Skip to main content Accessibility help

Maternal early pregnancy obesity and depressive symptoms during and after pregnancy

  • Satu M. Kumpulainen (a1), Polina Girchenko (a1), Marius Lahti-Pulkkinen (a1) (a2) (a3), Rebecca M. Reynolds (a2), Soile Tuovinen (a1) (a3), Anu-Katriina Pesonen (a1), Kati Heinonen (a1), Eero Kajantie (a4) (a5) (a6), Pia M. Villa (a7), Esa Hämäläinen (a8), Hannele Laivuori (a7) (a9) (a10) and Katri Räikkönen (a1)...



Previous studies have linked maternal obesity with depressive symptoms during and after pregnancy. It remains unknown whether obesity associates with consistently elevated depressive symptoms throughout pregnancy, predicts symptoms postpartum when accounting for antenatal symptoms, and if co-morbid hypertensive and diabetic disorders add to these associations. We addressed these questions in a sample of Finnish women whom we followed during and after pregnancy.


Early pregnancy body mass index, derived from the Finnish Medical Birth Register and hospital records in 3234 PREDO study participants, was categorized into underweight (<18.5 kg/m2), normal weight (18.5–24.99 kg/m2), overweight (25–29.99 kg/m2), and obese (⩾30 kg/m2) groups. The women completed the Center for Epidemiological Studies Depression Scale biweekly during pregnancy, and at 2.4 (s.d. = 1.2) and/or 28.2 (s.d. = 4.2) weeks after pregnancy.


In comparison to normal weight women, overweight, and obese women reported higher levels of depressive symptoms and had higher odds of clinically significant depressive symptoms during (23% and 43%, respectively) and after pregnancy (22% and 36%, respectively). Underweight women had 68% higher odds of clinically significant depressive symptoms after pregnancy. Overweight and obesity also predicted higher depressive symptoms after pregnancy in women not reporting clinically relevant symptomatology during pregnancy. Hypertensive and diabetic disorders did not explain or add to these associations.


Maternal early pregnancy overweight and obesity and depressive symptoms during and after pregnancy are associated. Mental health promotion should be included as an integral part of lifestyle interventions in early pregnancy obesity and extended to benefit also overweight and underweight women.


Corresponding author

Author for correspondence: Satu M. Kumpulainen, E-mail:


