Table 4 Summary table of the relationship of affect and excess gestational weight gain during pregnancy in systematic review of psychological antecedents of excess gestational weight gain

McAnarney 1992 [45]

Centre for Epidemiological Studies-Depression Scale (CES-D), validated

Rate of weight gain categorized as slow, average and rapid

Mean (SD) CES-D in each weight gain category: 22 (±9); 20 (±7); 24 (±8) (p <0.05)

OR (95% CI ) of rapid weight gain:

Covariates used but not reported

Only 1 item was significant on multivariate analysis ➔

Item: Suicidal thoughts and attempts

Item: ‘Suicidal thoughts and attempts’ 5.0 (1.28 to 19.57)

Proportion within each weight gain category 13%; 4.6%; 19.4% (p <0.05)

McPhie 2015 [62]

Depression, Anxiety, and Stress Scale-21 (DASS-21), validated

Excess GWG

In 1^st trimester, mild depression in 8.5% of those who gained in excess and 8.9% who gained within guidelines (for moderate depression, 2.8% and 0.9%, respectively); mild anxiety in 9.9% and 11.6%, respectively (for moderate anxiety, 7.0% and 0.9%, respectively)

NA

NA

NS on univariate analysis

Sangi-Haghpeykar 2013 [51]

Patient Health Questionnaire (PHQ), validated

Excess GWG

Proportion with GWG categories: 9%, 9% (p-value NS)

NA

NA

NS on univariate analysis; variable not entered in the multivariate study

Steven-Simon 1995 [52]

CES-D, validated

Effect estimate not reported; (p-value NS)

NA

NA

NS on univariate analysis

Multivariate analysis was not done

Walker 2002 [57]

CES-D, validated

Excess GWG

Correlation co-efficient (p-value): r = 0.02 (p-value NS)

β (SE): 0.0 (0.1)

Pre-pregnancy BMI, age, parity, ethnicity, newborn gender, maternal height, food habits

NS on univariate or multivariate analyses

Webb 2009 [2]

CES-D, validated

Excess GWG; Adequacy Ratio

RR (95% CI ):

RR (95% CI ):

Pre-gravid BMI, other socio-demographic, dietary and physical activity covariates

NS on univariate or multivariate analyses; Adequacy ratio outcome was significant only on univariate analysis

CES-D score (<20 weeks)

CES-D score (<20 weeks)

Low 1.0 (Reference); Moderate 1.06 (1.0 to 1.2); High 1.03 (0.9 to 1.1)

Low 1.0 (Reference); Moderate 1.01 (0.9 to 1.1); High 0.98 (0.9 to 1.1) (p = 0.91)

CES-D score (24–29 weeks)

CES-D score (24–29 weeks)

Low 1.0 (Reference); Moderate 1.08 (1.0 to 1.2); High 1.12 (1.0 to 1.1)

Low 1.0 (Reference); Moderate 1.02 (0.9 to 1.1); High 1.02 (0.9 to 1.1) (p = 0.76)

Wright 2013 [59]

Edinburgh Postnatal Depression Scale (EPDS), validated

Excess GWG ^$; GWG (continuous)^$$;

β (95% CI ): 0.88 (0.1 to 1.7)

Effect estimate not reported for excess GWG

Pre-pregnancy BMI, age, race

Results were reported to be similar to secondary outcome but estimates were not reported, hence considered non-significant on univariate or multivariate analysis

β (95% CI) for secondary outcome: 0.3 (−1.0 to 1.5)

McPhie 2015 [62]

Depression, Anxiety, and Stress Scale-21 (DASS-21), validated

Excess GWG

In 1^st trimester, mild anxiety in 9.9% of those who gained in excess and 11.6% who gained within guidelines, respectively (for moderate anxiety, 7.0% and 0.9%, respectively)

NA

NA

NS on univariate analysis

Webb 2009 [2]

State and Trait Anxiety Inventory (STAI), validated

Excess GWG; Adequacy Ratio

RR (95% CI):

RR (95% CI):

Pre-gravid BMI, other socio-demographic, dietary and physical activity covariates

NS on univariate or multivariate analyses; adequacy ratio was also NS on univariate or multivariate analyses

STAI-T (<20 weeks)

STAI-T (<20 weeks)

Low 1.0 (Reference); Moderate 1.04 (1.0 to 1.1); High 0.98 (0.9 to 1.1)

Low 1.0 (Reference); Moderate 1.02 (1.0 to 1.1); High 1.01 (1.0 to 1.1)

STAI-S (<20 weeks)

STAI-S (<20 weeks)

Low 1.0 (Reference); Moderate 0.94 (0.9 to 1.0); High 0.94 (0.9 to 1.0)

Low 1.0 (Reference); Moderate 1.06 (1.0 to 1.1); High 1.00 (0.9 to 1.1)

STAI-S (24–29 weeks)

STAI-S (24 to29 weeks)

