Occurrence and correlates of postpartum depression in overweight and obese women: results from the active mothers postpartum (AMP) study

A Cross-Sectional Study Exploring Postpartum Depression at a Tertiary Care Center in Eastern Uttar Pradesh, India

Background Postpartum depression (PPD) is a significant public health concern globally characterized by a spectrum of mood disturbances ranging from mild mood swings to severe depressive episodes initiating within four weeks post childbirth and potentially persisting up to 12 months. Besides affecting the mother, it also affects the mental health and development of the babies born to affected mothers. Despite its considerable burden and potential adverse effects on both maternal and child well-being, PPD often goes undetected and untreated. Materials and methods A cross-sectional study was conducted from January 2024 to March 2024 at a tertiary care center in Gorakhpur to assess PPD in 280 postpartum women. The Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 was used to confirm depression. Data collection involved a pretested, structured questionnaire. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY). A p-value < 0.05 was considered statistically significant. Results The prevalence of PPD was 12.14%. Age and education were significant sociodemographic risk factors (p < 0.05). In psychosocial factors, adverse life events (p < 0.001), wishing for a male child but giving birth to a female (p = 0.01), domestic violence (p = 0.005), relationship issues, an alcoholic spouse (p = 0.01), and poor in-law relations (p < 0.001) were found to be linked to PPD. Obstetric factors such as complicated antenatal history, physical illness, cesarean section, complicated intranatal history, and postpartum complications were also found to be important factors. Conclusion PPD affects many women, emphasizing the need for effective measures. Initiatives like the appointment of healthcare counselors and PPD screening programs in healthcare settings are essential to detect and support affected mothers.

Modifiable Maternal Factors and Their Relationship to Postpartum Depression

The purpose of the study was to examine how modifiable maternal factors (body mass index (BMI), household income, fatigue, sleep, breastfeeding status, diet, and physical activity) relate to postpartum depression (PPD) at 6 and 12 months postpartum. Participants (n = 26) participated in two study visits (6 and 12 months postpartum) where vitals, weight, body composition (skinfold anthropometrics), and physical activity levels (Actigraph GTX9 accelerometer) were assessed. Validated instruments (BRUMS-32, Subjective Exercise Experience Scale, Pittsburg Sleep Quality index, NIH breastfeeding survey, NIH Dietary History Questionnaire, and Edinburg Postnatal Depression Scale) assessed lifestyle and demographic factors of interest. PPD at six months was correlated to PPD at 12 months (r = 0.926, p < 0.001). At six months postpartum, PPD was positively correlated to BMI (r = 0.473, p = 0.020) and fatigue (r = 0.701, p < 0.001), and negatively correlated to household income (r = -0.442, p = 0.035). Mothers who were breastfeeding had lower PPD scores (breastfeeding 3.9 ± 3.5 vs. not breastfeeding 7.6 ± 4.8, p = 0.048). At 12 months, PPD was positively correlated to sleep scores (where a higher score indicates poorer sleep quality) (r = 0.752, p < 0.001) and fatigue (r = 0.680, p = 0.004). When analyzed collectively via regression analyses, household income and fatigue appeared to be the strongest predictors of PPD at six months postpartum.

Factors Associated with Risk of Perinatal Depressive Symptoms Among Puerto Rican Women with Hyperglycemia

OBJECTIVES

Rates of perinatal depression and pregnancy hyperglycemia are higher in Hispanic women as compared to non-Hispanic white women. In turn, depressive symptoms may reduce a woman's ability to engage in lifestyle changes that could reduce their subsequent diabetes risk.

METHODS

We conducted a secondary analysis using data from Estudio Parto to evaluate sociodemographic, behavioral, psychosocial, and medical factors associated with perinatal depressive symptoms. Estudio Parto was a randomized controlled trial conducted in Western Massachusetts from 2013 to 17. Eligible participants had pregnancy hyperglycemia. The Edinburgh Postnatal Depression Scale (EPDS) was administered at 24-28 weeks gestation and at 6 weeks, 6 months, and 12 months postpartum. An EPDS cutpoint of 10 or greater defined the presence of depressive symptoms.

