Mindfulness in Pregnancy and Postpartum: Protocol of a Pilot Randomized Trial of Virtually Delivered Mindfulness-Based Cognitive Therapy to Promote Well-Being during the Perinatal Period.

BACKGROUND: During the period from pregnancy through the first year postpartum, vulnerable individuals are at elevated risk for the onset or worsening of psychological distress, and accessible (e.g., virtually delivered) mental health interventions are needed. Research suggests that Mindfulness-Based Cognitive Therapy (MBCT) can effectively mitigate psychological distress, although few studies have evaluated MBCT in the perinatal period, and samples have been clinically homogenous. Thus, we have designed and are conducting a pilot trial of virtually delivered MBCT with pregnant individuals experiencing a range of psychological symptoms to assess its feasibility and preliminarily explore its effectiveness. Here, we present the study protocol. METHODS: Eligible participants (target N = 70) are ≥18 years with pregnancies between 12 and 30 weeks of gestation. Participants complete a diagnostic interview, self-report symptom ratings, and a computerized cognitive battery assessing self-regulation at the baseline. Participants are then randomized to either MBCT or care as usual. The MBCT intervention involves eight weekly group sessions delivered virtually, with each session focusing on a mindfulness practice followed by group discussion and skill development. Participants in the intervention group are also encouraged to practice mindfulness skills between sessions. Participants in the control condition are provided with information about mindfulness and treatment resources. Baseline measures are repeated following the eight-week intervention period and at three months postpartum. CONCLUSIONS: This pilot study is designed to evaluate the feasibility of virtually delivered MBCT and explore group differences in psychological symptoms during the perinatal period, and will lay the foundation for a larger clinical trial focused on optimizing this intervention to improve psychological functioning among diverse pregnant individuals.

Associations between prenatal loss of control eating and cardiovascular health during pregnancy.

OBJECTIVE: Loss of control (LOC) eating (feeling unable to control food type/amount eaten) during pregnancy is common and linked to risk for poor cardiovascular health (CVH), but it is unclear whether prenatal LOC eating directly relates to CVH during pregnancy. The current study tested associations between prenatal LOC eating and CVH during pregnancy in a sample with prepregnancy body mass index (BMI) ≥ 25. METHOD: At 12-20 weeks' gestation, participants (N = 124) self-reported: prenatal LOC eating, diet, physical activity, nicotine use, sleep; height/weight were measured. Data were collected during 2015-2017. We dichotomized LOC eating (0 = absent; 1 = present) and scored CVH metrics using Life's Essential 8 to create a composite CVH score (range = 0-100; higher = better). Linear and binary logistic regression models tested if LOC eating is related to composite CVH score and odds of scoring low (0)/moderate-high (1) on each CVH metric, respectively. All models employed propensity score adjustment, since those with/without LOC eating may differ in ways affecting CVH, and covaried for: age, gestational age, prepregnancy BMI, ethnicity, race, education, and income. RESULTS: Compared to those without, participants with LOC eating had significantly poorer composite CVH scores (b = -9.27, t(111) = -2.70, p < .01) and lower odds of scoring moderate-high on nicotine use (OR = 0.20, 95% CI [0.04, 0.85], p = .03) and sleep duration (OR = 0.19, 95% CI [0.04, 0.83], p = .03) CVH metrics. CONCLUSIONS: Prenatal LOC eating was associated with poorer CVH during pregnancy in this sample with prepregnancy BMI ≥ 25, even after controlling for propensity of experiencing LOC eating and known risk factors for poor CVH. Thus, prenatal LOC may represent a modifiable factor related to prenatal health risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Formative Development of ClockWork for the Postpartum Period: A Theory-Based Intervention to Harness the Circadian Timing System to Address Cardiometabolic Health-Related Behaviors.

