| Summary |
Obesity is a national public health issue that adversely affects women of reproductive age and increases the risk for chronic issues (cardiovascular disease, type II diabetes, decreased fertility) that can cause short- and long-term consequences during pregnancy. Obesity is also related to sexual functioning, with greater BMI being linked to greater sexual problems among this population. Two potential mediators that may explain the relation between weight and sexual problems during pregnancy are internalized weight bias and body image dissatisfaction. Indeed, how a person perceives their weight and body image as it changes during pregnancy likely affects their sexual functioning and satisfaction. Importantly, little research has explored the association between these constructs among a racially diverse sample (Black, White race), thus calling for more understanding of how these variables operate among diverse groups of pregnant people. The current study sought to examine the relationship between weight class, internalized weight bias, body dissatisfaction, and sexual health (functioning, satisfaction) during pregnancy among a racially diverse sample of Black and White pregnant women. Participants were 306 pregnant individuals (0-39 weeks gestation; 40.5% Black, 51.3% White race) living within the United States who were assigned female at birth, sexually active during pregnancy, and between the ages of 18-45 years of age. Participants were drawn from a Qualtrics Panel and completed an online survey assessing obstetric characteristics, sexual activity, functioning and satisfaction, as well as weight-related constructs. Structural equation modeling was utilized to evaluate a parallel mediation model to examine the indirect effects of internalized weight bias (M1) and body dissatisfaction (M2) on the relation between weight class (pre-pregnancy BMI [X1] and gestational weight gain [X2]) and sexual health (sexual functioning [Y1] and sexual satisfaction [Y2]). Results indicated that greater BMI prior to pregnancy was associated with greater internalized weight bias while participants were pregnant, and this was in turn related to lower sexual satisfaction while pregnant. Additionally, the same trend was found with body dissatisfaction, in that the heavier an individual weighed before pregnancy was related to worse body image during pregnancy, and thus greater sexual dysfunction and lower sexual satisfaction. Further, greater weight gained during pregnancy predicted women's sexual functioning and sexual satisfaction via body dissatisfaction, however, internalized weight bias only mediated the relationship between gestational weight gain and sexual satisfaction, similar to how internalized weight bias was not found to mediate the relationship to sexual functioning through pre-pregnancy BMI. These results indicate that BMI prior to pregnancy plays a role in sexual functioning and satisfaction during pregnancy, and that this relationship is partially explained by perceived level of internalized weight bias and body dissatisfaction. Further, gestational weight gain can also influence perceived sexual functioning during pregnancy, by way of a pregnant person's level of body dissatisfaction. However, minimal moderation effects of race were observed. Specifically, results supported differences in strength of the relationship between pre-pregnancy BMI and internalized weight bias by race, with the relationship being stronger among White women, as hypothesized. Altogether, these findings support that future work should aim to prioritize and center Black women's experiences with weight, stigma, and sexual health, through culturally-sensitive recruitment strategies, study methodologies, and with an ultimate goal of strengthening our measurement and assessment in order to adequately capture Black pregnant women's experiences and better serve their healthcare needs. |
