Multiple modifiable lifestyle factors and the risk of perinatal depression during pregnancy: Findings from the GUSTO cohort

Linde van Lee, Airu Chia, Desiree Phua, Marjorelee Colega, Natarajan Padmapriya, Jonathan Y. Bernard, Shirong Cai, Elaine K. H. Tham, Oon Hoe Teoh, Daniel Goh, Joshua J. Gooley, Peter D. Gluckman, Fabian Yap, Lynette P. C. Shek, Keith M. Godfrey, Kok Hian Tan, Yap-Seng Chong, Falk Müller-Riemenschneider, Birit Broekman, Michael MeaneyHelen Chen, Mary F. F. Chong*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: Studies have identified lifestyle risk factors for perinatal depression, but none have examined the cumulative effect of these risk factors in pregnant women. Methods: We considered the following six factors during pregnancy: poor diet quality (Healthy eating index for Singapore pregnant women<median), poor sleep quality (global Pittsburgh sleep quality index score > 5), physical inactivity (<600 MET-minutes/week), vitamin D insufficiency (<50 nmol/l), smoking before or during pregnancy, and the perceived need for social support. Probable depression was assessed using the Edinburgh postnatal depression scale during pregnancy (>15) and at three months postpartum (≥13). Prevalence risk ratios were calculated with Poisson regressions while adjusting for potential confounders. Results: Of 535 pregnant women, 207 (39%) had zero or one risk factor, 146 (27%) had two, 119 (22%) had three, 48 (9%) had four, and 15 (3%) had ≥5 risk factors at 26–28 weeks' gestation. These six lifestyle habits contributed to 32% of the variance in depressive symptoms during pregnancy. The prevalence of being probably depressed was 6.4 (95% CI 2.1, 19.8; p trend < 0.001) for expecting women who had ≥4 risk factors compared to women who had ≤1 risk factor. No association was observed between the number of risk factors and depressive symptoms at 3 months postpartum (p trend = 0.746). Conclusion: Pregnant women with ≥4 lifestyle risk factors showed a higher prevalence of depression during pregnancy, while no associations were observed for postpartum depression. Clinical trial registration: This cohort is registered under the Clinical Trials identifier NCT01174875;

Original languageEnglish
Article number152210
JournalComprehensive Psychiatry
Publication statusPublished - 1 Nov 2020

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