Pre-pregnancy obesity is associated with greater systemic inflammation and increased risk of antenatal depression

Luba Sominsky; Martin O'Hely; Katherine Drummond; Sifan Cao; Fiona Collier; Poshmaal Dhar; Amy Loughman; Samantha Dawson; Mimi Lk Tang; Toby Mansell; Richard Saffery; David Burgner; Anne-Louise Ponsonby; Peter Vuillermin; Barwon Infant Study Investigator Group

doi:10.1016/j.bbi.2023.07.005

Pre-pregnancy obesity is associated with greater systemic inflammation and increased risk of antenatal depression

Brain Behav Immun. 2023 Oct:113:189-202. doi: 10.1016/j.bbi.2023.07.005. Epub 2023 Jul 10.

Authors

Affiliations

¹ Barwon Health, Geelong, Victoria, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia. Electronic address: luba.sominsky@deakin.edu.au.
² Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
³ The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
⁴ Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia.
⁵ Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia.
⁶ Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia.
⁷ Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
⁸ Barwon Health, Geelong, Victoria, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia. Electronic address: peter.vuillermin@deakin.edu.au.

PMID: 37437818
DOI: 10.1016/j.bbi.2023.07.005

Abstract

Background: Pre-pregnancy obesity is an emerging risk factor for perinatal depression. However, the underlying mechanisms remain unclear. We investigated the association between pre-pregnancy body mass index (BMI) and perinatal depressive symptoms in a large population-based pre-birth cohort, the Barwon Infant Study. We also assessed whether the levels of circulating inflammatory markers during pregnancy mediated this relationship.

Methods: Depressive symptoms were assessed in 883 women using the Edinburgh Postnatal Depression Scale (EPDS) and psychological stress using the Perceived Stress Scale (PSS) at 28 weeks gestation and 4 weeks postpartum. Glycoprotein acetyls (GlycA), high-sensitivity C-reactive protein (hsCRP) and cytokines were assessed at 28 weeks gestation. We performed regression analyses, adjusted for potential confounders, and investigated mediation using nested counterfactual models.

Results: The estimated effect of pre-pregnancy obesity (BMI ≥ 30 kg/m²) on antenatal EPDS scores was 1.05 points per kg/m² increase in BMI (95% CI: 0.20, 1.90; p = 0.02). GlycA, hsCRP, interleukin (IL) -1ra and IL-6 were higher in women with obesity, compared to healthy weight women, while eotaxin and IL-4 were lower. Higher GlycA was associated with higher EPDS and PSS scores and partially mediated the association between pre-pregnancy obesity and EPDS/PSS scores in unadjusted models, but this association attenuated upon adjustment for socioeconomic adversity. IL-6 and eotaxin were negatively associated with EPDS/PSS scores, however there was no evidence for mediation.

Conclusions: Pre-pregnancy obesity increases the risk of antenatal depressive symptoms and is also associated with systemic inflammation during pregnancy. While discrete inflammatory markers are associated with antenatal depressive symptoms and perceived stress, their role in mediating the effects of pre-pregnancy obesity on antenatal depression requires further investigation.

Keywords: Antenatal depression; BMI; Chemokines; Cytokines; GlycA; Glycoprotein acetyls; Inflammation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

C-Reactive Protein
Depression / diagnosis
Depression, Postpartum*
Female
Humans
Infant
Inflammation
Interleukin-6
Obesity / complications
Pregnancy
Pregnancy Complications* / psychology
Risk Factors

Substances

C-Reactive Protein
Interleukin-6