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Maternal early pregnancy obesity and depressive symptoms during and after pregnancy

Published online by Cambridge University Press:  17 January 2018

Satu M. Kumpulainen ,
Polina Girchenko ,
Marius Lahti-Pulkkinen ,
Rebecca M. Reynolds ,
Soile Tuovinen ,
Anu-Katriina Pesonen ,
Kati Heinonen ,
Eero Kajantie ,
Pia M. Villa  and
Esa Hämäläinen
...Show all authors
Satu M. Kumpulainen*
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
Polina Girchenko
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
Marius Lahti-Pulkkinen
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK National Institute for Health and Welfare, Helsinki, Finland
Rebecca M. Reynolds
Affiliation:
British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
Soile Tuovinen
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland National Institute for Health and Welfare, Helsinki, Finland
Anu-Katriina Pesonen
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
Kati Heinonen
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
Eero Kajantie
Affiliation:
Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki and Oulu, Finland Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Pia M. Villa
Affiliation:
Obstetrics and Gynaecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
Esa Hämäläinen
Affiliation:
HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Hannele Laivuori
Affiliation:
Obstetrics and Gynaecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
Katri Räikkönen
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
*
Author for correspondence: Satu M. Kumpulainen, E-mail: satu.m.kumpulainen@helsinki.fi
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Abstract

Background

Previous studies have linked maternal obesity with depressive symptoms during and after pregnancy. It remains unknown whether obesity associates with consistently elevated depressive symptoms throughout pregnancy, predicts symptoms postpartum when accounting for antenatal symptoms, and if co-morbid hypertensive and diabetic disorders add to these associations. We addressed these questions in a sample of Finnish women whom we followed during and after pregnancy.

Methods

Early pregnancy body mass index, derived from the Finnish Medical Birth Register and hospital records in 3234 PREDO study participants, was categorized into underweight (<18.5 kg/m2), normal weight (18.5–24.99 kg/m2), overweight (25–29.99 kg/m2), and obese (⩾30 kg/m2) groups. The women completed the Center for Epidemiological Studies Depression Scale biweekly during pregnancy, and at 2.4 (s.d. = 1.2) and/or 28.2 (s.d. = 4.2) weeks after pregnancy.

Results

In comparison to normal weight women, overweight, and obese women reported higher levels of depressive symptoms and had higher odds of clinically significant depressive symptoms during (23% and 43%, respectively) and after pregnancy (22% and 36%, respectively). Underweight women had 68% higher odds of clinically significant depressive symptoms after pregnancy. Overweight and obesity also predicted higher depressive symptoms after pregnancy in women not reporting clinically relevant symptomatology during pregnancy. Hypertensive and diabetic disorders did not explain or add to these associations.

Conclusions

Maternal early pregnancy overweight and obesity and depressive symptoms during and after pregnancy are associated. Mental health promotion should be included as an integral part of lifestyle interventions in early pregnancy obesity and extended to benefit also overweight and underweight women.

Keywords

Antenatal depressionearly pregnancy body mass indexpostpartum depressionpregnancy disorders
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 14 , October 2018 , pp. 2353 - 2363
Copyright
Copyright © Cambridge University Press 2018 

