Self-esteem, partner support, and body image changes across pregnancy

Objective To examine longitudinal changes in body image, self-esteem, spousal support, dyadic adjustment, and sexual function across pregnancy trimesters and investigate the mediating role of relationship factors in the association between self-esteem and body image.Methods This prospective longitudinal cohort study followed 266 pregnant women from the first trimester (T1; 7 + 0 to 13 + 6 weeks) through the third trimester (T3; 32–36 weeks) at a tertiary care hospital in Turkey. Participants completed the Body Image in Pregnancy Scale, Rosenberg Self-Esteem Scale, Spousal Support Scale, Revised Dyadic Adjustment Scale, and Female Sexual Function Index each trimester. Pre-pregnancy BMI was included as a covariate in mediation analysesResults Body image deteriorated significantly from T1 to T3 (Cohen’s d = 1.72), while sexual function declined (d = 0.39). Self-esteem remained stable across pregnancy. The half-longitudinal mediation analysis demonstrated that T1 self-esteem was associated with T3 body image both directly and indirectly through T3 relationship quality. This association was partially mediated by relationship variables (19% of variance at T1, 16% at T3), with spousal support predominating in early pregnancy and couple adjustment in late pregnancy. Sexual function did not serve as a significant mediator.Conclusions Pregnancy involves substantial deterioration in body image and sexual function, while relationship quality improves. Sexual function decline was not significantly associated with the self-esteem–body image pathway in the present analyses, suggesting that different mechanisms may underlie sexual function changes during pregnancy. Self-esteem is associated with body image partly through perceived partner support in early pregnancy and relationship adjustment in late pregnancy.