Body dissatisfaction among pregnant women: an integrative review of
                    the literature

Meireles, Juliana Fernandes Filgueiras; Neves, Clara Mockdece; Carvalho, Pedro Henrique Berbert de; Ferreira, Maria Elisa Caputo

doi:10.1590/1413-81232015207.05502014

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Review • Ciênc. saúde coletiva 20 (7) • July 2015 • https://doi.org/10.1590/1413-81232015207.05502014 copy

Body dissatisfaction among pregnant women: an integrative review of the literature

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The body image of pregnant women is an issue that should be further investigated by professionals in the area, especially in view of the fact that maternal and infant health has gained such prominence. The scope of this integrative review is to analyze the literature relating to body image and body dissatisfaction among pregnant women. Research was based on articles extracted from the Scopus, PubMed, BVS and PsycINFO databases, by cross-referencing “pregnancy” with the keywords “body image” and “body dissatisfaction.” Once the inclusion and exclusion criteria had been adopted, forty studies were analyzed. These produced inconclusive data about body dissatisfaction during pregnancy. Symptoms of depression, low self-esteem, an inadequate approach towards healthy eating and weight gain above recommended limits have been associated with a negative body image. The contradictory findings could be related to the different instruments used to measure body image. In view of the possible impact that a negative body image can have on maternal and infant health during pregnancy, it is recommended that further investigations are made, in particular related to the development of a specific tool to evaluate the body image of pregnant women.

Key words
Body image; Pregnancy; Adult; Health; Review

Series	Scopus	PubMed	BVS	PsycINFO	Total
“body image“ and “pregnancy“	1377	377	349	137	2240
“body dissatisfaction“ and “pregnancy“	220	14	12	15	261
Total	1597	391	361	152	2501

		Scopus	PubMed	BVS	PsycINFO
Initial total in each database		1597	391	361	152
Exclusion criteria
	Duplicated articles	163	314	335	110
	Abstracts not available	107	9	17	1
	Other languages	76	3	0	8
	Non-empirical studies	248	19	2	4
	Without specific instrument for evaluation of body image	246	14	1	7
	Sample of non-pregnant women	679	21	1	15
	Pregnant adolescents	23	7	3	1
	Not available in full	18	1	2	6
Total for analysis		37	3	0	0

