A network analysis of nutritional markers and maternal perinatal mental health in the French EDEN cohort

BMC Pregnancy and Childbirth Knox et al. BMC Pregnancy and Childbirth (2023) 23:603 https://doi.org/10.1186/s12884-023-05914-w Open Access RESEARCH A network analysis of nutritional markers and maternal perinatal mental health in the French EDEN cohort Bethany Knox1, Cédric Galera2,3,4, Anne-Laure Sutter-Dallay2,3,4, Barbara Heude5, Blandine de Lauzon-Guillain5 and Judith van der Waerden6* Abstract Background Perinatal maternal depression and anxiety are associated with adverse maternal outcomes, and nutrition may play an important role in their emergence. Previous research shows that certain micro and macronutrients found in different dietary patterns may associate with perinatal mood disorders. This study aims to explore relationships between nutrition during pregnancy and perinatal maternal depression and anxiety symptoms using network analyses. Methods Using data from the French EDEN mother-child cohort, the sample consisted of 1438 women with available mental health outcomes (CES-D, STAI and EPDS) and nutritional markers collected from food frequency questionnaires. Four networks were constructed to explore the relationships between prenatal nutrient status, dietary patterns, and perinatal mental health, while accounting for important confounders. Results The Healthy dietary pattern was associated with the presence of vital micronutrients, while the Western dietary pattern was consistently associated with poorer intake of specific micronutrients and contained an excess of certain macronutrients. Western dietary pattern and symptoms of postnatal depression were connected by a positive edge in both the macronutrient and micronutrient networks. Lower education levels were associated with higher Western dietary pattern scores, from which a positive edge linked to postnatal depression symptoms in both models. Conclusions A Western dietary pattern was associated with increased symptoms of postnatal depression in our adjusted network models; The Healthy dietary pattern was associated with essential micronutrients but not with symptoms of depression or anxiety. Perinatal mental health might be impacted by specific dietary patterns in the context of psychosocial and physical stress associated with pregnancy. Keywords Perinatal mental health, Perinatal nutrition, Maternal health, Perinatal diet pattern, Network analysis *Correspondence: Judith van der Waerden 1 Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris F75012, France 2 University of Bordeaux, Bordeaux, France 3 INSERM, Bordeaux Population Health Center, UMR1219, Bordeaux, France 4 Centre Hospitalier Perrens, Bordeaux, France Université Paris Cité and Université Sorbonne Paris Nord, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Inserm, Paris, France 6 Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe de Recherche en Epidémiologie Sociale, 27 Rue Chaligny, Paris Cedex 12 75571, France 5 © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Knox et al. BMC Pregnancy and Childbirth (2023) 23:603 Background Perinatal depression and anxiety affect mothers worldwide and are associated with an increased likelihood of mental health problems in their offspring [1]. Prevalence rates during the perinatal period are estimated to be 11.9% for symptoms of depression and 22.9% for symptoms of anxiety [2, 3]. The need to identify factors that contribute to maternal mental illness, specifically during the vulnerable gestational and post-natal periods, remains a challenge. Historically, the literature has focused on common psychosocial risk factors including a personal or family history of mental health problems, adverse childhood events (ACE), or increased life stress [4, 5]. Nutrition has recently emerged as a factor that potentially contributes to perinatal anxiety and depression, possibly due to the increasing evidence of this association with mental health in the general population [6, 7]. Concomitantly, evidence links lower socioeconomic status (SES) and nutritional status, specifically a lack of micronutrients in the diets of lower SES individuals, creating a complex matrix of influential variables related to perinatal mental health [8]. The perinatal period is considered a time of intense nutritional demands for expectant mothers, mainly due to an increase in their resting metabolic rate [9]. Demanding pathophysiological changes require an additional intake of an extra 450 kcal/day on average throughout the course of pregnancy to account for total daily energy expenditure [9]. Throughout the life span, availability of vital nutrients is conditional upon patterns of dietary intake. Although no standardized definition of specific dietary patterns exists, previous studies have identified patterns such as ‘Healthy’ or ‘Western’ that generally consist of distinct food groups and their nutrients’ quality and quantity [10]. Research investigating dietary patterns and maternal mental health suggests that a ‘Healthy’ dietary pattern may have a protective effect against pre- and post-natal depression and potentially anxiety; however, the specific mechanisms surrounding these associations are not yet clear [11]. For example, a systemic review found a positive association between poor quality and unhealthy diets and prenatal depressive symptoms and that healthy diets were inversely associated with prenatal depressive and anxiety symptoms [12]. However, associations between perinatal diet and postnatal depressive remain inconsistent. Other previously studied factors increase the complexity of these mechanisms of action. This complexity is partly attributable to how nutrients are absorbed, processed, and utilized in the body during pregnancy and the ability to account for and accurately measure other factors that affect mental health. For example, Wang et al., found that in economically vulnerable women, a (...truncated)