• postpartum depression
• dysfunctional eating behaviours and cognitions
• postpartum outcomes

ABSTRACT
Aims of the study
1. To describe the socio-demographic and the psychopathological characteristics of a large non-clinical sample of women recruited at the 3rd month of pregnancy at the Department of Obstetrics and Gynaecology of the Azienda Ospedaliera Universitaria Pisana (Pisa, Italy), in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)’
2. To analyse the point and period prevalence and the incidence of depression during pregnancy and the postpartum period in the same sample (PND-ReScU study)
3. To compare the period prevalence and the incidence of depression during pregnancy and postpartum of women of the PND-ReScU study with and without full-blown and sub-threshold forms of Eating Disorders
4. To compare the course of anxiety and depressive symptomatology during pregnancy and postpartum of women of the PND-ReScU study with and without full-blown and sub-threshold forms of eating disorders
5. To examine the extent to which depression and anxiety in the postpartum period can be predicted by specific eating disorders, behaviours and cognitions in the total sample.
6. To evaluate the role of lifetime eating disorders and dysfunctional eating behaviours and cognitions on predicting negative perinatal and postpartum outcomes, defined as: maternal weight-gain, obstetric complications, prematurity, mode of delivery, birth-weight, Apgar score, mode of breastfeeding.
Method
1066 women between the 12th and the 15th week of gestation were recruited at the Department of Obstetrics and Gynaecology of the Azienda Ospedaliera Universitaria Pisana (Pisa, Italy) in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)’, were administered the Self-Report version of the Structured Clinical Interview for Anorexic-Bulimic Spectrum (ABS-SR lifetime version) (Mauri et al., 2000), and completed a brief self-report instrument that assessed maternal antenatal complications and both birth statistics and birth-related complications. Axis-I disorders were diagnosed with the Structured Clinical Interview for Axis-I Disorders (SCID-I) (First et al., 1995). Depressive symptoms were investigated with the Edinburgh Post-natal Depression Scale (EPDS) (Cox et al., 1987). Anxiety symptoms were assessed by the State-Trait Anxiety Inventory (STAI I-II) (Spielberger , 1983).
Results
In our sample eighty-seven (8.2%) women had a past history of Eating Disorders, and 10 women (0.9%) had a current ongoing Eating Disorder at the third month of pregnancy. In the total sample, 674 women (63,2%) completed the ABS-SR: 67 women (9,9%) had ABS ?45, and 607 (90,1%) had ABS <45.
The period prevalence of depression (DSM-IV Major Depressive Episode and Minor Depressive Episode during pregnancy was 9.7% (95%C.I.= 7.7-11.7), and the postpartum period prevalence of depression was 5.5% (95%C.I.= 3.7-7.2). The cumulative incidence of depression was 2.0% (95%C.I.= 1.0-3.0) during pregnancy and 3.3% (95%C.I.= 2.0-4.7) during postpartum period. We found that having a positive lifetime history of Eating Disorders increased about three-fold the likelihood to present depression during pregnancy (RR=3.09; 95% C.I.=1.65-5.79); we found similar results for women with a positive lifetime anorexic-bulimic spectrum compared to those without (RR=3.61; 95% C.I.=1.9-6.7). In the postpartum period these differences disappear when we consider the role of having a full-blown previous eating disorder, while they remain significant if we consider the Anorexic Bulimic Spectrum.
We found no association between current or lifetime Axis I Eating Disorders and obstetrical and gynaecological outcomes, including low birth-weight, LBW (<2500 g). The only category significantly associated with an increased risk of delivering LBW babies is “Any current Anxiety disorder excluding specific phobias” (RR=2.4 95%CI=2.15-4.91) This result remains significant also after allowing for smoking, psychopharmacological treatment and weeks of gestation (RR=3.17 95%CI=1.23-8.15).
Interestingly, we found a high rate, both of a relevant postpartum depressive symptomatology, defined as EPDS score ?13, and of post-partum depression (mDD, or MDD), diagnosed by the SCID, at the first month postpartum, in women with lifetime anorexic-bulimic spectrum phenomenology (respectively RR=4.05; 95%C.I.=1.78-9.2, and RR=3.88; 95%C.I.=1.45-10.3). The high rate of depressive phenomenology was not a function of the subject’s lifetime history of affective disorders, and in general of any previous Axis-I disorder. Similarly, these women seem to be at higher risk for developing post-partum anxiety symptoms, as defined by a STAI score >40 (RR=2.99; 95%C.I.=1.68-5.32).
In women with a lifetime Anorexic-Bulimic Spectrum, Postpartum depressive phenomenology (both EPDS?13 and MDD or mDD) seems to be associated with dysfunctional cognitions such as body dissatisfaction (e.g. feeling dissatisfied with her own appearance, or being worried that certain parts of her own body are too fat or out of proportion), behaviours such as constantly checking for fat or cellulite on thighs or legs, weight-gain phobia, and secondary social phobia. In fact, each additional item endorsed in the domain “Phobias” of the ABS-SR that investigates the above-mentioned behaviours and cognitions or lifestyles increased the likelihood of experiencing postpartum depressive symptoms or disorders respectively by 37% and 40%. In the total sample (including both women who reach ABS-SR threshold and women who do not), depression in the postpartum period seems to be associated with personality traits such as perfectionism, being overly conscientious or highly competitive, impulsivity, or dependency. In fact, each additional item endorsed in the domain “Associated features” of the ABS-SR that investigates the above-mentioned behaviours and cognitions or lifestyles increased the likelihood of experiencing postpartum depressive symptoms or disorders respectively by 26% and 30%.
Conclusions
Our results indicate that detecting dysfunctional women’s lifestyles related to body shape, weight control, and personality trait of perfectionism, dependency or impulsivity during pregnancy might help to identify a population at increased risk of developing postpartum depression.
Pregnancy may be an ideal time for intervention for women with full-blown and sub-threshold forms of eating disorder, both to mitigate the mother’s suffering during pregnancy, and to reduce the risk of mood and/or anxiety disorders in the post-partum period.