Reference (Year)	Country	Method	Sample	Tools
Sui et al.¹⁰10 Sui Z, Turnbull D, Dodd J. Effect of body image on gestational weight gain in overweight and obese women. Women Birth 2013; 26(4):267-272. (2013)	Australia	Longitudinal and Quantitative	442 pregnant women (first and third trimester)	Stunkard's figure rating scale; questionnaire with in-built questions.
Sweeney & Fingerhut¹¹11 Sweeney AC, Fingerhut R. Examining relationships between body dissatisfaction, maladaptive perfectionism, and postpartum depression symptoms. J Obstet Gynecol Neonatal Nurs 2013; 42(5):551-561. (2013)	USA	Longitudinal and Quantitative	46 pregnant women (equal to or more than 28 weeks and 2 months post-partum)	Body Attitudes Questionnaire; Post-partum Depression Predictors Inventory–Revised; Almost Perfect Scale—Revised; Edinburgh Postnatal Depression Scale.
Bagheri et al.⁹9 Bagheri M, Dorosty A, Sadrzadeh-Yeganeh H, Eshraghian M, Amiri E, Khamoush-Cheshm N. Pre-pregnancy body size dissatisfaction and excessive gestational weight gain. Matern Child Health J 2013; 17(4):699-707.	Iran	Cross-sectional and Quantitative	382 pregnant women (retrospective prepregnancy; more than 34 weeks	Body Image Assessment for Obesity; Pregnancy Physical Activity Questionnaire; list of portions of food consumed.
Fuller-Tyszkiewicz et al.¹⁷17 Fuller-Tyszkiewicz M, Skouteris H, Watson B, Hill B. Body image during pregnancy: an evaluation of the suitability of the body attitudes questionnaire. BMC Pregnancy Childbirth 2012; 12(1):91-101. (2012)	Australia	Longitudinal (pregnant) and Cross-sectional (non-pregnant women);	176 pregnant women (16, 24, 32 weeks) and 148 non-pregnant women	Body Attitudes Questionnaire.
Nash³3 Nash M. Weighty matters: Negotiating ‘fatness’ and ‘in -betweenness’ in early pregnancy. Feminism Psychology 2012; 22(3):307-323. (2012)	Australia	Longitudinal and Qualitative	38 pregnant women (more than 10 weeks)	Interview.
Hauff & Demerath³²32 Hauff LE, Demerath EW. Body image concerns and reduced breastfeeding duration in primiparous overweight and obese women. Am J Hum Biol 2012; 24(3):339-349. (2012)	USA	Longitudinal and Quantitative	233 pregnant women (third trimester, 2 weeks post-partum, 4 months post-partum)	Questionnaire with in-built questions; questions adapted from the Body Attitudes Questionnaire, Body Shape Questionnaire; Eating Disorder Examination.
Brooten et al.²⁹29 Brooten D, Youngblut JM, Golembeski S, Magnus MH, Hannan J. Perceived weight gain, risk, and nutrition in pregnancy in five racial groups. J Am Acad Nurse Pract 2012; 24(1):32-42. (2012)	USA	Cross-sectional and Quantitative	54 pregnant women (less than 20 weeks)	Body Image Assessment for Obesity; Food Frequency Questionnaire— Adults; questionnaire with in-built questions.
Mehta et al.³³33 Mehta UJ, Siega-Riz AM, Herring AH. Effect of body image on pregnancy weight gain. Matern Child Health J 2011; 15:(3)324-332.	USA	Longitudinal and Quantitative	1192 pregnant women (15–20, 17–22, 24–29, 27–30 weeks and post-partum)	Gestational record; Body Image Assessment for Obesity.
Loth et al.³⁴34 Loth KA, Bauer KW, Wall M, Berge J, Neumark-Sztainer D. Body satisfaction during pregnancy. Body Image 2011; 8(3):297-300. (2011)	USA	Longitudinal and Quantitative	68 pregnant women and 927 non-pregnant women	Specific questionnaire; Modified version of the Body Shape Satisfaction Scale.
Rauff & Downs³⁵35 Rauff EL, Downs DS. Mediating effects of body image satisfaction on exercise behavior, depressive symptoms, and gestational weight gain in pregnancy. Ann Behav Med 2011; 42(3):381-390.	USA	Longitudinal and Quantitative	151 pregnant women (14, 21 and 32 weeks)	Body Areas Satisfaction Scale; Centers for Epidemiological Studies-Depression scale; Leisure-Time Exercise Questionnaire.
Kazmierczak & Goodwin²²22 Kazmierczak M, Goodwin R. Pregnancy and body image in Poland: gender roles and self-esteem during the third trimester. J Reprod Infant Psychol 2011; 29(4):334-342. (2011)	Poland	Crosssectional and Quantitative	100 pregnant women (28-39 weeks	Body Image Questionnaire; Feminine Gender Role Stress Scale; Psychological Sex Inventory; Rosenberg Self-Esteem Scale.
