Postpartum Depression Rates Increase With Higher BMI
Women with prepregnancy overweight or obesity may be more likely to experience postpartum depression.
Rates of postpartum depression diagnoses have increased across all racial and ethnic groups, as well as all body mass index (BMI) categories, over the past decade, according to research results published in JAMA Network Open.1
Women with prepregnancy overweight or obesity may be more likely to experience postpartum depression. | image credit: grooveriderz - stock.adobe.com
In order to evaluate recent trends in postpartum depression—as well as how these trends are associated with race, ethnicity, and prepregnancy BMI—investigators conducted a serial, cross-sectional analysis of Kaiser Permanente Southern California electronic health records from 2010 to 2021.
The primary study outcome was postpartum depression diagnosis by a mental health specialist and/or via the use of antidepressants prescribed for postpartum depression within 12 months of childbirth.
The study cohort included 442,308 individuals with a median maternal age of 21 years at delivery (interquartile range [IQR], 27-34 years). A total of 41.2% of individuals identified as Asian/Pacific Islander, 52.4% identified as Hispanic, 7.5% as non-Hispanic Black, and 24.5% as non-Hispanic white. A majority of individuals were multiparous (56.1%), and 83.7% initiated prenatal care during the first trimester of their pregnancy.
During the study period, a total of 13.9% individuals had either a postpartum depression diagnosis and/or received a prescription for antidepressants within 12 months of childbirth. Postpartum depression was more frequently diagnosed in women who were older, compared with those without a postpartum depression diagnosis (age 30 to 34 years, 35.1% vs 33.3%; age 35 or older, 27.3% vs 23.1%).
Individuals with postpartum depression were more likely to be non-Hispanic white (29.3%) or non-Hispanic Black (8.5%), multiparous (58.5%), and to have smoked or used alcohol during pregnancy (3.8% and 17.9%, respectively). Weight also played a role in diagnosis, with postpartum depression more frequent among individuals who were overweight (26.3%) or with class I or class II/III obesity (16.7% and 13.5%, respectively).
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Rates of postpartum depression increased during the study period, from 9.4% in 2010 to 19% in 2021. Investigators saw the largest relative increases in 2013, with a 22% increase from 2021; 2018, with a 30% increase from 2017; and 2019, with a 20% increase from 2018. Rates of postpartum depression increased across all races and ethnicities, with the highest relative increase in Asian and Pacific Islanders, 3.6% to 13.8% in 2010 to 2021 (RR, 3.8; 95% CI, 3.2-4.5). Individuals who identified as non-Hispanic Black experienced the next highest relative increase, from 9.2% in 2010 to 22% in 2021 (RR, 2.4; 95% CI, 2.1-2.8).
When evaluating postpartum depression rates by prepregnancy BMI, investigators found that postpartum depression increased for all prepregnancy BMI groups during the study period: from 6.5% to 13.4% among underweight individuals, from 8.5% to 17% among normal weight individuals, from 9.5% to 19.8% among individuals with overweight, from 11% to 21.2% among individuals with class I obesity, and from 14.9% to 24.4% among individuals with class II/III obesity. Compared with baseline, the risk ratios for postpartum depression were 2.0, 2.1, 1.9, and 1.6, for each group, respectively. Investigators noted that the prevalence of postpartum depression and prepregnenacy BMI have both been rising over the past decade, with those with the highest prepregnancy BMI experiencing the highest rates of postpartum depression.
Study limitations included the potential of underestimated rates of postpartum depression prevalence, since postpartum depression is both underdiagnosed and undertreated; the use of health records not capturing care received outside of the Kaiser Permanente system; and a lack of generalizability to patients receiving care outside of integrated health care systems.
“Rising [postpartum depression] diagnoses may be a result of improved screening and diagnosis practices,” the researchers noted. “However, the high burden of postpartum depression underscores the need for enhanced treatment interventions to improve maternal mental health outcomes.”
“Our study emphasizes the need for continued research and closely monitoring the rising trends of [postpartum depression,” they concluded. “By identifying trends of [postpartum depression] and associated demographic and clinical factors, our findings provide valuable insights for guiding future public health initiatives aimed at improving perinatal mental health outcomes and promoting maternal and child wellbeing.”
READ MORE: Women’s Health Resource Center
