Social Media Use Impacts Body Image and Eating Behavior in Pregnant Women PDF

Current Psychology (2023) 42:4948–4955 https://doi.org/10.1007/s12144-021-01848-8 Social media use impacts body image and eating behavior in pregnant women N. Zeeni 1 & J. Abi Kharma 1 & L. Mattar 1 Accepted: 10 May 2021 / Published online: 15 May 2021 # The Author(s), under exclusive licenc...

Current Psychology (2023) 42:4948–4955 https://doi.org/10.1007/s12144-021-01848-8 Social media use impacts body image and eating behavior in pregnant women N. Zeeni 1 & J. Abi Kharma 1 & L. Mattar 1 Accepted: 10 May 2021 / Published online: 15 May 2021 # The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021 Abstract Social media (SM) use may have detrimental effects on the physical and mental wellbeing of young adults, including body image dissatisfaction (BID) and changes in dietary behavior. This issue may be of particular concern in pregnant women since adequate dietary behavior is essential during pregnancy for the health of the mother and fetus. The present study aimed to investigate how SM use and posting as well as dependence on technological devices relate to body image and dietary behavior in pregnant women. A descriptive, cross-sectional design was used. A sample of 192 Lebanese pregnant women (29.6 ± 6.2 years old) completed a self-report questionnaire assessing the aforementioned variables. SM usage and posting were both associated with healthy eating behaviors (p = 0.049 and p = 0.03 respectively). On the other hand, SM posting was associated with higher negative body image scores (p = 0.04), postnatal image concerns (p = 0.02), as well as competitiveness with regard to the pregnant body (p = 0.02). Also, dependence on technological devices and internet was associated with higher negative body image scores (p < 0.001), postnatal image concerns (p < 0.001) and increased anxiousness towards the pregnant body (p = 0.02). While SM use and posting are associated with healthy eating behaviors, SM posting and dependence on technological devices are also associated with increased appearance comparison and BID in pregnant women. The present study adds to the growing evidence supporting a significant impact of SM use on physical and mental wellbeing, emphasizing potential deleterious effects during pregnancy. Practical implications are discussed in terms of media literacy interventions and recommendations for healthcare team members to improve maternal counselling and support by encouraging healthy body image, diet and lifestyle behaviors during pregnancy. Keywords Social media. Pregnancy. Body image. Eating behavior. Healthy eating Introduction The type of content that one is exposed to through tradi- tional or SM may affect eating habits. For example, some Advances in information and communication have significantly studies have shown that violent movie content can have a improved people’s living standards around the world. However, significant impact on cravings and food choices, especially the time that people spend on social networking sites (SNS) and towards fatty and salty foods (Mattar, Zeeni & Bassil, 2015; the images they are exposed to may have a substantial impact Mattar, Farran, Kharma & Zeeni, 2019). In addition, exposure on their physical and mental health (Dalky, Momani, Al- to images of desirable or junk foods via digital interfaces was Drabaah, & Jarrah, 2016; Best, Manktelow, & Taylor, 2014). suggested to be inadvertently exacerbating tendencies for cravings and desire for food (Spence, Okajima, Cheok, Petit & Michel, 2016). On the other hand, the recently popular SM- * N. Zeeni based healthy eating community was shown to have a high [email protected] prevalence of orthorexia (i.e. obsessive preoccupation with eating healthy food), with higher Instagram use being linked J. Abi Kharma [email protected] to increased symptoms (Turner, & Lefevre, 2017). A recent meta-analysis examining SM, body image and food choices in L. Mattar healthy young adults reported that SM engagement or expo- [email protected] sure to image-related content was associated with dieting/ 1 School of Arts and Sciences, Department of Natural Sciences, restricting food, overeating, and choosing healthy foods Lebanese American University, P.O. Box 36, Byblos, Lebanon (Rounsefell et al., 2020). Therefore, SNS content exposure 13 Curr Psychol (2023) 42:4948–4955 4949 may have significant effects on dietary behavior by triggering associations between the aforementioned variables and prac- certain emotions and/ or setting standards for food quantities, tical implications are discussed in terms of media literacy in- preference, and choices. terventions as well as recommendations for healthcare team Recent evidence has shown that the use of SNS may be members to improve maternal counselling and support. associated with body image dissatisfaction (BID) and an un- healthy drive for thinness (Holland & Tiggemann, 2016). This could be because individuals who spend a lot of time on SNS Methods tend to compare their physique more to celebrities and peers, compared to those who spend less time on social media (SM) Participants (Vartanian & Dey, 2013). The putative link