Sacomori et al.³⁶36 Sacomori C, Cardoso FL, Vanderlinde C. Pelvic floor muscle strength and body self-perception among Brazilian pregnant women. Physiotherapy 2010; 96(4):337-343. (2010)	Brazil	Cross-sectional and Quantitative	35 pregnant women (3 = first trimester; 15 = second trimester; 17= third trimester)	Questionnaire of Human Corporeality; Gestational record; Vaginal palpation.
Chang et al.³⁷37 Chang SR, Kenney NJ, Chao YM. Transformation in self-identity amongst Taiwanese women in late pregnancy: a qualitative study. Int J Nurs Stud 2010; 47(1):60-66. (2010)	Taiwan	Cross-sectional and Qualitative	18 pregnant women (29 to 39 weeks)	Interview.
Clark et al.²2 Clark A, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J. The relationship between depression and body dissatisfaction across pregnancy and the postpartum: a prospective study. J Health Psychol 2009; 14(1):27-35.	Australia	Cross-sectional	20 pregnant women (10 = third trimester and 10 = postpartum)	Semi-structured interview
Clark et al.³⁸38 Clark A, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J. My baby body: A qualitative insight into women's body-related experiences and mood during pregnancy and the postpartum. J Reprod Infant Psychol 2009; 27(4):330-345. (2009)	Australia	Longitudinal and Quantitative	116 pregnant women (retrospective prepregnancy, 17-21, 32-35 weeks of pregnancy, 6 weeks, 6 and 12 months postpartum)	Body Attitudes Questionnaire; Beck Depression Inventory.
Pauls et al.³⁴34 Loth KA, Bauer KW, Wall M, Berge J, Neumark-Sztainer D. Body satisfaction during pregnancy. Body Image 2011; 8(3):297-300. (2008)	USA	Longitudinal and Quantitative	50 pregnant women (8, 30 weeks of pregnancy and 30 weeks of post-partum)	Female Sexual Function Index; Body Exposure During Sexual Activities Questionnaire; Urogenital Distress Inventory-short forms; Incontinence Impact Questionnaire; Fecal Incontinence Quality of life Scale.
Kamysheva et al.⁵5 Kamysheva E, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J. Examination of a multi-factorial model of body-related experiences during pregnancy: the relationships among physical symptoms sleep quality, depression, self-esteem, and negative body attitudes. Body Image 2008; 5(2):152-163. (2008)	Australia	Cross-sectional and Quantitative	215 pregnant women (retrospective pre-pregnancy and 15-25 weeks)	Body Attitudes Questionnaire; Beck Depression Inventory; Rosenberg Self-esteem Scale; Pittsburgh Sleep Quality Index; Pregnancy Discomfort Checklist.
Herring et al.¹⁵15 Herring SJ, Oken E, Haines J, Rich-Edwards JW, Rifas-Shiman SL, Kleinman KP, Gillman MW. Misperceived pre-pregnancy body weight status predicts excessive gestational weight gain: findings from a US cohort stud y . BMC Pregnancy Childbirth 2008; 22(8):1-9. (2008)	USA	Cross-sectional and Quantitative	1537 pregnant women (less than 22 weeks)	Physical Activity Scale; Semi-Quantitative Food Frequency Questionnaire; Medical record; Specific questionnaire.
Duncombe et al.¹⁴14 Duncombe D, Wertheim EH, Skouteris H, Paxton SJ, Kelly L. How well do women adapt to changes in their body size and shape across the course of pregnancy? J Health Psychol 2008; 13(4):503-515. (2008)	Australia	Longitudinal and Quantitative	158 pregnant women (retrospective pre-pregnancy; 16-23; 24-30 and 32-38 weeks)	Body Attitudes Questionnaire; Contour Drawing Rating Scale; Pregnancy Figure Rating Scales; Dutch Eating Behaviour Questionnaire -Restraint; Beck Depression Inventory.
Downs et al.¹⁶16 Downs DS, DiNallo JM, Kirner TL. Determinants of pregnancy and postpartum depression: prospective influences of depressive symptoms, body image satisfaction, and exercise behavior. Ann Behav Med 2008; 36(1):54-63. (2008)	USA	Longitudinal and Quantitative	230 pregnant women (first, second and third trimester and post-partum)	Body Areas Satisfaction Scale; Centers for Epidemiological Studies-Depression Scale; Leisure-Time Exercise Questionnaire.
