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Van Uytsel H, Ameye L, Devlieger R, Jacquemyn Y, Van Holsbeke C, Schreurs A, Bogaerts A. Mental Health during the Interpregnancy Period and the Association with Pre-Pregnancy Body Mass Index and Body Composition: Data from the INTER-ACT Randomized Controlled Trial. Nutrients 2023; 15:3152. [PMID: 37513569 PMCID: PMC10384439 DOI: 10.3390/nu15143152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Mental health problems and obesity are two common complications during pregnancy and postpartum. The preconception period is considered an appropriate period for prevention. Therefore, insights into interpregnancy mental health and the impact on weight and body composition are of interest to developing effective weight management strategies. The primary aim of this study is to assess the difference in women's mental health during the interpregnancy period and the association with pre-pregnancy body mass index (BMI) and body composition. The secondary aim is to study whether this association is affected by socio-demographic factors, interpregnancy interval and sleep. The study is a secondary analysis of the INTER-ACT e-health-supported lifestyle trial. Women were eligible if they had a subsequent pregnancy and mental health measurements at 6 weeks after childbirth and at the start of the next pregnancy (n = 276). We used univariate analyses to assess differences in mental health and performed regression analysis to assess their association with pre-pregnancy BMI and body composition at the start of the next pregnancy. Our results show a statistically significant increase in anxiety and depressive symptoms between 6 weeks after childbirth and the start of the next pregnancy (sSTAI-6 ≥ 40: +13%, p =≤ 0.001; GMDS ≥ 13: +9%, p = 0.01). Of the women who were not anxious at 6 weeks after childbirth (sSTAI < 40), more than one-third (39%) developed anxiety at the start of the next pregnancy (p =≤ 0.001). Regression analysis showed that sense of coherence (SOC-13) at the start of the next pregnancy was independently associated with women's pre-pregnancy BMI and fat percentage. We believe that the development of preconception lifestyle interventions that focus on both weight reduction and support in understanding, managing and giving meaning to stressful events (sense of coherence) may be of added value in optimizing women's preconception health.
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Affiliation(s)
- Hanne Van Uytsel
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Lieveke Ameye
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Roland Devlieger
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, 3000 Leuven, Belgium
- Department of Obstetrics and Gynecology, GZA Hospitals Sint-Augustinus, 2610 Antwerp, Belgium
| | - Yves Jacquemyn
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Obstetrics and Gynecology, University Hospital Antwerp, 2650 Antwerp, Belgium
| | | | - Annick Schreurs
- Department of Obstetrics and Gynecology, Jessa Hospital, 3500 Hasselt, Belgium
| | - Annick Bogaerts
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Faculty of Health, University of Plymouth, Devon PL4 8AA, UK
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Sharp M, Ward L, Solar C, Shea C, Carels RA, Dolbier C. Internalized Weight Bias, Weight-Related Experiences, And Peripartum Weight. J Midwifery Womens Health 2023; 68:490-498. [PMID: 36912269 PMCID: PMC10497705 DOI: 10.1111/jmwh.13480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate internalized weight bias (IWB) and its relationship with pregnancy-related weight changes and postpartum depression. IWB is defined as the internalization of negative attitudes and beliefs about people due to their weight. Although IWB has been linked with weight change and depression in other samples, it has never been investigated in the postpartum period. METHODS We used a cross-sectional survey design. Participants were 251 women recruited via social media who were living in the United States and 6 to 12 months postpartum. We calculated percentage of body weight gained during pregnancy and percentage of that weight that was retained postpartum from self-reported weights. Participants completed self-report measures of IWB (modified version of the Weight Bias Internalization Scale) and postpartum depression (Edinburgh Postnatal Depression Scale). RESULTS Gestational weight gain was not significantly associated with IWB or depression. Postpartum retention of gestational weight was significantly positively associated with both IWB and depressive symptoms. Furthermore, IWB mediated the relationship between postpartum weight retention and depressive symptoms. DISCUSSION Postpartum retention of weight gained during pregnancy, but not weight gain itself, was related to both IWB and depressive symptoms. The relationship between pregnancy-related weight changes and psychological distress is complex. Sociocultural pressures to return to a prepregnancy physical state swiftly after giving birth may increase risk for IWB during a time in life when stress is already likely to be high, posing additional psychological risk. IWB existing prepregnancy may also worsen postpartum self-concept, contributing to depression. This is the first study, to our knowledge, to directly assess associations among gestational weight change, IWB, and postpartum depression. In addition to discussing weight in pregnancy, perinatal care providers could improve postpartum health by helping women set realistic, body-positive goals postpartum.
