Associations between social-network characteristics and postpartum health behaviors and weight among a sample of women who were overweight/obese pre-pregnancy.

Abstract

Background: Retention of weight postpartum increases risk for long-term morbidity, including cardiometabolic disease. Although retained weight postpartum is a complex problem, interventions generally address individual diet and activity behaviors.

Objectives: We investigated the impact of social-network factors on postpartum health behaviors and weight.

Design: We used an explanatory-sequential mixed-methods approach. This article reports our quantitative findings.

Methods: Childbearing people receiving care at university-based clinics were eligible if aged 18+, 12-15 months postpartum, with a pre-pregnancy BMI ⩾ 25 kg/m². An online survey collected participants' demographic and outcome data and structured surveys collected personal social-network data. Block stepwise linear regression identified associations between social-network features and postpartum health behaviors and weight.

Results: One hundred women completed both surveys; 62% did not return to pre-pregnancy weight. Multivariable models found: (a) participants with lower postpartum weight ate meals with more people in their network (β = -0.173, p = 0.063); (b) lower consumption of sugar-sweetened beverages was associated with greater proportions of the network who were siblings (β = -0.231, p = 0.011), and who were perceived to eat a healthy diet (β = -0.201, p = 0.031); (c) higher consumption of fruit was associated with a greater proportion of the network who helped with participants' healthy-lifestyle goals (β = 0.288, p = 0.004), a smaller proportion of the network who were friends (β = -0.229, p = 0.022), and greater betweenness centrality (β = 0.302, p = 0.002); (d) lower consumption of fat was associated with smaller proportions of the network who were perceived to be sedentary (β = 0.288, p = 0.005), were friends (β = 0.311, p = 0.002), and were perceived to be normal weight (β = 0.202, p = 0.052) and with greater proportions of the network who encouraged participant goals (β = -0.257, p = 0.012) and were perceived to eat a healthy diet (β = -0.258, p = 0.015); (e) increased levels of activity were associated with a greater proportion of the network who were perceived to eat a healthy diet (β = 0.192, p = 0.044).

Conclusion: Results revealed evidence for the role of social-network norms, support, and structure in postpartum health behaviors and weight. Understanding social environments' impact on postpartum health behaviors and weight is essential in approaching the problem from a multilevel/domain approach.