Authors

1 Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Nutrition Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

3 Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

4 Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Postpartum weight retention (PPWR) is a factor that causes permanent obesity and subsequent
chronic and noncommunicable diseases. The relationship between depression/stress/anxiety and
PPWR has been studied in some articles, but there is no definitive conclusion in this regard. The
present systematic review was conducted to investigate the relationship between depression/stress/
anxiety and PPWR. An extensive search was performed in the PubMed, Scopus, Embase, Web
of Science, Google Scholar, SID, and Magiran, Irandoc databases using Medical Subject Headings
terms (or their Persian synonyms) from 2000 to 2020. Inclusion and exclusion criteria were used for
articles selection. The quality of the selected articles was assessed using the Newcastle–Ottawa Scale.
Out of 371 reviewed articles, 24 articles were selected. The total sample size was 51,613 (range:
49–37,127). The mean of PPWR ranged from 0.5 kg (standard deviation [SD] = 6.49) to 6.4
kg (SD = 8.5). There was a statistically significant relationship between depression/stress/anxiety
and PPWR in 12 of 23, 4 of 6, and 3 of 8 studies. This review demonstrates the relationship between
depression/stress/anxiety and PPWR. Time of depression/stress/anxiety assessment is an important
issue, as well as different measurement tools. Prevention of the mothers’ psychological problems
through educational and supportive programs may help to limit PPWR.