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Affiliation(s)
- Meghan Sharp
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - L.G. Ward
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
- Centers for Behavioral & Preventative Medicine, The Miriam Hospital, Providence, Rhode Island
| | | | - Chelsea Shea
- Lifespan Obstetrics and Gynecology, Providence, Rhode Island
| | - Robert A. Carels
- Department of Psychology, East Carolina University, Greenville, North Carolina
| | - Christyn Dolbier
- Department of Psychology, East Carolina University, Greenville, North Carolina
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Van Uytsel H, Ameye L, Devlieger R, Bijlholt M, Jacquemyn Y, Catry V, Schreurs A, Bogaerts A. Mental health after childbirth and the impact on postpartum weight retention and body composition. Data from the INTER-ACT randomized controlled trial. Clin Obes 2022; 12:e12550. [PMID: 36161779 DOI: 10.1111/cob.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the evolution of maternal mental health during the first year after childbirth in women with previous excessive gestational weight gain, and the relationship with postpartum weight retention and body composition. METHODS Anthropometric and mental health data of 505 women of the INTER-ACT RCT control group were collected and assessed using descriptive statistics and mixed model analyses. RESULTS At 6 weeks postpartum 28% of women reported depressive symptoms, 46% anxiety, 47% low sense of coherence and 48% low quality of life. From 6 weeks to 12 months postpartum there was a monthly increase (+0.38, p = .003) in anxiety and a monthly decrease (-0.39, p = .008) in quality of life. High levels of depressive symptoms at 6 weeks postpartum predicted higher body fat (+0.9%, p = .01) and higher waist circumference (+1.3 cm, p = .02) in the first year postpartum. High sense of coherence at 6 weeks postpartum predicted lower body fat (-0.8%, p = .01) the first year postpartum. CONCLUSIONS In women with a history of excessive gestational weight gain, the first year after childbirth is characterized by a high prevalence of mental health problems in which levels of anxiety and quality of life deteriorate over time. Moreover, high levels of depressive symptoms and low sense of coherence in the first weeks postpartum predict unfavourable body composition outcomes in the year after childbirth.
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Affiliation(s)
- Hanne Van Uytsel
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lieveke Ameye
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Roland Devlieger
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, GZA Hospitals Sint- Augustinus, Antwerp, Belgium
| | - Margriet Bijlholt
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Yves Jacquemyn
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Antwerp, Belgium
| | - Vincent Catry
- Department of Obstetrics and Gynecology, GZA Hospitals Sint- Augustinus, Antwerp, Belgium
| | - Annick Schreurs
- Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
| | - Annick Bogaerts
- REALIFE Research Group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Faculty of Health, University of Plymouth, Devon, UK
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Lee JI, Busler JN, Millett CE, Principe JL, Levin LL, Corrigan A, Burdick KE. Association between visceral adipose tissue and major depressive disorder across the lifespan: A scoping review. Bipolar Disord 2022; 24:375-391. [PMID: 34551182 DOI: 10.1111/bdi.13130] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Increasing evidence supports a bidirectional relationship between major depressive disorder (MDD) and obesity, but the role of visceral adipose tissue (VAT) as a measure of obesity in relation to MDD is not well understood. Here we review literature investigating the link between MDD and VAT in terms of biomarkers, sex differences, and aging. METHODS PubMed, EMBASE, PsycINFO, and CINAHL searches were conducted on December 11, 2020. No date or language limits were imposed. Major concepts searched were Depressive Disorder linked with Adipose Tissue, White, Hypothalmo-Hypophyseal System, and Pituitary-Adrenal System in addition to keywords. A final set of 32 items meeting criteria for inclusion. RESULTS Converging biological evidence suggests a significant bidirectional relationship between VAT and MDD across the lifespan. In adulthood, greater VAT was associated with increased risk for depression, especially in vulnerable groups such as individuals who are overweight/obese, postmenopausal women, and individuals with comorbid medical or psychiatric illness. In older adults, sarcopenia had an impact on the relationship between abnormal VAT and risk of depression. Additionally, sex differences emerged as a potential factor affecting the strength of the association between VAT and depression. CONCLUSIONS Elucidating the pathophysiological mechanisms associated with increased rates of depression in obese individuals will be crucial for developing specific treatment strategies that seek to improve outcomes in individuals with comorbid depression and obesity. Moreover, identifying age- and sex-specific risk factors may contribute to a more personalized medicine approach, thereby improving the quality of clinical care.