RESULTS

In this sample of Puerto Rican women with pregnancy hyperglycemia, 32% and 27% showed prenatal and postpartum depressive symptoms, respectively. Among participants, 35.5% were diagnosed with GDM, 44.3% with isolated hyperglycemia, and 20.2% with impaired glucose tolerance. In multivariable models, being unmarried (OR 3.87; 95% CI 1.51-9.94), prenatal substance use (smoking or alcohol consumption; OR 2.96; 95% CI 1.41-6.18), and maternal age (1.11 for each year; 95% CI 1.04-1.18) were associated with higher odds of prenatal depressive symptoms. None of the risk factors were associated with subsequent postpartum depression in adjusted analyses.

CONCLUSIONS

Identifying factors associated with prenatal and postpartum depression in Puerto Rican women with pregnancy hyperglycemia can inform targeted lifestyle interventions in this at-risk group, increase the likely adoption of healthy lifestyle behaviors, and thereby work to address health disparities.

CLINICALTRIALS

gov NCT01679210; date of registration 08/07/2012.

Neurobiological approaches of high-fat diet intake in early development and their impact on mood disorders in adulthood: A systematic review

The early stage of development is a vulnerable period for progeny neurodevelopment, altering cytogenetic and correct cerebral functionality. The exposure High-Fat Diet (HFD) is a factor that impacts the future mental health of individuals. This review analyzes possible mechanisms involved in the development of mood disorders in adulthood because of maternal HFD intake during gestation and lactation, considering previously reported findings in the last five years, both in humans and animal models. Maternal HFD could induce alterations in mood regulation, reported as increased stress response, anxiety-like behavior, and depressive-like behavior. These changes were mostly related to HPA axis dysregulations and neuroinflammatory responses. In conclusion, there could be a relationship between HFD consumption during the early stages of life and the development of psychopathologies during adulthood. These findings provide guidelines for the understanding of possible mechanisms involved in mood disorders, however, there is still a need for more human clinical studies that provide evidence to improve the understanding of maternal nutrition and future mental health outcomes in the offspring.

Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis

BACKGROUND

Postpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery.

METHODS

We searched in three electronic databases: PubMed, EMBASE and Cochrane Library.

RESULTS

This paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]).

CONCLUSION

The mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

Pregnancy-Related Weight and Postpartum Depressive Symptoms: Do the Relationships Differ by Race/Ethnicity?

Background: There are significant racial/ethnic disparities in the prevalence of postpartum depression. Prior research in the general population suggests that weight status is related to depression and that this relationship varies by race/ethnicity. However, few studies have investigated whether race/ethnicity moderates the relationship between pregnancy-related weight and postpartum depressive symptoms (PPDS). The objective of this study is to examine the relationship between pregnancy-related weight and maternal PPDS overall and by race/ethnicity. Materials and Methods: This study used data from the Early Childhood Longitudinal Study-Birth Cohort (n ≈ 6950). Ordinary least-squares and logistic regression was used to examine whether pregnancy-related weight, including preconception weight status and gestational weight gain (GWG), was associated with PPDS measured using the Center for Epidemiologic Studies-Depression Scale (CES-D). Stratified analyses were used to assess whether these relationships varied by race/ethnicity. Results: Preconception obesity (body mass index [BMI] ≥30 kg/m²) was associated with higher levels of PPDS (β = 0.601, 95% confidence interval [CI], 0.149-1.053). GWG adequacy was not associated with PPDS. Among non-Hispanic (NH) whites, preconception obesity was positively associated with PPDS (β = 1.016, 95% CI, 0.448-1.584). In contrast, among Hispanics, preconception overweight (25 kg/m² ≤ BMI <30 kg/m²) was associated with lower levels of PPDS (β = -0.887, 95% CI, -1.580 to -0.195). There were no statistically significant relationships between pregnancy-related weight and PPDS among NH black or Asian women, but both groups were significantly more likely than NH whites to report PPDS. Conclusion: Whether and how pregnancy-related weight is associated with PPDS varies by race/ethnicity. Addressing preconception weight could help reduce overall levels of PPDS among NH whites but would likely fail to mitigate racial/ethnic disparities in postpartum mental health.

Association of Pain Catastrophizing with Postnatal Depressive States in Nulliparous Parturients: A Prospective Study

PURPOSE

Postnatal depression (PND) is associated with maternal morbidity and socioeconomic burden. Recent studies have shown an association between pain catastrophizing, increased labor pain, and subsequent adverse postnatal adjustment; however, little is known on its role in PND development. We aimed to investigate the association between pain catastrophizing and probable PND.

