Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, England.
Department of Women and Children's Health, King's College, London, England.
BMC Pregnancy Childbirth. 2018 Sep 18;18(1):378. doi: 10.1186/s12884-018-2004-x.
Lifestyle interventions for obese pregnant women have been widely researched but little is known about predictors of low adherence or poor outcomes. This study evaluated the prospective associations between elevated symptoms of antenatal depression and gestational diabetes, adherence and gestational weight gain in a large RCT of a behavioural intervention for obese pregnant women. The effect of the intervention on symptoms of depression at follow-up was also examined.
The UPBEAT RCT randomised 1555 obese pregnant women to receive a dietary and physical activity lifestyle intervention or standard care. Symptoms of antenatal depression were assessed with the Edinburgh Postnatal Depression Scale at baseline (15-18 weeks' gestation) and follow-up (27-28 weeks' gestation). Gestational diabetes was assessed with an oral glucose tolerance test at 27-28 weeks' gestation. Adherence was pre-defined as receiving at least 5 of 8 intervention sessions. Gestational weight gain was calculated as the difference between pre-pregnancy weight (estimated as measured baseline weight minus 1.25 kg) and last measured weight at 34-36 weeks' gestation. Due to substantial missing data in certain variables, multiple imputation was used to impute missing data. Women who were no longer pregnant at 27-28 weeks' gestation were excluded from the sample for these analyses.
One thousand five-hundered twenty-six women were included in these analyses following multiple imputation; 797 (52.2%) had complete data. 13.4% had elevated symptoms of antenatal depression at baseline. There was no evidence for associations between antenatal depression status and gestational diabetes (adjusted OR 0.80, 95%CI 0.52 to 1.22, p = 0.30), adherence (adjusted OR 1.16, 95%CI 0.63 to 2.15, p = 0.63) or gestational weight gain (adjusted regression coefficient 0.52, 95%CI -0.26 to 1.29, p = 0.19). The intervention was not associated with change in depressive symptoms at follow-up (regression coefficient 0.003, 95%CI -0.49 to 0.49, p = 0.99). Similar results were obtained in complete case analyses.
Elevated symptoms of antenatal depression did not predict gestational diabetes, adherence or gestational weight gain in this large RCT of a lifestyle intervention for obese pregnant women. The intervention also did not influence symptoms of depression at follow-up. Obese pregnant women with elevated symptoms of depression should not be excluded from lifestyle interventions.
ISRCTN89971375 . Registered 28 November 2008.
针对肥胖孕妇的生活方式干预已得到广泛研究，但对于低依从性或不良结局的预测因素知之甚少。本研究评估了在一项针对肥胖孕妇的行为干预的大型 RCT 中，产前抑郁症状升高与妊娠期糖尿病、依从性和妊娠体重增加之间的前瞻性关联。还检查了干预措施对随访时抑郁症状的影响。
UPBEAT RCT 将 1555 名肥胖孕妇随机分为接受饮食和身体活动生活方式干预或标准护理的两组。在基线（妊娠 15-18 周）和随访（妊娠 27-28 周）时使用爱丁堡产后抑郁量表评估产前抑郁症状。妊娠 27-28 周时通过口服葡萄糖耐量试验评估妊娠期糖尿病。依从性预先定义为接受 8 次干预课程中的至少 5 次。妊娠体重增加的计算方法是从妊娠前体重（估计为测量的基线体重减去 1.25 公斤）到妊娠 34-36 周时的最后一次测量体重之间的差异。由于某些变量存在大量缺失数据，因此使用多重插补来插补缺失数据。在妊娠 27-28 周时不再怀孕的女性被排除在这些分析之外。
在多重插补后，共有 1526 名女性纳入了这些分析；其中 797 名（52.2%）数据完整。13.4%的女性在基线时出现产前抑郁症状升高。产前抑郁状态与妊娠期糖尿病（调整后的 OR 0.80，95%CI 0.52 至 1.22，p=0.30）、依从性（调整后的 OR 1.16，95%CI 0.63 至 2.15，p=0.63）或妊娠体重增加（调整后的回归系数 0.52，95%CI -0.26 至 1.29，p=0.19）之间均无关联。干预措施与随访时抑郁症状的变化无关（回归系数 0.003，95%CI -0.49 至 0.49，p=0.99）。完整病例分析也得到了类似的结果。
在针对肥胖孕妇的生活方式干预的大型 RCT 中，产前抑郁症状升高并未预测妊娠期糖尿病、依从性或妊娠体重增加。该干预措施也未影响随访时的抑郁症状。患有升高的产前抑郁症状的肥胖孕妇不应被排除在生活方式干预之外。
ISRCTN89971375。于 2008 年 11 月 28 日注册。
