Maternal and Child Health Journal

, Volume 18, Issue 1, pp 161–170 | Cite as

Nutritional Factors Associated with Antenatal Depressive Symptoms in the Early Stage of Pregnancy Among Urban South Indian Women

  • Ammu Lukose
  • Asha Ramthal
  • Tinku Thomas
  • Ronald Bosch
  • Anura V. Kurpad
  • Christopher Duggan
  • Krishnamachari Srinivasan
Article

Abstract

Many women of reproductive age from developing countries have poor nutritional status, and the prevalence of depression during pregnancy is high. The objective of the present study was to assess the prevalence of antenatal depressive symptoms in early pregnancy, and to identify the demographic and nutritional factors associated with these symptoms in a sample of urban South Indian pregnant women. This cross-sectional study was the baseline assessment of a prospective randomized controlled trial of vitamin B12 supplementation in urban pregnant south Indian women between the ages of 18 and 40 years (www.clinicaltrials.gov: NCT00641862). 365 women in their first trimester of pregnancy were screened for depressive symptoms at an urban clinic in Karnataka, South India, using the Kessler Psychological Distress Scale (K-10). Nutritional, clinical and biochemical factors were also assessed. Mean (SD) age of the cohort was 22.6 (3.7) years and mean (SD) BMI was 20.4 (3.3) kg/m2. 121 (33 %) of the women in the 1st trimester had symptoms consistent with depression (K-10 score >6). In multivariate log binomial regression analysis, presence of antenatal depressive symptoms in the first trimester were positively associated with vomiting, prevalence ratio (PR) = 1.54 (95 % CI 1.10, 2.16) and negatively with anemia, PR = 0.67 (95 % CI 0.47, 0.96). Nutrient intakes, serum vitamin B12, methylmalonic acid, homocysteine and red cell folate levels were not associated with measures of depression. Antenatal depressive symptoms in early pregnancy are highly prevalent in urban Indian women and are more common in women with vomiting and without anemia. In this cross-sectional data, blood concentrations of vitamin B12 and folate were not associated with depressive symptoms. The relationship between nutritional status and depressive symptoms may require larger and longitudinal studies.

