Does weight gain during pregnancy influence antenatal depressive symptoms? A systematic review and meta-analysis

Influencing factors of depressive symptoms during pregnancy in Beijing, China

Objective

Prenatal depression is a prevalent mental health challenge encountered during pregnancy and is notably associated with adverse maternal and neonatal outcomes. This study aimed to elucidate the likelihood and determinants of depressive symptoms among pregnant individuals in Beijing, thereby laying a foundational framework for the theoretical underpinning of prenatal screening and preemptive interventions for mental disorders.

Methods

The study dataset was derived from 4,564 pregnant individuals in Beijing utilizing a cross-sectional survey methodology. Data collection focused primarily on the personal and obstetric information of the participants. The Edinburgh Postnatal Depression Scale (EPDS) was employed as the primary screening tool to identify depressive symptoms.

Results

The prevalence of depressive symptoms among the included pregnant individuals was 4.1%. The univariate analysis results revealed statistically significant differences in the incidence of depressive symptoms in women with different parities, numbers of births, medication use, numbers of abortions, prepregnancy weights, and body mass indices (BMIs) (the χ2 values were 61.130, 52.008, 23.291, 5.293, and 12.681, respectively; P<0.05). There were statistically significant differences in the incidence of depressive symptoms among women with different occupation types (χ2 = 30.263, P<0.01). The multivariate logistic regression analysis results revealed that a greater number of pregnancies, number of births, and BMI were risk factors for prenatal depression, whereas the commercial and service worker occupation types were protective factors against prenatal depression.

Conclusion

Future directives should emphasize the enhancement of screening for depressive symptoms among pregnant individuals with greater parity and BMIs, alongside encouraging continued employment and flexible job selection. It is imperative to implement suitable intervention strategies for pregnant individuals exhibiting depressive symptoms to mitigate the incidence of adverse maternal and neonatal outcomes.

Maternal Pregnancy and Pre-Pregnancy Weight and Behavioural Outcomes in Children

Reported associations of pre-pregnancy weight and/or gestational weight gain with offspring behavioural outcomes are inconsistent. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to examine these associations at five developmental stages between the ages of 3 and 16. Over 6800 mother-offspring pairs at age 3 and 3925 pairs at age 16 were included. Pre-pregnancy underweight was associated with a 22% increased risk of total behavioural difficulties (OR = 1.22, 95% CI 1.02-1.45). In separate analyses using the SDQ subscales, pre-pregnancy underweight was linked to a 37% (OR = 1.37, 95% CI 1.14-1.65) and 33% (OR = 1.33, 95% CI 1.01-1.76) increased risk of emotional symptoms and prosocial behaviour problems over time, respectively. While pre-pregnancy overweight was associated with an 11% (OR = 1.11, 95% CI 1.03-1.20) and 18% (OR = 1.18, 95% CI 1.03-1.36) increased risk of conduct and peer relationship problems, respectively, pregnancy obesity was associated with a 43% increased risk of emotional problems (OR = 1.43, 95% CI 1.16-1.77). We found no evidence of associations between gestational weight gain and child behaviour except for a reduced risk in prosocial behaviour problems (OR = 0.82, 95% CI 0.70-0.96). Our findings provide insights into the link between preconception BMI and child behaviour, underscoring the necessity for further research to validate these associations and elucidate underlying mechanisms.

Depression during pregnancy and gestational weight gain: A study of Brazilian pregnant women

OBJECTIVES

The relationship between psychosocial factors/mental health/depressive symptoms and inadequate gestational weight (GW) change remains poorly understood. Thus, the aim of this study was to evaluate the association between depressive symptoms and inadequate GW change according to the criteria established by the Institute of Medicine in 2009.

METHODS

This cross-sectional study was part of a prospective cohort, and conducted in Botucatu, São Paulo, Brazil. Pregnant women who received prenatal care at basic health care units in the city participated in the study (n = 297). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms during pregnancy, and the cutoff point used for the positive screening of depressive symptoms was ≥13. The association between depressive symptoms and two outcomes (insufficient and excessive weight change during second and third trimesters) was investigated using logistic regression models with adjustment for potential confounders. Crude and adjusted effect measures (odds ratios) and their relevant 95% confidence intervals were estimated.

RESULTS

There was an association between a positive score for depression during pregnancy and insufficient GW gain. No association was observed between depressive symptoms and excessive GW gain.

CONCLUSIONS

The presence of depressive symptoms significantly increased the chance of insufficient GW change. This finding enhances the need for screening for depression in prenatal care.

Residential greenness and air pollution concerning excessive gestational weight gain during pregnancy: A cross-sectional study in Wuhan, China

BACKGROUND

Previous studies have indicated that exposure to residential greenness may benefit the health status of pregnant women, and air pollution may exert a mediating effect. Gestational weight gain (GWG) is an important indicator of pregnant women and fetuses' health and nutrition status. However, evidence concerning the impact of residential greenness on excessive gestational weight gain (EGWG) is scarce, and to what extent air pollution in urban settings mediates this relationship remains unclear.

OBJECTIVE

This study aims to explore the association of residential greenness with EGWG, consider the mediating effect of air pollution, and estimate the combined impact of residential greenness and air pollution exposures on EGWG.

METHOD

This population-based cross-sectional study involved 51,507 pregnant women with individual-level data on residential addresses in the Wuhan Maternal and Child Health Management Information System. Two spectral indexes, the normalized difference vegetation index (NDVI) and soil-adjusted vegetation index (SAVI), were used to proxy residential greenness. The air pollution data included six indicators (PM_2.5, PM₁₀, SO₂, CO, NO₂, O₃) and used the Ordinary Kriging interpolation method to estimate overall pregnancy exposure to air pollutants. Generalized linear mixed regression models were utilized to explore the relationship between residential greenness and EGWG. Restricted cubic spline (RCS) models were developed to examine the dose-response relationships. Mediation analyses explored the potential mediating role of air pollution in the residential greenness-EGWG associations. Finally, the weighted-quantile-sum (WQS) regression model was used to investigate the association between residential greenness-air pollutants co-exposure and EGWG.

RESULT

Among all participants, 26,442 had EGWG. In the adjusted model, the negative association was found significant for NDVI_100-m, NDVI_200-m, and NDVI_500-m with EGWG. For example, each IQR increase in NDVI_100-m was associated with 2.8% (95% CI: 0.6-5.0) lower odds for EGWG. The result of WQS regression showed that, when considering the six air pollutants and NDVI_-100m together, both positive and negative WQS indices were significantly associated with EGWG, PM₁₀, PM_2.5, with SO₂ having significant weights in the positive effect direction and CO, O₃, NO₂, and NDVI_100-m having a negative effect. Our results also suggested that SO₂, NO₂, PM₁₀, PM_2.5, and CO significantly mediated the association between NDVI_-100m and EGWG, and our estimates were generally robust in the sensitivity analysis.

CONCLUSION

Exposure to a higher level of residential greenness is associated with a reduced risk of EGWG, in which air pollution may exert a mediating effect. Pregnant women might benefit more in gaining healthy gestational weight when greenness levels increase from low to medium than from medium to high. Given the current cross-sectional study design, large-sale prospective cohort studies are needed to confirm our findings further.