between SNS use and BID is supported by the Tripartite Influence Model of Participants were recruited from public and private obstetrics body image and eating disturbance (Thompson, Heinberg, clinics across Lebanon. Thirteen clinics were randomly select- Altabe & Tantleff-Dunn, 1999), which proposes that three ed in the four most populated Lebanese governorates: South, formative influences - peers, parents, and media - affect body Beirut, North Lebanon, and Mount Lebanon (Fig. 1). The final image and eating through two mediational mechanisms: inter- sample consisted of 192 pregnant women (> 4 weeks gesta- nalization of the thin-ideal and appearance comparison. This tion) aged from 17 to 42 years old (M = 29.65; SD = 6.25). theory supports the idea that societal beauty ideals are promul- gated through the media including social media, especially Procedure that social media present images of celebrities but also family members and peers. After obtaining the ethical approval of the Lebanese American The relationship between SNS use and BID may also be a University IRB, which is constituted in accordance with the concern in pregnant women especially that they face many US Code of Federal Regulation (45CFR 46.107, 21CFR changes during pregnancy. These include normative body 56.107), and Good Clinical Practice ICH (Section 3), a con- changes such as weight gain, hormonal changes, stress, nesting venience sample of pregnant women was asked to voluntarily behaviors, anticipation, peripartum depression (including anxi- participate in the study. Participants were recruited in obstetric ety) and partner relationship changes. Moreover, the presence of clinic waiting rooms and were asked to complete a 20-min glamourized images of pregnant celebrities may set impossible paper survey, that was available in English or Arabic (after body image standards for pregnant women (Hopper, 2010). In back-translation). In order to minimize misunderstandings and fact, it was shown that pregnant women had high incidence of improve accuracy, the participants were told that they could BID du rin g pregn ancy an d th e postna ta l pe riod (Roomruangwong, Kanchanatawan, Sirivichayakul & Maes, Contacted public and private 2017). Furthermore, recent work has shown that pregnant wom- obstetrics clinics in four en with Facebook accounts had higher body image concerns Lebanese governorates (13 out of 15 clinics accepted) than those without. Similarly, increased Facebook use was as- sociated with increased BID, mostly in terms of postnatal con- cerns as well as recurrent comparisons of the body to other pregnant women on the SNS (Hicks & Brown, 2016). Taken together, results from the literature suggest that, by Enrollment increasing internalization of the thin-ideal and appearance Women assessed for eligibility (n=242) comparison, SNS use may worsen body image and lead to changes in eating behavior, notably during pregnancy. This issue is of prime importance given the very rapid global rise in SNS use coupled to the fact that that maternal diet quality Excluded (n= 47) Not meeting inclusion criteria (n= 2) during pregnancy is positively associated with child physical Declined to participate (n= 44) and cognitive development (Borge, Aase, Brantsæter & Biele, Other reasons (n=1) 2017). To our knowledge, very few studies have investigated the effect of use of SM on pregnant women’s body image and dietary behaviors. Thus, the aim of the present study was to Analysis examine the relationship between SM use and anxiety/ dependence on technological devices with body image per- Analysed (n= 195) Excluded from analysis (missing data) (n=3) ception, and dietary behavior in pregnant women. For this purpose, a cross-sectional survey of 192 Lebanese pregnant women was conducted. In the current paper, we present the Fig. 1 Experimental flow diagram 13 4950 Curr Psychol (2023) 42:4948–4955 ask for clarifications about the intended meaning of survey Body Image was adapted from a pregnancy-specific tool questions at any time while filling it. All participants gave developed and validated by (Hicks & Brown, 2016). The tool written informed consent after reading a participation infor- consists of 33 questions that try to find out the body image mation sheet and data remained anonymous and confidential. perception in pregnant women and the answer for each ques- The questionnaires were distributed to patients in 11 private tion can range from strongly disagree to strongly agree. One clinics between January and February 2018. example is “I am worried about stretch marks.” The adapted tool included six subscales labelled as follows: ‘positive’ (e.g. enjoying the changes, feeling happy about their shape), ‘neg- Measures ative’ (e.g. feeling under pressure not to gain weight, disliking changes), ‘proud’ (e.g. enjoying attention her changing shape The inclusion criteria for female volunteers taking part in the brings), ‘concern for postnatal image’ (e.g. concerns for how study were to be pregnant, literate (able to read and write), and her body will look after pregnancy and losing weight), ‘com- living in Lebanon. petitive’ (e.g. about her pregnant body image), ‘anxious’ (e.g. The