Hide All
Afari, N, Noonan, C, Goldberg, J, Roy-Byrne, P, Schur, E, Golnari, G et al. (2010) Depression and obesity: do shared genes explain the relationship? Depression and Anxiety 27, 799806.
Amare, AT, Schubert, KO, Klingler-Hoffmann, M, Cohen-Woods, S and Baune, BT (2017) The genetic overlap between mood disorders and cardiometabolic diseases: a systematic review of genome wide and candidate gene studies. Translational Psychiatry 7, e1007.
Anderson, G and Maes, M (2013) Postpartum depression: psychoneuroimmunological underpinnings and treatment. Neuropsychiatric Disease and Treatment 9, 277.
Ban, L, Gibson, JE, West, J, Fiaschi, L, Oates, MR and Tata, LJ (2012) Impact of socioeconomic deprivation on maternal perinatal mental illnesses presenting to UK general practice. British Journal of General Practice 62, 671678.
Bogaerts, AF, Devlieger, R, Nuyts, E, Witters, I, Gyselaers, W, Guelinckx, I et al. (2013) Anxiety and depressed mood in obese pregnant women: a prospective controlled cohort study. Obesity Facts 6, 152164.
Brunton, PJ and Russell, JA (2008) The expectant brain: adapting for motherhood. Nature Reviews Neuroscience 9, 1125.
Chen, D, Meng, L, Pei, F, Zheng, Y and Leng, J (2017) A review of DNA methylation in depression. Journal of Clinical Neuroscience 43, 3946.
Christian, LM, Iams, JD, Porter, K and Glaser, R (2012) Epstein-Barr virus reactivation during pregnancy and postpartum: effects of race and racial discrimination. Brain Behavior and Immunity 26, 12801287.
Clarke, T-K, Hall, LS, Fernandez-Pujals, AM, MacIntyre, DJ, Thomson, P, Hayward, C et al. (2015) Major depressive disorder and current psychological distress moderate the effect of polygenic risk for obesity on body mass index. Translational Psychiatry 5, e592.
Denison, FC, Roberts, KA, Barr, SM and Norman, JE (2010) Obesity, pregnancy, inflammation, and vascular function. Reproduction 140, 373385.
Dick, KJ, Nelson, CP, Tsaprouni, L, Sandling, JK, Aïssi, D, Wahl, S et al. (2014) DNA methylation and body-mass index: a genome-wide analysis. The Lancet 383, 19901998.
Dotlic, J, Terzic, M, Babic, D, Vasiljevic, N, Janosevic, S, Janosevic, L et al. (2014) The influence of body mass index on the perceived quality of life during pregnancy. Applied Research in Quality of Life 9, 387399.
Duthie, L and Reynolds, RM (2013) Changes in the maternal hypothalamic-pituitary-adrenal axis in pregnancy and postpartum: influences on maternal and fetal outcomes. Neuroendocrinology 98, 106115.
Edvinsson, Å, Bränn, E, Hellgren, C, Freyhult, E, White, R, Kamali-Moghaddam, M et al. (2017) Lower inflammatory markers in women with antenatal depression brings the M1/M2 balance into focus from a new direction. Psychoneuroendocrinology 80, 1525.
Ertel, KA, Kleinman, K, Van Rossem, L, Sagiv, S, Tiemeier, H, Hofman, A et al. (2012) Maternal perinatal depression is not independently associated with child body mass index in the generation r study: methods and missing data matter. Journal of Clinical Epidemiology 65, 13001309.
Ertel, KA, Silveira, ML, Pekow, PS, Dole, N, Markenson, G and Chasan-Taber, L (2015) Prepregnancy body mass index, gestational weight gain, and elevated depressive symptoms in a Hispanic cohort. Health Psychology 34, 274278.
Evans, J, Melotti, R, Heron, J, Ramchandani, P, Wiles, N, Murray, L et al. (2012) The timing of maternal depressive symptoms and child cognitive development: a longitudinal study. Journal of Child Psychology and Psychiatry and Allied Disciplines 53, 632640.
Fowles, ER, Timmerman, GM, Bryant, M and Kim, S (2011) Eating at fast-food restaurants and dietary quality in low-income pregnant women. Western Journal of Nursing Research 33, 630651.
Girchenko, P, Lahti, M, Tuovinen, S, Savolainen, K, Lahti, J, Binder, EB et al. (2017) Cohort profile: prediction and prevention of preeclampsia and intrauterine growth restriction (PREDO) study. International Journal of Epidemiology 46, 13801381g.
Gissler, M and Haukka, J (2004) Finnish health and social welfare registers in epidemiological research. Norsk Epidemiologi 14, 113120.
Godfrey, KM, Reynolds, RM, Prescott, SL, Nyirenda, M, Jaddoe, VWV, Eriksson, JG et al. (2017) Influence of maternal obesity on the long-term health of offspring. The Lancet Diabetes and Endocrinology 5, 5364.
