Mood and quality of life changes in pregnancy and postpartum and the effect of a behavioral intervention targeting excess gestational weight gain in women with overweight and obesity: a parallel-arm randomized controlled pilot trial

Abby D Altazan, Leanne M Redman, Jeffrey H Burton, Robbie A Beyl, Loren E Cain, Elizabeth F Sutton, Corby K Martin, Abby D Altazan, Leanne M Redman, Jeffrey H Burton, Robbie A Beyl, Loren E Cain, Elizabeth F Sutton, Corby K Martin

Abstract

Background: Intensive lifestyle interventions in pregnancy have shown success in limiting gestational weight gain, but the effects on mood and quality of life in pregnancy and postpartum are less known. The purpose was to quantify changes in mental and physical quality of life and depressive symptoms across pregnancy and the postpartum period, to determine the association between gestational weight gain and change in mood and quality of life, and to assess the effect of a behavioral intervention targeting excess gestational weight gain on these outcomes.

Methods: A three group parallel-arm randomized controlled pilot trial of 54 pregnant women who were overweight or obese was conducted to test whether the SmartMoms® intervention decreased the proportion of women with excess gestational weight gain. Individuals randomized to Usual Care (n = 17) did not receive any weight management services from interventionists. Individuals randomized to the SmartMoms® intervention (n = 37) were provided with behavioral weight management counseling by interventionists either in clinic (In-Person, n = 18) or remotely through a smartphone application (Phone, n = 19). In a subset of 43 women, mood and mental and physical quality of life were assessed with the Beck Depression Inventory-II and the Rand 12-Item short form, respectively, in early pregnancy, late pregnancy, 1-2 months postpartum, and 12 months postpartum.

Results: The SmartMoms® intervention and Usual Care groups had higher depressive symptoms (p < 0.03 for SmartMoms® intervention, p < 0.01 for Usual Care) and decreased physical health (p < 0.01) from early to late pregnancy. Both groups returned to early pregnancy mood and physical quality of life postpartum. Mental health did not change from early to late pregnancy (p = 0.8), from early pregnancy to 1-2 months (p = 0.5), or from early pregnancy to 12 months postpartum (p = 0.9), respectively. There were no significant intervention effects. Higher gestational weight gain was associated with worsened mood and lower physical quality of life across pregnancy.

Conclusion: High depressive symptoms and poor quality of life may be interrelated with the incidence of excess gestational weight gain. The behavioral gestational weight gain intervention did not significantly impact these outcomes, but mood and quality of life should be considered within future interventions and clinical practice to effectively limit excess gestational weight gain.

Trial registration: NCT01610752 , Expecting Success, Registered 31 May 2012.

Keywords: Gestational weight gain; Mental health; Pregnancy; Quality of life.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Pennington Biomedical Research Center and Woman’s Hospital Institutional Review Boards, and written informed consent was obtained for by all participants prior to the initiation of procedures.

Consent for publication

No individual patient data is included in this manuscript.

Competing interests

SmartMoms® is a registered trademark of the Louisiana State University System, with the trademarked approach having been developed by Drs. Redman and Martin. There are no direct benefits to the authors for publication of this manuscript. Drs. Redman and Martin have no financial affiliations with the companies who conducted the work to develop the SmartMoms® Virtual Weight Management Suite. Any licensing of SmartMoms® could financially benefit LSU-Pennington Biomedical Research Center, Montclair State University, and Drs. Redman and Martin. All other authors did not report any potential competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Change in Mood (BDI-II) Over Time for the SmartMoms® Intervention (open circles with dashed lines) and Usual Care (closed circles with solid lines) groups. Data is displayed as Mean and SE and was derived using repeated measures over time in a mixed effect linear model. BDI-II: Beck Depression Inventory II, Preg: Pregnancy, Ppm: Postpartum, SE: Standard error
Fig. 2
Fig. 2
Mental Health (SF-12 MCS) (Panel a) and Physical Health (SF-12 PCS) (Panel b) Over Time for the SmartMoms® Intervention (open circles with dashed lines) and Usual Care (closed circles with solid lines) groups. Data is displayed as Mean and SE and was derived using repeated measures over time in a mixed effect linear model. SF-12: Rand 12-Item Short Form, MCS: Mental health composite score, PCS: Physical health composite score, Preg: Pregnancy, Ppm: Postpartum, SE: Standard error
Fig. 3
Fig. 3
Association between Overall Gestational Weight Gain and Change in Mood (BDI-II) from early pregnancy to late pregnancy (Panel a), early pregnancy to 1–2 months postpartum (Panel b), and early pregnancy to 12 months postpartum (Panel c). Data is presented as individual overall gestational weight gain versus change in BDI-II scores and was derived using repeated measures over time in a mixed effect linear model. BDI-II: Beck Depression Inventory II, Preg: Pregnancy, Ppm: Postpartum, kg: kilogram
Fig. 4
Fig. 4
Association between Overall Gestational Weight Gain and Change in Mental Health (SF-12 MCS) from early pregnancy to late pregnancy (Panel a), early pregnancy to 1–2 months postpartum (Panel b), and early pregnancy to 12 months postpartum (Panel c) and Physical Health (SF-12 PCS) from early pregnancy to late pregnancy (Panel d), early pregnancy to 1–2 months postpartum (Panel e), and early pregnancy to 12 months postpartum (Panel f). Data is presented as individual overall gestational weight gain versus change in SF-12 scores and was derived using repeated measures over time in a mixed effect linear model. MCS: Mental health composite score, PCS: Physical health composite score, Preg: Pregnancy, Ppm: Postpartum, kg: kilogram

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