Differential trajectories of depression symptoms during pregnancy and prospective associations with postpartum eating disorder symptoms and cardiovascular health behaviors

Abstract

Purpose

Approximately one-in-ten individuals experience depression during pregnancy, a period marked by considerable biopsychosocial change. Prior research has investigated perinatal depressive symptom change and identified links to negative health outcomes, such as hypertension and delivery complications. However, it is unknown if these findings extend to pregnant people with higher weight, who may have increased risk. Additionally, understanding how depression experiences during pregnancy impact postpartum eating disorder (ED) symptoms and cardiovascular health behaviors can provide insight into prospective health consequences.

Methods

Participants (N = 257 individuals with pre-pregnancy BMI ≥ 25) completed assessments of depression, ED symptoms, and cardiovascular health behaviors at six timepoints across pregnancy and at six-months postpartum. In this secondary analysis, growth mixture modeling identified differential depressive symptom trajectories; ANOVA and Chi-square tests examined differences in postpartum ED symptoms, diet quality, physical activity, and sleep across trajectory groups.

Results

Four prenatal depressive symptom trajectory groups were identified: low depression (64.3%), moderate depression (19.2%), high, decreasing depression (8.6%), and stable, high depression (7.8%). Trajectory groups comprising individuals with higher prenatal depressive symptoms (stable and decreasing) had higher postpartum eating, shape, and weight concerns, more frequent loss of control eating, and worse sleep quality, relative to moderate- and low-symptom groups. Restraint, diet quality, and physical activity did not differ across groups.

Conclusions

Prenatal depressive symptom trajectories may differentially relate to risk for postpartum ED symptoms and sleep behaviors among higher weight pregnant people. Future research should continue investigating perinatal depression, ED symptoms, and associated health behaviors to optimize screening and intervention in maternal healthcare.