Keywords

1. Fadzil F, Shamsuddin K, Wan Puteh SE, Mohd Tamil A, Ahmad S,
Abdul Hayi NS, et al. Predictors of postpartum weight retention
among urban Malaysian mothers: A prospective cohort study.
Obes Res Clin Pract 2018;12:493‑9.
2. Oken E, Taveras EM, Popoola FA, Rich‑Edwards JW, Gillman MW. Television, walking, and diet: Associations with postpartum
weight retention. Am J Prev Med 2007;32:305‑11.
3. Bogaerts A, Van den Bergh BR, Ameye L, Witters I, Martens E,
Timmerman D, et al. Interpregnancy weight change and risk for
adverse perinatal outcome. Obstet Gynecol 2013;122:999‑1009.
4. Lim S, O’Reilly S, Behrens H, Skinner T, Ellis I, Dunbar J. Effective
strategies for weight loss in post-partum women: A systematic
review and meta-analysis. Obesity Rev 2015;16:972‑87.
5. Hollis  JL, Crozier  SR, Inskip  HM, Cooper  C, Godfrey  KM,
Harvey NC, et al. Modifiable risk factors of maternal postpartum
weight retention: An analysis of their combined impact and
potential opportunities for prevention. Int J Obes  (Lond)
2017;41:1091‑8.
6. Endres LK, Straub H, McKinney C, Plunkett B, Minkovitz CS,
Schetter CD, et al. Postpartum weight retention risk factors and
relationship to obesity at 1 year. Obstet Gynecol 2015;125:144‑52.
7. Phillips  J, King  R, Skouteris  H. A  conceptual model of
psychological predictors of postpartum weight retention.
J Reproduct Infant Psychol 2012;30:278‑88.
8. McKinley MC, Allen‑Walker V, McGirr C, Rooney C, Woodside JV.
Weight loss after pregnancy: Challenges and opportunities. Nutr
Res Rev 2018;31:225‑38.
9. Salehi‑Pourmehr  H, Niroomand  S, Shakouri  SK, Asgarlou  Z,
Farshbaf‑Khalili  A. Association between antenatal and
postpartum depression and anxiety with weight retention 1 year
after childbirth: A longitudinal study. Community Ment Health
J 2018;54:1284‑94.
10. Herring  SJ, Rich‑Edwards  JW, Oken  E, Rifas‑Shiman  SL,
Kleinman  KP, Gillman  MW. Association of postpartum
depression with weight retention 1  year after childbirth.
Obesity (Silver Spring) 2008;16:1296‑301.
11. Huberty J, Leiferman JA, Kruper AR, Jacobson LT, Waring ME,
Matthews  JL, et al. Exploring the need for interventions to
manage weight and stress during interconception. J Behav Med
2017;40:145‑58.
12. Goldstein ND, Rogers S, Ehrenthal DB. The impact of psychosocial
stressors on postpartum weight retention. Arch Womens Ment
Health 2016;19:691‑4.
13. Hartley E, Hill B, McPhie S, Skouteris H. The associations between
depressive and anxiety symptoms, body image, and weight in the
first year postpartum: A rapid systematic review. J Reprod Infant
Psychol 2018;36:81‑101.
14. Xiao RS, Kroll‑Desrosiers AR, Goldberg RJ, Pagoto SL, Person SD,
Waring  ME. The impact of sleep, stress, and depression on
postpartum weight retention: A systematic review. J Psychosom
Res 2014;77:351‑8.
15. Nagl  M, Linde  K, Stepan  H, Kersting  A. Obesity and anxiety
during pregnancy and postpartum: A systematic review. J Affect
Disord 2015;186:293‑305.
16. Collings R, Hill B, Skouteris H. The influence of psychological
factors on postpartum weight retention 12  months post‑birth.
J Reprod Infant Psychol 2018;36:177‑91.
17. Ertel KA, Huang T, Rifas‑Shiman SL, Kleinman K, Rich‑Edwards J,
Oken E, et al. Perinatal weight and risk of prenatal and postpartum
depressive symptoms. Ann Epidemiol 2017;27:695‑7000.
18. Rogers  SL, Hughes  BA, Tomlinson  JW, Blissett  J. Cortisol
metabolism, postnatal depression and weight changes in the first
12 months postpartum. Clin Endocrinol (Oxf) 2016;85:881‑90.
19. Moher  D, Shamseer  L, Clarke  M, Ghersi  D, Liberati  A,
Petticrew M, et al. Preferred reporting items for systematic review
and meta‑analysis protocols (PRISMA‑P) 2015 statement. Syst Rev
2015;4:1.
20. Herzog R, Álvarez‑Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM,
Gil Á. Are healthcare workers’ intentions to vaccinate related to
their knowledge, beliefs and attitudes? A systematic review. BMC
Public Health 2013;13:154.
21. Wells  G. Shea  B, O’Connell  D, Peterson  J, Welch  V, Losos  M,
et al. The newcastle ottawa scale (NOS) for assessing the quality
of nonrandomized studies in meta‑analyses. [Internet]. Canada:
Department of Epidemiology and Community Medicine,
University of Ottawa, Available from: http://www.ohri.ca/
programs/clinical_epidemiology/oxford.asp. [Last accessed on
2020 Jun 01].
22. Rong K, Yu K, Han X, Szeto IM, Qin X, Wang J, et al. Pre‑pregnancy
BMI, gestational weight gain and postpartum weight retention:
A  meta‑analysis of observational studies. Public Health Nutr
2015;18:2172‑82.
23. Adib‑Hajbaghery Zare M. The barriers to patient education
from the viewpoint of nurses in Iran: A systematic review. Nurs
Midwifery J 2017;15:544‑58. [Persian].
24. Biesmans K, Franck E, Ceulemans C, Jacquemyn Y, Van Bogaert P.
Weight during the postpartum period: What can health care
workers do? Matern Child Health J 2013;17:996‑1004.
25. Bogaerts A, De Baetselier E, Ameye L, Dilles T, Van Rompaey B,
Devlieger R. Postpartum weight trajectories in overweight and
lean women. Midwifery 2017;49:134‑41.
26. Bogaerts AF, Van den Bergh BR, Witters I, Devlieger R. Anxiety
during early pregnancy predicts postpartum weight retention in
obese mothers. Obesity (Silver Spring) 2013;21:1942‑9.
27. Gunderson  EP, Rifas‑Shiman  SL, Oken  E, Rich‑Edwards  JW,
Kleinman KP, Taveras EM, et al. Association of fewer hours of
sleep at 6 months postpartum with substantial weight retention
at 1 year postpartum. Am J Epidemiol 2008;167:178‑87.
28. Huang TT, Wang HS, Dai FT. Effect of pre‑pregnancy body size
on postpartum weight retention. Midwifery 2010;26:222‑31.
29. Pedersen  P, Baker  JL, Henriksen  TB, Lissner  L, Heitmann  BL,
Sørensen TI, et al. Influence of psychosocial factors on postpartum
weight retention. Obesity (Silver Spring) 2011;19:639‑46.
30. Phillips J, King R, Skouteris H. The influence of psychological
factors on post-partum weight retention at 9 months. Br J Health
Psychol 2014;19:751‑66.
31. Phillips J, King R, Skouteris H. The influence of psychological
distress during pregnancy on early postpartum weight retention.
J Reproduct Infant Psychol 2014;32:25‑40.
32. Riazi H, Torkashvand R, Mahmoodi Z, Boroomandnia N.
Postpartum weight retention and its relation with depression.
Koomesh 2017;19:276‑85. [Persian].
33. Sha  T, Cheng  G, Li  C, Gao  X, Li  L, Chen  C, et al. Patterns of
women’s postpartum weight retention and its associations with
maternal obesity‑related factors and parity. Int J Environ Res
Public Health 2019;16(22):4510.
34. Siega‑Riz  AM, Herring  AH, Carrier  K, Evenson  KR, Dole  N,
Deierlein  A. Sociodemographic, perinatal, behavioral, and
psychosocial predictors of weight retention at 3 and 12 months
postpartum. Obesity (Silver Spring) 2010;18:1996‑2003.
35. Straub H, Simon C, Plunkett BA, Endres L, Adam EK, Mckinney C,
et al. Evidence for a complex relationship among weight retention,
cortisol and breastfeeding in postpartum women. Matern Child
Health J 2016;20:1375‑83.
36. van Poppel MN, Hartman MA, Hosper K, van Eijsden M. Ethnic
differences in weight retention after pregnancy: The ABCD study.
Eur J Public Health 2012;22:874‑9.
37. Walker LO. Low‑income women’s reproductive weight patterns
empirically based clusters of prepregnant, gestational, and
postpartum weights. Womens Health Issues 2009;19:398‑405.
38. Whitaker K, Young‑Hyman D, Vernon M, Wilcox S. Maternal
stress predicts postpartum weight retention. Matern Child Health
J 2014;18:2209‑17.
39. Wan Noor Fatehah  WZ, Yong  H, Zalilah  M, Zulida  R,
Barakatun Nisak MY. Correlation of pre‑pregnancy bmi, sleep and
depression with postpartum weight retention among chilbearing
age women. Int J Public Health and Clin Sci 2019;6:148‑59.
40. Zanotti  J, Capp  E, Wender  MC. Factors associated with
postpartum weight retention in a Brazilian cohort. Rev Bras Ginecol Obstet 2015;37:164‑71.
41. Schmitt  NM, Nicholson  WK, Schmitt  J. The association
of pregnancy and the development of obesity‑results of
a systematic review and meta‑analysis on the natural
history of postpartum weight retention. Int J Obes  (Lond)
2007;31:1642‑51.
42. McCall‑Hosenfeld  JS, Phiri  K, Schaefer  E, Zhu  J, Kjerulff  K.
Trajectories of depressive symptoms throughout the peri‑ and
postpartum period: Results from the first baby study. J Womens
Health (Larchmt) 2016;25:1112‑21.
43. Vliegen  N, Casalin  S, Luyten  P. The course of postpartum
depression: A review of longitudinal studies. Harv Rev Psychiatry
2014;22:1‑22.
44. Ghaedrahmati  M, Kazemi  A, Kheirabadi  G, Ebrahimi  A,
Bahrami  M. Postpartum depression risk factors: A  narrative
review. J Educ Health Promot 2017;6:60.
45. Faleschini S, Millar L, Rifas‑Shiman SL, Skouteris H, Hivert MF,
Oken E. Women’s perceived social support: Associations with
postpartum weight retention, health behaviors and depressive
symptoms. BMC Womens Health 2019;19:143.
46. Nasiri S, Akbari H, Tagharrobi L, Tabatabaee AS. The effect of
progressive muscle relaxation and guided imagery on stress,
anxiety, and depression of pregnant women referred to health
centers. J Educ Health Promot 2018;7:41.
47. Abdolaliyan  N, Shahnazi  H, Kzemi  A, Hasanzadeh  A.
Determinants of the self‑efficacy of physical activity for
maintaining weight during pregnancy: The application of the
health belief model. J Educ Health Promot 2017;6:93.