BACKGROUND Maternal nutrition during pregnancy has a significant effect on the health of the offspring and mother, highlighting the need for identifying factors that may affect diet during pregnancy. Research in nonpregnant and pregnant populations suggest depression may play a role. OBJECTIVE To investigate the relationship between prenatal depression and diet quality during pregnancy overall and by race/ethnicity and to explore the relationships between prenatal depression and the 12 Healthy Eating Index 2010 dietary components. DESIGN A cross-sectional secondary analysis of a cohort study of Kaiser Permanente Northern California women entering prenatal care between October 2011 and April 2013. PARTICIPANTS/SETTING Participants included 1,160 adult pregnant women. MAIN OUTCOME MEASURES Poor diet quality was defined as a Healthy Eating Index 2010 score in the lowest quartile. STATISTICAL ANALYSES PERFORMED Logistic regression was used to assess the relationship between prenatal depression (defined as a depression diagnosis, Patient Health Questionnaire score of 10 or greater or antidepressant medication dispensing between the last menstrual period and completion of the food frequency questionnaire) and poor diet quality overall and by race/ethnicity. Relationships between prenatal depression and each of the 12 Healthy Eating Index 2010 dietary components were assessed using t-tests and linear regression analyses. RESULTS One hundred fifty-nine (14%) participants had prenatal depression. Women with prenatal depression had nearly two times the odds of poor diet quality (odds ratio 1.80, 95% CI 1.23 to 2.60) compared with women without prenatal depression, after adjusting for potential confounders. Differences emerged by race/ethnicity; after adjusting for potential confounders the adjusted odds of poor diet quality were significant only among Hispanic women. Hispanic women with prenatal depression had an increased odds of poor diet quality compared with Hispanic women without prenatal depression (odds ratio 2.66, 95% CI 1.15 to 6.06). Women with prenatal depression had a higher consumption of empty calories (from solid fats, alcohol, and added sugars; threshold for counting alcohol >13 g/1,000 kcal) (P=0.01) and lower consumption of greens and beans (P<0.05), total fruit (P<0.01), and whole fruit (P<0.01), compared with women without prenatal depression. Except for empty calories, these findings remained after adjusting for potential confounders. CONCLUSIONS Study findings suggest that women with prenatal depression are at a higher risk of poor diet quality compared with women without prenatal depression, and the relationship is stronger among Hispanic women. Nutrition counseling interventions for women with depression should consider the use of culturally sensitive materials and target limiting empty calories from solid fats, alcohol, and added sugars and encourage eating more greens, beans, and fruit.

中文翻译：

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孕期产前抑郁症和饮食质量

背景 孕期母体营养对后代和母亲的健康有显着影响，突出了确定可能影响孕期饮食的因素的必要性。对非怀孕和怀孕人群的研究表明抑郁症可能起作用。目的 调查产前抑郁与孕期饮食质量之间的关系，并按种族/民族分析产前抑郁与 2010 年 12 项健康饮食指数饮食成分之间的关​​系。设计 一项对 2011 年 10 月至 2013 年 4 月期间进入产前护理的 Kaiser Permanente 北加州妇女的队列研究的横断面二次分析。参与者/环境 参与者包括 1,160 名成年孕妇。主要观察指标 饮食质量差被定义为 2010 年健康饮食指数得分最低的四分位数。执行的统计分析 Logistic 回归用于评估产前抑郁症（定义为抑郁症诊断，患者健康问卷评分为 10 或更高，或在末次月经期和完成食物频率问卷之间分配抗抑郁药物）与不良饮食质量之间的关系整体和种族/民族。使用 t 检验和线性回归分析评估产前抑郁症与 2010 年健康饮食指数 12 项饮食成分中的每一项之间的关系。结果 159 名 (14%) 参与者患有产前抑郁症。患有产前抑郁症的女性饮食质量差的几率几乎是其两倍（几率比 1.80，95% CI 1.23 到 2。60) 与没有产前抑郁症的女性相比，在调整了潜在的混杂因素后。种族/民族造成的差异；调整潜在混杂因素后，调整后饮食质量差的几率仅在西班牙裔女性中显着。与没有产前抑郁症的西班牙裔女性相比，患有产前抑郁症的西班牙裔女性饮食质量差的几率增加（几率 2.66，95% CI 1.15 至 6.06）。患有产前抑郁症的女性摄入的空热量较高（来自固体脂肪、酒精和添加糖；计算酒精的阈值 >13 g/1,000 kcal）（P=0.01），而绿色和豆类摄入量较低（P<0.05） ，与没有产前抑郁症的女性相比，总果实（P<0.01）和整个果实（P<0.01）。除了空卡路里，在调整了潜在的混杂因素后，这些发现仍然存在。结论 研究结果表明，与没有产前抑郁症的女性相比，患有产前抑郁症的女性饮食质量差的风险更高，并且在西班牙裔女性中这种关系更强。针对抑郁症女性的营养咨询干预措施应考虑使用具有文化敏感性的材料，目标是限制来自固体脂肪、酒精和添加糖的空热量，并鼓励多吃蔬菜、豆类和水果。