Obesity and Mental Disorders During Pregnancy and Postpartum

Abstract

Objective-To evaluate the prevalence and risk of antenatal and postpartum mental disorders among obese and overweight women.Data sources-Seven databases (including MEDLINE and ClinicalTrials.gov) were searched from inception to January 7, 2013, in addition to citation tracking, hand-searches and expert recommendations.Methods of study selection-Studies were eligible if antenatal or postpartum mental disorders were assessed with diagnostic or screening tools among women who were obese or overweight at the start of pregnancy. Of the 4,687 screened articles, 62 met the inclusion criteria for the review. The selected studies included a total of 540,373 women.Tabulation, integration, and results-Unadjusted odds ratios were pooled using randomeffects meta-analysis for antenatal depression (n=29), postpartum depression (n=16) and antenatal anxiety (n=10). Obese and overweight women had significantly higher odds of elevated depression symptoms than normal-weight women and higher median prevalence estimates. This was found both during pregnancy (obese OR 1.43, 95%CI 1.27-1.61, overweight OR 1.19, 95%CI 1.09-1.31; median prevalence: obese 33.0%, overweight 28.6%, normal-weight 22.6%) and postpartum (obese OR 1.30, 95%CI 1.20-1.42, overweight OR 1.09, 95%CI 1.05-1.13; median prevalence: obese 13.0%, overweight 11.8%, normal-weight 9.9%). Obese women also had higher odds of antenatal anxiety (OR 1.41, 95%CI 1.10-1.80). The few studies identified for postpartum anxiety (n=3), eating disorders (n=2) or serious mental illness (n=2) also suggested increased risk among obese women.Conclusion-Healthcare providers should be aware that women who are obese when they become pregnant are more likely to experience elevated antenatal and postpartum depression symptoms than normal-weight women, with intermediate risks for overweight women.

A systematic review of reviews on the prevalence of anxiety disorders in adult populations

“…There is also some evidence from UK and US studies that a high BMI may contribute to anxiety symptoms during pregnancy (Molyneaux et al. 2014). …”

“…2014; Mckechnie and John 2014; Molyneaux et al. 2014; Marrie et al. 2015), included clinical and general population samples (Mirza and Jenkins 2004; Bryant et al.…”

“…2014; Molyneaux et al. 2014), and used mainly DSM or ICD criteria to ascertain diagnoses (Fajutrao et al. 2009; Hawton et al.…”

“…2013; Molyneaux et al. 2014), such as older people with cognitive impairment (Yates et al. 2013), were also more likely to experience anxiety.…”

“…studies 33 Meta‐analysis: no Caregivers of people with dementia Range: 34–979 Case‐note review to identify caregivers of old people referred to psychiatry service; cohort studies UK and US studies Diagnostic interview schedules, symptom scale 3.7–76.5% Prev depended on study time period, sample, anxiety caseness definition Pregnant women Russell 2013 Search: August 2012 # incl. studies 17 Meta‐analysis: yes Pregnant and postpartum women (up to 12 months) Range: 27–3929 Community and outpatient referrals Controls: general population samples All continents included Structured diagnostic interviewsOverall prev: 1.08% (0.80, 1.46) in general pop of women, 2.07% (1.26, 3.37) during pregnancy, 2.43% (1.46, 4.00) during postpartum Molyneaux 2014 Search: Jan 2013 # incl. studies 62 Meta‐analysis: insufficient studies for meta‐a for anxiety Overweight or obese women at start of pregnancy vs normal weight control women Total 540,373 women Medical records; women seeking prenatal care; primary care or hospital centre sample; all women living in Avon expected to deliver in a certain time period; Recruitment from prenatal exercise classes, obstetrician and gynaecologist waiting rooms (through newsletter), women with low‐income insurance Clinical and community Mostly Western studies (esp.…”