Associations between lifestyle and well-being in early and late pregnancy in women with overweight or obesity: Secondary analyses of the PEARS RCT

Abstract

Objectives: The associations between individual lifestyle behaviours and well-being are still poorly understood, particularly in the antenatal period when women are exposed to physiological changes and increased psychological distress. A healthy lifestyle score (HLS) comprising protective lifestyle behaviours may be useful for studying links between overall lifestyle and psychosocial outcomes. This study aimed to examine bidirectional associations between a HLS and its components and psychological well-being in pregnant women with overweight/obesity.

Design: Secondary analyses of data from the PEARS trial.

Methods: Healthy lifestyle scores (scored 0-5) based on maternal diet (AHEI-P), physical activity (MET-minutes), alcohol consumption, smoking, and sleep habits were created for 330 and 287 mothers with overweight/obesity in early (14-16 weeks gestation) and late pregnancy (28 weeks gestation), respectively. Psychological well-being was measured with the WHO-5 well-being index. Cross-lagged path models (crude/adjusted) tested the directionality of relationships between lifestyle (composite score/individual components) and well-being cross-sectionally and over time in pregnancy.

Results: The mean early pregnancy BMI was 29.2 kg/m². The mean well-being score was 56.3% in early and 60.7% in late pregnancy. Significant autoregressive effects were observed for the HLS, all individual components, and well-being from early to late pregnancy. Well-being was positively correlated with the HLS, physical activity, and sleep variables within time points (in early and/or late pregnancy). Sleep and no smoking in early pregnancy predicted higher well-being in late pregnancy.

Conclusions: Overall healthy lifestyle, physical activity, and especially sleep duration and quality are associated with psychological well-being in pregnancy, and should be promoted antenatally.

Keywords: diet; healthy lifestyle score; overweight and obesity; physical activity; psychological well‐being; sleep; smoking.