Psychosocial correlates of health-promoting and health-impairing behaviors in pregnancy

Abstract

Behaviors during pregnancy including eating, exercise, cigarette smoking, and other substance use affect the health of a pregnant woman and her fetus. However, little is known about what influences pregnant women to engage in these health behaviors. Based upon relevant theory, we hypothesized that because health-promoting behaviors require continuous efforts that may depend upon a reliable, stable set of resources, intrapersonal traits, namely self-esteem and optimism, would be associated with the practice of health-promoting behaviors during pregnancy. In addition, we hypothesized that variables reactive to the more immediate context, pregnancy-specific stress and perceived control over pregnancy, would be associated with the practice of health-impairing behaviors. We distinguished health-promoting and health-impairing behaviors in a diverse sample of 165 pregnant women and investigated whether such behaviors are associated with distinct psychosocial factors. Results supported study hypotheses and provide evidence that even after controlling for maternal age, income, body mass index, and gestation, a stable, self-relevant disposition, self-esteem, is associated with the practice of health-promoting behaviors in pregnancy whereas pregnancy-specific stress, a situationally-evoked factor, is associated with the practice of health-impairing prenatal behaviors. Perceived control over pregnancy, which may reflect stable disposition and situational perceptions, was associated with health-promoting and health-impairing behaviors.

Psychometric properties of the Prenatal Health Behavior Scale in mid- and late pregnancy

“…Responses were summed. This instrument has exhibited excellent psychometric properties in previous work [22,41] and had acceptable internal consistency here (α=0.76).…”

“…Healthier behaviors in pregnancy as assessed by this single-factor scale were associated with adequate prenatal weight gain and better psychological and physical functioning [25,27,28]. However, more recent evidence suggests that healthful and harmful behaviors are sufficiently independent to be conceptualized and operationalized separately in pregnant women and in a variety of non-pregnant populations [22,29]. In a recent study [22], scores on the health-promoting and health-impairing behavior subscales of the PHBS were only moderately correlated ( r =−0.33) in a socioeconomically diverse sample of pregnant women.…”

“…However, more recent evidence suggests that healthful and harmful behaviors are sufficiently independent to be conceptualized and operationalized separately in pregnant women and in a variety of non-pregnant populations [22,29]. In a recent study [22], scores on the health-promoting and health-impairing behavior subscales of the PHBS were only moderately correlated ( r =−0.33) in a socioeconomically diverse sample of pregnant women. Furthermore, the validity and independence of the subscales were bolstered by their distinct associations with other variables, including pregnancy-specific stress and perceived control over pregnancy [22].…”

“…In a recent study [22], scores on the health-promoting and health-impairing behavior subscales of the PHBS were only moderately correlated ( r =−0.33) in a socioeconomically diverse sample of pregnant women. Furthermore, the validity and independence of the subscales were bolstered by their distinct associations with other variables, including pregnancy-specific stress and perceived control over pregnancy [22]. Previous studies have not examined the reliability and validity of the PHBS across different time points in pregnancy, however.…”

“…Considerable change can occur over the course of pregnancy in a woman's medical and emotional status [37], and these may influence her health behaviors. A third goal of this study was to examine the validity of the PHBS at these two time periods in pregnancy via hypothesized associations with psychological variables [21,22] and individual characteristics [17,22,30] that have been associated with health behaviors in prior research. For example, younger women and those with less education are more likely to smoke while pregnant than older and more educated women [31,32].…”