Advertisement

Association of Prepregnancy Dietary Patterns and Anxiety Symptoms from Midpregnancy to Early Postpartum in a Prospective Cohort of Brazilian Women

Published:March 11, 2015DOI:https://doi.org/10.1016/j.jand.2015.01.007

      Abstract

      Background

      Adherence to unhealthy dietary patterns may alter the risk of mental disorders during pregnancy and the postpartum period.

      Objective

      To analyze the association between prepregnancy dietary patterns and prospective variations on anxiety symptoms from midpregnancy to early postpartum.

      Methods

      A prospective cohort of 207 healthy pregnant women was followed at 5 to 13, 20 to 26, and 30 to 36 gestational weeks, and once at 30 to 45 days postpartum. The State-Trait Anxiety Inventory was used to evaluate anxiety symptoms at the second and third gestational trimesters and during the postpartum period. Dietary intake was assessed using a food frequency questionnaire administered during the first trimester of pregnancy that referred to the 6 months before pregnancy. Principal components analysis was used to identify dietary patterns and three prepregnancy dietary patterns were identified: common-Brazilian, healthy, and processed. Three longitudinal mixed-effect models were estimated to verify the association between dietary patterns and anxiety symptoms, adjusted for confounding variables.

      Results

      The mean anxiety symptom scores were 40.4, 40.5, and 37.2 for the second trimester, third trimester, and postpartum, respectively. The rate of variation of the State-Trait Anxiety Inventory score was 0.535 (95% CI –0.035 to 1.107; P=0.066) and –0.010 (95% CI –0.018 to –0.002; P=0.019) when accounting for gestational age and quadratic gestational age, respectively. The common-Brazilian pattern, comprised mainly of rice and beans (β=–1.200, 95% CI –2.220 to –0.181; P=0.021), and the healthy pattern comprised mostly of vegetables, fruits, fish, and tea (β=–1.290, 95% CI –2.438 to –0.134; P=0.029), were negatively associated with prospective changes in anxiety symptoms.