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References

Afari, N, Noonan, C, Goldberg, J, Roy-Byrne, P, Schur, E, Golnari, G et al. (2010) Depression and obesity: do shared genes explain the relationship? Depression and Anxiety 27, 799–806.Google Scholar
Amare, AT, Schubert, KO, Klingler-Hoffmann, M, Cohen-Woods, S and Baune, BT (2017) The genetic overlap between mood disorders and cardiometabolic diseases: a systematic review of genome wide and candidate gene studies. Translational Psychiatry 7, e1007.Google Scholar
Anderson, G and Maes, M (2013) Postpartum depression: psychoneuroimmunological underpinnings and treatment. Neuropsychiatric Disease and Treatment 9, 277.Google Scholar
Ban, L, Gibson, JE, West, J, Fiaschi, L, Oates, MR and Tata, LJ (2012) Impact of socioeconomic deprivation on maternal perinatal mental illnesses presenting to UK general practice. British Journal of General Practice 62, 671–678.Google Scholar
Bogaerts, AF, Devlieger, R, Nuyts, E, Witters, I, Gyselaers, W, Guelinckx, I et al. (2013) Anxiety and depressed mood in obese pregnant women: a prospective controlled cohort study. Obesity Facts 6, 152–164.Google Scholar
Brunton, PJ and Russell, JA (2008) The expectant brain: adapting for motherhood. Nature Reviews Neuroscience 9, 11–25.Google Scholar
Chen, D, Meng, L, Pei, F, Zheng, Y and Leng, J (2017) A review of DNA methylation in depression. Journal of Clinical Neuroscience 43, 39–46.Google Scholar
Christian, LM, Iams, JD, Porter, K and Glaser, R (2012) Epstein-Barr virus reactivation during pregnancy and postpartum: effects of race and racial discrimination. Brain Behavior and Immunity 26, 1280–1287.Google Scholar
Clarke, T-K, Hall, LS, Fernandez-Pujals, AM, MacIntyre, DJ, Thomson, P, Hayward, C et al. (2015) Major depressive disorder and current psychological distress moderate the effect of polygenic risk for obesity on body mass index. Translational Psychiatry 5, e592.Google Scholar
Denison, FC, Roberts, KA, Barr, SM and Norman, JE (2010) Obesity, pregnancy, inflammation, and vascular function. Reproduction 140, 373–385.Google Scholar
Dick, KJ, Nelson, CP, Tsaprouni, L, Sandling, JK, Aïssi, D, Wahl, S et al. (2014) DNA methylation and body-mass index: a genome-wide analysis. The Lancet 383, 1990–1998.Google Scholar
Dotlic, J, Terzic, M, Babic, D, Vasiljevic, N, Janosevic, S, Janosevic, L et al. (2014) The influence of body mass index on the perceived quality of life during pregnancy. Applied Research in Quality of Life 9, 387–399.Google Scholar
Duthie, L and Reynolds, RM (2013) Changes in the maternal hypothalamic-pituitary-adrenal axis in pregnancy and postpartum: influences on maternal and fetal outcomes. Neuroendocrinology 98, 106–115.Google Scholar
Edvinsson, Å, Bränn, E, Hellgren, C, Freyhult, E, White, R, Kamali-Moghaddam, M et al. (2017) Lower inflammatory markers in women with antenatal depression brings the M1/M2 balance into focus from a new direction. Psychoneuroendocrinology 80, 15–25.Google Scholar
Ertel, KA, Kleinman, K, Van Rossem, L, Sagiv, S, Tiemeier, H, Hofman, A et al. (2012) Maternal perinatal depression is not independently associated with child body mass index in the generation r study: methods and missing data matter. Journal of Clinical Epidemiology 65, 1300–1309.Google Scholar
Ertel, KA, Silveira, ML, Pekow, PS, Dole, N, Markenson, G and Chasan-Taber, L (2015) Prepregnancy body mass index, gestational weight gain, and elevated depressive symptoms in a Hispanic cohort. Health Psychology 34, 274–278.Google Scholar
Evans, J, Melotti, R, Heron, J, Ramchandani, P, Wiles, N, Murray, L et al. (2012) The timing of maternal depressive symptoms and child cognitive development: a longitudinal study. Journal of Child Psychology and Psychiatry and Allied Disciplines 53, 632–640.Google Scholar
Fowles, ER, Timmerman, GM, Bryant, M and Kim, S (2011) Eating at fast-food restaurants and dietary quality in low-income pregnant women. Western Journal of Nursing Research 33, 630–651.Google Scholar
Girchenko, P, Lahti, M, Tuovinen, S, Savolainen, K, Lahti, J, Binder, EB et al. (2017) Cohort profile: prediction and prevention of preeclampsia and intrauterine growth restriction (PREDO) study. International Journal of Epidemiology 46, 1380–1381g.Google Scholar
Gissler, M and Haukka, J (2004) Finnish health and social welfare registers in epidemiological research. Norsk Epidemiologi 14, 113–120.Google Scholar
