Pre-pregnancy obesity is associated with greater systemic inflammation and increased risk of antenatal depression
Luba Sominsky1, Martin O'Hely2, Katherine Drummond3
1Barwon Health, Geelong, Victoria, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.
Insights
Pre-pregnancy obesity is linked to antenatal depression. While inflammation markers like GlycA show associations, their role as mediators is complex and requires more research.
Area of Science:
- Reproductive health
- Maternal mental health
- Immunology
Background:
- Pre-pregnancy obesity is an emerging risk factor for perinatal depression.
- The specific biological mechanisms linking obesity to perinatal depression are not fully understood.
- Investigating inflammatory markers may elucidate these underlying pathways.
Purpose of the Study:
- To examine the association between pre-pregnancy body mass index (BMI) and perinatal depressive symptoms.
- To determine if circulating inflammatory markers during pregnancy mediate the relationship between obesity and depression.
- To analyze data from the large, population-based Barwon Infant Study cohort.
Main Methods:
- Assessed depressive symptoms (Edinburgh Postnatal Depression Scale) and perceived stress (Perceived Stress Scale) at 28 weeks gestation and 4 weeks postpartum.
- Measured inflammatory markers (Glycoprotein acetyls, hsCRP, cytokines) at 28 weeks gestation.
- Employed regression analyses and nested counterfactual models to investigate mediation.
Main Results:
- Pre-pregnancy obesity (BMI ≥ 30 kg/m²) was associated with increased antenatal depressive symptoms.
- Several inflammatory markers (GlycA, hsCRP, IL-1ra, IL-6) were elevated in women with obesity.
- Higher Glycoprotein acetyls (GlycA) showed partial mediation between obesity and depressive symptoms/stress in unadjusted models, but this effect diminished with socioeconomic adjustments.
Conclusions:
- Pre-pregnancy obesity is associated with higher risks of antenatal depressive symptoms and systemic inflammation.
- While inflammatory markers correlate with depressive symptoms, their mediating role in the obesity-depression link needs further exploration.
- Socioeconomic factors may influence the relationship between inflammation and perinatal depression.
Background:
Pre-pregnancy obesity is an emerging risk factor for perinatal depression. However, the underlying mechanisms remain unclear. We investigated the association between pre-pregnancy body mass index (BMI) and perinatal depressive symptoms in a large population-based pre-birth cohort, the Barwon Infant Study. We also assessed whether the levels of circulating inflammatory markers during pregnancy mediated this relationship.
Methods:
Depressive symptoms were assessed in 883 women using the Edinburgh Postnatal Depression Scale (EPDS) and psychological stress using the Perceived Stress Scale (PSS) at 28 weeks gestation and 4 weeks postpartum. Glycoprotein acetyls (GlycA), high-sensitivity C-reactive protein (hsCRP) and cytokines were assessed at 28 weeks gestation. We performed regression analyses, adjusted for potential confounders, and investigated mediation using nested counterfactual models.
Results:
The estimated effect of pre-pregnancy obesity (BMI ≥ 30 kg/m2) on antenatal EPDS scores was 1.05 points per kg/m2 increase in BMI (95% CI: 0.20, 1.90; p = 0.02). GlycA, hsCRP, interleukin (IL) -1ra and IL-6 were higher in women with obesity, compared to healthy weight women, while eotaxin and IL-4 were lower. Higher GlycA was associated with higher EPDS and PSS scores and partially mediated the association between pre-pregnancy obesity and EPDS/PSS scores in unadjusted models, but this association attenuated upon adjustment for socioeconomic adversity. IL-6 and eotaxin were negatively associated with EPDS/PSS scores, however there was no evidence for mediation.
Conclusions:
Pre-pregnancy obesity increases the risk of antenatal depressive symptoms and is also associated with systemic inflammation during pregnancy. While discrete inflammatory markers are associated with antenatal depressive symptoms and perceived stress, their role in mediating the effects of pre-pregnancy obesity on antenatal depression requires further investigation.
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