Our study revealed that approximately one in ten participants reported experiencing body dissatisfaction during pregnancy. Additionally, nearly half of the sample showed clinically significant anxiety-depressive symptoms. Finally, we found a significant association between depression, anxiety, and body dissatisfaction. These findings underscore the noteworthy prevalence of body dissatisfaction during pregnancy and its interconnectedness with other mental health problems, highlighting the significance of addressing this issue within the context of maternal well-being.
More specifically, the primary objective of this study was to investigate the presence of body dissatisfaction in a cohort of 711 pregnant women in Italy. Body dissatisfaction was observed to reach clinical significance in approximately ten percent of the sample, with a notably higher prevalence in concerns related to body shape, affecting more than one-sixth of participants. These data indicate a slightly lower prevalence of body discomfort within our population compared to previous studies in the literature, which have reported body dissatisfaction in up to one-quarter to one-third of pregnant individuals [15, 16]. Conversely, concerns regarding restrictive behaviors and food-related issues were less prevalent, affecting fewer than 10% of the individuals. Approximately 4.6% of our sample had a documented history of ED, consistent with epidemiological data regarding the lifetime prevalence of ED in Western countries [39].
In contrast to previous research, which documented an increase in body dissatisfaction during pregnancy, our study offers a unique observation, as it did not reveal significant variations in body dissatisfaction when comparing different trimesters [23]. Similarly, our analysis did not reveal significant differences in body dissatisfaction when comparing different pregnancy risk categories. We found a significant divergence in levels of body dissatisfaction between primiparae and pluriparae. These results imply that while the trimester of pregnancy and pregnancy risk may not substantially impact body dissatisfaction, a noteworthy differentiation exists between primiparous and pluriparous individuals, underscoring the importance of considering parity status when assessing body image perceptions during pregnancy.
Regarding the characteristics of our sample, the average age of the participants was approximately 30 years. The mean prepregnancy BMI was 24 kg/m², with 60% of the cohort falling within the normal weight range, 20% classified as overweight, 14% as obese, and 6% categorized as underweight. In terms of weight gain during pregnancy, our observations closely aligned with recommended gynecological guidelines [40]. In particular, nearly 50% of the women adhered to the recommended guidelines for weight gain, 20% exhibited slightly greater values, 15% showed slightly lesser values, and less than 10% displayed significantly higher or lower weight gain. It is worth noting that these findings deviate from the prevailing literature data, suggesting higher levels of weight gain [41, 42]. This discrepancy may be attributed to various factors, including differences in eating habits among diverse geographical populations or the potential influence of selection bias. Moreover, pregnant women engaging with social media channels dedicated to pregnancy health may exhibit heightened awareness and diligence regarding nutritional aspects and weight control, which could differentiate them from pregnant women in the broader population.
In terms of the general mental health profile, approximately 7% had a history of MDD, and over 20% of the sample had a history of AD. These findings are approximately aligned with the epidemiologic data of the prevalent literature [39, 43–45]. Furthermore, approximately 20% of the sample exhibited depressive symptoms significant enough to warrant clinical attention (PHQ-9 score > 9). Additionally, in accordance with the literature, anxiety symptoms surpassed the diagnostic threshold (GAD-7 score > 9) for nearly 20% of the subjects, with three-fourths of them experiencing moderate anxiety symptoms. These results are similar to those found in previous scientific research on gestational depression and gestational anxiety [48, 49]. Moreover, a 2012 Italian study reported similar data, both with depression and anxiety rates during pregnancy [50].
The second objective of this study was to explore the association between depression, anxiety, and body dissatisfaction. These findings build upon the existing body of literature, which has previously reported associations between body image dissatisfaction and anxious-depressive symptoms during pregnancy [16, 21, 22, 25, 51]. Different studies [23, 25, 26, 52] have underscored the significant role of body image in the heightened risk of perinatal depression or anxiety. Of particular note, Riquin et al. (2019) [25] suggested that the investigation of body dissatisfaction during an early prenatal visit may offer a means of early detection of perinatal depression. This proactive approach holds the potential to prevent the stigmatization of women during pregnancy and reduce the risk of underdiagnosing depression during the pregnancy and postpartum periods.
