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Depressed pregnant women more likely to eat poorer diets, Kaiser Permanente analysis finds

Poor nutrition during pregnancy can increase the risk of adverse health outcomes for mother and child


Pregnant women with depression were more likely to eat poor diets with a higher intake of empty calories and lower intake of greens, beans, and fruit, according to an analysis of 1,160 adult pregnant women who were treated at Kaiser Permanente Northern California.

Of the study participants, 14% had depression. They were nearly twice as likely as the pregnant women without depression to have a poor-quality diet. The study was published Feb. 12 in the Journal of the Academy of Nutrition and Dietetics.

Lyndsay Avalos, PhD, MPH the study’s lead author

Poor diet quality during pregnancy can lead to gestational diabetes and excess weight gain, both risk factors for pregnancy complications. Maternal nutrition can also significantly affect fetal growth and development and the long-term health of the child.

“The findings are a reminder to clinicians that their pregnant patients with depression may be at risk of eating lower quality food,” said study lead author Lyndsay Avalos, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research.

The women were enrolled in the Study of How Pre-pregnancy and Pregnancy Lifestyle Influences the Outcome of Delivery (PEAPOD), carried out by Division of Research investigators between 2011 and 2013. Among other factors, the researchers evaluated participants’ diets according to the 2010 Dietary Guidelines for Americans, which emphasize fruits, vegetables, whole grains, lower fat milk and milk products, lean meats and seafood, eggs, beans and peas, and nuts and seeds. It recommends limiting intake of sodium, solid fats, added sugars, and refined grains.

Avalos and coauthors of the new study used data from PEAPOD to look for any associations between depression and diet quality. They found women with prenatal depression had higher consumption of empty calories, and lower consumption of greens and beans, total fruit, and whole fruits.

The relationship between prenatal depression and diet was stronger among Hispanic women; those with depression were two-and-a-half times more likely to have poor diet quality compared with women without the disorder, the research found.

Monique hedderson headshot
Monique Hedderson, PhD, research scientist with the Division of Research

Clinicians may want to seek nutritional and wellness resources for these patients in coordination with any treatment for depression symptoms, Avalos said. “Given the health concerns for the mother and child associated with an unhealthy diet in pregnancy, pregnant women who screen positive for depression should also be provided nutritional counseling or wellness coaching to encourage healthy eating as part of their depression treatment,” she said.

Identifying nutritional quality during pregnancy is an important preventive tool to head off chronic disease later in life, said senior author Monique Hedderson, PhD, a research scientist with Division of Research. “It’s important to understand what factors might impact dietary intake so that clinicians can try to intervene earlier and hopefully decrease the risk of obesity and cardiovascular disease for both the mom and her children,” Hedderson said.

Because of the possibility that the association is the other way around – that poor diet can contribute to low mood – the researchers designed the study to identify depression prior to the completion of the dietary survey. Still, there is likely some overlap between the onset of depression and dietary intake reporting. Avalos said additional research should be done to better understand the timing of the relationships between diet and depression during pregnancy.

The study was supported by a career development award to Avalos by the National Institute of Mental Health. Coauthor Yeyi Zhu, PhD, was also supported by National Institutes of Health grants. Funding also came from the U.S. Health Resources and Services Administration.

Coauthors included Bette Caan, PhD, Nerissa Nance, MPH, Yeyi Zhu, PhD, Rebecca J. Hyde, MPH, De-Kun Li, MD, PhD, Charles Quesenberry, PhD, all of the Division of Research.



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