METHODS

Parturients planning to undergo epidural labor analgesia were recruited. Predelivery questionnaires, including the Pain Catastrophizing Scale (PCS) and Edinburgh Postnatal Depression Scale (EPDS), were administered during early labor. A phone survey at 5- 9 weeks postdelivery was conducted to determine postdelivery EPDS and Spielberger's State-Trait-Anxiety Inventory scores. The primary outcome was a binary variable of postdelivery EPDS with cutoff of ≥10, whereas the secondary outcome was a continuous variable on increases in EPDS score.

RESULTS

Probable PND (EPDS ≥10) occurred in 10.5% (95% CI 8.0%-13.5%, 55 of 525) of women who underwent epidural labor analgesia. We found that high pain catastrophizing (PCS ≥25) was associated with increased postdelivery EPDS scores (adjusted β estimate 0.36, 95% CI 0.15-0.57; p=0.0008), but did not meet significance for increased risk of probable PND (p=0.1770). Additionally, presence of breakthrough pain during epidural analgesia (adjusted β estimate 0.24, 95% CI 0.02-0.46; p=0.0306) and lower BMI at term (adjusted β estimate -0.04, 95% CI -0.07 to -0.01; p=0.0055) were associated with increased postdelivery EPDS scores.

CONCLUSION

No significant association was found between high pain catastrophizing and probable PND; however, high predelivery pain catastrophizing, presence of breakthrough pain during epidural analgesia, and lower BMI at term were associated with increased postdelivery EPDS scores. Further research will be needed to validate this association in the context of the risk of PND development.

Young adult pregnancy status and the risk of developing overweight and obesity among women and men

Pregnancies can end in miscarriage, birth or termination. Although it is well known that pregnancy results in weight gain across the life course, it is unknown whether pregnancies which end in termination and miscarriage contribute to this. The study used a sub-sample of 3630 adult offspring from the original cohort of the Mater University of Queensland Study of Pregnancy (MUSP) and its outcomes, in Brisbane, Australia. Anthropometric data were measured at 5, 14 and 21 years of age and experience of pregnancy including termination, miscarriage and births were self-reported at 21 years. Multivariable analyses were conducted to determine whether pregnancy status of young people independently associated with overweight or obesity status. The women who had at least one birth were more likely to have overweight (odds ratio [OR] 1.52; 95% confidence interval [CI]: 1.01, 2.27) or obese (OR 2.38; 95% CI: 1.58, 3.59) compared to women who did not experience any pregnancy. Women whose pregnancies were terminated or miscarried were at the same risk of overweight or obesity as women who did not experience any pregnancy. For men, there is no association between the pregnancies in their partners and the mean difference in their body mass index. Young women whose pregnancies result in a birth, but not terminations or miscarriages, are at greater risk of having overweight or obesity following the birth.

Low serum levels of High-Density Lipoprotein cholesterol (HDL-c) as an indicator for the development of severe postpartum depressive symptoms

Postpartum depression (PPD) is a psychiatric complication of childbirth affecting 10-20% of new mothers and has negative impact on both mother and infant. Serum lipid levels have been related to depressive disorders, but very limited literatures are available regarding the lipid levels in women with postpartum depression. The present study is aimed to examine the association of serum lipids with the development of postpartum depressive symptoms. This is a cross sectional study conducted at a tertiary care hospital in South India. Women who came for postpartum check-up at 6th week post-delivery were screened for PPD (September 2014-October 2015). Women with depressive symptoms were assessed using EPDS (Edinburgh Postnatal Depression Scale). The study involved 186 cases and 250 controls matched for age and BMI. Serum levels of lipid parameters were estimated through spectrophotometry and the atherogenic indices were calculated in all the subjects. Low serum levels of Total Cholesterol (TC) and High Density Lipoprotein cholesterol (HDL-c) were significantly low in PPD women with severe depressive symptoms. The study recorded a significant negative correlation between HDL-c and the EPDS score in PPD women (r = -0.140, p = 0.05). Interestingly, the study also observed a significant negative correlation between Body Mass Index (BMI) and EPDS scores in case group (r = -0.146, p = 0.047), whereas a positive correlation between the same in controls (r = 0.187, p = 0.004). Our study demonstrated that low levels of serum HDL-c is correlated with the development of severe depressive symptoms in postpartum women. Study highlights the role of lipids in the development of postpartum depressive symptoms.

The association between pre-pregnancy obesity and screening results of depression for all trimesters of pregnancy, postpartum and 1 year after birth: a cohort study

OBJECTIVE

To determine the relationship between pre-pregnancy obesity and screening results of gestational and post-delivery depression in women referred to the health centers of Tabriz, Iran.

