Excessive gestational weight gain and emotional eating are positively associated with postpartum depressive symptoms among taiwanese women

BMC Women's Health Wu et al. BMC Women's Health (2023) 23:464 https://doi.org/10.1186/s12905-023-02625-4 Open Access RESEARCH Excessive gestational weight gain and emotional eating are positively associated with postpartum depressive symptoms among taiwanese women Chia-Hsun Wu1, Meei-Ling Gau2 , Su-Fen Cheng3 , Tzu-Ling Chen2* and Chih-Jung Wu4 Abstract Background Excessive gestational weight gain and emotional eating may be associated with postpartum depression symptoms. This study was designed to identify how gestational weight gain and eating behaviors are related to postpartum depression (PPD) symptoms among women in Taiwan. Methods A cross-sectional study was conducted from March 2022 to October 2022 with 318 postpartum women recruited in Taipei, Taiwan. Gestational weight gain (GWG) for the total pregnancy period was recorded as inadequate, adequate, or excessive, based on the 2009 Institute of Medicine recommendations (IOM), accounting for prepregnancy body mass index category. Eating behavior at one month postpartum was measured on a 16-item 5-point Likert scale with three subscales: uncontrolled, restrained, and emotional. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale with a cutoff score of 13. Results The prevalence of postpartum depression symptoms (Edinburgh Postnatal Depression Scale ≥ 13) was 23.9% at one month postpartum. Logistic regression analysis revealed that excessive gestational weight gain and emotional eating were positively associated with postpartum depression symptoms at that time. Conclusion Evidence presented here suggests that emotional eating and excessive GWG are associated with PPD symptoms in a Taiwanese population. In addition, it should be a public health priority to ensure a particular focus on mental health during the postpartum period. Healthcare providers should discourage pregnant women from unhealthy eating habits by targeting appropriate GWG and focusing on demand eating to reduce PPD in the postpartum period. Keywords Gestational weight gain, Postpartum women, Emotional eating, Eating behavior, Postpartum depressive symptoms *Correspondence: Tzu-Ling Chen 1 Obstetrician and gynecologist, Department of Obstetrics and Gynecology, Cheng-Hsin General Hospital, Taipei, Taiwan 2 Department of Nurse-Midwifery and Women’s Health, National Taipei University of Nursing and Health Sciences, 365, Ming-Te Rd, Peitou District, 11219 Taipei, Taiwan 3 Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan 4 School of Nursing, China Medical University, Taichung, Taiwan © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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. Wu et al. BMC Women's Health (2023) 23:464 Introduction Postpartum depression (PPD) is an important public health issue that impacts postpartum women, affects parent-child interactions, and disrupts the harmony of family relationships. According to published statistics, PPD peaks 1 month after childbirth, with an incidence rate of 8.2–38.2% [1]. Fluctuations in body weight during the course of pregnancy and childbirth may affect the mental health of postpartum women [2]. Furthermore, recent empirical studies suggest that unhealthy weight gain during pregnancy coupled with poor birth outcomes and changes in body shape may have negative effects on selfesteem and body image, leading to psychological depression [3]. In Western countries, weight gain in pregnant women is commonly classified based on the 2009 Institute of Medicine (IOM) guidelines [4]. Both excessive and insufficient weight gain during pregnancy have been linked to a higher incidence of PPD than is associated with healthy weight gain [5, 6]. These relationships may involve impacts on levels of cortisol and insulin and on the hypothalamic-pituitary-adrenal axis, which can precipitate depression [7, 8]. Despite near-universal uptake of prenatal exams (98.2% of expecting mothers had ≥ 4 and 93.8% had ≥ 8 tests) in Taiwan in 2019 [9], associations between IOM-classified gestational weight changes and PPD are poorly understood. Postpartum women tend to increase their intake of high-calorie and fatty foods as they adapt to multiple roles, and this affects the balance of their body’s satiety center [10]. They resort to emotional overeating and comfort eating [11, 12], consuming more food than their bodies require [13]. However, tools to assess early postpartum eating in Asian women are limited. Consuming more fruit, vegetables and dietary supplements is associated with lower depression at 2 months postpartum. In contrast, higher intake of high-sugar and fast food (such as cookies, French fries, and sugary drinks) has been linked to worsened depression symptoms [14, 15]. A previous study by Yu et al. (2022). found that emotional overeating and other unhealthy eating behaviors were positively associated with postpartum depression (PPD) in women 6–18 months after childbirth [16]. Research has also indicated concerning links between early postpartum eating habits, such as emotion-driven eating and problematic eating attitudes requiring psychiatric attention, and PPD [2]. These findings highlight a potential connection between postpartum women’s eating patterns and their mental health. The elucidation of relationships between gestational weight gain, eating behaviors, and depression in postpartum women, especially in the early postpartum period and among Asian populations, may help decrease postpartum depression incidence and improve women’s Page 2 of 9 postpartum health outcomes. The objectives of this study were to investigate the connections between excessive gestational weight gain (GWG) and emotional eating with PPD symptoms among postpartum women. Methods Study design, study settings and study participants A cross-sectional study design with convenience sampling was used, in which study participants were recruited at tw (...truncated)