questionnaire included 58 questions divided in the anxious about weight gain). In our sample, the internal con- following four sections: sistencies of the body image subscales were as follows: 0.77 for positive, 0.81 for negative, 0.75 for proud, 0.80 for con- Demographics including age, height, weight before pregnan- cerns for postnatal image, 0.73 for competitive and 0.71 for cy, present weight, weeks of gestation, and highest level of anxious. education. In addition, this section included general questions about the participant’s gravidity, if she has a SM account, and Statistical Analysis takes any supplements. Social Media Usage and Dependence Towards Technology Descriptive analysis was used to summarize the study vari- were measured through subscales of the Media and Technology ables and to check for out-of-range values. Categorical vari- Usage and Attitudes Scale, (Rosen, Whaling, Carrier, Cheever ables were described as frequencies and percentages, while & Rokkum, 2013a; Rosen, Whaling, Rab, Carrier & Cheever, means and standard deviations were used to represent contin- 2013b) which was recently validated in Lebanon (Zeeni, uous variables. The weeks of pregnancy were converted into Doumit, Kharma & Sanchez-Ruiz, 2018). Three subscales first (beginning till week 13), second (weeks 14–26) and third (SM posting, SM usage and technological anxiety/dependence) (weeks 27 till end) trimesters. The weight gain/week of preg- were used for the purpose of this study. The usage and posting nancy was computed from the difference between the present subscales are rated on a 10-point likert scale ranging from 1 and the pre-pregnancy weight. The latter was compared to the (‘never’) to 10 (‘all the time’). The technological anxiety/ expected mean weight gain recommendations set by the 2009 dependence subscale is rated on a 5-point likert scale ranging Institute of Medicine (IOM) per BMI category for second and from 1 (‘strongly disagree’) to 10 (‘strongly agree’). An exam- third trimesters of pregnancy as such 0.51 kg/week for under- ple of an item for dependence attitude towards technology is “I weight BMIs, 0.42 kg/week normal BMIs, 0.28 kg/week for get anxious when I don’t have my cell phone. The internal overweight BMIs and 0.22 kg/week for obese BMIs respec- consistencies of the SM posting, SM usage and technological tively. Independent t-tests were used to compare the mean anxiety/dependence subscales in our sample were 0.78, 0.78 scores between the main variables of interest and gravidity and 0.79 respectively. and the actual versus expected weight gain for females who Dietary Behavior was measured through an adapted ver- were in the second and third trimesters of pregnancy. The sion of the Arab Teens Lifestyle (ATLS) Questionnaire which unhealthy eating questions in the dietary behavior scale were was developed in Saudi Arabia (Al-Hazzaa & Musaiger, reverse scored before computing the total score; higher scores 2010), of which 10 items assessed healthy/unhealthy eating. were indicative of healthier dietary behaviors. Pearson’s cor- This scale was previously validated in Bahrain, where it had relations were used to examine the relationship between the good reliability (Musaiger, Bader, Al-Roomi & D'souza, main study variables, dietary behavior scores, body image 2011) and was used in a study in Lebanese young adults with subscales, and technology usage and attitude subscales, and high internal consistency (Zeeni, Doumit, Kharma & age. Univariate linear regression models were used to identify Sanchez-Ruiz, 2018). The items are rated on an 8-point scale the association between the main study variables and the cat- ranging from 1 (‘none’) to ≥7 (‘7 times or more’), with the egorical demographic/participant characteristics, trimester of unhealthy eating-related items being reverse scored. An ex- pregnancy, pre-pregnancy BMI and level of education. The ample of an unhealthy eating item is “How many times per latter were the independent variables in the models and the week do you eat pastries such as cakes, biscuits, donuts, or main study variables were the dependent ones. All analyses similar food?”. A higher total score indicates healthier eating. were completed using STATA version 11 and a two tailed The internal consistency of this scale in our sample was 0.70. alpha of 0.05 was used to assess for statistical significance. 13 Curr Psychol (2023) 42:4948–4955 4951 Results Social Media Usage and Dependence towards Technology Participants’ Characteristics The mean scores on SM usage, posting and anxiety/ A total of 192 pregnant women were enrolled in the study. dependence attitudes toward technology were 28.80 (SD = Demographic characteristics of the sample are presented in 8.71), 10.02 (SD = 4.46) and 9.96 (SD = 3.09) respectively Table 1. The mean age of the participants was 29.65 (SD = in our sample. SM posting scores were significantly negative- 6.25). The majority of the recruited females were in their third ly associated with age (r = −0.17, p = 0.02). Pregnant women trimester (49%), had completed bachelor degrees (63.87%) and who had bachelor degrees and those who had finished school/ had normal BMIs prior to pregnancy (65.96%). Half of the technical degrees had significantly higher scores on SM usage women were pregnant for the first time. The mean weight gain compared to those who have not finished school (β = 9.63, during pregnancy was 1.74 kg after the first trimester, 8.01 kg p < 0.001 and β = 9.37, p < 0.001 respectively). However, after the second trimester and 11.16 kg by the end of the preg- those who finished school/technical degrees had significantly nancy. The great majority of participants (94%) were using higher scores on SM posting (β = 3.38, p = 0.005) compared dietary supplements with the most reported being multi-vita- to those who had bachelor degrees and those who have not mins, folic acid, iron and vitamin D. Most surveyed women finished school even after accounting for age. There was no (91%) had SM accounts including Facebook, Instagram, association between education and dependence/anxiety atti- Snapchat and WhatsApp. tudes towards technology. There was no significant association between the BMI cat- a. Rate of weight gain egories, being pregnant for the first time, trimester of pregnan- cy, rate of weight gain during pregnancy and SM posting, SM Pregnant women in the third trimester gained 1.2 kg less usage and anxiety attitude towards technology. than the recommended based on the 2009 IOM recom- mendations and the result was statistically significant (t Dietary Behavior (59) = 1.68, p = 0.049). The mean score on dietary behavior was 52.84 (SD = 9.08) in our sample. Pregnant women who had completed bachelor Table 1 Demographic and characteristics of study participants degrees and those who had finished school/technical degrees M (SD) had significantly higher scores on dietary behavior compared to those who have not finished school (β = 8.78, p < 0.001 and Age 29.65 (6.25) β = 5.63, p = 0.023 respectively). SM usage was associated Dietary behavior score 52.84 (9.08) with higher healthier dietary behaviors’ scores (β = 5.56, N (%) p = 0.023). There was no significant association between Education age, BMI categories, being pregnant for the first time, supple- No schooling completed 6 (3.14%) ment use, rate of weight gain during pregnancy, the trimesters 9th grade (brevet) 15 (7.85%) of pregnancy variables and dietary behavior score. High school graduate, diploma or the equivalent 37 (19.37%) Trade/technical/vocational training 11 (5.76%) Table 2 displays the correlations between dietary behavior Bachelor’s degree or above 122 (63.87%) score and SM usage and anxiety/dependence on technological BMI Category devices subscales. SM posting, SM usage and technological < 18.5 kg/m2 6 (3.19%) anxiety/dependence were significantly positively correlated 18.5–24.9 kg/m2 124 (65.96%) with higher healthier dietary behavior scores (r = 0.17, p = 25–29.9 kg/m2 36 (19.15%) 0.03; r = 0.15, p = 0.049 and r = 0.15, p = 0.048 respectively). > 30 kg/m2 22 (11.70%) Trimester of pregnancy Body Image Subscales 1st (1–13) 39 (22%) 2nd (14–26) 52 (29%) 3rd (27 – delivery) 87 (49%) i. Positive: The mean positive score was 17.21 (SD = 3.50) First pregnancy in our sample. Females who were pregnant for the first Yes 100 (52.08%) time had significantly higher scores on the positive sub- Supplement use scale compared to those who were multiparous (β = 1.24, Yes 180 (94%) p = 0.020). Higher healthy dietary behavior scores were Social media usage negatively correlated with positive subscale scores (r = Yes 175 (91%) −0.16, p = 0.03). There was no statistically significant as- sociation between age, BMI categories, level of education, 13 4952 Curr Psychol (2023) 42:4948–4955 Table 2 Correlations between all body image dissatisfaction Social media usage Social media posting Anxiety attitudes subscales, dietary behavior and Social Media Usage and Body Image Dissatisfaction subscales dependence Positive.06. 04 −.04 Negative. 09.16*.30** Proud.09.001.009 Concerns for postnatal image.14. 17*.25 Competitive.08.18*.11 Anxious.02.05.17* Dietary Behavior.15*.17*.15* * p <.05, **p <.001 trimester of pregnancy, SM posting, SM usage, anxiety 0.18, p = 0.02). There was no significant association be- attitudes towards technology score, rate of weight gain tween age, BMI categories, level of education, trimester during pregnancy and positive scores (Tables 2 and 3). of pregnancy, being pregnant for the first time, dietary be- ii. Negative: The mean negative score was 18.23 (SD = 4.75) havior score, SM usage, anxiety attitudes towards technol- in our sample. Social media posting and anxiety attitudes ogy and competitive scores (Tables 2 and 3). towards technology were significantly positively correlated vi. Anxious: The mean anxious score was 4.60 (SD = 1.90) with higher scores on the negative subscale (r = 0.16, p = in our sample. Pregnant women who had bachelor de- 0.04 and r = 0.30, p < 0.001 respectively). There was no grees and those who had finished school/technical de- statistically significant association between age, BMI cate- grees had significantly lower scores on anxious subscale gories, level of education, trimester of pregnancy, being compared to those who have not finished school (β = pregnant for the first time, dietary behavior score, SM usage −1.24, p < 0.01 and β = −1.33, p < 0.01 respectively). and negative subscale scores (Tables 2 and 3). Anxiety attitudes towards technology were significantly iii. Proud: The mean proud score was13.89 (SD = 3.25) in positively correlated with higher scores on anxious sub- our sample. Females who were pregnant for the first time scale (r = 0.17, p = 0.02). There was no significant asso- had significantly higher scores on the proud subscale ciation between age, BMI categories, trimester of preg- compared to those who were multiparous (β = 1.75, nancy, being pregnant for the first time, dietary behavior p < 0.001). There was no significant association between score, SM usage, SM posting and anxious subscale age, BMI, level of education, trimester of pregnancy, scores (Tables 2 and 3). dietary behavior score, SM posting, SM usage, anxiety attitudes towards technology score and proud subscale scores (Tables 2 and 3). iv. Concerns for postnatal image: The mean score on con- cerns for postnatal image was 25.86 (SD = 6.21) in our Discussion sample. Females who were pregnant for the first time had significantly higher scores on the concerns for postnatal The present study aimed to investigate SM use and anxiety/ image subscale compared to those who were multiparous dependence on technological devices, and their relationship to (β = 1.84, p = 0.046). There was no significant associa- tion between age, level of education, BMI categories, Table 3 Correlations between dietary behavior and all body image supplement use, rate of weight gain during pregnancy, dissatisfaction subscales trimester of pregnancy and concerns for postnatal image Dietary behavior scores. SM posting and anxiety attitudes towards technol- ogy were significantly positively correlated with higher Body image dissatisfaction subscales scores on concerns for postnatal image subscale (r = 0.17, Positive −.16* p = 0.02 and r = 0.25, p < 0.001 respectively). There was Negative −.04 no significant association between dietary behavior score, Proud. 08 SM usage, and concerns for postnatal image scores Concerns for postnatal image −.006 (Tables 2 and 3). Competitive. 13 v. Competitive: The mean competitive score was 4.44 (SD = Anxious −.04 1.96) in our sample. Social media posting was significantly correlated with higher scores on competitive subscale (r = * p <.05, **p <.001 13 Curr Psychol (2023) 42:4948–4955 4953 body image and dietary behavior in pregnant women. Results The present study showed that SM usage and posting were showed that SM usage and SM posting were both associated both associated with healthy eating behaviors. In parallel, a with healthy eating behaviors. On the other hand, SM posting recent meta-analysis reported that SM engagement or expo- and dependence on technological devices were associated sure to image-related content was associated with dieting/ with worsened body image-related outcomes. The present restricting food, overeating, and choosing healthy foods in findings are of high relevance given the increasing use of young adults (Rounsefell et al., 2020). During pregnancy, SNS around the globe and the high impact of diet quality the tendency towards choosing healthy foods might be stron- during pregnancy on the baby’s physical and mental health. ger given that pregnant women are concerned with the health Social media posting was associated with higher negative of their unborn child. However, it was shown that pregnant body image scores, postnatal concerns, as well as competitive- women report reducing intake of foods that could harm their ness with regard to the pregnant body. This result is in agreement pregnancy, but do not increase their intake of foods that pro- with the findings of a recent study using semi-structured in-depth vide important nutrients required for pregnancy. This suggests interviews, where pregnant and postpartum women were found that women do not prioritize having a nutrient-dense diet to question the realism of media depictions of pregnancy and when making dietary changes, which may result in suboptimal recognized that social media had a negative impact on their body intakes of nutrients that are key for prenatal development. image (Liechty, Coyne, Collier & Sharp 2018). Similarly, a re- (Forbes, Graham, Berglund & Bell, 2018). It is worthy to note cent meta-analysis showed that increased SNS use is associated that in the present study pregnant women in their third trimes- with higher internalization of a thin ideal (Mingoia, Hutchinson, ter gained on average 1.2 kg less than expected. While it Wilson & Gleaves, 2017). This may be justified by the Social cannot directly be inferred from the present results, SM usage Comparison theory, which suggests that individuals are more and posting may not only have led to healthier eating choices likely to compare themselves to similar others (Festinger, but also to restrictive dietary behavior leading to poor weight 1954). As SM forums such as Facebook or Instagram involve gain. In fact, it was shown that engagement in different SNS one’s peers, they may therefore increase body image comparison increases the risk of developing ED (Becker, Fay, Agnew- and competitiveness. In