Predicting health behaviors and health outcomes during pregnancy : A biopsychosocial approach

Abstract: Pregnancy is a major health event. The biomedical perspective alone is unable to predict complications,particularly for nulliparous women. This dissertation takes an integrative approach by using psychosocial,personality, and contextual factors as predictors of health behaviors and outcomes during pregnancy whiletaking biomedical factors into account. Nulliparous, Swedish women were studied longitudinally startingfrom their first prenatal health care visit to postpartum using a repeated measures design.Study I examined smoking and exercise at mid and late pregnancy. Independent of prepregnancybehavior, we found that healthy lifestyle behaviors were predicted by health awareness (moderated bypregnancy adjustment) and by perceived stress (moderated by social support and hostility). Hostility waspositively related to exercise and negatively to smoking. Study II indicated that women reported a widerange of symptoms during gestational week 28, however, only a small portion of these symptoms weredocumented in the medical record. Self-reported symptoms were moderately correlated to psychosocial andpersonality factors. Social support and biomedical factors accounted for the number of symptomsdocumented in the medical record to a similar extent as, and independent of, self-reports. Self-reportedsymptoms subsequently predicted various forms of medical care utilization, while documented symptomspredicted some delivery and neonatal outcomes. Study III examined the antecedents and consequences ofperceived health while holding medical risk factors constant. Social support, negative affect, and stresspredicted medically relevant symptoms, which in turn, and in conjunction with pregnancy adjustment,predicted perceived health. Perceived health accounted for subsequent medial care utilization, i.e. numberof visits to an obstetrician, which in turn was associated with emergency room visits. Stress predictedemergency room visits. The present research highlights the interplay between psychosocial, personality,contextual and biomedical factors as they relate to health behaviors and to understudied health outcomesduring pregnancy.