Associations between marital adjustment, motherhood perception, and body image perception during pregnancy: Statistical indirect associations involving perceived social support and depressive symptoms

Pregnancy is a complex developmental period characterized by substantial biological, psychological, and social changes that may be associated with women’s self-perceptions. Although marital adjustment, perceived social support, and depressive symptoms have individually been associated with maternal well-being, the relationships among these variables and their associations with motherhood perception and body image perception during pregnancy remain insufficiently understood. This study aimed to examine the associations among marital adjustment, perceived social support, depressive symptoms, motherhood perception, and body image perception in pregnant women and to investigate statistical indirect associations involving perceived social support and depressive symptoms.

This descriptive cross-sectional study was conducted with 381 pregnant women attending three hospitals in Eskişehir, Türkiye, between December 2019 and November 2020. Data were collected using a Personal Information Form, the Marital Adjustment Test (MAT), the Multidimensional Scale of Perceived Social Support (MSPSS), the Beck Depression Inventory (BDI), and the Self-perception of Pregnants Scale (SpPS). Pearson correlation analyses and hierarchical multiple regression analyses were performed.

Simple and serial statistical indirect-association analyses were conducted using PROCESS Macro Models 4 and 6 with 5,000 bootstrap samples and 95% confidence intervals. Marital adjustment was positively associated with perceived social support and motherhood perception and negatively associated with depressive symptoms, whereas its association with body image perception was not statistically significant. The final regression models explained 19.9% of the variance in motherhood perception and 5.4% of the variance in body image perception.

Marital adjustment and depressive symptoms were significant correlates of motherhood perception, whereas depressive symptoms were the only significant correlate of body image perception. Statistically significant indirect associations involving depressive symptoms and the sequential combination of perceived social support and depressive symptoms were observed for both outcomes. Because the data were cross-sectional, these findings do not establish temporal ordering or causal mechanisms.

Marital adjustment, perceived social support, and depressive symptoms showed distinct cross-sectional associations with motherhood perception and body image perception during pregnancy. Indirect associations involving depressive symptoms and the sequential combination of perceived social support and depressive symptoms were identified for both outcomes. These findings should be interpreted as statistical association patterns rather than evidence of causal mechanisms or differences in the relative strength of the indirect pathways.

Multidimensional Scale of Perceived Social Support Department of Nursing, Faculty of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Türkiye The authors declare no competing interests. This study was approved by the Non-Interventional Clinical Research Ethics Committee of Eskişehir Osmangazi University (Date: 29/07/2019, Decision No: 2019 − 261). Institutional permissions were also obtained from the participating healthcare facilities (University Research and Training Hospital, Date: 26/11/2019, No: E.135095; Eskişehir Provincial Directorate of Health, Date: 22/11/2019, Decision No: 505).