title: Prenatal Maternal Depression Symptoms and Dietary Intake – A Population Based Study in Rural Pakistan
Creators: name: Khan, Rukhsana
Publisher: name: University of Liverpool Repository
Year: 2018

description: Background: High prevalence of depression among pregnant women has been observed in low and middle-income countries including Pakistan.Pregnancy is an important stressor for depression and depressed women tend to have poor dietary intake.The present study aimed to determine the prevalence of prenatal depression and its risk factors, and explored the relationship of prenatal depression with dietary intake in a representative sample of women living in a rural setting of Pakistan. Methods: This study was conducted at the baseline of a large cluster randomised controlled trial. Five hundred pregnant women in the second and third trimester of pregnancy, living a in a rural area of district Rawalpindi Pakistan, were recruited for the baseline of the trial. Depression was assessed using “Patient Health Questionnaire” (PHQ9), with a cut-off score of 10, and the dietary intake assessment was carried out by“Food Frequency Questionnaire” and “24 Hour Dietary Recall”.Data on stressful life-events and perceived social support were captured through “Life Events Checklist” and “Multidimensional Scale of Perceived Social Support”.All pregnant women who had PHQ-9 scores of 10 or more were invited to participate. Those women whose PHQ 9 was less than 10 were selected through simple random sampling and invited for baseline measurements after obtaining informed consent. Response rate was around 98%.Appropriate tests of significance were used for bivariate analysis. Final Generalized Linear Model with logit link function was obtained. Results: The prevalence of prenatal depression was found to be 27%.Depressed pregnant women belonged to 23-30 years age group, were less educated had,lived in joint family and had less perceived support from family and friends.Depressed women suffered from at least 3-4 stressful life events .Food variety scores were generated and dichotomized at median for dietary inadequacy. Mean intake of all the energy, macronutrients and micronutrients was significantly less among depressed (p&lt;0.001).Prenatal depression was significantly associated with dietary inadequacy (P&lt;0.05). In addition factors like life satisfaction, husband away from home in last six months (P&lt;0.05), physical IPV (P&lt;0.05) and stressful life events (P&lt;0.01) were also independently associated with dietary inadequacy. Conclusion: The current study to the best of my knowledge is the first study to investigate in a large rural community based sample of women the link between prenatal depression and dietary intake. Most of the depressed women did not eat sufficient items from various food groups to meet the recommended dietary allowance. Prenatal depression was independently associated with inadequate dietary intake. Risk factors for prenatal depression as well as dietary inadequacy were psychosocial in nature. There is a need to screen women at antenatal visit and provide nutritional counselling to improve dietary behaviors for better pregnancy outcomes.