Haedt & Keel²⁰20 Haedt A, Keel P. Maternal attachment, depression, and body dissatisfaction in pregnant women. J Reprod Infant Psychol 2007; 25(4):285-295. (2007)	USA	Cross-sectional and Quantitative	196 pregnant women (2-40 weeks)	10 items of the Body Shape Questionnaire; Edinburgh Postnatal Depression Scale Maternal Fetal Attachment Scale.
Chang et al.³⁹39 Chang SR, Chao YM, Kenney NJ. I am a woman and I'm pregnant: body image of women in Taiwan during the third trimester of pregnancy. Birth 2006; 33(2):147-153. (2006)	Taiwan	Cross-sectional and Qualitative	18 pregnant women (29-39 weeks)	Interview.
Skouteris et al.⁴4 Skouteris H, Carr R, Wertheim EH, Paxton SJ, Duncombe D. A prospective study of factors that lead to body image dissatisfaction during pregnancy. Body Image 2005; 2(4):347-361. (2005)	Australia	Longitudinal and Quantitative	128 pregnant women (retrospective pre-gestation, 16-23, 24-31 and 32-39 weeks of gestation)	Body Attitudes Questionnaire; Contour Drawing and Pregnancy Figure Rating Scales; Beck Depression Inventory; Physical Appearance Comparison Scale; Perception of Teasing Scale; Perceived Socio-Cultural Pressure Scale; Public Self-Consciousness Scale.
Lai et al.²⁵25 Lai BP, Tang CS, Tse WK. Prevalence and psychosocial correlates of disordered eating among Chinese pregnant women in Hong Kong. Eat Disord 2005; 13(2):171-186. (2005)	China	Cross-sectional and Quantitative	359 pregnant women (6 to 40 weeks)	Eating Disorder Inventory-2; Bem Sex Role Inventory; Maternal Antenatal Attachment Scale; Spousal Support Scale; Gestational record.
Rocco et al.²⁶26 Rocco PL, Orbitello B, Perini L, Pera V, Ciano RP, Balestrieri M. Effects of pregnancy on eating attitudes and disorders: a prospective study. J Psychosom Res 2005; 59(3):175-179. (2005)	Italy	Longitudinal and Qualitative	97 pregnant women (12, 22, 32 weeks of gestation; 2 days and 4 months post-partum)	Body Attitude Test; Eating Disorder Inventory-2; EDI-Symptom Checklist.
Johnson et al.⁴⁰40 Johnson S, Burrows A, Williamson I. ‘Does my bump look big in this?’ The meaning of bodily changes for first-time mothers-to-be. J Health Psychol 2004; 9(3):361-374. (2004)	England	Cross-sectional and Qualitative	6 pregnant women (33 to 39 weeks)	Semi-structured interview.
Huang et al.⁴¹41 Huang HC, Wang SY, Chen CH. Body image, maternal-fetal attachment, and choice of infant feeding method: a study in Taiwan. Birth 2004; 31(3):183-188. (2004)	Taiwan	Cross-sectional and Quantitative	195 pregnant women (from 28 weeks onwards)	Attitude to Body Image Scale; Modified Maternal-Fetal Attachment Scale.
Earle⁴²42 Earle S. “Bumps and Boobs”: fatness and women's experiences of pregnancy. Womens Stud Int Forum 2003; 26(3):245-252. (2003)	England	Cross-sectional and Qualitative	19 pregnant women (6-14; 36-39 weeks of gestation and 6-14 weeks post-partum)	Interview.
Dipietro et al.¹³13 DiPietro JA, Millet S, Costigan KA, Gurewitsch E, Caulfield LE. Psychosocial influences on weight gain attitudes and behaviors during pregnancy. J Am Diet Assoc 2003; 103(10):1314-1319. (2003)	USA	Cross-sectional and Quantitative	130 pregnant women (28 to 36 weeks)	Pregnancy and Weight Gain Attitude Scale; Spielberger State Anxiety Inventory; Pregnancy Experience Scale; Daily Stress Inventory; Profile of Moods States; Marlowe-Crowne Social Desirability Scale.
Boscaglia et al.²⁷27 Boscaglia N, Skouteris H, Wertheim EH. Changes in body image satisfaction during pregnancy: a comparison of high exercising and low exercising women. Aust N Z J Obstet Gynaecol 2003; 43(1):41-45. (2003)	Australia	Longitudinal and Quantitative	71 pregnant women (retrospective pre-gestation, 15-22 and 23-30 weeks and prospective post-partum)	Body Cathexis Scale; Specific physical activity questionnaire.
Schmied & Lupton⁴³43 Schmied V, Lupton D. The externality of the inside: body images of pregnancy. Nurs Inq 2001; 8(1):32-40. (2001)	Australia	Longitudinal and Qualitative	25 pregnant women (prior to birth; 10 days, 4-8 weeks, 12-14 weeks, 5-6 months after birth)	Interview.