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Affiliation(s)
- Jia-In Lee
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jessica N Busler
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Caitlin E Millett
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica L Principe
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Leonard L Levin
- Countway Library, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Alexandra Corrigan
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Qiu X, Zhang S, Yan J. Gestational weight gain and risk of postpartum depression: A meta-analysis of observational studies. Psychiatry Res 2022; 310:114448. [PMID: 35227990 DOI: 10.1016/j.psychres.2022.114448] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/29/2022] [Accepted: 02/12/2022] [Indexed: 01/23/2023]
Abstract
The association between gestational weight gain (GWG) and postpartum depression (PPD) is still controversial. The present study aimed to assess the association between GWG and the risk of developing PPD by means of a meta-analysis. PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disk, Chinese National Knowledge Infrastructure, Weipu, and Wanfang database were searched up to May 19, 2021 to identify relevant studies that evaluated the association between GWG and PPD. Meta-analysis was conducted by using RevMan software and Stata software. Subgroup and sensitivity analyses were carried out to explore the potential heterogeneity source, and Begg's funnel plots and Begg's linear regression test were performed to assess the potential publication bias. A total of sixteen studies involving 100,438 participants were identified in this study. Overall, the total, excessive and inadequate GWG was significantly associated with a higher risk of developing PPD. These results emphasize the necessity of strengthening the prevention and intervention of excessive and inadequate weight gain during pregnancy to promote maternal and infant health. However, further studies on the association between GWG at different stages of pregnancy and the risk of developing PPD are warranted.
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Affiliation(s)
- Xing Qiu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Senmao Zhang
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jin Yan
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Remes O, Mendes JF, Templeton P. Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature. Brain Sci 2021; 11:1633. [PMID: 34942936 PMCID: PMC8699555 DOI: 10.3390/brainsci11121633] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.
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Affiliation(s)
- Olivia Remes
- Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK
| | | | - Peter Templeton
- IfM Engage Limited, Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK;
- The William Templeton Foundation for Young People’s Mental Health (YPMH), Cambridge CB2 0AH, UK
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Leonard KS, Adams EL, Savage JS, Paul IM, Kraschnewski JL, Pattison KL, Kjerulff KH, Symons Downs D. Influence of prenatal perceived stress on postpartum weight retention is mediated by high gestational weight gain in women with overweight. Clin Obes 2021; 11:e12446. [PMID: 33675292 DOI: 10.1111/cob.12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/13/2021] [Accepted: 02/13/2021] [Indexed: 12/17/2022]
Abstract
Women with excessive gestational weight gain (GWG) are at risk for poor psychosocial well-being and postpartum weight retention (PPWR). Scant research has examined longitudinal interrelations of GWG, psychosocial factors, and PPWR. This study examined: (a) pre-pregnancy weight status (ie, normal, overweight, obesity) differences in PPWR and its psychosocial determinants (perceived social support, perceived stress, depression) in women with excessive GWG (ie, above 2009 Institute of Medicine guidelines); and (b) whether GWG mediated associations between psychosocial determinants and PPWR. Women (N = 1352) reported third trimester perceived social support, perceived stress, and depressive symptoms, GWG, and 6- and 12-month PPWR via telephone interviews. Multivariate ANOVA analyses showed women with normal weight had higher 6-month PPWR than women with obesity; univariate ANOVA showed no group differences in psychosocial factors. Hayes mediation analyses indicated that GWG mediated the association between perceived stress and PPWR in women with overweight but not women with normal weight or obesity; perceived stress predicted GWG, and in turn, PPWR. Prenatal perceived stress may be a modifiable target of GWG and PPWR. Future research is needed to examine the utility of tailoring perinatal weight regulation interventions to reduce perceived stress in pregnant women with overweight.
