Evaluation of antenatal risk factors for postpartum depression: a secondary cohort analysis of the cluster-randomised GeliS trial

Hamimatunnisa Johar, Julia Hoffmann, Julia Günther, Seryan Atasoy, Lynne Stecher, Monika Spies, Hans Hauner, Karl-Heinz Ladwig, Hamimatunnisa Johar, Julia Hoffmann, Julia Günther, Seryan Atasoy, Lynne Stecher, Monika Spies, Hans Hauner, Karl-Heinz Ladwig

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.

Keywords: Anxiety; EPDS; Gestational weight gain; Lifestyle intervention; Obesity prevention; Postpartum depression; Predictor; Routine care; Well-being.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of included study participants. EPDS, Edinburgh Postnatal Depression Scale; GDM, gestational diabetes mellitus; GWG, gestational weight gain
Fig. 2
Fig. 2
Association between pre-pregnancy overweight or obesity and PPD stratified by history antenatal anxiety or depressive symptoms. Depicted are odds ratios assessed in the fully adjusted model using logistic regression analyses controlled for the following confounders: age, group allocation, marital status, educational level, parity, smoking, alcohol intake, physical activity, and gestational diabetes mellitus as covariates. Normal weight is considered as reference category, and the corresponding odds are illustrated as dotted vertical line

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