Healthy lifestyle during pregnancy may prevent depression

Poor lifestyle during pregnancy, such as physical inactivity, inappropriate sleep and diet, and smoking, appear to aggravate the risk of developing depression, according to a recent Singapore study.

“These lifestyle risk factors are modifiable, suggesting that multi-component 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 researchers said.

Drawing from the Growing Up in Singapore Towards Healthy Outcomes study, the researchers enrolled 535 pregnant women who were assessed for the following lifestyle factors: poor diet quality, poor sleep quality, physical inactivity, vitamin D insufficiency, smoking, and the perceived need for social support. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EDPS).

Most of the participants had at least one (28 percent) or two (27 percent) of the lifestyle risk factors, while only 1 percent (n=4) self-reported all six risk factors; 11 percent (n=59) had none of the risk factors. Poor diet and sleep quality, as well as the perceived need for external emotional support, were the most common risk factors, observed in almost half of the women. [Compr Psychiatry 2020;doi:10.1016/j.comppsych.2020.152210]

Thirty-eight participants were found to have probable antepartum depression, and each possessed a median of three lifestyle factors. On the other hand, the remaining patients who had no depression only had a median of two risk factors (p<0.001).

Poisson regression analysis revealed that women with four to six lifestyle risk factors were more than six times as likely to have probable depression at 26–28 weeks of gestation, as compared with those who only had one risk factor at most (prevalence ratio [PR], 6.43, 95 percent confidence interval [CI], 2.09–19.77; p=0.001).

Similarly, having three risk factors significantly correlated with probable depression before birth (PR, 3.44, 95 percent CI, 1.12–10.59; p=0.032). While no such interaction was found for the presence of two risk factors, the overall linear trend was significant. That is, each additional risk factor corresponded to a nearly twofold increase in the likelihood of probable depression at 26–28 weeks of gestation (PR, 1.87, 95 percent CI, 1.32–2.63; p_trend<0.001).

Looking at the individual risk factors, the researchers found that poor sleep quality was the strongest predictor of perinatal depression, while vitamin D intake and physical activity had the least impact.

“To the best of our knowledge, we are the first to study the relationships of a combination of multiple, modifiable lifestyle risk factors (diet quality, vitamin D concentrations, smoking, physically activity, sleep quality, and need for emotional support) with mental well-being during the perinatal period,” the researchers said.

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