Ultra-processed food intake during pregnancy and perinatal depression symptoms: a Mediterranean cohort study

Background Ultra-processed foods (UPF) are linked to many adverse health outcomes, including poor mental health. However, evidence during pregnancy remains limited. We examined associations between total and subgroup UPF intake during pregnancy and perinatal depression symptoms. Methods Longitudinal study of 726 pregnant women recruited during their first trimester (2018–2021) into the Barcelona Life Study Cohort. Dietary intake from 20 weeks' gestation was assessed with a 114-item food frequency questionnaire. UPF intake was classified using the Nova system. Depressive symptoms were measured at 32 weeks' gestation (subsample, n  = 495) and two months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Associations were assessed using generalised additive models and linear regression, adjusting for potential confounders. Analyses were conducted continuously (per 10% increase in UPF intake) and by UPF quartile expressed as the proportion of total food intake by weight. Results Median UPF intake was 17.9% of total food intake (IQR 11.5%-25.3%). Compared with women in the lowest quartile of UPF intake, adjusted EPDS scores at two months were higher among those in the third quartile (mean difference 0.79, 95% confidence interval 0.05–1.54) and fourth quartile (0.83, 0.09–1.57). Ultra-processed dairy products and sweet drinks showed positive associations with EPDS score, whereas pre-prepared meals showed an inverse association. Higher UPF intake was associated with higher prenatal EPDS scores. Conclusions Higher UPF intake during pregnancy was associated with greater perinatal depressive symptoms, associations differed across UPF subgroups. Findings highlight dietary quality during pregnancy as a potentially modifiable target for improving maternal mental health.