Associations Between Postpartum Depression and Child Overweight and Obesity: Mediating Effect of Maternal Feeding Behaviors and Beliefs
Purpose. Postpartum depression (PPD) is a mental condition that significantly affects 10% to 25% of women within the first year after the birth of their child. The mother-infant relationship is key to child growth. Previous studies have shown that PPD has a detrimental effect on children’s physical and psychological well-being as it affects the child through the mother’s parenting behavior. Depressed mothers show a lack of engagement with their children, which could extend to feeding practices influencing weight gain. The prevalence and severity of childhood overweight and obesity is a global public health problem. An increase in weight gain in infancy can be the initiation of childhood and adult overweight and obesity. We investigated the association between postpartum depression and child overweight and obesity, evaluating maternal feeding practices and beliefs as mediating factors in this relationship. Methods. We performed a secondary analysis on data from 1,425 mother/child dyads from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study that enrolled healthy pregnant women in Shelby County, Tennessee, from 2006 through 2011. We performed logistic regression analysis to investigate the relationship between PPD and child BMI trajectories from birth to 4-6 years, and child overweight and obesity at years 1, 2, 3, 4 – 6; multiple linear regression to investigate the relationship between PPD measured at 4 weeks and maternal feeding behaviors and beliefs as measured by the Infant Feeding Questionnaire (IFQ); and causal mediation analysis to investigate the association between PPD, maternal feeding behaviors and beliefs, and child overweight and obesity. Results. There was a significant association between PPD and child overweight and obesity at 1 year (p = 0.01, OR = 1.04, 95% CI = 1.008, 1.06). The association with the BMI trajectories and child overweight and obesity at 2, 3, and 4 – 6 years was non-significant. We found a significant association between PPD and five maternal feeding behaviors and beliefs. After evaluating the association between these 5 factors and childhood overweight and obesity, two factors were significant. Both concern for the child undereating or becoming underweight (p = 0.002, B = 0.99, 95% CI = 0.98, 0.995) and concern for the child overeating or becoming overweight (p = <.0001, B = 1.02, 95% CI = 1.01, 1.03) mediated the relationship between PPD and child overweight and obesity. Conclusion. Our study supports evidence that PPD is associated with the risk of children being overweight and obese at 1 year of age. While our study found a mediating association between PPD, maternal feeding behaviors and beliefs, and childhood overweight and obesity, more research is needed to fully understand these relationships. This includes controlling for potential confounders in the design and analysis phases to provide an estimate of the causal effects of the associations described above.