title: Effect of antenatal depression on maternal dietary intake and neonatal outcome: a prospective cohort.
abstract: In Pakistan, incidence of antenatal depression ranges from 18 to 80 %, which goes undiagnosed, resulting in maternal and neonatal implications. The current study aimed to examine the association of antenatal depression with maternal dietary intake and neonatal outcome.
  
  
  
  A hospital-based, prospective cohort study was conducted on 94 middle class antenatal attendees coming to a tertiary care hospital in Lahore, Pakistan at the beginning of second trimester. Participants fulfilling eligibility were enrolled consecutively after taking written informed consent. Exposure group was identified by Edinburgh Postnatal Depression Scale (EPDS) and cohort members were followed till after delivery. Maternal dietary intake was assessed by 24-h Recall and Food Frequency Checklist, while neonatal outcome was identified through patient files before discharge. Data on potential confounders was collected. Loss to follow up was 13 % (82/94). Data was collected from April-September 2013. Results for 82 participants were analyzed using SPSS version 21.
  
  
  
  EPDS screened 35/82 (43 %) eligible antenatal attendees as depressed, out of which 16/35 (20 %) were severely depressed and 19/35 (23 %) were moderately depressed. Incidence of poor maternal dietary intake was more in females with antenatal depression. Antenatal depression increased the risk of poor Healthy Eating Index (RR = 2.58, C.I 1.60-5.23, AR = 62 %), carbohydrate <175 gm (RR = 1.188, CI 0.836-1.688, AR = 15 %), protein <71 gm (RR = 1.343, CI 1.059-1.703, AR = 26 %) and fat <55 gm (RR = 2.954, CI 1.612-5.416, AR = 67 %) Incidence of neonatal outcomes included, Fetal Growth Retardation (RR = 2.70, C.I 0.69-3.70, AR = 60 %), preterm birth (RR = 1.60, C.I 0.72-2.45, AR = 54 %), low Apgar score (RR = 2.70, C.I 0.69-3.70, AR = 60 %) and Low Birth Weight (RR = 0.56, C.I 0.93-1.39, AR = -44 %).
  
  
  
  Antenatal women with depression developed poor dietary intake and had increased incidence of Fetal Growth Retardation, preterm birth and low Apgar score, but not of Low Birth Weight.
authors.affiliation: Home Economics (Food and Nutrition), College of Home Economics, Gulberg, Lahore, Pakistan. ayeshasaeed1980@hotmail.com.|Department of Nutrition Sciences, Faculty of Health Sciences, University of South Asia, 47- Tufail Road, Lahore, Pakistan. ayeshasaeed1980@hotmail.com.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Saeed
authors.affiliation: Department of Human Development and Family Studies, Govt. College of Home Economics, Gulberg, Lahore, Pakistan.
authors.forename: Tahira
authors.initials: T
authors.lastname: Raana
authors.affiliation: Kinnaird College for Women University, Lahore, Pakistan.
authors.forename: Amina Muhammad
authors.initials: AM
authors.lastname: Saeed
authors.affiliation: Department of Public Health and Community Medicine & Department of Undergraduate Medical Education, SheikhKhalifa Bin Zayed Al-Nahyan Medical College, Lahore, Pakistan.|Registrar Shaikh Zayed Medical Complex, Lahore, Pakistan.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Humayun
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003863:Depression / Q000150:complications / Q000175:diagnosis*; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology* / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight / Q000254:growth & development; D039382:Maternal Nutritional Physiological Phenomena; D011939:Mental Recall; D008875:Middle Aged; D015596:Nutrition Assessment; D010154:Pakistan / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins
keywords: Apgar score; Depression; Diet; Fetal Growth Retardation; Gestational age; Low Birth Weight; Macronutrients