Haeri, S, Baker, AM and Ruano, R (2013) Do pregnant women with depression have a pro-inflammatory profile? Journal of Obstetrics and Gynaecology Research 39, 948952.
Jacka, FN and Berk, M (2013) Depression, diet and exercise. The Medical Journal of Australia 199, S21S23.
Jokela, M, Berg, V, Silventoinen, K, Batty, GD, Singh-Manoux, A, Kaprio, J et al. (2016) Body mass index and depressive symptoms: testing for adverse and protective associations in two twin cohort studies. Twin Research and Human Genetics 19, 306311.
Lahti, M, Savolainen, K, Tuovinen, S, Pesonen, A-K, Lahti, J, Heinonen, K et al. (2017) Maternal depressive symptoms during and after pregnancy and psychiatric problems in children. Journal of the American Academy of Child and Adolescent Psychiatry 56, 3039. e7.
Ligthart, S, Marzi, C, Aslibekyan, S, Mendelson, MM, Conneely, KN, Tanaka, T et al. (2016) DNA methylation signatures of chronic low-grade inflammation are associated with complex diseases. Genome Biology 17, 255.
Lindsay, JR and Nieman, LK (2005) The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment. Endocrine Reviews 26, 775799.
Lukose, A, Ramthal, A, Thomas, T, Bosch, R, Kurpad, AV, Duggan, C et al. (2014) Nutritional factors associated with antenatal depressive symptoms in the early stage of pregnancy among urban South Indian women. Maternal and Child Health Journal 18, 161170.
Luppino, FS, de Wit, LM, Bouvy, PF, Stijnen, T, Cuijpers, P, Penninx, BW et al. (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry 67, 220229.
Maloni, JA, Park, S, Anthony, MK and Musil, CM (2005) Measurement of antepartum depressive symptoms during high-risk pregnancy. Research in Nursing and Health 28, 1626.
McEwan, M, Lins, RJ, Munro, SK, Vincent, ZL, Ponnampalam, AP and Mitchell, MD (2009) Cytokine regulation during the formation of the fetal-maternal interface: focus on cell-cell adhesion and remodelling of the extra-cellular matrix. Cytokine and Growth Factor Reviews 20, 241249.
Mina, TH, Denison, FC, Forbes, S, Stirrat, LI, Norman, JE and Reynolds, RM (2015) Associations of mood symptoms with ante- and postnatal weight change in obese pregnancy are not mediated by cortisol. Psychological Medicine 45, 31333146.
Molyneaux, E, Pasupathy, D, Kenny, LC, McCowan, LME, North, RA, Dekker, GA et al. (2016 a) Socio-economic status influences the relationship between obesity and antenatal depression: data from a prospective cohort study. Journal of Affective Disorders 202, 124127.
Molyneaux, E, Poston, L, Ashurst-Williams, S and Howard, LM (2014) Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis. Obstetrics and Gynecology 123, 857867.
Molyneaux, E, Poston, L, Khondoker, M and Howard, LM (2016 b) Obesity, antenatal depression, diet and gestational weight gain in a population cohort study. Archives of Women's Mental Health 19, 899907.
Nagl, M, Steinig, J, Klinitzke, G, Stepan, H and Kersting, A (2016) Childhood maltreatment and pre-pregnancy obesity: a comparison of obese, overweight, and normal weight pregnant women. Archives of Women's Mental Health 19, 355365.
Nascimento, SL, Surita, FG and Cecatti, JG (2012) Physical exercise during pregnancy. Current Opinion in Obstetrics and Gynecology 24, 387394.
Nast, I, Bolten, M, Meinlschmidt, G and Hellhammer, DH (2013) How to measure prenatal stress? A systematic review of psychometric instruments to assess psychosocial stress during pregnancy. Paediatric and Perinatal Epidemiology 27, 313322.
NCD Risk Factor Collaboration (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet 387, 13771396.
O'Brien, TE, Ray, JG and Chan, WS (2003) Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology (Cambridge, Massachusetts) 14, 368374.
O'Hara, MW and McCabe, JE (2013) Postpartum depression: current status and future directions. Annual Review of Clinical Psychology 9, 379407.
Osborne, L, Clive, M, Kimmel, M, Gispen, F, Guintivano, J, Brown, T et al. (2016) Replication of epigenetic postpartum depression biomarkers and variation with hormone levels. Neuropsychopharmacology 41, 16481658.
Poston, L, Bell, R, Croker, H, Flynn, AC, Godfrey, KM, Goff, L et al. (2015) Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. The Lancet Diabetes and Endocrinology 3, 767777.
Radloff, LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385401.
Rahman, MM, Abe, SK, Kanda, M, Narita, S, Rahman, MS, Bilano, V et al. (2015) Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis. Obesity Reviews 16, 758770.