Individuals with body mass index (BMI) ≥ 25 kg/m2 before pregnancy have greater difficulty losing the weight gained during pregnancy, and this postpartum weight retention predicts higher risk for cardiometabolic disease. The postpartum period involves substantial disruptions in circadian rhythms, including rhythms related to eating, physical activity, sleep, and light/dark exposure, each of which are linked to obesity and cardiometabolic disease in non-pregnant adult humans and animals. We posit that a multi-component, circadian timing system-based behavioral intervention that uses digital tools-ClockWork-will be feasible and acceptable to postpartum individuals and help promote weight- and cardiometabolic health-related behaviors. We provide data from stakeholder interviews with postpartum individuals (pre-pregnancy BMI ≥ 25; n = 7), which were conducted to obtain feedback on and improve the relevance and utility of digital self-monitoring tools for health behaviors and weight during the postpartum period. Participants perceived the ClockWork intervention and digital monitoring app to be helpful for management of postpartum weight-related health behaviors. They provided specific recommendations for increasing the feasibility intervention goals and improving app features for monitoring behaviors. Personalized, easily accessible interventions are needed to promote gestational weight loss after delivery; addressing circadian behaviors is an essential component of such interventions. Future studies will evaluate the efficacy of the ClockWork intervention and associated digital tools for improving cardiometabolic health-related behaviors linked to the circadian timing system during the postpartum period.

Improvements in cardiovascular health over the perinatal period predicts lower postpartum psychological distress.

Background: Adverse cardiovascular events during pregnancy (e.g., pre-eclampsia) occur at higher rates among individuals with pre-pregnancy overweight or obesity (body mass index [BMI]≥25kg/m2) and have been associated with postpartum depression. However, it is unclear whether cardiovascular health (CVH), defined more holistically than the absence of cardiovascular conditions in pregnancy, relates to postpartum psychological functioning. The present study examined whether changes in CVH during the perinatal period predicted postpartum psychological functioning among individuals with pre-pregnancy BMI≥25kg/m2. Methods: Individuals (N=226; Mage=28.43±5.4 years; MBMI=34.17±7.15kg/m2) were recruited when their pregnancies were 12-20 weeks gestation (M=15.64±2.45 weeks) for a longitudinal study of health and well-being. Participants completed the Center for Epidemiological Studies Depression Scale (CES-D) and Perceived Stress Scale (PSS) and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6-months postpartum. BMI and CVH behaviors were coded according to the American Heart Association's Life's Essential 8 to create a CVH score at both timepoints. Linear regression analyses were performed to examine whether change in CVH related to postpartum CES-D and PSS scores. Because sleep was only measured in a subset of participants (n=114), analyses were conducted with and without sleep included. Baseline CVH, CES-D and PSS scores, and demographic factors were included as covariates in all models. Results: Improved CVH was associated with lower postpartum CES-D (ß=-0.18, p<0.01) and PSS (ß=-0.13, p=0.02) scores when excluding sleep. Compared to those whose CVH improved by >1SD from pregnancy to 6-months postpartum, individuals whose CVH worsened by >1SD scored 6.42 points higher on the CESD (MCESD=15.25±10.92 vs. 8.52±6.90) and 6.12 points higher on the PSS (MPSS=24.45±8.29 vs. 17.83±8.70). However, when including sleep, these relationships were no longer significant (ps>0.4). Conclusions: Improvements in CVH from early pregnancy to 6-months postpartum were associated with lower postpartum depressive symptoms and perceived stress. However, these relationships were no longer significant when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.

Relation of social network support to child health behaviors among children in treatment for overweight/obesity.

PURPOSE: Little is known about the influence of social network support on child health behaviors in the context of weight-loss interventions. This study examined the associations between a child's co-participation (i.e., network support) in weight-related health behaviors (i.e., physical and sedentary activity, eating behavior) and the child's own health behaviors during family-based behavioral treatment (FBT). METHODS: Children (n = 241) with overweight/obesity (mean age = 9.4 ± 1.3y; 63% female) completed semi-structured interviews assessing network support for healthy/unhealthy eating and physical/sedentary activity, and a 3-day dietary recall. Physical activity was assessed with accelerometry, and sedentary activity was measured via parent-reported child screen time use. All assessments were taken at baseline and after 4 months of FBT. Hierarchical linear regressions examined changes in network support as they related to changes in health behaviors from baseline to the end of FBT. RESULTS: Changes in network support for healthy eating were related to changes in vegetable, but not fruit, intake across FBT, while changes in network support for unhealthy eating were negatively related to changes in diet quality. Changes in network support for sedentary activity were negatively related to changes in minutes of physical activity and positively related to changes in screen time. CONCLUSION: The present findings suggest that a child's network support for health behaviors may relate to behavior change among children during FBT and provide opportunities for targeted intervention. LEVEL OF EVIDENCE: III. cohort study.

