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Obesity and Mental Disorders During Pregnancy and Postpartum: A Systematic Review and Meta-analysis

Molyneaux, Emma MSc; Poston, Lucilla PhD, FRCOG; Ashurst-Williams, Sarah MBBS; Howard, Louise M. PhD, MRCPsych

doi: 10.1097/AOG.0000000000000170
Contents: Review

OBJECTIVE: To evaluate the prevalence and risk of antenatal and postpartum mental disorders among obese and overweight women.

DATA SOURCES: Seven databases (including MEDLINE and ClinicalTrials.gov) were searched from inception to January 7, 2013, in addition to citation tracking, hand searches, and expert recommendations.

METHODS OF STUDY SELECTION: Studies were eligible if antenatal or postpartum mental disorders were assessed with diagnostic or screening tools among women who were obese or overweight at the start of pregnancy. Of the 4,687 screened articles, 62 met the inclusion criteria for the review. The selected studies included a total of 540,373 women.

TABULATION, INTEGRATION, AND RESULTS: Unadjusted odds ratios were pooled using random-effects meta-analysis for antenatal depression (n=29), postpartum depression (n=16), and antenatal anxiety (n=10). Obese and overweight women had significantly higher odds of elevated depression symptoms than normal-weight women and higher median prevalence estimates. This was found both during pregnancy (obese odds ratio [OR] 1.43, 95% confidence interval [CI] 1.27–1.61, overweight OR 1.19, 95% CI 1.09–1.31, median prevalence: obese 33.0%, overweight 28.6%, normal-weight 22.6%) and postpartum (obese OR 1.30, 95% CI 1.20–1.42, overweight OR 1.09, 95% CI 1.05–1.13, median prevalence: obese 13.0%, overweight 11.8%, normal-weight 9.9%). Obese women also had higher odds of antenatal anxiety (OR 1.41, 95% CI 1.10–1.80). The few studies identified for postpartum anxiety (n=3), eating disorders (n=2), or serious mental illness (n=2) also suggested increased risk among obese women.

CONCLUSION: Health care providers should be aware that women who are obese when they become pregnant are more likely to experience elevated antenatal and postpartum depression symptoms than normal-weight women, with intermediate risks for overweight women.

Obese women are more likely to have antenatal and postpartum mental disorders than normal-weight women, with intermediate risks for overweight women.Supplemental Digital Content is Available in the Text.

Institute of Psychiatry and the Division of Women's Health, Kings College London, London, United Kingdom.

Corresponding author: Louise M. Howard, PhD, MRCPsych, Heath Service and Population Research Department, PO31 Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, United Kingdom; e-mail: louise.howard@kcl.ac.uk.

This review was carried out as part of a PhD studentship funded by the Medical Research Council and Tommy's Charity. This report is independent research supported through salary support to Louise Howard by the National Institute for Health Research (NIHR) Research Professorship NIHR-RP-R3-12-011 and the NIHR Mental Health Biomedical Research Centre at South London and Maudsley National Health Service (NHS) Foundation Trust and King's College London.

The authors thank the authors of included articles who provided additional data and Clare Taylor for her assistance in study screening.

Presented at the UK and Ireland Marcé Society meeting, September 19, 2013, London, United Kingdom.

The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.