Keywords

Antenatal depression Pregnancy Nutritional status South India 

References

  1. 1.
    Chandra, P. S. (2009). The interface between reproductive health and psychiatry. Contemporary topics in womens mental health-global perspectives (pp. 189–196). UK: Wiley.CrossRefGoogle Scholar
  2. 2.
    Karmaliani, R., Asad, N., Bann, C. M., et al. (2009). Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan. International Journal of Social Psychiatry, 55(5), 414–424.PubMedCrossRefGoogle Scholar
  3. 3.
    Bowen, A., & Muhajarine, N. (2006). Prevalence of antenatal depression in women enrolled in an outreach program in Canada. Journal of Obstetric Gynecologic and Neonatal Nursing, 35(4), 491–498.CrossRefGoogle Scholar
  4. 4.
    van Bussel, J. C., Spitz, B., & Demyttenaere, K. (2006). Women’s mental health before, during, and after pregnancy: A population-based controlled cohort study. Birth, 33(4), 297–302.PubMedCrossRefGoogle Scholar
  5. 5.
    Bowen, A., Stewart, N., Baetz, M., et al. (2009). Antenatal depression in socially high-risk women in Canada. Journal of Epidemiology and Community Health, 63(5), 414–416.PubMedCrossRefGoogle Scholar
  6. 6.
    Limlomwongse, N., & Liabsuetrakul, T. (2006). Cohort study of depressive moods in Thai women during late pregnancy and 6–8 weeks of postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Archives of Women’s Mental Health, 9(3), 131–138. doi:10.1007/s00737-005-0115-7.PubMedCrossRefGoogle Scholar
  7. 7.
    Patel, V., & Prince, M. (2006). Maternal psychological morbidity and low birth weight in India. The British Journal of Psychiatry, 188, 284–285. doi:10.1192/bjp.bp.105.012096.PubMedCrossRefGoogle Scholar
  8. 8.
    Rahman, A., & Creed, F. (2007). Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: Prospective study from Rawalpindi, Pakistan. Journal of Affective Disorders, 100(1–3), 115–121. doi:10.1016/j.jad.2006.10.004.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Kheirabadi, G. R., Maracy, M. R., Barekatain, M., et al. (2009). Risk factors of postpartum depression in rural areas of Isfahan province Iran. Archives of Iranian medicine, 12(5), 461–467.PubMedGoogle Scholar
  10. 10.
    Imran, N., & Haider, I. I. (2009). Screening of antenatal depression in Pakistan: Risk factors and effects on obstetric and neonatal outcomes. Asia-Pacific Psychiatry, 2(1), 26–32.CrossRefGoogle Scholar
  11. 11.
    Kazi, A., Fatmi, Z., Hatcher, J., et al. (2006). Social environment and depression among pregnant women in urban areas of Pakistan: Importance of social relations. Social Science and Medicine, 63(6), 1466–1476.PubMedCrossRefGoogle Scholar
  12. 12.
    Gausia, K., Fisher, C., Ali, M., et al. (2009). Antenatal depression and suicidal ideation among rural Bangladeshi women: A community-based study. Archives of Women’s Mental Health, 12(5), 351–358.PubMedCrossRefGoogle Scholar
  13. 13.
    Chandran, M., Tharyan, P., Muliyil, J., et al. (2002). Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India Incidence and risk factors. The British Journal of Psychiatry, 181(6), 499–504.PubMedCrossRefGoogle Scholar
  14. 14.
    Savarimuthu, R., Ezhilarasu, P., Charles, H., et al. (2010). Post-partum depression in the community: A qualitative study from rural south India. International Journal of Social Psychiatry, 56(1), 94–102.PubMedCrossRefGoogle Scholar
  15. 15.
    Wachs, T. D., Black, M. M., & Engle, P. L. (2009). Maternal depression: A Global Threat to Children’s Health, Development, and Behavior and to Human Rights. Child Development Perspectives, 3(1), 51–59.CrossRefGoogle Scholar
  16. 16.
    Bodnar, L. M., & Wisner, K. L. (2005). Nutrition and depression: Implications for improving mental health among childbearing-aged women. Biological Psychiatry, 58(9), 679–685.PubMedCrossRefGoogle Scholar
  17. 17.
    Leung, B. M., & Kaplan, B. J. (2009). Perinatal depression: Prevalence, risks, and the nutrition link–a review of the literature. Journal of the American Dietetic Association, 109(9), 1566–1575.PubMedCrossRefGoogle Scholar
  18. 18.
    Paulson, J. F., Dauber, S., & Leiferman, J. A. (2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics, 118(2), 659–668. doi:10.1542/peds.2005-2948.PubMedCrossRefGoogle Scholar
