Anxiety and Depression in Severely Obese Pregnancy: Associations with Gestational Weight Gain and Birthweight

Rationale/statement of the problem : Obesity is associated with increased symptoms of anxiety and depression. We hypothesised that severe obesity in pregnancy would be associated with adverse psychological health, with effects on gestational weight gain (GWG) and baby birthweight (BWT). We aimed to study mood and birth outcomes among participants in a longitudinal study of severe obesity in pregnancy. Methods : In this study, 140 severely obese (body mass index [BMI] (mean (SD)) 44.1 (4.1) kg/m2) and 96 lean (BMI 22.6 (1.6) kg/m2) pregnant women were recruited. Ethical approval and written, informed consent were obtained. Obese women were advised about healthy eating and weight maintenance. Serial weights were recorded and GWG calculated between 16 and 36 weeks’ gestation. Women were asked to complete validated questionnaires to assess mood, including ‘satisfaction with life’, Hospital Anxiety and Depression Scale (HADS) and Spielberger State and Trait Anxiety in early (12–20 weeks’ gestation) and late pregnancy (28–32 weeks’ gestation). Term BWT (>37 weeks’ gestation) was recorded (n=234). Results : Obese women were significantly less satisfied with life than lean women and had higher HADS depression and anxiety scores, and state and trait anxiety scores at both time points (all p<0.05). Findings remained significant after adjustment for social class.Obese women had less GWG than lean women (5.3 (6.0) vs. 10.2 (3.7) kg, p<0.05). About 23% of obese had more GWG than that prescribed in the Institute of Medicine guidelines. Offspring BWT was similar in obese and lean (3644 (515) vs. 3557 (505), p=ns).In lean, increased BWT was associated with higher BMI (r=0.68, p=0.002) and greater GWG (r=0.57, p=0.005). BWT was not related to BMI or GWG in obese. Higher HADS anxiety scores were associated with less GWG in lean (r= − 0.38, p=0.01) but more GWG in obese (r=0.33, p=0.04). Increased state anxiety was associated with lower BWT in early pregnancy in both groups (p=0.03) with similar patterns in late pregnancy. BWT was not related to satisfaction with life or HADS scores. Findings remained significant after adjustment for gender, delivery gestation, maternal smoking, social class, parity and ethnicity. Conclusion : Severely obese pregnant women have more symptoms of anxiety and depression and are less satisfied with life than lean women. Increased anxiety in response to pregnancy is associated with lower BWT in all, but altered mood has differing associations with GWG in lean and obese. Understanding mood may help interventions to optimise GWG in severely obese women.