A network analysis of barriers to physical activity and depressive symptoms in pregnant women with prepregnancy overweight or obesity

Background Previous research has shown that depressive symptoms are associated with barriers to physical activity in pregnant women with prepregnancy overweight or obesity. However, there is currently not much research exploring the dynamic interactions between these concepts. This study aimed to explore the complex network relationship between barriers to physical activity and depressive symptoms in pregnant women with prepregnancy overweight and obesity. Method This cross-sectional study was conducted from May to October 2025 at two Asian hospital obstetric outpatient clinics in Nanjing and Yangzhou, Jiangsu Province, China. A total of 813 pregnant women with prepregnancy overweight or obesity were enrolled. Barriers to physical activity and Depression were assessed using the Barriers to Physical Activity during Pregnancy Scale (BPAPS) and the Hospital Anxiety and Depression Scale (HADS), respectively. Central and bridge symptoms were identified through centrality and bridge centrality indices. Network stability and accuracy were evaluated, and age-group differences were examined using the Network Comparison Test. Results The average age of the participants in the study was 30.57 years old (SD = 3.57), and 723 (88.9%) lived in urban areas. The overall network demonstrated high stability, with HADS3 (I feel cheerful), HADS5 (I look forward with enjoyment to things), and BPAPS1 (Pregnancy-related intrapersonal barriers) identified as central nodes. BPAPS1 (Pregnancy-related intrapersonal barriers), BPAPS3 (Interpersonal barriers), and BPAPS4 (Environmental barriers) emerged as key bridge nodes linking barriers to physical activity and depressive symptoms. The edge connecting BPAPS1 (Pregnancy-related intrapersonal barriers) and HADS3(I feel cheerful) represented the strongest inter-community connection in the network. The global connectivity strength of individuals over 30 years old is significantly stronger than that of those under 30 years old(over 30 years old = 5.04, under 30 years old = 3.92, p = 0.006). Conclusions The identification of central and bridge symptoms holds promise for enabling early detection and guiding targeted interventions to address barriers to physical activity and depressive symptoms among pregnant women with prepregnancy overweight or obesity, with consequent benefits for maternal and infant health outcomes.