Postnatal depression was the only type of depression known to the world two decades back and those women suffering from antenatal depression were simply told that it’s just their hormone calling for attention. It’s been observed that 1 in every 10 women will be depressed at any point of time during pregnancy while 1 of every 30 women will be depressed during pregnancy and after delivery. Pregnancy, as we all know, is the most joyous period in a woman’s life as the pregnant woman experiences the peak of womanhood looking forward to the birth of her loving child. But according to some pregnant women who experience prenatal depression, the same pregnancy term instead of being filled with happiness and excitement turns out into a period of despair and gloom. There are various causes including physical, emotional and hormonal effects that can raises the risk of prenatal depression but this has dangerous consequences on the newborn, child and adult health outcomes putting the individual at a higher risk of common disorders.
Disasters of Depression in Pregnant Women
Depression as such is one of the highly common mental disorders that’s 50% more common in women than men. Almost 10-15% of women in developed countries and 20-40% of women in developing countries experience depression during pregnancy or after childbirth. Such depressions in pregnant women could have debilitating health outcomes when it is not stopped at the right time. Beyond affecting the immediate family, it also affects the society. Pregnancy is the period during which the woman undergoes numerous hormonal changes, her nutrient requirements vary and the mind goes through a sea of conflicting emotions simultaneously. We often hear elderly people advice the pregnant lady to eat for two as she is carrying another human inside but dietary guidelines don’t support this. Still, nutrient requirements increase to meet the needs of the developing fetus and the mother as well and fulfilling these requirements prepares the woman for a healthy delivery and a healthy baby thereafter. But depression brings about changes in her nutrient intakes which finally affects the health of the baby and the mother. Generally, these women eat fewer macronutrients (with the exception of fats), their nutrient levels are lower (with the exception of phosphorus) than recommendations and there are also theories that while these women have sufficient intake of macronutrients they witness a decrease in micronutrient intake.
Often we see people eating according to their mood. We indulge in sweets when we are happy or even refrain from eating when we are sad. Some people cope up with sorrows in life by eating tubs of cheesy fries and it has been shown that mental health of women affects their nutritional intake and also impacts the fetus. Depressed women are at an increased risk of giving birth to neonates with low birth weight (LBW) (this is a leading cause of neonate mortality and morbidity), preterm birth or with an Apgar score of 1-5 some five minutes after birth. Women around the world suffer from antenatal depression with each of them experiencing different outcomes.
A Study on Antenatal Depression in Pakistani Pregnant Women
Pakistan has a maternal mortality rate of 260 for every 1,00,000 live births with almost 18-80% pregnant women suffering from antenatal depression. The study aimed at measuring association of depression with maternal dietary intake and neonate outcomes. Participants were pregnant women aged between 18 and 49 years at the start of their second trimester and having normal nutrient intakes. The study group ensured that those with depression, chronic diseases such as diabetes, anemia, BP and CHD or belonging to the high-risk pregnancy category were excluded from the study. Information about the participants such as demography, husband’s employment, gestational age and expected delivery date was collected using questionnaires. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure the participant’s state of mind. Of the 94 participants who were cleared for the study 12 of them were excluded following no-show during follow up and finally the study was carried out with a sample size of 82.
An EPDS score of 9 indicated absence of depression, a score of 9-12 indicated moderate depression and a score of more than 13 indicated severe depression. Maternal intake was noted using a 24-hour dietary recall and a Food Frequency checklist at the start of the study and the same was repeated at the 36th week of gestation to analyze poor maternal nutrient intake. Food items were classified and their frequency of consumption (between never and 6+ times in a week) was noted. Each of the participants were questioned on their methods of preparation, portion sizes consumed and the types of snacks eaten. The 24-hour dietary recall was used to calculate macronutrient intake. The Healthy Eating Index (HEI) was used to score the 24 h recall with the overall score being reduced to 50 with the score split based on the type of food consumed-total fruit (5 score), whole fruit (5 score), total vegetables (5 score), greens and beans (5 score), whole grain (10 score), dairy (10 score), total protein foods (5 score) and seafood and plant proteins (5 score). Following dietary guidelines protocol to the dot yielded full score, a score ≥40 indicated good diet, a score between 25 and 40 was rated as moderate and a score below 25 was considered poor diet. Cut off points for carbohydrate and protein intake were ≥175 g and ≥71 g while it was ≥55 g for fats. Height, weight and BMI measurements of all the participants were taken and each of them was classified as underweight, normal weight, overweight or obese based on WHO guidelines. Information on the newborn was acquired in the form of fetal growth retardation (FGR), low (score of 6 or less) Apgar score and low birth weight (LBW) scores (<2500 g).
While mean age of the participants was 29 years almost 51% of them were between 24-29 years and 66% of them were between 151 and 160 cm. Mean weight of moms was 70 kg and BMI was 26.6. Results showed that there was a mean difference of only one HEI between depressed and non-depressed women as depressed antenatal women were consuming 151 kcal lesser than non-depressed women at the start. But at the end of the study, there was a difference of 5 HEI between depressed and non-depressed antenatal women. Depressed women ate almost 321 kcal lesser than non-depressed women by the end of cohort. At baseline, the type and quantity of foods consumed by both categories (depressed and non-depressed) of women were almost similar. While consumption of cereal, beans and lentils remained almost constant even after succumbing to antenatal depression usage of eggs decreased drastically (by almost 43% initially up to 75% later). Though 85% women were drinking milk at the start of the study it dropped to 65% later. Similar changes were seen in fruits and vegetables intake too. 60% of depressed antenatal women consumed one serving of fruit at baseline but the figures decreased to 37% by the end of cohort. Sadly, none of them were having green leafy vegetables even once a week. It was seen that almost 62% of poor dietary intake was due to antenatal depression. Protein and fat intake in antenatal depressed women decreased to less than 71g and 55g at the end of cohort.
Mean gestational age (born 2 days earlier), weight (200 g less) and low (0.5lower) Apgar score were low among neonates of depressed antenatal women compared to non-depressed women. FGR, preterm birth and poor Apgar score was predominantly seen among neonates of depressed antenatal women but not LBW and in this, 60% of FGR and poor Apgar score and 54% of preterm births could be attributed to antenatal depression. The study clearly reveals the impact of depression on the nutrient intake of pregnant women and dietary intake must be an important topic of discussion during nutrition counseling in the absence of which birth of a healthy baby and survival of a healthy mother both remain questionable.
Effect of Antenatal Depression on Maternal Dietary Intake & Neonatal Outcome: https://nutritionj.biomedcentral.com/articles/10.1186/s12937-016-0184-7
The Interplay between Maternal Nutrition and Stress during Pregnancy: https://www.karger.com/Article/PDF/457136
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