Betts Grace M, Lipsky Leah M, Temmen Chelsie D, Siega-Riz Anna Maria, Faith Myles S, Nansel Tonja R
Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr., MSC 7004, Bethesda, MD, 20892, USA.
Departments of Nutrition and Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 109 Arnold House, 715 Pleasant St, Amherst, MA, 01003-9303, USA.
Int J Behav Nutr Phys Act. 2021 May 1;18(1):58. doi: 10.1186/s12966-021-01124-9.
Depression, stress, and poor-quality sleep are common during pregnancy and postpartum, but the relationship of these factors with reward-related eating is not well understood. This observational cohort study examines associations of depression, stress, and sleep quality with self-reported reward-related eating in pregnancy and postpartum.
Participants were enrolled at < 12 weeks gestation and followed through 1 year postpartum. Self-reported measures obtained at baseline and 23-31 weeks postpartum included the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Pittsburgh Sleep Quality Index; reward-related eating measures included the Power of Food Scale (assessing hedonic hunger), modified Yale Food Addiction Scale (assessing addictive-like eating), and frequency and intensity of cravings. Linear and logistic regression models estimated associations of depressive symptoms, stress, and sleep quality with reward-related eating during pregnancy and postpartum, as well as change in each predictor with change in outcome.
During pregnancy, greater depressive symptoms (β ± SE = 0.03 ± 0.01, p < .01), higher stress (0.03 ± 0.01, p < .01), and worse sleep quality (0.03 ± 0.01, p = 0.03) were associated with greater hedonic hunger. Similarly, greater depressive symptoms (OR = 1.08, 95% CI: 1.02, 1.14, p = .01), higher stress (OR = 1.09, 95% CI: 1.04, 1.14, p = <.01), and worse sleep quality (OR = 1.09, 95% CI: 1.00, 1.18, p = .04) were associated with greater odds of addictive-like eating. These associations were also significant in postpartum except that sleep quality was not associated with hedonic hunger. Greater depressive symptoms (β ± SE = 0.06 ± 0.02, p < .01; 0.08 ± 0.02, p = <.01), higher stress (0.04 ± 0.01, p < .01; 0.06 ± 0.02, p < .01), and worse sleep quality (0.11 ± 0.03, p < .01; 0.13 ± 0.03, p < .01) during pregnancy were associated with stronger and more frequent cravings, respectively. Increased depressive symptoms from pregnancy to postpartum was associated with increased hedonic hunger (β ± SE = 1.17 ± 0.57, p = 0.01) and addictive-like eating (0.88 ± 0.33, p = 0.01), and increased stress was associated with increased hedonic hunger (1.71 ± 0.76, p = 0.02). Change in stress was not associated with change in addictive-like eating and change in sleep quality was not associated with change in either hedonic hunger or addictive-like eating.
Greater depressive symptoms, perceived stress, and poorer sleep quality are associated with greater self-reported reward-related eating during pregnancy and postpartum, suggesting that efforts to improve diet during and after pregnancy may benefit from addressing mental health and sleep.
Clinicaltrials.gov Registration ID - NCT02217462 . Date of registration - August 13, 2014.
孕期和产后抑郁、压力及睡眠质量差很常见，但这些因素与奖励性进食之间的关系尚不清楚。这项观察性队列研究探讨孕期和产后抑郁、压力及睡眠质量与自我报告的奖励性进食之间的关联。
参与者在妊娠小于12周时入组，并随访至产后1年。在基线和产后23 - 31周获得的自我报告测量指标包括爱丁堡产后抑郁量表、感知压力量表、匹兹堡睡眠质量指数；奖励性进食测量指标包括食物力量量表（评估享乐性饥饿）、改良耶鲁食物成瘾量表（评估成瘾性进食）以及渴望的频率和强度。线性和逻辑回归模型估计孕期和产后抑郁症状、压力及睡眠质量与奖励性进食之间的关联，以及每个预测因素的变化与结果变化之间的关系。
孕期，更严重的抑郁症状（β±标准误 = 0.03±0.01，p <.01）、更高的压力（0.03±0.01，p <.01）以及更差的睡眠质量（0.03±0.01，p = 0.03）与更高的享乐性饥饿相关。同样，更严重的抑郁症状（优势比 = 1.08，95%置信区间：1.02，1.14，p = 0.01）、更高的压力（优势比 = 1.09，95%置信区间：1.04，1.14，p = <.01）以及更差的睡眠质量（优势比 = 1.09，95%置信区间：1.00，1.18，p = 0.04）与成瘾性进食的更高几率相关。这些关联在产后也很显著，只是睡眠质量与享乐性饥饿无关。孕期更严重的抑郁症状（β±标准误 = 0.06±0.02，p <.01；0.08±0.02，p = <.01）、更高的压力（0.04±0.01，p <.01；0.06±0.02，p <.01）以及更差的睡眠质量（0.11±0.03，p <.01；0.13±0.03，p <.01）分别与更强烈和更频繁的渴望相关。从孕期到产后抑郁症状增加与享乐性饥饿增加（β±标准误 = 1.17±0.57，p = 0.01）和成 瘾性进食增加（0.88±0.33，p = 0.01）相关，压力增加与享乐性饥饿增加（1.71±0.76，p = 0.02）相关。压力变化与成瘾性进食变化无关，睡眠质量变化与享乐性饥饿或成瘾性进食变化均无关。
孕期和产后更严重的抑郁症状、感知压力及更差的睡眠质量与自我报告的奖励性进食增加相关，这表明在孕期及产后改善饮食的努力可能受益于解决心理健康和睡眠问题。
Clinicaltrials.gov注册编号 - NCT02217462。注册日期 - 2014年8月13日。
