Associations of dietary patterns during pregnancy with perinatal fatigue and depression among urban women in South Africa : the NuPED study

Abstract

Background: Perinatal depression is a serious problem worldwide and the prevalence is higher in low- and middle-income countries (LMIC) than in high-income countries (HIC). The South African prevalence of perinatal depression is estimated to be four times the global average. One of the potential risk factors for depression is an unhealthy diet, which women from LMIC have a higher risk of developing than women from HIC. An “unhealthier” diet has been associated with higher depressive symptoms during the perinatal period. Perinatal fatigue is common and has also been shown to have a bi-directional relationship with depression. Objectives: The aim of this study was to investigate the association between dietary patterns during early pregnancy and perinatal depression and fatigue among women. Methods: Forming part of the Nutrition during Pregnancy and Early Development (NuPED) study, dietary data were obtained at enrolment (< 18 weeks gestation) using a quantified food frequency questionnaire from which nutrient patterns were determined by means of exploratory factor analysis. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depressive symptoms and the Multidimensional Assessment of Fatigue (MAF) scale to measure fatigue at three time points during pregnancy and two postnatally. Results: The prevalence of perinatal depression ranged from 17.3% to 26.4% and perinatal fatigue ranged from 8.4% to 18.8% across the various time points. Three nutrient patterns were identified: 1) “Plant protein, iron, thiamine and folate”, which decreased the risk of fatigue at 6 months postnatally. This decrease in risk was attributed to the B-vitamins, iron and zinc present in the nutrient pattern; 2) “Animal protein, vitamin A, vitamin B12 and copper”, which increased the risk of depression at 12 months postnatally. The increased risk of depression may be due to the high meat content of the nutrient pattern; 3) “Fatty acids and sodium” which increased the risk for depression at 6 months postnatally. A possible reason for this increased risk of depression may be the high amount of saturated fatty acids in the nutrient pattern. Perinatal fatigue was also found to be positively associated with perinatal depression. Conclusion: This research illustrates the potential role of maternal diet during pregnancy in the development of maternal fatigue and depression.