Clinical, Psychosocial, and Digital Factors Associated with Guideline-Discordant Gestational Weight Gain

Background/Objectives: Gestational weight gain (GWG) outside recommended ranges remains common. Although body image, sociocultural appearance-related influences, and social media may shape maternal health behaviors, their independent associations with objectively measured GWG remain insufficiently understood. This study investigated the independent associations of clinical characteristics, body image, sociocultural appearance-related influences, and Instagram use with guideline-discordant GWG. Methods: A cross-sectional study was conducted. GWG was classified according to Institute of Medicine (IOM) recommendations using objectively recorded maternal weights. Body image and sociocultural appearance-related influences were assessed using validated instruments, and Instagram use was assessed across pregnancy. Multivariable analyses were performed. Results: Of 370 recruited women, 298 were included in the final analysis. Younger maternal age and higher pre-pregnancy body mass index (ppBMI) were independently associated with excessive GWG, whereas greater peer-related sociocultural pressure was associated with lower odds of inadequate GWG. Body image dimensions were not independently associated with GWG after adjustment. In secondary trimester-specific analyses, lower Instagram use was consistently associated with higher odds of inadequate GWG across all trimesters, whereas excessive GWG was observed only among women reporting moderate Instagram use. Conclusions: Clinical and psychosocial factors were independently associated with guideline-discordant GWG in the primary models. Associations with Instagram use were identified only in secondary exploratory analyses and require confirmation in prospective studies.