Mood and quality of life changes in pregnancy and postpartum and the effect of a behavioral intervention targeting excess gestational weight gain in women with overweight and obesity: a parallel-arm randomized controlled pilot trial

Abstract

BackgroundIntensive lifestyle interventions in pregnancy have shown success in limiting gestational weight gain, but the effects on mood and quality of life in pregnancy and postpartum are less known. The purpose was to quantify changes in mental and physical quality of life and depressive symptoms across pregnancy and the postpartum period, to determine the association between gestational weight gain and change in mood and quality of life, and to assess the effect of a behavioral intervention targeting excess gestational weight gain on these outcomes.MethodsA three group parallel-arm randomized controlled pilot trial of 54 pregnant women who were overweight or obese was conducted to test whether the SmartMoms® intervention decreased the proportion of women with excess gestational weight gain. Individuals randomized to Usual Care (n = 17) did not receive any weight management services from interventionists. Individuals randomized to the SmartMoms® intervention (n = 37) were provided with behavioral weight management counseling by interventionists either in clinic (In-Person, n = 18) or remotely through a smartphone application (Phone, n = 19). In a subset of 43 women, mood and mental and physical quality of life were assessed with the Beck Depression Inventory-II and the Rand 12-Item short form, respectively, in early pregnancy, late pregnancy, 1–2 months postpartum, and 12 months postpartum.ResultsThe SmartMoms® intervention and Usual Care groups had higher depressive symptoms (p < 0.03 for SmartMoms® intervention, p < 0.01 for Usual Care) and decreased physical health (p < 0.01) from early to late pregnancy. Both groups returned to early pregnancy mood and physical quality of life postpartum. Mental health did not change from early to late pregnancy (p = 0.8), from early pregnancy to 1–2 months (p = 0.5), or from early pregnancy to 12 months postpartum (p = 0.9), respectively. There were no significant intervention effects. Higher gestational weight gain was associated with worsened mood and lower physical quality of life across pregnancy.ConclusionHigh depressive symptoms and poor quality of life may be interrelated with the incidence of excess gestational weight gain. The behavioral gestational weight gain intervention did not significantly impact these outcomes, but mood and quality of life should be considered within future interventions and clinical practice to effectively limit excess gestational weight gain.Trial registrationNCT01610752, Expecting Success, Registered 31 May 2012.Electronic supplementary materialThe online version of this article (10.1186/s12884-019-2196-8) contains supplementary material, which is available to authorized users.

Mobile Apps for the Management of Comorbid Overweight/Obesity and Depression/Anxiety: A Systematic Review

“…Also, Naslund and colleagues [47] reported that their lifestyle behavioural intervention on patients with severe mental illness increased physical activity (i.e., step count) and weight loss, although not fitness. Altazan and colleagues [50] found in the group of pregnant women an association between higher weight gain and worse mood and an increment of depressive symptoms over time; yet, regarding the SmartMoms intervention, no significant effects were found on mood and quality of life.…”

“…e two studies by Naslund and colleagues [46,47] and the one by Levinson and colleagues [48] were neither randomized nor blinded. Although the other four studies [44,45,49,50] were randomized controlled trials, only the study by Ma and colleagues [45] was blind. Although the target populations of the studies were diverse (e.g., pregnant women and people with an eating disorder or a severe mental illness), according to their reports, a common bias is the recruitment by convenience sampling, which limits the generalization of their results.…”

“…It must be pointed out that SmartMoms intervention was designed to assist an expectant mother in gaining weight within the recommended guidelines. e study by Altazan and colleagues [50] measured psychological variables such as mood, depressive symptoms, and quality of life; nevertheless, these were not treated or monitored through the use of a mobile app.…”

“…Cognitive behavioral therapy seems the most suitable framework for interventions, aiming at long term behavioral change. Yet, as the diversity of the studies suggests, an intervention program needs to be adapted considering if its purpose is the prevention (e.g., the SmartMoms Behavioral program [50]) or the management of comorbid unhealthy weight and mental conditions (e.g., the I-CARE program [45]).…”

A Machine Learning Approach for Studying the Comorbidities of Complex Diagnoses

“…It has been constructed exclusively around the ICD-10 code O99 (Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium, 100%) and includes, as can be deduced, exclusively women of a relatively early age (mean = 34.7). This sample does not include patients with postpartum depression (O90.6); therefore, what we are seeing is probably soon-to-be mothers with a single depressive episode due to pregnancy-related problems [37][38][39].…”