METHODS

In this cohort study, 62 and 245 pregnant women with class 2-3 obesity [body mass index (BMI)≥35 kg/m2] and normal-weight (BMI 18.5-24.9 kg/m2) were enrolled, respectively, in the first trimester of pregnancy from December 2012 to January 2016. For matching of groups, nulliparous and multiparous mothers aged 18-35 years were selected with the ratio of 1:4 in obese and normal BMI groups from the same recruitment center and to controlling the confounder factors, inclusion criteria were considered. The Edinburgh Postnatal Depression Scale (EPDS) was completed in five time points, the first, second, third trimester of pregnancy, 6-8 weeks and 12 months after delivery. Independent t-test, Mann-Whitney, chi-square, Fisher's exact tests and multivariate logistic and linear regression adjusted for confounders were used. P<0.05 was considered as statistically significant.

RESULTS

Based on the EPDS, 12.7% of normal weight women in first, 13.5% in second, 10.2% in third trimester of pregnancy, 7.8% in 6-8 weeks of postpartum and 10.6% in 1 year after delivery screened positive for depression. This proportion was greater in class 2-3 obese women (32.3%, 33.3%, 28.8% in trimesters of pregnancy and 35.4%, 19.4% in postpartum period, respectively) (P<0.05). The results of multivariate logistic regression adjusted for confounding factors showed that the risk of depression in the first trimester of pregnancy for class 2-3 obesity was 3.25-fold greater than normal weight group [adjusted odds ratio (aOR) 3.25, 95% confidence interval (CI) 1.68-6.28]. This risk was 3.29-fold in the second (aOR 3.29, 95% CI 1.67-6.47), 4-folds in the third trimester (aOR 4.003, 95% CI 1.84-8.70 for third), 7.5-fold in the 6-8 weeks of postpartum (aOR 7.46, 95% CI 3.30-16.89) and 1.83-fold (aOR 7.46, 95% CI 3.30-16.89) for 1 year after birth.

CONCLUSIONS

Pre-pregnancy obesity was associated with probability of gestational and post-delivery depression. Therefore, training and planning to conduct required interventions to resolve obesity seem be helpful in this regard.

Electronic-based lifestyle interventions in overweight or obese perinatal women: a systematic review and meta-analysis

Electronic-based (e-based) lifestyle interventions provide potential and cost-effective delivery of remote interventions for overweight and obese perinatal women. To date, no meta-analysis has reported the efficacy of maternal and neonatal outcomes. Seven electronic databases were searched from inception up to July 13, 2016, including the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, ProQuest Dissertations and Theses, PsycINFO, PubMed and Scopus. Among the 1,145 studies retrieved, 14 randomized controlled trials were selected among 17 publications. The Cochrane risk of bias tool was used to appraise the quality assessment. The meta-analyses demonstrated a significant result for limiting gestational weight gain, losing postnatal weight in 1-2 months, increasing self-reported moderate and vigorous physical activity and reducing caloric intake using diet-related software. Our review shows that an e-based lifestyle intervention is an acceptable approach. The findings reveal the variability in intervention methods and provide limited conclusive evidence. Thus, future studies should examine the efficacy and essential components as well as the various approaches using optimal portions of in-person and phone sessions. Further evaluations comparing the effectiveness of different e-based lifestyle intervention approaches toward activity-related and diet-related outcomes are necessary.

Cesarean section and risk of postpartum depression: A meta-analysis

OBJECTIVE

The association of cesarean section (CS) with the risk of postpartum depression (PPD) remains controversial. Therefore, we conducted a meta-analysis to explore the association between CS and the risk of PPD.

METHODS

A systematic literature search was performed in PubMed, Web of Science and Embase databases for relevant articles up to November 2016. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with fixed-effects model or random-effects model.

RESULTS

A total of 28 studies from 27 articles involving 532,630 participants were included in this meta-analysis. The pooled OR of the association between CS and PPD risk was 1.26 (95% CI: 1.16-1.36). In subgroup analyses stratified by study design [cohort studies: (1.25, 95% CI: 1.10-1.41); case-control studies: (1.25, 95% CI: 1.00-1.56); cross-sectional studies: (1.44, 95% CI: 1.14-1.82)] and adjustment status of complications during pregnancy [adjusted for: (1.29, 95% CI: 1.12-1.48); not-adjusted for: (1.24, 95% CI: 1.13-1.36)], the above-mentioned associations remained consistent. The pooled ORs of PPD were 1.15 (95% CI: 0.92-1.43) for elective cesarean section (ElCS) and 1.47 (95% CI: 1.33-1.62) for emergency cesarean section (EmCS).