Kendall et al.⁴⁴44 Kendall A, Olson CM, Frongillo EA Jr. Evaluation of psychosocial measures for understanding weight-related behaviors in pregnant women. Ann Behav Med 2001; 23(1):50-58. (2001)	USA	Cross-sectional and Quantitative	622 (22 = first trimester; 423 = second trimester; 177 = third trimester)	Structured questionnaire based on other validated instruments.
Goodwin et al.²⁸28 Goodwin A, Astbury J, McMeeken J. Body image and psychological well-being in pregnancy: a comparison of exercisers and non-exercisers. Aust N Z J Obstet Gynaecol 2000; 40(4):442-447. (2000)	Australia	Longitudinal and Quantitative	65 pregnant women (14-20 and 27-32 weeks)	Body Cathexis Scale; Questionnaire for the self-reported exercise record; General Health Questionnaire
Clark & Ogden²⁴24 Clark M, Ogden J. The impact of pregnancy on eating behaviour and aspects of weight concern. Int J Obes 1999; 23(1):18-24. (1999)	England	Cross-sectional and Quantitative	50 pregnant women (24-28 weeks) and 50 non-pregnant women	Questionnaire with in-built questions; Dutch Eating Behavior Questionnaire; Eating Self-Efficacy Scale; Three Factor Eating Questionnaire; Body Shape Questionnaire.
Fox & Yamaguchi³¹31 Fox P, Yamaguchi C. Body image change in pregnancy: a comparison of normal weight and overweight primigrávidas. Birth 1997; 24(1):35-40. (1997)	England	Cross-sectional and Qualitative/Quantitative	76 pregnant women (more than 30 weeks)	Two open questions; modified Body Shape Questionnaire.
Foster et al.⁴⁵45 Foster SF, Slade P, Wilson K. Body image, maternal fetal attachment, and breast feeding. J Psychosom Res 1996; 41(2):181-184. (1996)	England	Cross-sectional and Quantitative	38 pregnant women (32-38 weeks)	Body Satisfaction Scale; Maternal Fetal Attachment Scale; Eating Disorders Examination.
Oyemade et al.²³23 Oyemade UJ, Cole OJ, Johnson AA, Knight EM, Westney OE, Laryea H, et al. Prenatal substance abuse and pregnancy outcomes among African American women. J Nutr 1994; 124(Supl. 6):994-999. (1994)	USA	Longitudinal and Quantitative	467 pregnant women	Maternal Attitude Toward Pregnancy Instrument; Self-esteem Scale; IPAT Anxiety Scale Questionnaire; Partners Interaction Scale; Social Support Network; Locus of control; Social Readjustment Scale; Daily Hassles Scale; Obstetrical Complications scale; Self-reported alcohol abuse.
Edwards et al.²¹21 Edwards CH, Cole OJ, Oyemade UJ, Knight EM, Johnson AA, Westney OE, Laryea H, West W, Jones S, Westney LS. Maternal stress and pregnancy outcomes in a prenatal clinic population. J Nutr 1994; 124(Supl. 6):1006-1021. (1994)	USA	Longitudinal and Quantitative	239 pregnant women	Food recall list; Maternal Attitude to Pregnancy Instrument; Life Events Inventory; Anxiety Scale Questionnaire; Rosenberg Self-esteem Scale; Locus of control; Sex Role Inventory.
Davies & Wardle³⁰30 Davies K, Wardle J. Body image and dieting in pregnancy. J Psychosom Res 1994; 38(8):787-799. (1994)	England	Cross-sectional and Quantitative	76 pregnant women (third trimester) and 97 non-pregnant women	Eating Disorder Inventory; Figure Rating Scale; The Restraint Scale of the Dutch Eating Behaviour Questionnaire.
Ruggieri et al.⁴⁷47 Ruggieri V, Milizia M, Romano MF. Effects of body image on tactile sensitivity to a tickle: a study of pregnancy. Percept Mot Skills 1979; 49(2):555-563. (1979)	Italy	Cross-sectional and Quantitative	20 pregnant women (third trimester) and 20 non-pregnant women	Fisher's Body Prominence Test; Body Cathexis Scale.

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[1] Collaborations

JF Filgueiras contributed towards the concept of this project, the database research, publication analysis, and the drafting and discussion of the text of this article. CM Neves and MEC Ferreira contributed towards the project concept and a critical review of this article. PHB Carvalho participated in the critical review of this article. All authors have approved this version for publication.