Godfrey, KM, Reynolds, RM, Prescott, SL, Nyirenda, M, Jaddoe, VWV, Eriksson, JG et al. (2017) Influence of maternal obesity on the long-term health of offspring. The Lancet Diabetes and Endocrinology 5, 53–64.Google Scholar
Haeri, S, Baker, AM and Ruano, R (2013) Do pregnant women with depression have a pro-inflammatory profile? Journal of Obstetrics and Gynaecology Research 39, 948–952.Google Scholar
Jacka, FN and Berk, M (2013) Depression, diet and exercise. The Medical Journal of Australia 199, S21–S23.Google Scholar
Jokela, M, Berg, V, Silventoinen, K, Batty, GD, Singh-Manoux, A, Kaprio, J et al. (2016) Body mass index and depressive symptoms: testing for adverse and protective associations in two twin cohort studies. Twin Research and Human Genetics 19, 306–311.Google Scholar
Lahti, M, Savolainen, K, Tuovinen, S, Pesonen, A-K, Lahti, J, Heinonen, K et al. (2017) Maternal depressive symptoms during and after pregnancy and psychiatric problems in children. Journal of the American Academy of Child and Adolescent Psychiatry 56, 30–39. e7.Google Scholar
Ligthart, S, Marzi, C, Aslibekyan, S, Mendelson, MM, Conneely, KN, Tanaka, T et al. (2016) DNA methylation signatures of chronic low-grade inflammation are associated with complex diseases. Genome Biology 17, 255.Google Scholar
Lindsay, JR and Nieman, LK (2005) The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment. Endocrine Reviews 26, 775–799.Google Scholar
Lukose, A, Ramthal, A, Thomas, T, Bosch, R, Kurpad, AV, Duggan, C et al. (2014) Nutritional factors associated with antenatal depressive symptoms in the early stage of pregnancy among urban South Indian women. Maternal and Child Health Journal 18, 161–170.Google Scholar
Luppino, FS, de Wit, LM, Bouvy, PF, Stijnen, T, Cuijpers, P, Penninx, BW et al. (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry 67, 220–229.Google Scholar
Maloni, JA, Park, S, Anthony, MK and Musil, CM (2005) Measurement of antepartum depressive symptoms during high-risk pregnancy. Research in Nursing and Health 28, 16–26.Google Scholar
McEwan, M, Lins, RJ, Munro, SK, Vincent, ZL, Ponnampalam, AP and Mitchell, MD (2009) Cytokine regulation during the formation of the fetal-maternal interface: focus on cell-cell adhesion and remodelling of the extra-cellular matrix. Cytokine and Growth Factor Reviews 20, 241–249.Google Scholar
Mina, TH, Denison, FC, Forbes, S, Stirrat, LI, Norman, JE and Reynolds, RM (2015) Associations of mood symptoms with ante- and postnatal weight change in obese pregnancy are not mediated by cortisol. Psychological Medicine 45, 3133–3146.Google Scholar
Molyneaux, E, Pasupathy, D, Kenny, LC, McCowan, LME, North, RA, Dekker, GA et al. (2016 a) Socio-economic status influences the relationship between obesity and antenatal depression: data from a prospective cohort study. Journal of Affective Disorders 202, 124–127.Google Scholar
Molyneaux, E, Poston, L, Ashurst-Williams, S and Howard, LM (2014) Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis. Obstetrics and Gynecology 123, 857–867.Google Scholar
Molyneaux, E, Poston, L, Khondoker, M and Howard, LM (2016 b) Obesity, antenatal depression, diet and gestational weight gain in a population cohort study. Archives of Women's Mental Health 19, 899–907.Google Scholar
Nagl, M, Steinig, J, Klinitzke, G, Stepan, H and Kersting, A (2016) Childhood maltreatment and pre-pregnancy obesity: a comparison of obese, overweight, and normal weight pregnant women. Archives of Women's Mental Health 19, 355–365.Google Scholar
Nascimento, SL, Surita, FG and Cecatti, JG (2012) Physical exercise during pregnancy. Current Opinion in Obstetrics and Gynecology 24, 387–394.Google Scholar
Nast, I, Bolten, M, Meinlschmidt, G and Hellhammer, DH (2013) How to measure prenatal stress? A systematic review of psychometric instruments to assess psychosocial stress during pregnancy. Paediatric and Perinatal Epidemiology 27, 313–322.Google Scholar
NCD Risk Factor Collaboration (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet 387, 1377–1396.Google Scholar
O'Brien, TE, Ray, JG and Chan, WS (2003) Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology (Cambridge, Massachusetts) 14, 368–374.Google Scholar
O'Hara, MW and McCabe, JE (2013) Postpartum depression: current status and future directions. Annual Review of Clinical Psychology 9, 379–407.Google Scholar
