Sabrina Karim

Date of Award

Summer 2022

Document Type

Open Access Dissertation


Epidemiology and Biostatistics

First Advisor

Jihong Liu



Perinatal depression is one of the most common and underdiagnosed obstetric complications. Extant research on perinatal depression is mostly focused on white women and women who are not at risk for depression. Little is known about the trajectories, prevention strategies and adverse outcomes of perinatal depression among high-risk populations, for example, women with overweight and obesity or women of color or low socioeconomic status.


Our study examined the longitudinal trajectories of perinatal depression, effect of a behavioral lifestyle intervention on perinatal depression and association between prenatal physical activity and perinatal depression among women with overweight and obesity. We also assessed the association between antenatal depressive symptoms and adverse birth outcomes among women with low socio-economic status and determine whether receiving mental health services from Healthy Start program reduced the odds of the adverse birth outcomes among those with antenatal depressive symptoms.


Data from a RCT of 217 pregnant women with overweight and obesity was used to identify trajectories and effective prevention strategy. We used data of 1,922 women with singleton pregnancy from the Midlands Healthy Start program, South Carolina vi between 2010-2019 to assess the association between antenatal depressive symptoms and adverse birth outcomes.


We identified three stable trajectories of depressive symptoms, among women with overweight and obesity, from early pregnancy to one year postpartum: mild-stable (63.1%), moderate-stable (34.4%), and high stable (2.5%). Increased perceived stress at early pregnancy (≤ 16 weeks pregnancy) was a risk factor for both moderate- and highstable trajectory groups. Medicaid recipients (Adjusted OR 3.04, 95% CI 1.17-7.83) had higher odds of being in the moderate-stable depressive symptoms group compared to low stable group. We did not find any significant intervention effect on perinatal depressive symptoms. However, pregnant women who met the 2018 physical activity guidelines at one (AOR 0.07, 95% CI 0.01-0.76) or both time points (AOR 0.08, 95% CI 0.01-0.69) during pregnancy had lower odds of probable minor postpartum depression at six months after delivery than women who never met the physical activity guidelines during pregnancy. No significant associations were found between antenatal depressive symptoms and adverse birth outcomes. Mothers with antenatal depressive symptoms who received services for depression had significantly lower odds of small for gestational age (AOR 0.38, 95% CI 0.18, 0.81) compared to those who did not receive any services during antenatal period. We did not find any significant association between type of MHS services and preterm birth and low birth weight.


Our findings of the chronic, moderate, and high level of symptoms underscore the need for the early detection and treatment of depression during the prenatal period. Our vii findings also shed light on the benefit of meeting physical activity guidelines during pregnancy on mental health during postpartum period. Future studies are needed to develop and evaluate interventions, especially tailored for women with overweight and obesity, to reduce the risk of perinatal depression.


© 2022, Sabrina Karim

Available for download on Saturday, October 05, 2024

Included in

Epidemiology Commons