Association Between Maternal Weight Perception Before and During Pregnancy and Postpartum Depression Status in Southern China

Abstract

Objective: Postpartum depression (PPD) is a common complication after childbirth. Weight misperception can lead to self-esteem issues and mental health problems, especially in women and adolescents. The aim of this study was to investigate the association between weight perception before and during pregnancy and the status of PPD in Southern China.

Methods: From October 2021 to November 2023, a multi-stage sampling method was used to recruit 2169 eligible mothers aged 18-49 who had delivered live-born singleton infants within 3 to 180 days postpartum. Anthropometric measurements and face-to-face questionnaire surveys were conducted to collect data. The Kappa test was used to assess the agreement between actual and perceived weight. The generalized linear model incorporating multiplicative interaction analysis was applied to explore the associations among variables.

Results: The prevalence of PPD status was 18.0%. Among women, 35.2% perceived their pre-pregnancy weight (PPW) as abnormal, while 33.1% perceived their gestational weight gain (GWG) as inappropriate. There was poor agreement between maternal actual and perceived PPW/GWG (Kappa = 0.366, p < 0.001; Kappa = 0.188, p < 0.001), with 27.8% of women misperceiving their PPW and 52.1% misperceiving their GWG. The results of the general linear model indicated that women who perceived their PPW as underweight (β = 0.70, p = 0.016) or overweight/obese (β = 0.86, p < 0.001), as well as those who perceived their GWG as excessive (β = 0.47, p = 0.028) were more likely to exhibit PPD status. The interaction analysis results showed that those who perceived their PPW as underweight and their GWG as insufficient (β = 1.75, p = 0.020), as well as those who perceived their PPW as overweight/obese and their GWG as excessive (β = 0.90, p = 0.001) had a positive interactive effect on the occurrence of PPD status, while underestimating PPW and GWG may be a protective factor against PPD status (β = -1.03, p = 0.037).

Conclusion: These findings support that maternal weight perception plays a role in the development of PPD status. Further improvement is needed in personalized health education for weight management, both prior to and throughout the pregnancy period. This can help women reduce weight anxiety, better understand their body image, and potentially lower the risk of developing PPD.

Keywords: gestational weight gain; postpartum depression; pre-pregnancy weight; weight perception.

Figure 1

Proportions of exact agreement between maternal actual and perceived PPW. PPW, pre-pregnancy weight. Red circles: the proportion of participants who perceived pre-pregnancy underweight. Yellow circles: the proportion of participants who perceived pre-pregnancy normal weight. Blue circles: the proportion of participants who perceived pre-pregnancy overweight/obesity. The proportion of the classification is visually depicted by the size of the circle.

Figure 2

Proportions of exact agreement between actual and perceived GWG. GWG, gestational weight gain. Red circles: the proportion of participants who perceived insufficient GWG. Yellow circles: the proportion of participants who perceived appropriate GWG. Blue circles: the proportion of participants who perceived excessive GWG. The proportion of the classification is visually depicted by the size of the circle.

Figure 3

The multiplicative interaction between PPW perception and GWG perception on PPD status. * Indicates an interaction effect between variables; PPW, pre-pregnancy weight; GWG, gestational weight gain; PPD, postpartum depression; PPPN, perceived pre-pregnancy normal weight; PPPU, perceived pre-pregnancy underweight; PPPO, perceived pre-pregnancy overweight/obesity; PAGWG, perceived appropriate GWG; PIGWG, perceived insufficient GWG; PEGWG, perceived excessive GWG. Adjusted for maternal postpartum age, region of residence, household income, education level, physical activity level, and parity.

Figure 4

The multiplicative interaction between actual and perceived agreement of PPW and that of GWG on PPD status. * Indicates an interaction effect between variables; PPW, pre-pregnancy weight; GWG, gestational weight gain; PPD, postpartum depression; PPWC, PPW consistency; PPWU, PPW underestimation; PPWO, PPW overestimation; GWGC, GWG consistency; GWGU, GWG underestimation; GWGO, GWG overestimation. Adjusted for maternal postpartum age, region of residence, household income, education level, physical activity level, and parity.