Chrononutrition and prenatal mental health: The relationship between food intake indicators and prenatal depressive symptomatology

Aim

Examine cross-sectional associations between mid-pregnancy food intake indicators and prenatal depressive symptomatology.

Methods

This secondary analysis of the Comparison of Two Screening Strategies for Gestational Diabetes trial (N = 718) examined domains of mid-pregnancy food intake (direct timing, energy timing, meal/snack structure, meal energy distribution, diet quality) derived from 24-hour dietary recalls. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS). Generalized linear models examined associations between food intake indicators, total, and high (EPDS ≥13) depressive symptoms.

Results

Mean (SD) EPDS score was [6.3 (4.9)]; 12.4% (n = 89) had high depressive symptoms. Eating frequency (B = 0.08 [0.02, 0.14], p = 0.009), snack frequency (B = 0.06 [0.00, 0.12], p = 0.040), nighttime snacking frequency (B = 0.06 [0.00, 0.11], p = 0.041), and total daily energy intake (B = 0.06 [0.01, 0.12], p = 0.031) were positively associated with total depressive symptoms. Energy intake from breakfast (PR = 1.2 [1.0, 1.3], p = 0.017) was associated with a higher prevalence of high depressive symptoms. Energy intake from dinner (PR = 0.81 [0.69, 0.94], p = 0.007), later timing of the first eating episode (PR = 0.83 [0.70, 0.99], p = 0.034) and first energy quartile (PR = 0.84 [0.70, 1.0], p = 0.048), were associated with a lower prevalence of high depressive symptoms.

Conclusion

These findings extend prior chrononutrition-depression literature to the prenatal period, implicating eating frequency, energy intake, and meal energy timing and distribution in depressive symptomatology during pregnancy, warranting further longitudinal investigation.

Key Messages

• Eating frequency, snacking, nighttime snacking, and longer eating windows were positively associated with increased prevalence of depressive symptomatology within the prenatal period. Each of these results align with previous literature in general adult or postpartum populations and extend to prenatal populations specifically. These results suggest the role of circadian misalignment (potentially via mechanisms including nocturnal cortisol response, serotonin and dopamine dysregulation, systemic inflammation, and delayed melatonin production) in prenatal psychopathology. Importantly, the potential bidirectional nature of food intake and depression cannot be overlooked.

• Total energy consumed per day, percentage of energy from breakfast and dinner, as well as later timing of initial energy intake and first caloric quartile were positively associated with prenatal depression. Additionally, particular indicators of dietary quality and macronutrient percentages (e.g., percentage of energy obtained from fat), were not significantly associated with prenatal depression. These findings call for future research to explore nuance regarding macronutrient consumption, energy intake percentages, meal timing regularity, and the possible implications of emotionally responsive eating in the relationship between food intake and prenatal depression

• The current study is exploratory in nature, being the first to explore a robust range of food intake indicators and their relationship to depressive symptomatology in the prenatal period. As prenatal depression is a strong predictor of worsening mental health during postpartum, it is important that future research test a priori hypotheses regarding food intake indicators and prenatal depression longitudinally in order to determine both temporal precedence and validate the associations found within our study. If validated, multiple domains of food intake may potentially provide modifiable behaviors that can protect against depression during the prenatal period.