  19. 19.
    Cho, Y. J., Han, J. Y., Choi, J. S., et al. (2008). Prenatal multivitamins containing folic acid do not decrease prevalence of depression among pregnant women. Journal of Obstetrics and Gynaecology, 28(5), 482–484.PubMedCrossRefGoogle Scholar
  20. 20.
    Watanabe, H., Suganuma, N., Hayashi, A., et al. (2010). No relation between folate and homocysteine levels and depression in early pregnant women. Bioscience Trends, 4(6), 344–350.PubMedGoogle Scholar
  21. 21.
    Corwin, E. J., Murray-Kolb, L. E., & Beard, J. L. (2003). Low hemoglobin level is a risk factor for postpartum depression. The Journal of Nutrition, 133(12), 4139–4142.PubMedGoogle Scholar
  22. 22.
    Beard, J. L., Hendricks, M. K., Perez, E. M., et al. (2005). Maternal iron deficiency anemia affects postpartum emotions and cognition. The Journal of Nutrition, 135(2), 267–272.PubMedGoogle Scholar
  23. 23.
    Miyake, Y., Sasaki, S., Tanaka, K., et al. (2006). Dietary folate and vitamins B12, B6, and B2 intake and the risk of postpartum depression in Japan: The Osaka Maternal and Child Health Study. Journal of Affective Disorders, 96(1–2), 133–138.PubMedCrossRefGoogle Scholar
  24. 24.
    Yajnik, C. S., Deshpande, S. S., Jackson, A. A., et al. (2008). Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: The Pune Maternal Nutrition Study. Diabetologia, 51(1), 29–38. doi:10.1007/s00125-007-0793-y.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Toteja, G. S., Singh, P., Dhillon, B. S., et al. (2006). Prevalence of anemia among pregnant women and adolescent girls in 16 districts of India. Food and Nutrition Bulletin, 27(4), 311–315.PubMedGoogle Scholar
  26. 26.
    Bharathi, A. V., Kurpad, A. V., Thomas, T., et al. (2008). Development of food frequency questionnaires and a nutrient database for the Prospective Urban and Rural Epidemiological (PURE) pilot study in South India: Methodological issues. Asia Pacific Journal of Clinical Nutrition, 17(1), 178–185.PubMedGoogle Scholar
  27. 27.
    Dwarkanath, P., Soares, M. J., Thomas, T., et al. (2012). Food frequency questionnaire is a valid tool for the assessment of dietary habits of South Indian pregnant women. Asia-Pacific Journal of Public Health/Asia-Pacific Academic Consortium for Public Health,. doi:10.1177/1010539512459945.PubMedGoogle Scholar
  28. 28.
    Willett, W. C. (1998). Nutritional epidemiology (2nd ed.). New York: Oxford University Press.CrossRefGoogle Scholar
  29. 29.
    Samuel, T. M., Thomas, T., Finkelstein, J., et al. (2012). Correlates of anaemia in pregnant urban South Indian women: A possible role of dietary intake of nutrients that inhibit iron absorption. Public Health Nutrition, 1(1), 1–9.Google Scholar
  30. 30.
    WHO/CDC. (2004). Joint report by World Health Organization/Centres for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level (2nd ed.). Geneva, Switzerland: World Health Organization.Google Scholar
  31. 31.
    Rempher, K. J., & Little, J. (2004). Assessment of red blood cell and coagulation laboratory data. AACN Clinical Issues, 15(4), 622–637. quiz 44-5.PubMedGoogle Scholar
  32. 32.
    Kessler, R. C., Barker, P. R., Colpe, L. J., et al. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189.PubMedCrossRefGoogle Scholar
  33. 33.
    Patel, V., Araya, R., Chowdhary, N., et al. (2008). Detecting common mental disorders in primary care in India: A comparison of five screening questionnaires. Psychological Medicine, 38(2), 221–228. doi:10.1017/S0033291707002334.PubMedCrossRefGoogle Scholar
  34. 34.
    Baillie, A. J. (2005). Predictive gender and education bias in Kessler’s psychological distress scale (k-10). Social Psychiatry and Psychiatric Epidemiology, 40(9), 743–748. doi:10.1007/s00127-005-0935-9.PubMedCrossRefGoogle Scholar
  35. 35.
    Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. The British Journal of Psychiatry : The Journal of Mental Science, 150, 782–786.CrossRefGoogle Scholar
  36. 36.
    Fernandes, M. C., Srinivasan, K., Stein, A. L., et al. (2011). Assessing prenatal depression in the rural developing world: A comparison of two screening measures. Archives of Women’s Mental Health, 14(3), 209–216. doi:10.1007/s00737-010-0190-2.PubMedCrossRefGoogle Scholar
