{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:45:48Z","timestamp":1792057548007,"version":"4.4.0"},"reference-count":58,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp;amp; Child Nutrition"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      Pre\u2010pregnancy overweight or obesity delays the onset of lactogenesis II, posing an early barrier to achieving optimal infant nutrition and long\u2010term health. However, the underlying pathophysiological mechanisms remain incompletely elucidated. This prospective cohort study conducted in China aimed to delineate the distinct pathways through which pre\u2010pregnancy overweight\/obesity, compared to normal body mass index (BMI), leads to delayed lactogenesis II. Guided by an expanded biopsychosocial framework, we enrolled and stratified 296 primiparous women into pre\u2010pregnancy overweight\/obese (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009146) and normal BMI (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009150) groups. Data on biological, psychological, social, and infant\u2010related factors were collected prospectively at prenatal, delivery, and one\u2010week postpartum stages. Structural equation modeling was used to identify and compare the mediating pathways between the two groups. Results demonstrated that the association between pre\u2010pregnancy overweight\/obesity and delayed lactogenesis II was primarily mediated through four distinct pathways: biological (e.g., breastfeeding difficulties:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.203, 95% CI: 0.144\u22120.265,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), psychological (e.g., internalized weight stigma:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.095, 95% CI: 0.016\u22120.181,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026), social (e.g., reduced pro\u2010breastfeeding practices:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.076, 95% CI: 0.017\u22120.144,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019), and infant\u2010related (e.g., higher formula intake:\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.114, 95% CI: 0.047\u22120.195,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). This study validates the expanded biopsychosocial model by elucidating the distinct pathways through which pre\u2010pregnancy overweight\/obesity contributes to delayed lactogenesis II. These findings underscore the necessity for clinical practice to move beyond a purely biological focus and advocate for a paradigm shift in clinical support towards integrated, multi\u2010faceted interventions tailored to this vulnerable population.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>This study was registered at the Chinese Clinical Trial Registry (registry number: ChiCTR2200057038). The trial was registered on February 26, 2022.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/mcn.70225","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:31:22Z","timestamp":1782916282000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Expanded Biopsychosocial Model Elucidates the Association Between Pre\u2010Pregnancy Overweight\/Obesity and Delayed Lactogenesis II: A Prospective Cohort Study"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5285-5794","authenticated-orcid":false,"given":"Ziqi","family":"Ren","sequence":"first","affiliation":[{"name":"School of Nursing Nanjing Medical University Nanjing Jiangning District China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1266-0925","authenticated-orcid":false,"given":"Aixia","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital) Nanjing Qinhuai District China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital) Nanjing Qinhuai District China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Nursing Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital) Nanjing Qinhuai District China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiting","family":"Tang","sequence":"additional","affiliation":[{"name":"School of Nursing Nanjing Medical University Nanjing Jiangning District China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-7-9"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13006-015-0046-5"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2014.06.003"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2012.03.035"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12865"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.12.035"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/089033449901500207"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2021.630202"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2019.0138"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2018.0185"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-016-2871-x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105320988325"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2020.05.011"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1754.2000.00562.x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13324"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2008.448"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.847460"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.newideapsych.2019.100755"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12344"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2024.103937"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines13081848"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0031-3955(05)70286-8"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2019.05.005"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNR.0b013e3181b25558"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000711"},{"key":"e_1_2_10_27_1","volume-title":"Weight Gain During Pregnancy: Reexamining the Guidelines","author":"Institute of Medicine and National Research Council","year":"2009"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2014.08.002"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0253-9624.2016.12.008"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-015-1858-z"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12783"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.5114\/pjr\/189566"},{"key":"e_1_2_10_33_1","volume-title":"Principles and Practice of Structural Equation Modeling","author":"Kline R. B.","year":"2023"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022029920000047"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.172.5.433"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2018.0262"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.113.073049"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0266-6138(88)80071-8"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13481"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-2747"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/desc.12625"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu12092684"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.115.214619"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijchp.2019.03.001"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(16)30217-0"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.3758\/brm.40.3.879"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1177\/0890334417727716"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2008.636"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/10998004221097085"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.appet.2021.105833"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192214692"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03071-y"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1037\/hea0000107"},{"key":"e_1_2_10_54_1","volume-title":"Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals","author":"World Health Organization","year":"2009"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13006-020-00256-1"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1177\/1099800416636687"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12486"},{"key":"e_1_2_10_58_1","volume-title":"Factors Associated With Breastfeeding Self\u2010efficacy Among Beijing New Mothers","author":"Zhao M.","year":"2008"},{"issue":"1","key":"e_1_2_10_59_1","first-page":"83","article-title":"Predictive Values of Body Mass Index and Waist Circumference for Risk Factors of Certain Related Diseases in Chinese Adults\u2010\u2010Study on Optimal Cut\u2010Off Points of Body Mass Index and Waist Circumference in Chinese Adults","volume":"15","author":"Zhou B. F.","year":"2002","journal-title":"Biomedical and Environmental Sciences: BES"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70225","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/mcn.70225","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70225","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:56:19Z","timestamp":1792054579000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.70225"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":58,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/mcn.70225"],"URL":"https:\/\/doi.org\/10.1111\/mcn.70225","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-12-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70225"}}