Beyond the mirror: Exploring the impact of maternal body image attitudes on gestational weight gain and maternal and neonatal outcomes, a systematic review

BACKGROUND: Body image concerns before and during pregnancy can significantly influence gestational weight gain (GWG), psychological well-being, maternal behaviors, and perinatal outcomes. OBJECTIVE: This systematic review aims to synthesize quantitative evidence on the association between maternal body image attitudes and GWG, as well as other maternal and neonatal outcomes. METHOD: We systematically searched MEDLINE, PsycINFO, and CINAHL Plus for studies published between January 1, 2000, and January 15, 2025. Eligible studies were quantitative in design and examined maternal body image attitudes before or during pregnancy in relation to GWG, maternal outcomes, neonatal outcomes, or breastfeeding practices. Two reviewers independently screened studies and assessed methodological quality using Joanna Briggs Institute (JBI) tools, resolving discrepancies through consensus. Data extraction was performed by one reviewer and cross-checked by a second; findings were narratively synthesized and summarized in tables. RESULTS: Of the 2524 studies identified, 19 met the inclusion criteria. Among the 15 studies assessing GWG, 10 reported significant associations between negative body image and higher or excessive GWG. Three studies linked body image concerns with antenatal or postpartum depressive symptoms, while two studies examined postpartum weight retention, yielding mixed findings. Only one study investigated neonatal outcomes, identifying an association between negative body image constructs and increased risk of small-for-gestational-age newborns. Two studies explored breastfeeding outcomes, showing that positive body image was associated with breastfeeding initiation and continuation, whereas negative body image was linked to formula use and early cessation. CONCLUSION: Maternal body image concerns assessed before or during pregnancy were frequently associated with higher or excessive GWG. Evidence for associations with maternal depressive symptoms, breastfeeding outcomes, and neonatal outcomes was more limited and heterogeneous and should be interpreted with caution. Future research using standardized measures and longitudinal designs is needed to clarify directionality and mechanisms underlying these associations.