Depression during pregnancy tied to multiple lifestyle risk factors

Becoming a mom may be emotionally taxing for some, and mental well-being during the perinatal period is associated with six modifiable lifestyle risk factors, namely diet quality, vitamin D concentrations, smoking, physical activity, sleep quality, and the presence of emotional support, according to data from a Singapore cohort study.

“We observed that pregnant women with ≥4 risk factors had at least a sixfold higher prevalence of having antepartum probable depression compared to those having zero or one risk factor, while no association was observed for postpartum depression,” said a team of investigators from the Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research and National University of Singapore.

The corresponding prevalence risk ratio was 6.4 (95 percent confidence interval [CI], 2.1–19.8; p_trend<0.001). This association was not seen for depressive symptoms at 3 months postpartum (p_trend=0.715). [Compr Psychiatry 2020;103:152210]

“This combination of six lifestyles factors accounted for over a third of the variance in antepartum depressive symptoms,” the investigators noted.

Among the lifestyle risk factors examined, sleep quality was the most important predictor of antepartum depression, whereas vitamin D concentrations and MET-minutes of physical activity contributed the least to the variance explained. The variance increased from 10 percent to 32 percent after combining all lifestyle risk factors.

The finding on sleep quality did not surprise the investigators, who explained that pregnant women may experience difficulty sleeping owing to the changes in their body such as hormonal fluctuations, need to urinate more frequently, abdominal discomfort, leg cramps, back pain, and anxiety for labour and delivery.

Also, poor sleep is a hallmark feature of mood disorders and might have common causes, the investigators added. “These suggest that programmes on mental well-being during pregnancy could include emphasis on sleep habits and improvement of sleep hygiene practices through environmental changes, or behavioural therapies, alongside other lifestyle changes.” [Sleep Med Rev 2010;14:35-46; Pak J Med Sci 2016;32:1030-1037]

“However, we acknowledge that the directionality of this association cannot be made from this study, and more research is needed,” they said.

The analysis included 535 pregnant women from the growing up in Singapore towards healthy outcomes (GUSTO) birth cohort. At 26–28 gestational weeks, 207 women (39 percent) had zero to one risk factor, 146 (27 percent) had two, 119 (22 percent) had three, 48 (9 percent) had four, and 15 (3 percent) had ≥5 risk factors.

There were few women who smoked before and during pregnancy (13 percent) and had vitamin D insufficiency (13 percent), whereas almost half of the population reported poor sleep quality (44 percent), eating poorly (48 percent), and a perceived need for emotional support from someone (46 percent). Meanwhile, 37 percent of women were insufficiently active according to the World Health Organization recommendations.

“These lifestyle risk factors are modifiable, suggesting that multicomponent lifestyle behavioural interventions could provide a more holistic and comprehensive strategy for prevention or cotreatment of depressive symptoms in pregnant women and therefore possibly also postpartum depression,” the investigators said.

“Our research should be replicated in longitudinal studies, and the effectiveness of behavioural programs should be further examined in intervention studies,” they added.