CONCLUSION

This meta-analysis suggests that CS and EmCS increase the risk of PPD. Further evidence is needed to explore the associations between the specific types of CS and the risk of PPD.

Factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes mellitus

Women with gestational diabetes mellitus (GDM) have a substantial risk of subsequently developing type 2 diabetes. This risk may be mitigated by engaging in healthy eating, physical activity, and weight loss when indicated. Since postpartum depressive symptoms may impair a woman's ability to engage in lifestyle changes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. The participants are part of the baseline cohort of the TEAM GDM (Taking Early Action for Mothers with Gestational Diabetes Mellitus) study, a one-year randomized trial of a lifestyle intervention program for women with a recent history of GDM, conducted in Boston, Massachusetts between June 2010 and September 2012. We administered the Edinburgh Postnatal Depression Scale (EPDS) at 4-15 weeks postpartum to women whose most recent pregnancy was complicated by GDM (confirmed by laboratory data or medical record review). An EPDS score ≥9 indicated depressive symptoms. We measured height and thyroid stimulating hormone, and administered a questionnaire to collect demographic data and information about breastfeeding and sleep. We calculated body mass index (BMI) using self-reported pre-pregnancy weight and measured height. We reviewed medical records to obtain data about medical history, including history of depression, mode of delivery, and insulin use during pregnancy. We conducted bivariable analyses to identify correlates of postpartum depressive symptoms, and then modeled the odds of postpartum depressive symptoms using multivariable logistic regression. Our study included 71 women (mean age 33 years ± 5; 59 % White, 28 % African-American, 13 % Asian, with 21 % identifying as Hispanic; mean pre-pregnancy BMI 30 kg/m(2) ± 6). Thirty-four percent of the women scored ≥9 on the EPDS at the postpartum visit. In the best fit model, factors associated with depressive symptoms at 6 weeks postpartum included cesarean delivery (aOR 4.32, 95 % CI 1.46, 13.99) and gestational weight gain (aOR 1.21 [1.02, 1.46], for each additional 5 lbs gained). Use of insulin during pregnancy, breastfeeding, personal history of depression, and lack of a partner were not retained in the model. Identifying factors associated with postpartum depression in women with GDM is important since depression may interfere with lifestyle change efforts in the postpartum period. In this study, cesarean delivery and greater gestational weight gain were correlated with postpartum depressive symptoms among women with recent GDM (Clinicaltrials.gov NCT01158131).

Relationships of race and socioeconomic status to postpartum depressive symptoms in rural African American and non-Hispanic white women

This study examines the potential racial disparity in postpartum depression (PPD) symptoms among a cohort of non-Hispanic white and African American women after taking into consideration the influence of socioeconomic status (SES). Participants (N = 299) were recruited from maternity clinics serving rural counties, with oversampling of low SES and African Americans. The Edinburgh Postnatal Depression Scale (EPDS) was administered 1 and 6 months postpartum, and subjective SES scale at 6 months postpartum. Demographic information was collected during enrollment and 1 month postpartum, with updates at 6 months postpartum. Separate logistic regressions were conducted for 1 and 6 month time points for minor-major PPD (EPDS ≥ 10) and major PPD (EPDS > 12); with marital status, poverty, education, subjective SES, and race predictors entered in block sequence. After including all other predictors, race was not a significant predictor of minor-major or major PPD at 1 or 6 months postpartum. Subjective SES was the most consistent predictor of PPD, being significantly associated with minor-major PPD and major PPD at 6 months postpartum, with higher subjective SES indicating lower odds of PPD, even after accounting for all other predictors. This study shows that significant racial disparities were not observed for minor-major or major PPD criteria at 1 or 6 months postpartum. The most consistent and significant predictor of PPD was subjective SES. Implications of these findings for future research, as well as PPD screening and intervention are discussed.

Applying a social disparities lens to obesity in pregnancy to inform efforts to intervene

OBJECTIVE

to examine the social correlates of pre-pregnancy overweight and obesity in an Australian population-based sample and consider implications for intervention effectiveness during pregnancy.