Osborne, L, Clive, M, Kimmel, M, Gispen, F, Guintivano, J, Brown, T et al. (2016) Replication of epigenetic postpartum depression biomarkers and variation with hormone levels. Neuropsychopharmacology 41, 1648–1658.Google Scholar
Poston, L, Bell, R, Croker, H, Flynn, AC, Godfrey, KM, Goff, L et al. (2015) Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. The Lancet Diabetes and Endocrinology 3, 767–777.Google Scholar
Radloff, LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.Google Scholar
Rahman, MM, Abe, SK, Kanda, M, Narita, S, Rahman, MS, Bilano, V et al. (2015) Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis. Obesity Reviews 16, 758–770.Google Scholar
Rallis, S, Pgd, B, Skouteris, H, Wertheim, EH, Paxton, SJ (2007) Predictors of Body Image During the First Year Postpartum: A Prospective Study Predictors of Body Image During the First Year Postpartum: A Prospective Study 45, 87–104.Google Scholar
Reynolds, RM, Allan, KM, Raja, EA, Bhattacharya, S, McNeill, G, Hannaford, PC et al. (2013) Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years. British Medical Journal 347, f4539.Google Scholar
Rivera, M, Locke, AE, Corre, T, Czamara, D, Wolf, C, Ching-Lopez, A et al. (2017) Interaction between the FTO gene, body mass index and depression: meta-analysis of 13701 individuals. British Journal of Psychiatry 211, 70–76.Google Scholar
Ruhstaller, KE, Elovitz, MA, Stringer, M, Epperson, CN and Durnwald, CP (2017) Obesity and the association with maternal mental health symptoms. Journal of Maternal-Fetal and Neonatal Medicine 30, 1897–1901.Google Scholar
Ruyak, SL, Lowe, NK, Corwin, EJ, Neu, M and Boursaw, B (2016) Prepregnancy obesity and a biobehavioral predictive model for postpartum depression. Journal of Obstetric, Gynecologic and Neonatal Nursing 45, 326–338.Google Scholar
Sahrakorpi, N, Koivusalo, SB, Stach-Lempinen, B, Eriksson, JG, Kautiainen, H and Roine, RP (2017) “The burden of pregnancy”; heavier for the heaviest? The changes in health related quality of life (HRQoL) assessed by the 15D instrument during pregnancy and postpartum in different body mass index groups: a longitudinal survey. Acta Obstetricia et Gynecologica Scandinavica 96, 352–358.Google Scholar
Salehi-Pourmehr, H, Mohammad-Alizadeh, S, Jafarilar-Agdam, N, Rafiee, S and Farshbaf-Khalili, A (2017) 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. Journal of Perinatal Medicine, in pressGoogle Scholar
Shelton, M, Schminkey, D and Groer, M (2014) Relationships among prenatal depression, plasma cortisol, and inflammatory cytokines. Biological Research for Nursing 17, 1–8.Google Scholar
Stommel, M and Schoenborn, CA (2009) Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001–2006. BMC Public Health 9, 421.Google Scholar
Sundaram, S, Harman, JS, Peoples-Sheps, MD, Hall, AG and Simpson, SH (2012) Obesity and postpartum depression: does prenatal care utilization make a difference? Maternal and Child Health Journal 16, 656–667.Google Scholar
Torloni, MR, Betran, AP, Horta, BL, Nakamura, MU, Atallah, AN, Moron, AF et al. (2009) Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obesity Reviews 10, 194–203.Google Scholar
Van Poppel, MNM, Hartman, MA, Hosper, K and Van Eijsden, M (2012) Ethnic differences in weight retention after pregnancy: the ABCD study. European Journal of Public Health 22, 874–879.Google Scholar
Venkatesh, KK, Riley, L, Castro, VM, Perlis, RH and Kaimal, AJ (2016) Association of antenatal depression symptoms and antidepressant treatment with preterm birth. Obstetrics and Gynecology 127, 926–933.Google Scholar
Vilagut, G, Forero, CG, Barbaglia, G and Alonso, J (2016) Screening for depression in the general population with the center for epidemiologic studies depression (CES-D): a systematic review with meta-analysis. PLoS ONE 11, e0155431.Google Scholar
Walter, S, Kubzansky, LD, Koenen, KC, Liang, L, Tchetgen Tchetgen, EJ, Cornelis, MC et al. (2015) Revisiting Mendelian randomization studies of the effect of body mass index on depression. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 168B, 108–115.Google Scholar
World Health Organization (2000) Obesity: Preventing and Managing the Global Epidemic: Report of A WHO Consultation, vol. 894. Geneva: WHO.Google Scholar
Xuto, P, Sinsuksai, N, Piaseu, N, Nityasuddhi, D and Phupong, V (2012) A causal model of postpartum weight retention among Thais. Pacific Rim International Journal of Nursing Research 16, 48–63.Google Scholar
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