fact, recent work analyzing young preg- Blais, Khan, Striegel-Moore & Gilman, 2011) and specifically nant women’s Facebook posts revealed that they often frame orthorexia nervosa (Turner, & Lefevre, 2017). Moreover, a their thoughts and feelings regarding weight gain in pregnancy review about EDs during pregnancy has pointed out that be- in the context of food cravings and body image and that friends sides the classical EDs (anorexia nervosa and bulimia and family are important influencers to these behaviors nervosa) the newer types (e.g., orthorexia nervosa), and sub- (Marshall et al., 2019). In addition, the use of appearance- clinical disorders also occur in a significant number of preg- related features (e.g., posting or viewing photographs) was pre- nant women (Dukay-Szabó, Varga & Túry, 2016). viously shown to have a stronger relationship with the internal- Furthermore, recent work shows a very high prevalence of ization of a thin ideal than broad use of SNSs (Mingoia, orthorexia nervosa tendencies and behaviors in a representa- Hutchinson, Wilson & Gleaves, 2017). A meta-analysis by tive sample of the Lebanese population (Haddad et al., 2019). Holland & Tiggemann (2016) also showed that specific SM- Therefore, while SM use and posting may encourage heathy related activities, such as viewing and uploading photos or seek- eating, SM posting and anxiety/dependence on technological ing reactions via status updates, were predominantly associated devices seem to have a negative impact on body image which with body image and eating concerns. Therefore, being an active could potentially contribute to disordered and/or restrictive participant in media creation while using SNS may significantly eating in pregnant women. increase appearance comparison and BID in pregnant women. Despite being a Middle Eastern country, Lebanon has a The present study revealed that dependence on technolog- significant Western influence evident in its society due to ical devices and internet was associated with higher negative globalization. Therefore, similar to Western culture, different body image scores, postnatal concerns and increased anxious- types of media spread the idea of the ‘perfect body’ and in- ness towards the pregnant body. This result is in agreement crease individuals’ concerns about body weight and/or shape. with recent work in which separation anxiety from technolog- The present results are in line with a study conducted in ical devices and dependence on them was associated with Lebanese university students, investigating psychosocial and increased BID, eating disorder (ED) risk, depression and anx- weight-related variables as predictors of ED through disor- iety in Lebanese university students (Zeeni, Doumit, Kharma dered eating dimensions (restrained, external, and emotional & Sanchez-Ruiz, 2018). Moreover, a study by eating). The latter revealed a crucial role of media influence Roomruangwong et al. (2017) showed that BID in pregnant and media pressure which was linked to ED via emotional and women was associated with trait anxiety and mood disorders. restrained eating (Sanchez-Ruiz et al., 2019). The increasing In other words, pregnant women who are dependent on tech- importance of SM in the recent years may have amplified this nology and SM may have increased anxiety which is associ- relationship between media pressure, poor body image and ated with BID and pregnancy-related concerns. 13 4954 Curr Psychol (2023) 42:4948–4955 disordered eating/ eating restraint. The present study under- in non-communicable disease (Saleh et al., 2018a; Saleh et al., lines SM’s pervasive effects in pregnant women. 2018b), as well as during pregnancy (Wallwiener et al., 2016). Therefore, targeting SM as a platform for intervention and prevention to decrease BID and enhance healthy eating and Limitations and Recommendations for Future weight gain during pregnancy may be helpful. As such, SM Research platforms may become part of the solution. Limitations of the present study include its rather small sample size, correlational nature, self-reported data and potential se- Supplementary Information The online version contains supplementary lection bias. Forthcoming studies could therefore investigate material available at https://doi.org/10.1007/s12144-021-01848-8. the directionality of the relationship between SNS use, body image and eating concerns in pregnant women, ideally Acknowledgements Data from this manuscript has been presented pre- through longitudinal designs that include direct assessments viously in a conference abstract which can be accessed at https:// obesityweek.com/abstract/social-media-use-and-dependence- pre- and post-partum. Also, future studies could determine associations-with-body-image-and-eating-behavior-in-pregnant-women/ orthorexia prevalence in pregnant women by using specialized assessment tools for orthorexic behaviors. Lastly, to capture Data Availability All data generated or analyzed during this study are the full complexity of pregnant women’s SNS use and asso- included in a supplementary file. ciated behaviors, future work could investigate the types of social media accounts that they use and follow. Declarations