DESIGN

population-based survey distributed by hospitals to women 6 months after birth.

SETTING

two states of Australia.

PARTICIPANTS

women who gave birth in Victoria and South Australia in September/October 2007.

MEASUREMENTS AND FINDINGS

surveys were completed by 4,366 women. Pre-pregnancy body mass index (BMI) was calculated from women's self-reported weight in kilograms/(height in metres)(2). Results showed high rates of overweight (22%) and obesity (14%) among Australian women entering pregnancy. After adjusting for other factors in the model, pre-pregnancy obesity was significantly associated with lower household income levels, less education, the experience of financial stress in pregnancy and increasing parity.

KEY CONCLUSIONS

to date, there is little evidence to support the efficacy of interventions to manage problematic weight in pregnancy. Applying a social disparities lens to obesity in pregnancy challenges us to consider social factors that may seem distal to obesity but are highly relevant to efficacious intervention.

IMPLICATIONS FOR PRACTICE

pregnancy care offers an opportunity to address social issues on the pathway to obesity. Current clinical care guidelines on maternal overweight and obesity in pregnancy rarely consider social contexts that place some women at risk and are a likely impediment to efficacious intervention.

Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study

BACKGROUND

Although studies have shown an association between anxiety and depression and obesity, psychological health among obese women during and after pregnancy has not been carefully studied. The aim of this study was to investigate psychological well-being using symptoms of depression and/or anxiety among obese pregnant women attending a weight gain restriction program and to then compare this group with a control group receiving traditional antenatal care.

METHODS

151 obese pregnant women in an intervention group and 188 obese pregnant women in a control group answered the Beck Anxiety Inventory (BAI) and the Edinburgh Postnatal Depression Scale (EPDS). Group differences between the two groups were estimated by using the χ2 - test on categorical variables. The Student's t-test on continuous, normally distributed variables measuring changes in mean score on BAI and EPDS over time was used. To make a more comprehensive assessment of group differences, between as well as within the two groups, logistic regressions were performed with the BAI and EPDS as dependent variables, measured at gestational weeks 15 and 35 and 11 weeks postnatal. The grouping variable has been adjusted for socio-demographic variables and complications.

RESULTS

The prevalence of symptoms of anxiety during pregnancy varied between 24% and 25% in the intervention group and 22% and 23% in the control group. The prevalence of symptoms of anxiety postnatally was 9% in the intervention group and 11% in the control group. Five percent of the women in the intervention group and 4% of the women in the control group showed symptoms of anxiety during the course of pregnancy and at the postpartum assessment. The prevalence of symptoms of depression during pregnancy varied between 19% and 22% in the intervention group but was constant at 18% in the control group. Postnatal prevalence was 11% in both groups. Six percent of the women in the intervention group and 4% in the control group showed symptoms of depression during the course of pregnancy and at the postpartum assessment. We found no differences between the two groups as concerns demographic characteristics, weight gain in kg, or the distribution of scores on anxiety and depressive symptoms nor did we find differences in the fluctuation of anxiety and depressive symptoms over time between the women in the intervention group and in the control group.

CONCLUSION

Obese pregnant women attending an intervention program seem to have the same risk of experiencing anxiety and/or depressive symptoms as do obese pregnant and postnatal women in general.

Multiparity is associated with high motivation to change diet among overweight and obese postpartum women

BACKGROUND

Pregnancy is associated with weight gain and obesity. The aim of this study was to identify the effect of parity and other factors on motivation to change diet to lose weight in a cohort of overweight and obese postpartum women.

STUDY DESIGN

Active Mothers Postpartum is a randomized, controlled trial aimed at postpartum weight reduction. At baseline, we measured motivation to change diet to lose weight among 491 overweight/obese postpartum women. Logistic regression was used to model the effect of parity on motivation to change diet at baseline while adjusting for potential confounders including age, race, education, body mass index category, and breastfeeding status.

RESULTS

Approximately two thirds (68%) of participants were highly motivated to change their diet to lose weight. In the multivariable model, women with three or more children had 2.5 times the odds of high motivation compared with primigravid women, and women not breastfeeding had 1.6 times the odds of high motivation compared with any breastfeeding.

CONCLUSION

Although risk for obesity is incurred starting with a woman's first pregnancy, women in this study were more motivated to change their diet to lose weight after their third pregnancy. Further research is needed to understand how to best capitalize on the high motivation in women with several children as well as how to improve motivation for primigravid women and women who are breastfeeding.