General and Eating Disorder Psychopathology in Relation to Short- and Long-Term Weight Change in Treatment-Seeking Children: A Latent Profile Analysis.

BACKGROUND: Concurrent general psychopathology (GP) and eating disorder psychopathology (EDP) are commonly reported among youth with overweight/obesity and may impact weight change. PURPOSE: We identified patterns of GP and EDP in children with overweight/obesity and examined the impact on weight change following family-based behavioral obesity treatment (FBT) and maintenance interventions. METHODS: Children (N = 172) participated in 4 month FBT and subsequent 8 month weight maintenance interventions. GP and EDP were assessed prior to FBT (baseline). Child percentage overweight was assessed at baseline, post-FBT (4 months), and post-maintenance (12 months). Latent profile analysis identified patterns of baseline GP and EDP. Linear mixed-effects models examined if profiles predicted 4- and 12-month change in percentage overweight and if there were two-way and three-way interactions among these variables, adjusting for relevant covariates. RESULTS: Results indicated a three-profile structure: lower GP and EDP (LOWER); subclinically elevated GP and EDP without loss of control (LOC; HIGHER); and subclinically elevated GP and EDP with LOC (HIGHER + LOC). Across profiles, children on average achieved clinically meaningful weight loss (i.e., ≥9 unit change in percentage overweight) from baseline to 4 month FBT and sustained these improvements at 12 month maintenance. There was no evidence that latent profiles were related to percentage overweight change from baseline to FBT (p > .05) or baseline to maintenance (p > .05). There was no evidence for two-way or three-way interactions (p > .05). CONCLUSION: Concurrent GP and EDP do not portend differential short- or long-term weight change following FBT and maintenance. Future research is warranted on the durability of weight change among youth with GP and EDP. TRIAL REGISTRATION: NCT00759746.

Demographic, Pregnancy-Related, and Health-Related Factors in Association with Changes in Sleep Among Pregnant Women with Overweight or Obesity.

BACKGROUND: Women with prepregnancy overweight/obesity are at high risk for obstetric complications and cardiometabolic disease. Poorer sleep quality is associated with obesity in non-pregnant individuals and, during pregnancy, poor sleep predicts negative obstetric and health outcomes. This study examined sleep patterns among women with overweight/obesity and factors associated with different sleep trajectories during pregnancy. METHODS: Women (N = 146, 17-40 years old) with a prepregnancy body mass index ≥ 25 kg/m2 were recruited during early pregnancy. Participants reported demographic information and completed the Pittsburgh Sleep Quality Index (PSQI) at up to six monthly assessments, with the first assessment occurring between 12 and 20 weeks gestation and the final assessment between 35 weeks gestation and delivery. PSQI scores > 5 indicate "poor sleep." RESULTS: On average, women's PSQI scores were 6.66 ± 3.58 in the first half of pregnancy and were significantly higher (worse) at the end of pregnancy (t(644) = 4.55, p < 0.001), with the greatest change occurring in the third trimester (t(636.3) = 3.72, p < 0.001). Women who currently smoked had poorer sleep than women who did not currently smoke (t(1) = 2.29, p = 0.02). Prepregnancy weight status, age, parity, race, education, and income were not significantly associated with sleep changes (t(1) < 1.76, ps > 0.08). The percentage of women with PSQI scores > 5 (the threshold for poor sleep quality) was 37-63% across assessments, with the greatest increase occurring during the third trimester (t(633) = 2.92, p = 0.004). CONCLUSIONS: Sleep quality worsens during the third trimester and is associated with current smoking. Future studies of sleep during pregnancy should examine health outcomes among women with overweight/obesity and early intervention to mitigate sleep disturbances as pregnancy progresses.

Factors associated with depression and anxiety symptoms among children seeking treatment for obesity: A social-ecological approach.