  37. 37.
    Indian Council of Medical Research. (2010). Nutrient requirements and recommended dietary allowances for Indians. A report of the Expert Group of the ICMR, National Institute of Nutrition, Hyderabad, India.Google Scholar
  38. 38.
    Satyanarayana, V. A., Lukose, A., & Srinivasan, K. (2011). Maternal mental health in pregnancy and child behavior. Indian J Psychiatry, 53(4), 351–361.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Bunevicius, R., Kusminskas, L., Bunevicius, A., et al. (2009). Psychosocial risk factors for depression during pregnancy. Acta Obstetricia et Gynecologica Scandinavica, 88(5), 599–605.PubMedCrossRefGoogle Scholar
  40. 40.
    Lee, A. M., Lam, S. K., Sze Mun Lau, S. M., et al. (2007). Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics and Gynecology, 110(5), 1102–1112.PubMedCrossRefGoogle Scholar
  41. 41.
    Karatas, J. C., Matthey, S., & Barnett, B. (2009). Antenatal psychosocial assessment: How accurate are we in determining ‘low-risk’ status? A pilot study. Archives of Women’s Mental Health, 12(2), 97–103.PubMedCrossRefGoogle Scholar
  42. 42.
    Mariam, K. A., & Srinivasan, K. (2009). Antenatal psychological distress and postnatal depression: A prospective study from an urban clinic. Asian Journal of Psychiatry, 2(2), 71–73. doi:10.1016/j.ajp.2009.04.002.PubMedCrossRefGoogle Scholar
  43. 43.
    Rahman, A., Iqbal, Z., & Harrington, R. (2003). Life events, social support and depression in childbirth: Perspectives from a rural community in the developing world. Psychological Medicine, 33(7), 1161–1167.PubMedCrossRefGoogle Scholar
  44. 44.
    Hartley, M., Tomlinson, M., Greco, E., et al. (2011). Depressed mood in pregnancy: Prevalence and correlates in two cape town peri-urban settlements. Reprod Health, 8, 9.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Bennett, H. A., Einarson, A., Taddio, A., et al. (2004). Prevalence of depression during pregnancy: Systematic review. Obstetrics and Gynecology, 103(4), 698–709. doi:10.1097/01.AOG.0000116689.75396.5f.PubMedCrossRefGoogle Scholar
  46. 46.
    Cott, A. D., & Wisner, K. L. (2003). Psychiatric disorders during pregnancy. International Review of Psychiatry, 15(3), 217–230. doi:10.1080/0954026031000136848.PubMedCrossRefGoogle Scholar
  47. 47.
    Irfan, N., & Badar, A. (2003). Determinants and pattern of postpartum psychological disorders in Hazara division of Pakistan. Journal of Ayub Medical College Abbottabad, 15(3), 19–23.Google Scholar
  48. 48.
    Gotlib, I. H., Whiffen, V. E., Mount, J. H., et al. (1989). Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. Journal of Consulting and Clinical Psychology, 57(2), 269–274.PubMedCrossRefGoogle Scholar
  49. 49.
    Husain, N., Parveen, A., Husain, M., et al. (2011). Prevalence and psychosocial correlates of perinatal depression: A cohort study from urban Pakistan. Archives of Women’s Mental Health, 14(5), 395–403. doi:10.1007/s00737-011-0233-3.PubMedCrossRefGoogle Scholar
  50. 50.
    Klainin, P., & Arthur, D. G. (2009). Postpartum depression in Asian cultures: A literature review. International Journal of Nursing Studies, 46(10), 1355–1373.PubMedCrossRefGoogle Scholar
  51. 51.
    Da Costa, D., Larouche, J., Dritsa, M., et al. (2000). Psychosocial correlates of prepartum and postpartum depressed mood. Journal of Affective Disorders, 59(1), 31–40.PubMedCrossRefGoogle Scholar
  52. 52.
    Alami, K. M., Kadri, N., & Berrada, S. (2006). Prevalence and psychosocial correlates of depressed mood during pregnancy and after childbirth in a Moroccan sample. Archives of Women’s Mental Health, 9(6), 343–346.PubMedCrossRefGoogle Scholar
  53. 53.
    Kitamura, T., Sugawara, M., Sugawara, K., et al. (1996). Psychosocial study of depression in early pregnancy. The British Journal of Psychiatry, 168(6), 732–738.PubMedCrossRefGoogle Scholar
  54. 54.
    Reeves, N., Potempa, K., & Gallo, A. (1991). Fatigue in early pregnancy. An exploratory study. Journal of Nurse-midwifery, 36(5), 303–309.PubMedCrossRefGoogle Scholar
  55. 55.