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Affiliation(s)
- Krista S Leonard
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Elizabeth L Adams
- Center of Childhood Obesity Research, Department of Nutritional Sciences, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Jennifer S Savage
- Center of Childhood Obesity Research, Department of Nutritional Sciences, The Pennsylvania State University, State College, Pennsylvania, USA
| | - Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jennifer L Kraschnewski
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Krista L Pattison
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, State College, Pennsylvania, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Psychosocial stratification of antenatal indicators to guide population-based programs in perinatal depression. BMC Pregnancy Childbirth 2021; 21:277. [PMID: 33823838 PMCID: PMC8025384 DOI: 10.1186/s12884-021-03722-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. To maximise the impact of population-based interventions for optimising perinatal wellbeing, health services can utilise empirical methods to identify subgroups at highest risk of poor outcomes relative to the overall population. METHODS This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. Subgroup differences in antenatal and postnatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. RESULTS Latent class analysis identified four distinct subgroups within the cohort, who were distinguished empirically on the basis of their native language, current smoking status, previous involvement with Family-and-Community Services (FaCS), history of child abuse, presence of a supportive partner, and a history of intimate partner psychological violence. One group consisted of socially supported 'local' women who speak English as their primary language (Group L), another of socially supported 'migrant' women who speak a language other than English as their primary language (Group M), another of socially stressed 'local' women who speak English as their primary language (Group Ls), and socially stressed 'migrant' women who speak a language other than English as their primary language (Group Ms.). Compared to local and not socially stressed residents (L group), the odds of antenatal depression were nearly three times higher for the socially stressed groups (Ls OR: 2.87 95%CI 2.10-3.94) and nearly nine times more in the Ms. group (Ms OR: 8.78, 95%CI 5.13-15.03). Antenatal symptoms of depression were also higher in the not socially stressed migrant group (M OR: 1.70 95%CI 1.47-1.97) compared to non-migrants. In the postnatal period, Group M was 1.5 times more likely, while the Ms. group was over five times more likely to experience suboptimal mental health compared to Group L (OR 1.50, 95%CI 1.22-1.84; and OR 5.28, 95%CI 2.63-10.63, for M and Ms. respectively). CONCLUSIONS The application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimising perinatal maternal wellbeing.
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Dachew BA, Ayano G, Betts K, Alati R. The impact of pre-pregnancy BMI on maternal depressive and anxiety symptoms during pregnancy and the postpartum period: A systematic review and meta-analysis. J Affect Disord 2021; 281:321-330. [PMID: 33341015 DOI: 10.1016/j.jad.2020.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/13/2020] [Accepted: 12/05/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies have reported conflicting results on the association between maternal pre-pregnancy weight and adverse mental health outcomes during pregnancy and the postpartum period. This systematic review and meta-analysis aim to provide the current state of evidence concerning the association between maternal pre-pregnancy BMI and the risk of antenatal and postnatal depressive and anxiety symptoms. METHODS PubMed, EMBASE, Web of Science and Scopus databases were searched from their inception through August 31, 2020. Observational studies assessing the association between maternal pre-pregnancy BMI and risk of depression and/anxiety during pregnancy and the postpartum period were included. We used random-and quality-effects meta-analyses to estimate risks. Subgroup, sensitivity and meta-regression analyses were performed. RESULTS Pre-pregnancy obesity was associated with a 33% increased risk of antenatal depressive symptoms (pooled OR = 1.33 [95% CI; 1.20-1.48]). The pooled ORs for the association between underweight, overweight and obesity and postnatal depressive symptoms were 1.71 [95% CI; 1.27 - 2.31], 1.14 [95% CI; 1.0 - 1.30] and 1.39 [95% CI; 1.23 - 1.57], respectively. Low to moderate level of between-study heterogeneity was noted. The association between pre-pregnancy BMI and perinatal anxiety symptoms remain uncertain. CONCLUSIONS Pre-pregnancy obesity was associated with an increased risk of maternal depressive symptoms both in pregnancy and the postpartum period. The findings suggest that women with both high and low pre-pregnancy weight may benefit from receiving mental health screening and interventions during prenatal care.