Author Disclosure Statement The authors have no relevant financial or Conclusions and Implications for Practice non-financial interests to disclose. The present study adds to the growing evidence supporting a significant impact of SNS use on physical and mental References wellbeing, emphasizing potential deleterious effects during Abreu, B. S., Mihailidis, P., Lee, A. Y., Melki, J., & Mcdougall, J. (2017). pregnancy. Our findings emphasize the need for pregnant Arc of research and central issues in media literacy education. women to understand the importance of having a healthy body International Handbook of Media Literacy Education, 1-15. image and adequate dietary behavior during pregnancy as well https://doi.org/10.4324/9781315628110-1. as the potentially harmful effects of SM use. Al-Hazzaa, H. M., & Musaiger, A. O. (2010). Physical activity patterns and eating habits of adolescents living in major Arab cities. The The present findings may be used to improve maternal Arab Teens Lifestyle Study.. counselling and support. Health professionals should be Becker, A. E., Fay, K. E., Agnew-Blais, J., Khan, A. N., Striegel-Moore, trained to raise awareness about the effects of SM on physical R. H., & Gilman, S. E. (2011). Social network media exposure and and mental well-being and to incorporate protocols for assess- adolescent eating pathology in Fiji. British Journal of Psychiatry, 198(1), 43–50. https://doi.org/10.1192/bjp.bp.110.078675. ment, education, and counseling of pregnant women on the Best, P., Manktelow, R., & Taylor, B. (2014). Online communication, healthy usage of SM into their clinical practice. Members of social media and adolescent wellbeing: A systematic narrative re- the healthcare team such as physicians, dietitians, nurses and view. Children and Youth Services Review, 41, 27–36. https://doi. psychologists should join efforts to face the complexity of the org/10.1016/j.childyouth.2014.03.001. Borge, T. C., Aase, H., Brantsæter, A. L., & Biele, G. (2017). The im- problem and facilitate the prevention and treatment of SM and portance of maternal diet quality during pregnancy on cognitive and body image-related concerns before, during and after behavioural outcomes in children: A systematic review and meta- pregnancy. analysis. BMJ Open, 7(9), e016777. https://doi.org/10.1136/ Given that media literacy programs can protect youth bmjopen-2017-016777. Dalky, H. F., Momani, M. H., Al-Drabaah, T. K., & Jarrah, S. (2016). against negative media messages and help them deconstruct Eating habits and associated factors among adolescent students in the hidden values behind them (Abreu, Mihailidis, Lee, Melki Jordan. Clinical Nursing Research, 26(4), 538–552. https://doi.org/ & Mcdougall, 2017; Mihailidis, Lee, Melki & McDougall, 10.1177/1054773816646308. 2017), they may be warranted to encourage healthy body im- Dukay-Szabó, S., Varga, M., & Túry, F. (2016). Eating disorders and pregnancy-a review of literature. Ideggyogyaszati Szemle. age, diet and lifestyle behaviors during pregnancy. Moreover, Festinger, L. (1954). A theory of social comparison processes. Human SM may be used as a venue to conduct awareness efforts and Relations, 7(2), 117–140. https://doi.org/10.1177/ interventions. In fact, a recent SM intervention to improve 001872675400700202. nutrition knowledge and behaviors of low income, pregnant Forbes, L. E., Graham, J. E., Berglund, C., & Bell, R. C. (2018). Dietary change during pregnancy and women’s reasons for change. adolescents and adult women showed promising results (Wyst Nutrients, 10(8), 1032. et al., 2019). Additionally, recent evidence has shown the Haddad, C., Obeid, S., Akel, M., Honein, K., Akiki, M., Azar, J., & potential positive impact of e-health and mobile health tools Hallit, S. (2019). Correlates of orthorexia nervosa among a 13 Curr Psychol (2023) 42:4948–4955 4955 representative sample of the Lebanese population. Eating and healthy young adults: A mixed methods systematic review. Weight Disorders - Studies on Anorexia, Bulimia and Obesity, Nutrition & Dietetics, 77(1), 19–40. https://doi.org/10.1111/1747- 24(3), 481–493. https://doi.org/10.1007/s40519-018-0631-x. 0080.12581. Hicks, S., & Brown, A. (2016). Higher Facebook use predicts greater Saleh, S., Alameddine, M., Farah, A., Arnaout, N. E., Dimassi, H., body image dissatisfaction during pregnancy: The role of self-com- Muntaner, C., & Morr, C. E. (2018a). EHealth as a facilitator of parison. Midwifery, 40, 132–140. https://doi.org/10.1016/j.midw. equitable access to primary healthcare: The case of caring for non- 2016.06.018. communicable diseases in rural and refugee settings in Lebanon. Holland, G., & Tiggemann, M. (2016). A systematic review of the impact International Journal of Public Health, 63(5), 577–588. https:// of the use of social networking sites on body image and disordered doi.org/10.1007/s00038-018-1092-8. eating outcomes. Body Image, 17, 100–110. https://doi.org/10.1016/ Saleh, S., Farah, A., Dimassi, H., Arnaout, N. E., Constantin, J., Osman, j.bodyim.2016.02.008. M.,... Alameddine, M. (2018b). Using Mobile health to enhance Hopper, K. M. (2010). Bumping up the body: Examining the impact of outcomes of