title: Pregnancy complications associated with the co-prevalence of excess maternal weight and depression.
abstract: OBJECTIVE
  Obesity and depression have become prevalent pregnancy complications, individually associated with adverse perinatal health outcomes. Despite the co-prevalence of these two risk factors, their combined effects on maternal health are yet to be studied. The objective of this study was to examine the combined associations of overweight/obesity and depression with maternal and delivery complications.
  
  
  METHODS
  A retrospective cohort study of women with singleton gestations at >20 weeks, in Ontario, Canada (April 2007 to March 2010), was conducted. Our primary outcomes were a composite of maternal complications (for example, gestational hypertension, pre-eclampsia, preterm premature rupture of membranes and so on), and a composite of delivery complications (for example, caesarean delivery, shoulder dystocia, postpartum haemorrhage and so on).
  
  
  RESULTS
  The study population consisted of 70 605 women, of whom 50.3% were overweight/obese. Depression was reported in 5.0% of normal-weight women and 6.2% of overweight/obese women. The proportion of women with maternal complications was the highest among the overweight/obese depressed pregnant women (16% of normal-weight non-depressed, 22% of normal-weight depressed, 22% of overweight/obese non-depressed and 29% of overweight/obese depressed, P<0.001), as was the proportion of women with delivery complications (44%, 49%, 50% and 53%, respectively, P<0.001). Overweight/obese depressed pregnant women also experienced the highest odds of the composite of maternal complications and the composite of delivery complications (adjusted odds ratio (OR): 1.55, 95% confidence interval (CI): 1.35-1.77 and OR: 1.27, 95% CI: 1.13-1.42, respectively) after adjustment for potential confounders.
  
  
  CONCLUSIONS
  The combined associations of excess weight and depression with adverse pregnancy outcomes are important to recognize in order to focus counselling and care, both before and during pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: O
authors.initials: O
authors.lastname: Lutsiv
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: B
authors.initials: B
authors.lastname: McKinney
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Foster
authors.affiliation: Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: V H
authors.initials: VH
authors.lastname: Taylor
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Pullenayegum
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada and Department of Diagnostic Imaging, McMaster University, Hamilton, Ontario, Canada.
authors.forename: S D
authors.initials: SD
authors.lastname: McDonald
mesh_terms: D000328:Adult; D001034:Apgar Score; D015992:Body Mass Index; D002170:Canada / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003863:Depression / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011256:Pregnancy Outcome / Q000453:epidemiology / Q000523:psychology; D037841:Pregnant People / Q000523:psychology; D047928:Premature Birth / Q000453:epidemiology* / Q000523:psychology; D012189:Retrospective Studies; D012307:Risk Factors; D015430:Weight Gain