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Affiliation(s)
- Berihun Assefa Dachew
- School of Public health, Curtin University, Perth, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Getinet Ayano
- School of Public health, Curtin University, Perth, Australia; Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Kim Betts
- School of Public health, Curtin University, Perth, Australia
| | - Rosa Alati
- School of Public health, Curtin University, Perth, Australia; Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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Kheirouri S, Alizadeh M. Maternal excessive gestational weight gain as a risk factor for autism spectrum disorder in offspring: a systematic review. BMC Pregnancy Childbirth 2020; 20:645. [PMID: 33092575 PMCID: PMC7579946 DOI: 10.1186/s12884-020-03324-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Abnormal gestational weight gain (GWG) is a prenatal complication that may contribute to long-term behavioral and neurodevelopmental differences in offspring. This systematic review summarizes research on the association between maternal GWG and risk of autism spectrum disorder (ASD) in offspring. Methods Google and electronic databases, including PubMed, SCOPUS, Embase, Cochrane Library and Google Scholar, were searched for original human studies published in English through June 2020. Articles that examined the association between GWG and risk of ASD in offspring were included. Duplicate and irrelevant studies were removed; and data were obtained through critical analysis. Results Of 96 articles searched, eight studies were included in the final review. All studies (n = 7) investigating the association of maternal excessive GWG with risk of ASD in offspring indicated that high GWG was independently associated with an increased risk of ASD. Of five studies investigating the association of inadequate GWG with the risk of ASD, four indicated that low GWG was not associated with an increased risk of ASD. Of seven studies examining the association of maternal pre-pregnancy BMI or weight with the risk of ASD, five reported that maternal pre-pregnancy BMI or weight did not appear to be independently associated with risk of ASD. The GWG-ASD association is independent of maternal BMI and child’s intellectual disability, but offspring’s genetic susceptibility connection to the GWG-ASD association remains a topic of debate. Conclusions The findings suggest that maternal excessive GWG may be associated with increased risk of ASD in offspring. However, insufficient GWG does not appear to have such association.
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Affiliation(s)
- Sorayya Kheirouri
- Department of Nutrition, Tabriz University of Medical Sciences, Attar Nishabouri St., POBOX: 14711, Tabriz, IR, Postal code: 5166614711, Iran.
| | - Mohammad Alizadeh
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Evaluation of antenatal risk factors for postpartum depression: a secondary cohort analysis of the cluster-randomised GeliS trial. BMC Med 2020; 18:227. [PMID: 32703266 PMCID: PMC7379365 DOI: 10.1186/s12916-020-01679-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Maternal weight variables are important predictors of postpartum depression (PPD). While preliminary evidence points to an association between pre-pregnancy obesity and PPD, the role of excessive gestational weight gain (GWG) on PPD is less studied. In this secondary cohort analysis of the German 'healthy living in pregnancy' (GeliS) trial, we aimed to investigate associations between weight-related variables and PPD and to assess the influence of GWG on the risk for PPD. METHODS We included women with normal weight, overweight, and obesity (BMI 18.5-40.0 kg/m2). Symptoms of PPD were assessed 6-8 weeks postpartum using the Edinburgh Postnatal Depression Scale. Pre-pregnancy BMI was self-reported. During the course of pregnancy, weight was measured at gynaecological practices within regular check-ups. GWG was defined as the difference between the last measured weight before delivery and the first measured weight at the time of recruitment (≤ 12th week of gestation). Excessive GWG was classified according to the Institute of Medicine. Multiple logistic regression analyses were used to estimate the odds of PPD in relation to pre-pregnancy BMI, GWG, and excessive GWG adjusting for important confounders. RESULTS Of the total 1583 participants, 45.6% (n = 722) showed excessive GWG and 7.9% (n = 138) experienced PPD. Pre-pregnancy BMI (per 5-unit increase; OR = 1.23, 95% CI 1.08-1.41, p = 0.002) and pre-pregnancy overweight or obesity were significantly positively associated with the odds of developing PPD, particularly among women with an antenatal history of anxiety or depressive symptoms (overweight: OR = 1.93, 95% CI = 1.15-3.22, p = 0.01; obesity: OR = 2.11, 95% CI = 1.13-3.96, p = 0.02). Sociodemographic or lifestyle factors did not additively influence the odds of having PPD. In fully adjusted models, there was no significant evidence that GWG or the occurrence of excessive GWG increased the odds of experiencing PPD (excessive vs. non-excessive: OR = 3.48, 95% CI 0.35-34.94; GWG per 1 kg increase: OR = 1.16, 95% CI 0.94-1.44). CONCLUSION Pre-pregnancy overweight or obesity is associated with PPD independent of concurrent risk factors. History of anxiety or depressive symptoms suggests a stress-induced link between pre-pregnancy weight and PPD. TRIAL REGISTRATION NCT01958307 , ClinicalTrials.gov, retrospectively registered on 9 October 2013.
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