Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen and Marburg, Giessen, Friedrichstr. 33, 35392, Gießen, Germany.
BMC Med. 2020 Jul 24;18(1):227. doi: 10.1186/s12916-020-01679-7.
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.
We included women with normal weight, overweight, and obesity (BMI 18.5-40.0 kg/m). 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 (≤ 12 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.
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).
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.
NCT01958307 , ClinicalTrials.gov, retrospectively registered on 9 October 2013.
产妇体重变量是产后抑郁症（PPD）的重要预测因素。虽然初步证据表明孕前肥胖与 PPD 之间存在关联，但关于妊娠体重过度增加（GWG）对 PPD 的影响的研究较少。在德国“孕期健康生活”（GeliS）试验的这项二次队列分析中，我们旨在调查体重相关变量与 PPD 之间的关联，并评估 GWG 对 PPD 风险的影响。
我们纳入了体重正常、超重和肥胖的女性（BMI 18.5-40.0 kg/m）。使用爱丁堡产后抑郁量表在产后 6-8 周评估 PPD 症状。孕前 BMI 由自我报告。在妊娠期间，体重在妇科检查期间的常规检查中测量。GWG 定义为分娩前最后一次测量体重与招募时第一次测量体重之间的差值（≤ 12 周妊娠）。根据医学研究所的标准对 GWG 进行分类。使用多因素逻辑回归分析来估计与孕前 BMI、GWG 和 GWG 过度相关的 PPD 发生的几率，调整了重要的混杂因素。
在总共 1583 名参与者中，45.6%（n=722）出现 GWG 过度，7.9%（n=138）经历了 PPD。孕前 BMI（每增加 5 个单位；OR=1.23，95%CI 1.08-1.41，p=0.002）和孕前超重或肥胖与 PPD 发病几率显著正相关，特别是在有产前焦虑或抑郁症状史的女性中（超重：OR=1.93，95%CI=1.15-3.22，p=0.01；肥胖：OR=2.11，95%CI=1.13-3.96，p=0.02）。社会人口学或生活方式因素不会对 PPD 的发病几率产生附加影响。在完全调整的模型中，没有证据表明 GWG 或 GWG 过度增加 PPD 的发病几率（过度与非过度：OR=3.48，95%CI 0.35-34.94；GWG 每增加 1 公斤：OR=1.16，95%CI 0.94-1.44）。
孕前超重或肥胖与 PPD 相关，独立于同时存在的危险因素。焦虑或抑郁症状史提示孕前体重与 PPD 之间存在应激相关联系。
NCT01958307，ClinicalTrials.gov，于 2013 年 10 月 9 日回顾性注册。