      Conclusions

      High adherence to the common-Brazilian or healthy patterns was negatively associated with higher anxiety symptom scores from mid-pregnancy to early postpartum in this group of Brazilian women.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Andersson L.
        • Sundström-Poromaa I.
        • Wulff M.
        • Aström M.
        • Bixo M.
        Implications of antenatal depression and anxiety for obstetric outcome.
        Obstet Gynecol. 2004; 104: 467-476
        • Marcus S.M.
        Depression during pregnancy: Rates, risks and consequences—Motherisk Update 2008.
        Can J Clin Pharmacol. 2009; 16: 15-22
        • Meijer J.L.
        • Bockting C.L.
        • Stolk R.P.
        • Kotov R.
        • Ormel J.
        • Burger H.
        Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression.
        Midwifery. 2014; 30: 526-531
        • Broekman B.F.
        • Chan Y.H.
        • Chong Y.S.
        • et al.
        The influence of anxiety and depressive symptoms during pregnancy on birth size.
        Paediatr Perinat Epidemiol. 2014; 28: 116-126
        • Linzer M.
        • Spitzer R.
        • Kroenke K.
        • et al.
        Gender, quality of life, and mental disorders in primary care: Results from the PRIMEMD 1000 study.
        Am J Med. 1996; 101: 526-533
        • Ansseau M.
        • Dierick M.
        • Buntinkx F.
        • et al.
        High prevalence of mental disorders in primary care.
        J Affect Disord. 2004; 78: 49-55
        • Almeida M.S.
        • Nunes M.A.
        • Camey S.
        • Pinheiro A.P.
        • Schmidt M.I.
        Mental disorders in a sample of pregnant women receiving primary health care in Southern Brazil.
        Cad Saude Publica. 2012; 28: 385-393
        • Faisal-Cury A.
        • Menezes P.
        • Araya R.
        • Zugaib M.
        Common mental disorders during pregnancy: Prevalence and associated factors among low-income women in São Paulo, Brazil: Depression and anxiety during pregnancy.
        Arch Womens Ment Health. 2009; 12: 335-343
        • Takahasi E.H.
        • Alves M.T.
        • Alves G.S.
        • et al.
        Mental health and physical inactivity during pregnancy: A cross-sectional study nested in the BRISA cohort study.
        Cad Saude Publica. 2013; 29: 1583-1594
        • Sanchez S.E.
        • Puente G.C.
        • Atencio G.
        • et al.
        Risk of spontaneous preterm birth in relation to maternal depressive, anxiety, and stress symptoms.
        J Reprod Med. 2013; 58: 25-33
        • Vesga-López O.
        • Blanco C.
        • Keyes K.
        • Olfson M.
        • Grant B.F.
        • Hasin D.S.
        Psychiatric disorders in pregnant and postpartum women in the United States.
        Arch Gen Psychiatry. 2008; 65: 805-815
        • Andersson L.
        • Sundström-Poromaa I.
        • Wulff M.
        • Aström M.
        • Bixo M.
        Depression and anxiety during pregnancy and six months postpartum: A follow-up study.
        Acta Obstet Gynecol Scand. 2006; 85: 937-944
        • Figueiredo B.
        • Conde A.
        Anxiety and depression in women and men from early pregnancy to 3-months postpartum.
        Arch Womens Ment Health. 2011; 14: 247-255
        • Liou S.R.
        • Wang P.
        • Cheng C.Y.
        Longitudinal study of perinatal maternal stress, depressive symptoms and anxiety.
        Midwifery. 2014; 30: 795-801
        • Giardinelli L.
        • Innocenti A.
        • Benni L.
        • et al.
        Depression and anxiety in perinatal period: Prevalence and risk factors in an Italian sample.
        Arch Womens Ment Health. 2012; 15: 21-30
        • Cullen C.L.
        • Burne T.H.
        • Lavidis N.A.
        • Moritz K.M.
        Low dose prenatal ethanol exposure induces anxiety-like behaviour and alters dendritic morphology in the basolateral amygdala of rat offspring.
        PLoS One. 2013; 8: e54924
        • Gourounti K.
        • Anagnostopoulos F.
        • Sandall J.
        Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women.
        Midwifery. 2014; 30: 628-635
        • Hurley K.M.
        • Caulfield L.E.
        • Sacco L.M.
        • Costigan K.A.
        • Dipietro J.A.
        Psychosocial influences in dietary patterns during pregnancy.
        J Am Diet Assoc. 2005; 105: 963-966
        • Blumfield M.L.
        • Hure A.J.
        • Macdonald-Wicks L.
        • Smith R.
        • Collins C.E.
        A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries.
        Nutr Rev. 2013; 71: 118-132
        • Brunst K.J.
        • Wright R.O.
        • Digioia K.
        • et al.
        Racial/ethnic and sociodemographic factors associated with micronutrient intakes and inadequacies among pregnant women in an urban US population.
        Public Health Nutr. 2013; 13: 1-11
        • Slattery M.L.
        Analysis of dietary patterns in epidemiological research.
        Appl Physiol Nutr Metab. 2010; 35 (207-110)
        • Tucker K.L.
        Dietary patterns, approaches, and multicultural perspective.
        Appl Physiol Nutr Metab. 2010; 35: 211-218
        • Oddy W.H.
        • Robinson M.
        • Ambrosini G.L.
        • et al.
        The association between dietary patterns and mental health in early adolescence.
        Prev Med. 2009; 49: 39-44
        • Vaz J.S.
        • Kac G.
        • Emmett P.
        • Davis J.M.
        • Golding J.
        • Hibbeln J.R.
        Dietary patterns, n-3 fatty acids intake from sea food and high levels of anxiety symptoms during pregnancy: Findings from the Avon Longitudinal Study of Parents and Children.
        PLoS One. 2013; 8: e67671
        • Daley C.
        • Patterson A.
        • Sibbritt D.
        • Macdonald-Wicks L.
        Unsaturated fat intakes and mental health outcomes in young women from the Australian Longitudinal Study on Women's Health.
        Public Health Nutr. 2015; 18: 546-553
        • Jacka F.N.
        • Pasco J.A.
        • Mykletun A.
        • et al.
        Association of Western and traditional diets with depression and anxiety in women.
        Am J Psychiatry. 2010; 167: 305-311
        • Bakhtiyari M.
        • Ehrampoush E.
        • Enayati N.
        • et al.
        Anxiety as a consequence of modern dietary pattern in adults in Tehran-Iran.
        Eat Behav. 2013; 14: 107-112
        • Vilela A.A.
        • Farias D.R.
        • Eshriqui I.
        • et al.
        Prepregnancy Healthy dietary pattern is inversely associated with depressive symptoms among pregnant Brazilian women.
        J Nutr. 2014; 144: 1612-1618
        • Sichieri R.
        • Everhart J.E.
        Validity of a Brazilian food frequency questionnaire against dietary recalls and estimated energy intake.
        Nutr Res. 1998; 18: 1649-1659
      1. Tabela Brasileira de Composição de Alimentos/ NEPA - UNICAMP/SP – 4 ed. rev e ampl. 2011 [Brazilian Table of Food Composition / NEPA - UNICAMP/SP and 4th ed. rev and ampl. 2011]. http://www.unicamp.br/nepa/taco/contar/taco_4_edicao_ampliada_e_revisada. Accessed September 20, 2012.

      2. Nutrient Data Laboratory SR 24 food composition tables. http://www.ars.usda.gov/Services/docs.htm?docid=22808. Accessed October 12, 2012.

