SAN DIEGO — Prepregnancy obesity is an independent risk factor for postpartum depression, a large analysis demonstrates.
Common pregnancy stressors such as divorce or separation or being involved in a physical fight also were found to increase the risk.
“While I advocate that we should screen all women for depression, I think there are subsets of women whose risk is so high that we should either be identifying ways to prevent depression in this group or carry out early targeted surveillance and treatment,” Dr. D. Yvette LaCoursiere said in an interview during a poster session at the annual meeting of the Society for Maternal-Fetal Medicine.
“So if a woman comes to pregnancy with a BMI of greater than 35 kg/m
Previous research has shown that women with a history of depression are at increased risk of developing postpartum depression, but the possible association between prepregnancy obesity and subsequent postpartum depression has not been sufficiently studied, said Dr. LaCoursiere of the department of obstetrics and gynecology at the University of California at San Diego.
She and her associate, Dr. Michael W. Varner of the division of maternal-fetal medicine at the University of Utah, Salt Lake City, followed 1,053 women who were delivered of a term, singleton, live-born infant at one of four hospitals in Utah between 2005 and 2007.
At intake, the researchers obtained demographic and anthropomorphic information and pregnancy stressors, in addition to a psychiatric, medical, obstetric, and family history. Participants were also asked to complete the Pregnancy Risk Assessment Monitoring System (PRAMS).
Self-reported prepregnancy body mass index was stratified by the World Health Organization classification system for underweight (less than 18.5 kg/m
At 6–8 weeks after delivery, the women were asked to complete the Edinburgh Postnatal Depression Scale. Postpartum depression was defined as a score of 12 or more.
Dr. LaCoursiere reported that the rate of postpartum depression was directly related to the extremes of body mass index. For example, the rates of postpartum depression among those in the underweight, normal weight, and preobese groups were 18%, 14%, and 19%, respectively, while the rates among those in the obese class I, class II, and class III groups were 19%, 32%, and 40%, respectively.
After the researchers controlled for demographic, psychological, medical, and obstetrical risk factors, the overall adjusted odds ratio of postpartum depression was 2.87 for obese class II women and 3.94 for obese class III women.
In the PRAMS stressors component of the study, Dr. LaCoursiere and Dr. Varner found that common pregnancy stressors increase the risk of postpartum depression. For example, the adjusted odds ratio for postpartum depression among women who reported partner-associated stressors such as divorce or arguing more than usual was 2.61, while the adjusted odds ratio for those who reported traumatic stressors such as being homeless or being involved in a physical fight was 1.66.
The adjusted odds ratio for those who reported both types of stressors was 8.48.
Fewer than half of the study participants (44%) reported that their clinician asked about their mood during pregnancy, while 54% reported that they were asked about their mood during the postpartum period.
Dr. LaCoursiere acknowledged certain limitations of the study, including the self-reported height and weight data and the fact that while women who were being actively treated for depression were excluded, the questionnaire was not administered antepartum or immediately post partum. Therefore, she said, “this cohort may represent women who were depressed antenatally and continued to have antenatal depression into the postpartum period.”
Dr. LaCoursiere reported that she had no conflicts to disclose.