BACKGROUND: Children with overweight/obesity are more likely to exhibit symptoms of depression and anxiety than are their peers without overweight/obesity; however, the rates and correlates of depression and anxiety symptoms among children seeking obesity treatment remain unclear. OBJECTIVES: Examine the prevalence and associated factors of depression and anxiety symptoms among treatment-seeking children with overweight/obesity. METHODS: Children 7 to 11 years old (N = 241) and their parents completed assessments before beginning family-based behavioral weight-loss treatment. Disorder-specific self-report questionnaires assessed child depression and anxiety. The social-ecological model served as a framework for examining factors associated with depression and anxiety symptoms. RESULTS: Among our sample, 39.8% (96/241) met clinical cutoffs for depression and/or anxiety symptomatology. Specifically, of these 96, 48 met criteria for both depression and anxiety, 24 for depression only, and 24 for anxiety only. Child eating disorder pathology, parents' use of psychological control (ie, a parenting style characterized by emotional manipulation), and lower child subjective social status were significantly associated with greater child depression symptomatology. Child eating disorder pathology and parent psychological control were significantly associated with greater child anxiety symptomatology. CONCLUSION: Nearly 40% of children exhibited psychopathology symptoms, and a variety of correlates were found. Thus, pediatric weight-loss providers may consider screening for and addressing mental health concerns (and associated factors) prior to and during treatment.

Predictive utility of subtyping women smokers on depression, eating, and weight-related symptoms.

OBJECTIVE: Smoking and overweight or obesity are preventable causes of disease and death. Women are reluctant to quit smoking because of concerns about postcessation weight gain, underscoring the need to elucidate patterns of weight concerns and associated psychosocial factors that may affect smoking cessation outcomes. The present study aimed to subtype women smokers based on psychosocial and behavioral factors associated with smoking and weight, and examine the utility of these subtypes to predict abstinence and postcessation weight gain. METHOD: Weight-concerned women (N = 343) were randomized to 1 of 2 smoking cessation counseling adjuncts and 1 of 2 cessation medication conditions. At baseline, women were weighed and completed measures of depression, weight or appearance concerns, and eating behaviors. At 3-, 6-, and 12-months after the target quit date, women were weighed and completed self-report and biochemical smoking assessments. RESULTS: Latent profile (LP) analyses supported a 3-profile model. The groups had typical (53%, LP1), minimal (33%, LP2), and high (14%, LP3) levels of depressive symptoms and weight concerns. At 12-months posttarget quit date, women in LP3 were more likely to relapse than women in LP1 (odds ratio, OR = 2.93). Among abstinent women, those in LP2 and LP3 gained more postcessation weight than those in LP1. CONCLUSIONS: Heterogeneity in symptoms of depression, weight or appearance concerns, and eating behaviors was captured by three groups of women smokers, with unique risks for relapse and postcessation weight gain. The distinct profiles identified may help personalize the delivery of care for smoking cessation and, ultimately, reduce disease risk. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Child and parent reports of children's depressive symptoms in relation to children's weight loss response in family-based obesity treatment.

BACKGROUND: Studies of the association between children's depressive symptoms and obesity treatment response show mixed results. Different measurement may contribute to the inconsistent findings, as children's depressive symptoms are often based on parent-report about their child rather than child self-report. OBJECTIVES: We assessed both child- and parent-report of child depressive symptoms as predictors of children's obesity treatment response. METHODS: Children with overweight/obesity (body mass index [BMI] ≥ 85th percentile; N = 181) and their parents reported on children's depressive symptoms prior to family-based behavioral weight loss treatment. RESULTS: Child percent overweight reduction from baseline to post-treatment was not predicted by child self-reported depressive symptoms or parent-report of child symptoms (P > 0.80), but was significantly predicted by the interaction between child self-report and parent-report on child (ß = 0.14, P = 0.05). In analyses using clinical cutoffs, amongst children with high self-reported symptoms, those whose parents reported low child depressive symptoms had greater reduction in percent overweight (t = 2.67, P = 0.008), whereas amongst children with low self-reported symptoms, parent ratings were not associated with treatment outcome. CONCLUSIONS: Including both child self-report and parent-report of child depressive symptoms may inform obesity care. Research is needed to examine differences amongst child and parent depressive symptom reports and strategies to address symptoms and optimize pediatric obesity treatment.