noncommunicable diseases care in rural settings and celebrity gossip magazines on body image during pregnancy. refugee camps: Randomized controlled trial. JMIR mHealth and https://doi.org/10.32469/10355/12006. uHealth, 6(7). https://doi.org/10.2196/mhealth.8146, e137. Liechty, T., Coyne, S. M., Collier, K. M., & Sharp, A. D. (2018). “It’s just Sanchez-Ruiz, M. J., El-Jor, C., Abi Kharma, J., Bassil, M., & Zeeni, N. not very realistic”: Perceptions of media among pregnant and post- (2019). Personality, emotion-related variables, and media pressure partum women. Health Communication, 33(7), 851–859. predict eating disorders via disordered eating in Lebanese university Marshall, E., Moon, M. A., Mirchandani, A., Smith, D. G., Nichols, L. P., students. Eating and Weight Disorders-Studies on Anorexia, Zhao, X., Vydiswaran, V. G. V., & Chang, T. (2019). “Baby wants Bulimia and Obesity, 24(2), 313–322. tacos”: Analysis of health-related Facebook posts from young preg- Spence, C., Okajima, K., Cheok, A. D., Petit, O., & Michel, C. (2016). nant women. Maternal and Child Health Journal, 23(10), 1400– Eating with our eyes: From visual hunger to digital satiation. Brain 1413. and Cognition, 110, 53–63. https://doi.org/10.1016/j.bandc.2015. Mattar, L., Farran, N., Kharma, J. A., & Zeeni, N. (2019). Movie violence 08.006. acutely affects food choices in young adults. Eating Behaviors, 33, Thompson, J. K., Heinberg, L. J., Altabe, M., & Tantleff-Dunn, S. (1999). 7–12. https://doi.org/10.1016/j.eatbeh.2019.02.002. Exacting beauty: Theory, assessment, and treatment of body image Mattar, L., Zeeni, N., & Bassil, M. (2015). Effect of movie violence on disturbance. Washington, DC: American Psychological mood, stress, appetite perception and food preferences in a random Association. https://doi.org/10.1037/10312-000. population. European Journal of Clinical Nutrition, 69(8), 972– 973. https://doi.org/10.1038/ejcn.2014.262. Turner, P. G., & Lefevre, C. E. (2017). Instagram use is linked to in- Mihailidis, S. D. A., Lee, P., Melki, A. Y., & McDougall, J. (2017). creased symptoms of orthorexia nervosa. Eating and Weight International handbook of media literacy education. Routledge, Disorders - Studies on Anorexia, Bulimia and Obesity, 22(2), Taylor & Francis Group. 277–284. https://doi.org/10.1007/s40519-017-0364-2. Mingoia, J., Hutchinson, A. D., Wilson, C., & Gleaves, D. H. (2017). The Vartanian, L. R., & Dey, S. (2013). Self-concept clarity, thin-ideal inter- relationship between social networking site use and the internaliza- nalization, and appearance-related social comparison as predictors tion of a thin ideal in females: A meta-analytic review. Frontiers in of body dissatisfaction. Body Image, 10(4), 495–500. https://doi.org/ Psychology, 8. https://doi.org/10.3389/fpsyg.2017.01351. 10.1016/j.bodyim.2013.05.004. Musaiger, A., Bader, Z., Al-Roomi, K., & D'souza, R. (2011). Dietary Wallwiener, S., Müller, M., Doster, A., Laserer, W., Reck, C., and lifestyle habits amongst adolescents in Bahrain. Food & Pauluschke-Fröhlich, J., Brucker, S. Y., Wallwiener, C. W., & Nutrition Research, 55(1), 7122. https://doi.org/10.3402/fnr.v55i0. Wallwiener, M. (2016). Pregnancy eHealth and mHealth: User pro- 7122. portions and characteristics of pregnant women using web-based Roomruangwong, C., Kanchanatawan, B., Sirivichayakul, S., & Maes, information sources—A cross-sectional study. Archives of M. (2017). High incidence of body image dissatisfaction in preg- Gynecology and Obstetrics, 294(5), 937–944. https://doi.org/10. nancy and the postnatal period: Associations with depression, anx- 1007/s00404-016-4093-y. iety, body mass index and weight gain during pregnancy. Sexual & Wyst, K. B., Vercelli, M. E., O’Brien, K. O., Cooper, E. M., Pressman, E. Reproductive Healthcare, 13, 103–109. https://doi.org/10.1016/j. K., & Whisner, C. M. (2019). A social media intervention to im- srhc.2017.08.002. prove nutrition knowledge and behaviors of low income, pregnant Rosen, L., Whaling, K., Carrier, L., Cheever, N., & Rokkum, J. (2013a). adolescents and adult women. PLoS One, 14(10), e0223120. https:// The media and technology usage and attitudes scale: An empirical doi.org/10.1371/journal.pone.0223120. investigation. Computers in Human Behavior, 29(6), 2501–2511. Zeeni, N., Doumit, R., Kharma, J. A., & Sanchez-Ruiz, M. (2018). https://doi.org/10.1016/j.chb.2013.06.006. Media, technology use, and attitudes: Associations with physical Rosen, L., Whaling, K., Rab, S., Carrier, L., & Cheever, N. (2013b). Is and mental well-being in youth with implications for evidence- Facebook creating “iDisorders”? The link between clinical symp- based practice. Worldviews on Evidence-Based Nursing, 15(4), toms of psychiatric disorders and technology use, attitudes and anx- 304–312. https://doi.org/10.1111/wvn.12298. iety. Computers in Human Behavior, 29(3), 1243–1254. https://doi. org/10.1016/j.chb.2012.11.012. Publisher’s Note Springer Nature remains neutral with regard to jurisdic- Rounsefell, K., Gibson, S., Mclean, S., Blair, M., Molenaar, A., Brennan, tional claims in published maps and institutional affiliations. L., et al. (2020). Social media, body image and food choices in 13