Rallis, S, Pgd, B, Skouteris, H, Wertheim, EH, Paxton, SJ (2007) Predictors of Body Image During the First Year Postpartum: A Prospective Study Predictors of Body Image During the First Year Postpartum: A Prospective Study 45, 87104.
Reynolds, RM, Allan, KM, Raja, EA, Bhattacharya, S, McNeill, G, Hannaford, PC et al. (2013) Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years. British Medical Journal 347, f4539.
Rivera, M, Locke, AE, Corre, T, Czamara, D, Wolf, C, Ching-Lopez, A et al. (2017) Interaction between the FTO gene, body mass index and depression: meta-analysis of 13701 individuals. British Journal of Psychiatry 211, 7076.
Ruhstaller, KE, Elovitz, MA, Stringer, M, Epperson, CN and Durnwald, CP (2017) Obesity and the association with maternal mental health symptoms. Journal of Maternal-Fetal and Neonatal Medicine 30, 18971901.
Ruyak, SL, Lowe, NK, Corwin, EJ, Neu, M and Boursaw, B (2016) Prepregnancy obesity and a biobehavioral predictive model for postpartum depression. Journal of Obstetric, Gynecologic and Neonatal Nursing 45, 326338.
Sahrakorpi, N, Koivusalo, SB, Stach-Lempinen, B, Eriksson, JG, Kautiainen, H and Roine, RP (2017) “The burden of pregnancy”; heavier for the heaviest? The changes in health related quality of life (HRQoL) assessed by the 15D instrument during pregnancy and postpartum in different body mass index groups: a longitudinal survey. Acta Obstetricia et Gynecologica Scandinavica 96, 352358.
Salehi-Pourmehr, H, Mohammad-Alizadeh, S, Jafarilar-Agdam, N, Rafiee, S and Farshbaf-Khalili, A (2017) The association between pre-pregnancy obesity and screening results of depression for all trimesters of pregnancy, postpartum and 1 year after birth: a cohort study. Journal of Perinatal Medicine, in press
Shelton, M, Schminkey, D and Groer, M (2014) Relationships among prenatal depression, plasma cortisol, and inflammatory cytokines. Biological Research for Nursing 17, 18.
Stommel, M and Schoenborn, CA (2009) Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001–2006. BMC Public Health 9, 421.
Sundaram, S, Harman, JS, Peoples-Sheps, MD, Hall, AG and Simpson, SH (2012) Obesity and postpartum depression: does prenatal care utilization make a difference? Maternal and Child Health Journal 16, 656667.
Torloni, MR, Betran, AP, Horta, BL, Nakamura, MU, Atallah, AN, Moron, AF et al. (2009) Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obesity Reviews 10, 194203.
Van Poppel, MNM, Hartman, MA, Hosper, K and Van Eijsden, M (2012) Ethnic differences in weight retention after pregnancy: the ABCD study. European Journal of Public Health 22, 874879.
Venkatesh, KK, Riley, L, Castro, VM, Perlis, RH and Kaimal, AJ (2016) Association of antenatal depression symptoms and antidepressant treatment with preterm birth. Obstetrics and Gynecology 127, 926933.
Vilagut, G, Forero, CG, Barbaglia, G and Alonso, J (2016) Screening for depression in the general population with the center for epidemiologic studies depression (CES-D): a systematic review with meta-analysis. PLoS ONE 11, e0155431.
Walter, S, Kubzansky, LD, Koenen, KC, Liang, L, Tchetgen Tchetgen, EJ, Cornelis, MC et al. (2015) Revisiting Mendelian randomization studies of the effect of body mass index on depression. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 168B, 108115.
World Health Organization (2000) Obesity: Preventing and Managing the Global Epidemic: Report of A WHO Consultation, vol. 894. Geneva: WHO.
Xuto, P, Sinsuksai, N, Piaseu, N, Nityasuddhi, D and Phupong, V (2012) A causal model of postpartum weight retention among Thais. Pacific Rim International Journal of Nursing Research 16, 4863.


Type Description Title
Supplementary materials

Kumpulainen et al. supplementary material
Kumpulainen et al. supplementary material 1

 Unknown (556 KB)
556 KB

Maternal early pregnancy obesity and depressive symptoms during and after pregnancy

  • Satu M. Kumpulainen (a1), Polina Girchenko (a1), Marius Lahti-Pulkkinen (a1) (a2) (a3), Rebecca M. Reynolds (a2), Soile Tuovinen (a1) (a3), Anu-Katriina Pesonen (a1), Kati Heinonen (a1), Eero Kajantie (a4) (a5) (a6), Pia M. Villa (a7), Esa Hämäläinen (a8), Hannele Laivuori (a7) (a9) (a10) and Katri Räikkönen (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed