intake. The finding suggests that stress did not affect food intake in these subjects, rather it impacted the utilization of calories and nutrients from the foods consumed to support pregnancy.

Based on the published regression models, either crude or adjusted, there does not appear to be a robust association between the appraisals of stress, sufficiency of coping resources, and adequacy of GWG. However, when evaluating the risk ratio differences observed between women who gained either inadequate or excessive weight, the committee found that the women who gained inadequate weight tended to have a stronger, albeit modest, link to perceived stress. Brawarsky et al. (2005) found a similar pattern: women who reported high stress during pregnancy tended to gain weight below amounts recommended. Likewise, Orr et al. (1996) reported higher stress in relation to insufficient GWG.

Social Support

Evidence for a role of social support as a determinant of GWG is mixed and inconclusive. In a prospective study of 806 low-income, non-obese pregnant women, Hickey et al. (1995) found that the levels of social support did not predict low GWG for either black or white women. Casanueva et al. (1994) reported on the impact of psychological support, given to a group of adolescents during pregnancy, on GWG and found that adolescents who received additional psychological support by a psychotherapy team gained, on average, 2.8 kg more than adolescents who did not receive support. More recently, Olson and Strawderman (2003) found the effect of social support on GWG varied significantly by BMI group. Underweight, normal weight, and obese women who had low social support gained significantly more weight gain than their counterparts with average or high social support. However, obese women who had low social support gained significantly less weight relative to obese women with average or high social support.

Attitudes Toward Weight Gain or Weight Loss

Several studies have examined the relationship between maternal attitude toward weight gain during pregnancy and actual GWG. Palmer et al. (1985) developed an 18-item scale measuring pregnant women’s attitude toward their own weight gain and found among 29 white, middle-class women that positive attitude was significantly associated with higher actual weight gain. Stevens-Simon et al. (1993) conducted a study of 99 pregnant adolescents and found that weight gain was significantly related to 4 of 18 scale items but not the total attitude scale score. However, Copper et al. (1995) studied 1,000 black and white low-income women and found that

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