Supporting optimal dietary behaviors in women with perinatal depression: A qualitative exploration of experiences, practices, and challenges

BACKGROUND

Women with perinatal depression (PD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for women with PD have been developed. The objectives of this study were to identify nutrition-related challenges and needs among women with PD and to elucidate the role that feeding plays in mother-infant interaction, to inform the development of nutrition interventions.

METHODS

Using a qualitative study design, in-depth interviews were conducted with 18 mothers with a history of PD and 10 interdisciplinary healthcare providers with expertise in PD. Data were thematically analyzed using a hybrid inductive and deductive coding approach.

RESULTS

Mean age of mothers was 31 ± 6 years, 56% identified as non-Hispanic White, and 33% identified as Black/African American. Eighty percent of healthcare providers practiced for more than five years. Six themes were identified: (a) Time scarcity mindset; (b) Importance of social support; (c) Unrealistic expectations of motherhood; (d) Mom as the last priority; (e) Postpartum body changes and shape ideals; and (f) Contentment associated with infant and young child feeding.

CONCLUSION

Women with PD have several needs pertaining to their nutrition and that of their children. The findings from this study illustrate key considerations and recommendations for addressing these needs.

Intensive Perinatal Mental Health Programs in the United States: A Call to Action

Despite the growth of intensive perinatal mental health programs in the United States, too few programs serve women with perinatal mood and anxiety disorders (PMADs). Furthermore, little is known about program operations, services, the women served, and the methods of collecting outcome data. With this Open Forum, the authors aimed to share their investigation of intensive perinatal mental health programs in the United States and offer recommendations to improve services for women with PMADs. The authors recommend forming a national consortium that can foster collaboration to expand existing services and establish a national database to inform program development, evaluation, policies, and funding.

Nutrition-Related Challenges and Needs of Women With Perinatal Depression: Perspectives of Women With Perinatal Depression and Healthcare Providers

Objectives

Women with perinatal depression (WWPD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite mounting evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for WWPDs have been developed. The objectives of this study were to identify nutrition-related challenges and needs among WWPD, and to elucidate the role that feeding plays in mother-infant interaction.

Methods

Using a qualitative research design, in-depth interviews were conducted with 18 WWPDs and 10 healthcare professionals (HCPs) who work with WWPD. Interviews were audio recorded and transcribed verbatim. Data was thematically analyzed. Transcripts were coded by two research team members and a third member ensured accuracy and resolved discrepancies. Deductive and inductive coding was performed, and codes were refined and subsequently organized into themes.

Results

WWPD had a mean age of 31 ± 6 years and between 2–4 children. 89% reported college-level education, 56% were non-Hispanic white, and 33% were Black/African American. HCPs were in various specialties related to maternal mental health; 80% had practiced for > 5years. Seven themes with up to three subthemes were identified from interviews with HCPs and WWPDs: 1) Prioritizing mom - institutional and personal; 2) Scarce resources; 3) Body changes - body image and appetite; 4) Importance of support - source of affirmation and greater reliance; 5) Sense of fulfilment associated with infant and young child feeding - bonding and pride; 6) Challenges with breastfeeding - difficult experiences and need for liberalizing recommendations; and 7) Great expectations of motherhood - guilt and shame, overwhelm, and high anxiety.

Conclusions

WWPD face several barriers to their own healthful nutrition and that of their children, and findings from this study illustrate key considerations for tailoring dietary guidance to meet the unique needs of WWPD. Further, a person-centered approach for breastfeeding guidance is recommended.

Funding Sources

Drexel University College of Nursing and Health Professions, Dean's Rapid Response Relevant (R3) Grant.