母性に伴う心理社会的・行動的変化は、妊娠の長期的な体重増加に影響を与えるか？

Do the psychosocial and behavioral changes that accompany motherhood influence the impact of pregnancy on long-term weight gain?

• H E Harris
• G T Ellison
• S Clement

抄録

本研究の目的は、妊娠中と妊娠後に発生する心理社会的および行動の変化が長期的な体重増加に影響を与えるかどうかを評価することでした。この研究では、Antenatal Care（ANC）プロジェクト（サウスロンドンに拠点を置く妊産婦ケアのランダム化比較試験）に登録した74人の母親を調査したが、全員がその後の追跡調査に参加することを希望した。妊娠初期の体重に関するデータ、妊娠中のライフスタイルと行動、出産前のケアと産科歴、妊娠後の産後うつと子育てストレスの測定と一緒に、既存のANCプロジェクトのデータベースから取得しました。身長と体重の追加測定に加えて、さまざまなライフスタイルの変化や心理社会的特性に関する情報が、子どもが生まれてから2年半後に各母親の自宅で半構造化面接で収集されました。その結果、妊娠に関連した体重増加は、単に妊娠中に増えた体重を維持した結果ではなく、産後の体重増加にも起因していることがわかりました。子どもが生まれた後に食べる量が増えたと感じた母親は、食事の摂取量が増えていないと感じた母親に比べて、長期的な体重増加が有意に大きかった（2.78（1.42kg））（-1.15（0.76kg; t = 2.49、p = 0.016）。同様に、産後に食物へのアクセスが増えたと感じた母親は、食物へのアクセスが増えていないと感じた母親（-1.37（1.13）kg; t = 2.18、p = 0.032）に比べて、長期的な体重増加が有意に大きかった（1.70（0.87）kg）。妊娠と母性に伴うライフスタイルの変化が、摂食障害の精神病理に対する一部の女性の脆弱性を増加させるという証拠があった。妊娠後に以前よりも運動量が少ないと感じた母親は、長期的な体重増加のリスクも高かった（p = 0.028）、支持者の数が少ない母親と同様に（p = 0.033）。子育てのストレスも母親のうつ病も長期的な体重増加のリスクの増加と有意に関連していなかった（p > 0.05）。

The aim of the present study was to assess whether the psychosocial and behavioral changes that occur during and after pregnancy influence long-term weight gain. The study examined 74 mothers enrolled in the Antenatal Care (ANC) Project (a randomized controlled trial of antenatal care based in South London), all of whom had volunteered to take part in a subsequent follow-up study. Data on body weight at the beginning of pregnancy; lifestyle and behavior during pregnancy; antenatal care and obstetric history; together with measures of postnatal depression and parenting stress following pregnancy were taken from the existing ANC Project database. Additional measurements of height and weight together with information on a variety of lifestyle changes and psychosocial characteristics, were gathered during semi-structured interviews at each mother's home, two and a half years after their children had been born. The results show that pregnancy-related weight gains are not simply the result of retaining weight that is gained during pregnancy, but that they also originate from gaining additional weight in the postpartum period. Mothers who felt they ate more after their children were born, had significantly greater long-term weight gains (2.78 (1.42) kg) than those who felt that they had not increased their food intake (-1.15 (0.76) kg; t = 2.49, p = 0.016). Similarly, mothers who felt they had greater access to food postpartum, had significantly greater long-term weight gains (1.70 (0.87) kg) than those who felt they did not have greater access to food (-1.37 (1.13) kg; t = 2.18, p = 0.032). There was some evidence that the lifestyle changes which accompany pregnancy and motherhood increase some women's vulnerability to eating disorder psychopathology. Mothers who felt they did less exercise after pregnancy than they did before, were also at greater risk of long-term weight gain (p = 0.028), as were mothers with low numbers of supportive individuals (p = 0.033). Neither the stress of parenting nor maternal depression were significantly associated with an increased risk of long-term weight gain (p > 0.05).