Our results align with this body of research by demonstrating a strong connection between body dissatisfaction and symptoms of anxiety and depression during pregnancy, as well as a history of depression prior to pregnancy. These results suggest that within this specific population, discomfort with one’s body is primarily tied to internal inner experiences rather than objective physical parameters. One plausible explanation for this link could be rooted in the complex dynamics of a mother’s emotional experience during pregnancy: the ability to handle conflicting emotions regarding the child depends on psychological factors and the woman’s social support network [53, 54]. When these emotions are not openly expressed, they may be displaced onto body image concerns, masking deeper emotional issues. This underscores the importance of addressing the societal and cultural aspects that impact a mother’s experience during the perinatal period [55, 56]. Stigma, as highlighted in a study by Byatt et al. (2013), is a significant concern in this context [57].
It is worth noting that perinatal depression often presents with a higher prevalence of anxious features compared to nonperinatal depression, indicating that anxiety symptoms play a central role in peripartum depression for many women [58, 59]. The established relationship between anxiety, depression, and body dissatisfaction suggests a significant overlap among these dimensions [16, 25, 26]. This underscores the distinctive nature of psychopathology during pregnancy, warranting clinical attention. We posit that factors such as body dissatisfaction may act as a potential alert for healthcare practitioners, including general practitioners, gynecologists, nutritionists, or community nurses. The conspicuous presence of significant body dissatisfaction might prompt further assessments employing tools such as the PHQ-9 and GAD-7. Subsequently, this assessment could lead to considerations of pharmacological or psychological interventions, as well as environmental modifications, within a framework of secondary or tertiary prevention.
Several limitations should be acknowledged in our study. First, it is important to recognize that our investigation may underestimate the true prevalence of body dissatisfaction among pregnant women. This is in accordance with prior research, such as Bye et al. (2018), which suggests that some participants may have been hesitant to openly discuss their symptoms during research interviews, possibly due to the fear of social stigma associated with such disclosure. Second, our study is susceptible to selection bias, primarily attributable to the recruitment method employed, which relied on online platforms and social media. It is essential to acknowledge that this approach may not yield a comprehensive representation of the broader population of pregnant women. Our study predominantly captured responses from Italian participants, typically approximately 30 years of age, characterized by elevated educational attainment and active employment status. This sample composition introduces a notable degree of bias into our findings. Future research endeavors should seek to expand the sample’s diversity and inclusiveness by implementing a more targeted approach to data collection. This might involve administering the questionnaire within specific settings, such as pregnancy outpatient services, neighborhood social services, or other relevant contexts. Third, we must address the limitations associated with the use of the EDE-Q in our study. While the EDE-Q is a widely used tool for assessing EDs and body dissatisfaction, it is not formally validated for use during pregnancy. Furthermore, the utilization of a truncated version of the EDE-Q in our research, although potentially indicative of body dissatisfaction, cannot replace the diagnostic capabilities of the comprehensive 36-item version. Consequently, the findings, while valuable, should be interpreted with caution, particularly in the context of diagnosing EDs during pregnancy. Further research utilizing validated instruments specific to pregnancy may be necessary to provide a more accurate assessment of body dissatisfaction in this population.
In conclusion, this study has shed light on the conspicuous prevalence of body dissatisfaction during pregnancy. Our results indicate a robust connection between body dissatisfaction and affective symptoms related to anxiety and depression. This underscores the primary influence of internal emotional experiences in molding one’s body image perceptions. The association between body dissatisfaction and affective symptoms underscores the distinct nature of psychopathological experiences during pregnancy, warranting heightened clinical attention. This underscores the need for a holistic approach to maternal mental health care during pregnancy and the postpartum period. Additional research employing a representative sample and validated tools tailored to the specific contexts of pregnancy is essential to further our comprehension of body dissatisfaction in this demographic and to inform more efficacious clinical interventions.