    Chou, F. H., Lin, L. L., Cooney, A. T., et al. (2003). Psychosocial factors related to nausea, vomiting, and fatigue in early pregnancy. Journal of Nursing Scholarship, 35(2), 119–125.PubMedCrossRefGoogle Scholar
  56. 56.
    Tuffery, O., & Scriven, A. (2005). Factors influencing antenatal and postnatal diets of primigravid women. J R Soc Promot Health, 125(5), 227–231.PubMedCrossRefGoogle Scholar
  57. 57.
    Smith, G. C., Smith, M. F., McNay, M. B., et al. (1998). First-trimester growth and the risk of low birth weight. The New England Journal of Medicine, 339(25), 1817–1822. doi:10.1056/NEJM199812173392504.PubMedCrossRefGoogle Scholar
  58. 58.
    Smith, G. C. (2004). First trimester origins of fetal growth impairment. Seminars in Perinatology, 28(1), 41–50.PubMedCrossRefGoogle Scholar
  59. 59.
    Alpert, J. E., & Fava, M. (1997). Nutrition and depression: The role of folate. Nutrition Reviews, 55(5), 145–149.PubMedCrossRefGoogle Scholar
  60. 60.
    Tiemeier, H., van Tuijl, H. R., Hofman, A., et al. (2002). Vitamin B12, folate, and homocysteine in depression: The Rotterdam Study. American Journal of Psychiatry, 159(12), 2099–2101.PubMedCrossRefGoogle Scholar
  61. 61.
    Armony-Sivan, R., Shao, J., Li, M., et al. (2012). No relationship between maternal iron status and postpartum depression in two samples in China. Journal of Pregnancy, 2012, 7. doi:10.1155/2012/521431.CrossRefGoogle Scholar
  62. 62.
    Hunt, J. R., & Penland, J. G. (1999). Iron status and depression in premenopausal women: An MMPI study. Minnesota multiphasic personality inventory. Behavioral Medicine, 25(2), 62–68. doi:10.1080/08964289909595738.PubMedCrossRefGoogle Scholar
  63. 63.
    Albacar, G., Sans, T., Martin-Santos, R., et al. (2011). An association between plasma ferritin concentrations measured 48 h after delivery and postpartum depression. Journal of Affective Disorders, 131(1–3), 136–142. doi:10.1016/j.jad.2010.11.006.PubMedCrossRefGoogle Scholar
  64. 64.
    Rich-Edwards, J. W., Kleinman, K., Abrams, A., et al. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60(3), 221–227.PubMedCrossRefGoogle Scholar
  65. 65.
    Bloch, M., Rotenberg, N., Koren, D., et al. (2006). Risk factors for early postpartum depressive symptoms. General Hospital Psychiatry, 28(1), 3–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Kataoka, Y., Yukari, Y., Hiromi, E., et al. (2005). Domestic Violence against women during pregnancy. Japanese Journal of Public Health, 52(9), 785–795.PubMedGoogle Scholar
  67. 67.
    Woods, S. M., Melville, J. L., Guo, Y., et al. (2010). Psychosocial stress during pregnancy. American Journal of Obstetrics and Gynecology, 202(61), 1–7.Google Scholar
  68. 68.
    Rubertsson, C., Wickberg, B., Gustavsson, P., et al. (2005). Depressive symptoms in early pregnancy, 2 months and 1 year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Archives of Women’s Mental Health, 8(2), 97–104.PubMedCrossRefGoogle Scholar
  69. 69.
    Bilszta, J. L., Tang, M., Meyer, D., et al. (2008). Single motherhood versus poor partner relationship: Outcomes for antenatal mental health. Australian and New Zealand Journal of Psychiatry, 42(1), 56–65.PubMedCrossRefGoogle Scholar
  70. 70.
    Adewuya, A. O., Ola, B. A., Aloba, O. O., et al. (2007). Prevalence and correlates of depression in late pregnancy among Nigerian women. Depress Anxiety, 24(1), 15–21.PubMedCrossRefGoogle Scholar
  71. 71.
    Davey, H. L., Tough, S. C., Adair, C. E., et al. (2011). Risk factors for sub-clinical and major postpartum depression among a community cohort of canadian women. Maternal and Child Health Journal, 15(7), 866–875.PubMedCrossRefGoogle Scholar
  72. 72.
    Williams, D. (2003). Pregnancy: A stress test for life. Current Opinion in Obstetrics and Gynecology, 15(6), 465–471.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ammu Lukose
    • 1
  • Asha Ramthal
    • 1
  • Tinku Thomas
    • 1
  • Ronald Bosch
    • 2
  • Anura V. Kurpad
    • 1
  • Christopher Duggan
    • 2
  • Krishnamachari Srinivasan
    • 1
  1. 1.Division of Nutrition, Mother and Child UnitSt. John’s Research InstituteBangaloreIndia
  2. 2.Department of NutritionHarvard School of Public HealthBostonUSA

Personalised recommendations