Low 1.0 (Reference); Moderate 1.00 (0.9 to 1.1); High 0.95 (0.9 to 1.0)

Low 1.0 (Reference); Moderate 1.01 (0.9 to 1.1); High 0.99 (0.9 to 1.1)

Brawarsky 2005 [9]

Perceived Stress Scale-PSS (short form), validated

Excess GWG

Proportion within GWG categories:

NA

NA

NS on univariate or multivariate analyses

Stress categorised as:

Yes: 46.4%, 32.2%

No: 55.4%, 32.2%

Chasan-Taber 2008 [36]

Perceived Stress Scale-PSS (short form), validated

Excess GWG

OR (95% CI ):

Pre-pregnancy BMI, parity, age, generation in USA, prenatal care, caloric intake, household activity

NS on univariate or multivariate analyses

Proportion within GWG categories:

Maternal stress categorised as:

0-2: 51.5%, 25.0%;

0-2: 1.0 (Reference);

3-5: 39.5%, 38.4%;

3-5: 0.5 (0.3 to 0.9);

6-8: 43.4%, 34.4%;

6-8: 0.6 (0.4 to 1.1);

≥9: 51.3%, 28.6%;

≥9: 0.9 (0.5 to 1.6);

(p for trend = .75 and .82, respectively)

Missing: 1.1 (0.4 to 3.2)

Chasan-Taber 2008 [36]

PRAMS standard questions – based on modified Life Event Inventory, validated

Excess GWG

Proportions within GWG categories:

NA

NA

NS on univariate analysis; variable not entered in a multivariate model

Number of life events categorised as:

None: 46.4%, 33.6%;

1: 46.0%, 35.4%

2: 50.0%, 28.8;

≥3: 42.6%, 31.1%

(p for trend = .51 and .37 respectively)

Sangi-haghpeykar 2013 [51]

Prenatal Psychosocial Profile Hassles Scale, validated

Excess GWG ^{$ and $$}

Mean (±SD):

NA

NA

NS on univariate analysis; Variable not entered in the multivariate model

13.7 (±2.8), 14.4 (±4.0)

Walker 2009 [56]

PRAMS standard questions – based on modified Life Event Inventory, validated (18 items were used)

Excess GWG

Proportions within GWG categories:

NA

NA

NS on univariate analysis; Variable not entered in the multivariate model

Maternal stress categorised as:

None: 20.93%, 18.48%

1-2: 38.76%, 40.65%;

3-5: 32.11%, 31.49%;

6-18: 8.20%, 9.39%

Webb 2009 [2]

Perceived Stress Scale (PSS), validated

Excess GWG

RR (95% CI ):

RR (95% CI ):

Pre-gravid BMI, other socio-demographic, dietary and physical activity covariates

NS on univariate or multivariate analyses; NS results for adequacy ratio outcome

PSS 17–22 weeks

PSS 17–22 weeks

Low 1.0 (Reference);

Low 1.0 (Reference);

Moderate 0.99 (0.9 to 1.0);

Moderate 0.99 (0.9 to 1.0);

High 1.03 (1.0 to 1.1) ;

High 0.99 (0.9 to 1.1)

PSS 27–30 weeks

PSS 27–30 weeks

Low 1.0 (Reference);

Low 1.0 (Reference);

Moderate 1.04 (1.0 to 1.1);

Moderate 1.01 (1.0 to 1.1);

High 1.07 (1.0 to 1.2)

High 1.01 (1.0 to 1.1)

Wells 2006 [58]

PRAMS standard question – based on modified Life Event Inventory, validated (13 items were used)

Excess GWG

Proportions within GWG categories:

OR (95% CI ):

NS on univariate level or multivariate analyses

Maternal stress categorised as:

0 Stressor: 1.0 (Reference);

0 Stressors: 41.3%, 36.4%;

1-2 stressors: 1.03

1-2 Stressors: 41.7%, 36.2%;

(0.84 to 1.26);

3 or more stressors: 39.9%, 32.5%

≥3 stressors: 1.04 (0.82 to 1.32)

Olson 2003 [49]

Investigator developed series of statement on Feelings about motherhood, Not validated

Excess GWG ^$$

Proportion of exposure within Excess GWG category:

NA

NA

NS on univariate analysis; variable not entered in a multivariate model

Low 43.8%;

Medium 37.1%

High 41.9%

Tovar 2012 [55]

Psychological Acculturation Scale, validated

Excess GWG ^$

Proportions within GWG categories:

OR (95% CI ):

Pre-pregnancy weight, age, parity, perceived stress, gestational age and physical activity

NS on univariate or multivariate analysis; NS association with other weight gain outcomes (rate of weight gain, weight gain as continuous)

Low acculturation

Continuous acculturation score

49.3%, 30.6%;

1.0 (0.8 to 1.3)

Medium acculturation

42.2%, 31.1%;

High acculturation

47%, 31.5%

(p = 0.4)