six months. Int J Environ Res Public Health. Sep302020;17(19):7153. doi:10.3390/ijerph17197153.
72.
AksuAVefikulucay YilmazD.The relationship of postpartum sleep quality and breastfeeding self-efficacy of Turkish mothers. Scand J Caring Sci. Dec2019;33(4):833-839. doi:10.1111/scs.12679.
73.
GroërMW.Differences between exclusive breastfeeders, formula-feeders, and controls: a study of stress, mood, and endocrine variables. Biol Res Nurs. Oct2005;7(2):106-117. doi:10.1177/1099800405280936.
74.
WiklundPXuLLyytikäinenA, et al. Prolonged breast-feeding protects mothers from later-life obesity and related cardio-metabolic disorders. Public Health Nutr. Jan2012;15(1):67-74. doi:10.1017/s1368980011002102.
75.
KriegerN.Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001;30(4):668-677.
76.
KriegerN.Epidemiology and the People’s Health: Theory and Context. Oxford: Oxford University Press; 2011.
77.
BawakedRAGomezSFHomsC, et al. Association of eating behaviors, lifestyle, and maternal education with adherence to the Mediterranean diet in Spanish children. Appetite. Nov12018;130:279-285. doi:10.1016/j.appet.2018.08.024.
78.
LucasGOlanderEKSalmonD.Bodies of concern? A qualitative exploration of eating, moving and embodiment in young mothers. Health (London). Nov292021:13634593211060760. doi:10.1177/13634593211060760.
79.
AnekweCVJarrellARTownsendMJGaudierGIHiserodtJMStanfordFC.Socioeconomics of obesity. Curr Obes Rep. Sep2020;9(3):272-279. doi:10.1007/s13679-020-00398-7.
80.
BrownKLGrahamAKPereraRALaRoseJG.Eating to cope: advancing our understanding of the effects of exposure to racial discrimination on maladaptive eating behaviors. Int J Eat Disord. Dec2022;55(12):1744-1752. doi:10.1002/eat.23820.
81.
KewSYeCHanleyAJ, et al. Cardiometabolic implications of postpartum weight changes in the first year after delivery. Diabetes Care. Jul2014;37(7):1998-2006. doi:10.2337/dc14-0087.
82.
BastainTMChavezTHabreR, et al. Study design, protocol and profile of the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort: a prospective cohort study in predominantly low-income Hispanic women in urban Los Angeles. BMC Pregnancy Childbirth. May302019;19(1):189. doi:10.1186/s12884-019-2330-7.
83.
GrothSWFernandezIDBlockRC, et al. Biological changes in the pregnancy-postpartum period and subsequent cardiometabolic risk-UPSIDE MOMS: a research protocol. Res Nurs Health. Aug2021;44(4):608-619. doi:10.1002/nur.22141.
