Research
Original Research
Prenatal Depression and Diet Quality During Pregnancy

https://doi.org/10.1016/j.jand.2019.12.011Get rights and content

Abstract

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.

Section snippets

Study Setting

The study setting was Kaiser Permanente Northern California (KPNC), a large group practice prepaid health plan that provides comprehensive medical services to members living in a 14-county region of Northern California (approximately 30% of the surrounding population). The demographic, racial/ethnic, and socioeconomic characteristics of the KPNC membership are representative of the population residing in the same geographic area except that the very poor and very wealthy are underrepresented.18,

Results

Among the 1,810 pregnancies in the PEAPOD study, the second pregnancy of any woman in the study period was excluded to avoid nonindependent observations (n=13). In addition, to ascertain depression status during pregnancy and before completing the FFQ, women who did not have at least one of the following were excluded: a PHQ-9 screen administered through the perinatal depression screening program, a clinical depression diagnosis, or an antidepressant medication fill after the start of pregnancy

Discussion

Findings from this study suggest women with prenatal depression or high prenatal depressive symptoms may have a higher risk of poor diet quality compared with women without prenatal depression, and that the relationship may be stronger in Hispanic women. The findings remained significant after restricting the sample to women with a PHQ-9 screening score, suggesting that depressive symptoms at or above a threshold of moderate depression may be as important as a clinical depression diagnosis in

Conclusions

Findings from this study suggest that women with prenatal depression and or prenatal depressive symptoms 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 may consider the use of culturally sensitive material; target limiting empty calories from solid fats, alcohol, and added sugars; and encourage eating more greens, beans, and fruit.

Acknowledgements

The authors thank Linda Nkemere for her help with preparation of the manuscript.

Author Contributions

M. M. Hedderson collected the data, L. A. Avalos conceptualized the manuscript with input from B. Caan, M. M. Hedderson, Y. Zhu, D.-K. Li, and N. Nance, and R. J. Hyde conducted the analysis with oversight from L. A. Avalos and C. Quesenberry. L. A. Avalos drafted the manuscript. All authors reviewed and commented on subsequent drafts of the manuscript.

L. A. Avalos is a research scientist II, Division of Research, Kaiser Permanente, Oakland, CA.

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    • Cited by (0)

    L. A. Avalos is a research scientist II, Division of Research, Kaiser Permanente, Oakland, CA.

    M. Hedderson is a research scientist II, Division of Research, Kaiser Permanente, Oakland, CA.

    B. Caan is a research scientist III, Division of Research, Kaiser Permanente, Oakland, CA.

    D.-K. Li is a research scientist III, Division of Research, Kaiser Permanente, Oakland, CA.

    N. Nance is a consulting data analyst, Division of Research, Kaiser Permanente, Oakland, CA.

    Y. Zhu is a research scientist I, Division of Research, Kaiser Permanente, Oakland, CA.

    C. Quesenberry is an associate director, Division of Research, Kaiser Permanente, Oakland, CA.

    R. J. Hyde is a data scientist, Facebook, Menlo Park, CA; at the time of the study, she was a consulting data analyst, Division of Research, Kaiser Permanente, Oakland, CA.

    STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

    FUNDING/SUPPORT This study was supported by a career development award to L. A. Avalos (K01MH103444) by the National Institute of Mental Health. Y. Zhu was also supported by National Institutes of Health grants 5K12HD52163 and K01DK120807. This study was also partially funded by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under R40MC21515.

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