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Postpartum depression (PPD) affects 10 to 15% of women after giving birth worldwide. PPD is a depressive disorder characterised by fear of failure, emotional ambivalence, and major depressive symptoms which can ultimately impact maternal caregiving and lead to a disturbed mother-to-infant relationship. This in turn can influence the newborn’s long-term development. Thus, identification of underlying risk factors is important.
The aetiology of PPD is still not completely understood. Therefore, several studies endeavoured to shed light on the influence of potential predictors on the risk of developing PPD within the last years. While several studies suggested that pre-pregnancy overweight is associated with the risk of experiencing PPD, other studies were unable to provide evidence for this connection. In addition, (excessive) gestational weight gain has rarely been considered and examined as possible risk factor. This research gap motivated Johar and colleagues to further investigate if both pre-pregnancy overweight and gestational weight gain influence the risk of developing PPD. Moreover, they sought to examine the risk modification of sociodemographic and lifestyle factors and the antenatal history of anxiety or depressive symptoms.
In this cohort analysis, data from 1583 women gathered in Germany alongside routine care as part of the ‘Gesund leben in der Schwangerschaft’/‘healthy living in pregnancy’ (GeliS) study were included. Symptoms of PPD were assessed six to eight weeks after giving birth using a validated questionnaire. The weight of participants was grouped into categories according to the Body Mass Index (BMI). A BMI between 18.5 and 24.9 kg/m2 was considered as normal weight, between 25.0 and 29.9 kg/m2 as overweight, and between 30.0 to 40.0 kg/m2 as obesity. The weight measured within routine care visits at gynaecological practices was used to determine weight gain during pregnancy. Additionally, participants answered questionnaires about their pre-pregnancy alcohol consumption, physical activity behaviour, and their psychological well-being during pregnancy.
Overall, 8% of mothers developed PPD, with 30% of them having overweight and 17% of them having obesity. Moreover 54% of them gained excessively weight during pregnancy. The researchers found significant evidence that overweight and obesity are risk factors for PPD. The risk was increased especially for those women who additionally experienced anxiety or depression during pregnancy. Although excessive gestational weight gain occurred more often in women with PPD, weight gain during the course of pregnancy was not shown to be a consistent predictor of PPD. Being married decreased and a lower educational level increased the odds of developing PPD. A history of antenatal anxiety and depression was the most prominent and most concerning risk factor.
Some limitations of this study include relying on self-reported pre-pregnancy weight, which may have caused inaccuracies of pre-pregnancy BMI. Furthermore, gestational weight gain until birth was considered, and was not further pre-specified into trimester-specific weight-gain pattern. Nevertheless, this cohort analysis revealed new insights into the influence of pre-pregnancy weight and antenatal anxiety and depression on the risk of developing PPD with a lacking risk modification by gestational weight gain.
Article available at: BMC Medicine
Full list of authors: Hamimatunnisa Johar, Julia Hoffmann, Julia Günther, Seryan Ata
soy, Lynne Stecher, Monika Spies, Hans Hauner, Karl-Heinz Ladwig
