title: An exploratory factor analysis of nutritional biomarkers associated with major depression in pregnancy.
abstract: OBJECTIVE
  Major depressive disorder (MDD) during pregnancy increases the risk of adverse maternal and infant outcomes. Maternal nutritional status may be a modifiable risk factor for antenatal depression. We evaluated the association between patterns in mid-pregnancy nutritional biomarkers and MDD.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Pittsburgh, Pennsylvania, USA.
  
  
  METHODS
  Women who enrolled at ≤20 weeks' gestation and had a diagnosis of MDD made with the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) at 20-, 30- and 36-week study visits. A total of 135 women contributed 345 person-visits. Non-fasting blood drawn at enrolment was assayed for red cell essential fatty acids, plasma folate, homocysteine and ascorbic acid; serum 25-hydroxyvitamin D, retinol, vitamin E, carotenoids, ferritin and soluble transferrin receptors. Nutritional biomarkers were entered into principal components analysis.
  
  
  RESULTS
  Three factors emerged: Factor 1, Essential Fatty Acids; Factor 2, Micronutrients; and Factor 3, Carotenoids. MDD was prevalent in 21·5 % of women. In longitudinal multivariable logistic models, there was no association between the Essential Fatty Acids or Micronutrients pattern and MDD either before or after adjustment for employment, education or pre-pregnancy BMI. In unadjusted analysis, women with factor scores for Carotenoids in the middle and upper tertiles were 60 % less likely than women in the bottom tertile to have MDD during pregnancy, but after adjustment for confounders the associations were no longer statistically significant.
  
  
  CONCLUSIONS
  While meaningful patterns were derived using nutritional biomarkers, significant associations with MDD were not observed in multivariable adjusted analyses. Larger, more diverse samples are needed to understand nutrition-depression relationships during pregnancy.
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, A742 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA. bodnar@edc.pitt.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bodnar
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wisner
authors.forename: James F
authors.initials: JF
authors.lastname: Luther
authors.forename: Robert W
authors.initials: RW
authors.lastname: Powers
authors.forename: Rhobert W
authors.initials: RW
authors.lastname: Evans
authors.forename: Marcia J
authors.initials: MJ
authors.lastname: Gallaher
authors.forename: P K
authors.initials: PK
authors.lastname: Newby
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D002338:Carotenoids / Q000097:blood*; D003865:Major Depressive Disorder / Q000097:blood* / Q000209:etiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005228:Fatty Acids, Essential / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D018977:Micronutrients / Q000097:blood*; D015999:Multivariate Analysis; D009752:Nutritional Status; D010414:Pennsylvania; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000209:etiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005228:Fatty Acids, Essential; D018977:Micronutrients; D002338:Carotenoids