Prospective Associations of Maternal Dietary Patterns and Postpartum Mental Health in a Multi-Ethnic Asian Cohort: The Growing up in Singapore towards Healthy Outcomes (GUSTO) Study

Abstract

Diet in the first month postpartum, otherwise known as “the confinement diet” in Asia, has unique characteristics that are influenced by traditions, cultures, and beliefs. We aimed to characterize dietary patterns during confinement period in a multi-ethnic Asian cohort and examined their associations with postpartum depression (PPD) and anxiety (PPA). Dietary intakes of 490 women were ascertained in the first month postpartum using 3-day food diaries and dietary patterns were derived by factor analysis. Participants completed the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) at three months’ postpartum; higher scores are indicative of more depressive and anxiety symptoms, respectively. Four dietary patterns were identified: Traditional-Chinese-Confinement diet, Traditional-Indian-Confinement diet, Eat-Out diet and Soup-Vegetables-Fruits diet. The Traditional-Indian-Confinement diet was associated with less PPD symptoms [β (95% CI) −0.62 (−1.16, −0.09) EPDS score per SD increase in diet score] and a non-significant trend with reduced probable PPD (EPDS scores ≥ 13) [OR (95% CI) 0.56 (0.31, 1.01)]. The Soup-Vegetables-Fruits diet was associated with less PPA symptoms [β (95% CI) −1.49 (−2.56, −0.42) STAI-state score]. No associations were observed for other dietary patterns. Independent of ethnicity, adherence to the Traditional-Indian-Confinement diet that is characterized by intake of herbs and legumes, and Soup-Vegetables-Fruits diet high in fruits, vegetables and fish during the postpartum period were associated with less PPD and PPA symptoms, respectively.

Systematic review of the association between dietary patterns and perinatal anxiety and depression

“…Six studies examined usual dietary intake during pregnancy [26, 27, 30–32, 35]. Two studies [28, 29] evaluated 6 months prior to pregnancy, whereas two other studies evaluated in the postpartum period [33, 34]. The survey methods used included a food frequency questionnaire ( n = 7) [26–30, 32, 33], food history questionnaire ( n = 2) [31, 35], and 3-day food record ( n = 1) [34].…”

“…Two studies [28, 29] evaluated 6 months prior to pregnancy, whereas two other studies evaluated in the postpartum period [33, 34]. The survey methods used included a food frequency questionnaire ( n = 7) [26–30, 32, 33], food history questionnaire ( n = 2) [31, 35], and 3-day food record ( n = 1) [34]. For statistical analysis, nine studies used factor analysis [27–35] and one used cluster analysis for evaluation of dietary pattern [26].…”

“…The 10 studies included in this review identified food consumption patterns characterized by a Western pattern [26–35], which was referenced as processed ( n = 3) [28–30], Western ( n = 3), [31, 32, 35] , restricted ( n = 1) [26], unhealthy ( n = 1) [27], confectionery ( n = 1) [30], mixed ( n = 1) [33], or Eat-Out diet ( n = 1) [34]. Nine studies identified dietary patterns classified as healthy patterns [27–35], whereas traditional patterns were identified in seven studies [26, 28–31, 34, 35] conducted in Brazil ( n = 3) [26, 28, 29], the United Kingdom ( n = 1) [30], Japan ( n = 2) [31, 35], and Singapore ( n = 1) [34]. The food composition for western, healthy, and traditional dietary patterns is presented in Table 2.…”

Postpartum Depression and Risk Factors among Vietnamese Women

“…The sensitivity and specificity of EPDS were 65-100% and 49-100%, respectively [ 25 ]. EPDS has been translated and validated for non-English speaking population [ 26 , 27 ] and has used widely in Asian [ 28 , 29 ]. New mothers were also asked to report information about demographics, pregnancy and disease history, interpersonal skill, and characteristics.…”

Associations of Body Mass Index with Demographics, Lifestyle, Food Intake, and Mental Health among Postpartum Women: A Structural Equation Approach

“…Yet studies on the relationship between obesity and mental health seem insufficient so far. Among the existing research on this topic, Teo et al [36] investigated the correlation between mental health and food intake during the postpartum period, but the variables were not linked with BMI. Hence, limited evidence from previous studies focusing on mental health effects on postpartum obesity could be found.…”