        • Olinto M.T.
        • Willett W.C.
        • Gigante D.P.
        • Victora C.G.
        Sociodemographic and lifestyle characteristics in relation to dietary patterns among young Brazilian adults.
        Public Health Nutr. 2011; 14: 150-159
        • Newby P.K.
        • Tucker K.L.
        Empirically derived eating patterns using factor or cluster analysis: A review.
        Nutr Rev. 2004; 62: 177-203
        • Wirfält E.
        • Drake I.
        • Wallström P.
        What do review papers conclude about food and dietary patterns?.
        Food Nutr Res. 2013; 57: 20523
        • Spielberger C.D.
        • Smith L.H.
        Anxiety (drive), stress, and serial-position effects in serial-verbal learning.
        J Exp Psychol. 1966; 72: 589-595
        • Biaggio A.M.B.
        • Natalício L.
        • Spielberger C.D.
        The development and validation of an experimental Portuguese form of the State-Trait Anxiety Inventory.
        in: Spielberger C.D. Dias-Guerrero R. Cross-Cultural Research on Anxiety. Hemisphere/Wiley, Washington, DC1976: 29-40
        • Biaggio A.M.B.
        • Natalício L.
        Manual para o Inventário de Ansiedade Traço-Estado (IDATE).
        Centro Editor de Psicologia Aplicada-CEPA, Rio de Janeiro, RJ, Brazil1979
        • Tendais I.
        • Costa R.
        • Conde A.
        • Figueiredo B.
        Screening for depression and anxiety disorders from pregnancy to postpartum with the EPDS and STAI.
        Span J Psychol. 2014; 17: E7
        • Biaggio A.M.B.
        • Natalício L.
        • Spielberguer C.D.
        Desenvolvimento da forma experimental em português do Inventário de ansiedade traço estado (IDATE) de Spielberguer.
        Arq Bras Psicol Apl. 1977; 29 ([Development of the experimental form in Portuguese of the State-Trait Anxiety Inventory (STAI) of Spielberguer].): 31-44
        • Gordon C.C.
        • Chumlea W.C.
        • Roche A.F.
        Stature, recumbent length, and weight.
        in: Lohman T.G. Roche A.F. Martorell R. Anthropometric Standardization Reference Manual. Human Kinetics Books, Champaign, IL1988: 3-8
        • Institute of Medicine
        Weight Gain During Pregnancy: Reexamining the Guidelines.
        The National Academies Press, Washington, DC2009
        • Pinheiro J.
        • Bates D.
        Mixed Effects Models in S and S-Plus.
        Springer, New York2000
        • Singer J.D.
        • Willet J.B.
        Applied Longitudinal Data Analysis: Modeling Changes and Event Occurrence.
        Oxford University Press, New York, NY2003
        • Northstone K.
        • Emmett P.
        • Rogers I.
        Dietary patterns in pregnancy and associations with socio-demographic and lifestyle factors.
        Eur J Clin Nutr. 2008; 62: 471-479
        • Castro M.B.T.
        • Souza R.A.G.
        • Vilela A.A.F.
        • Kac G.
        Association between sociodemographics factors and dietary patterns during pregnancy.
        Rev Nutr. 2014; 27: 173-181
        • Glover V.
        Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done.
        Best Pract Res Clin Obstet Gynaecol. 2014; 28: 25-35
        • O'Hara M.W.
        • Wisner K.L.
        Perinatal mental illness: Definition, description and aetiology.
        Best Pract Res Clin Obstet Gynaecol. 2014; 28: 3-12
        • Jacka F.N.
        • Mykletun A.
        • Berk M.
        • Bjelland I.
        • Tell G.S.
        The association between habitual diet quality and the common mental disorders in community-dwelling adults: The Hordaland health study.
        Psychosom Med. 2011; 73: 483-490
        • Jacka F.N.
        • Maes M.
        • Pasco J.A.
        • Williams L.J.
        • Berk M.
        Nutrient intakes and the common mental disorders in women.
        J Affect Disord. 2012; 141: 79-85
        • Jacka F.N.
        • Pasco J.A.
        • Williams L.J.
        • Meyer B.J.
        • Digger R.
        • Berk M.
        Dietary intake of fish and PUFA, and clinical depressive and anxiety disorders in women.
        Br J Nutr. 2013; 109: 2059-2066
        • Yannakoulia M.
        • Panagiotakos D.B.
        • Pitsavos C.
        • et al.
        Eating habits in relations to anxiety symptoms among apparently healthy adults. A pattern analysis from the ATTICA Study.
        Appetite. 2008; 51: 519-525
        • Schmied V.
        • Johnson M.
        • Naidoo N.
        • et al.
        Maternal mental health in Australia and New Zealand: A review of longitudinal studies.
        Women Birth. 2013; 26: 167-178

      Biography

      A. A. F. Vilela is a doctoral student, Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, and Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.

      Biography

      C. Benaim is a master's degree student, Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, and Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.

      Biography

      J. Lepsch is a doctoral student, Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, and Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.

      Biography

      G. Kac is a professor, Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, and Graduate Program in Nutrition, Institute of Nutrition Josué de Castro, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.

      Biography

      T. J. P. Pinto is a doctoral student, National School of Public Health, Oswaldo Cruz Foundation, Nutritional Epidemiology Observatory, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.

      Biography

      F. Rebelo is a doctoral student, National School of Public Health, Oswaldo Cruz Foundation, Nutritional Epidemiology Observatory, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.

      Biography

      C. H. D. Silva is an undergraduate student, Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.

      Biography

      M. B. T. Castro is a professor, Department of Social and Applied Nutrition, Nutritional Epidemiology Observatory, Rio de Janeiro Federal University, Rio de Janeiro, Brazil.