Inadequate Dietary Intake in Women with Antenatal Psychological Distress: A Population Based Study in Pakistan

Zia ud Din^1, , Sadaf Ambreen¹, Zafar Iqbal², Mudassar Iqbal², Summiya Ahmad³, Muhammad Hussain¹ and Pauline Emmett⁴

¹Department of Human Nutrition, the University of Agriculture, Peshawar- Pakistan

²Department of Agricultural Chemistry, the University of Agriculture, Peshawar- Pakistan

³Department of Psychology, University of Peshawar, Pakistan

⁴School of Social & Community Medicine, University of Bristol, United Kingdom

Cite this paper:
Zia ud Din, Sadaf Ambreen, Zafar Iqbal, Mudassar Iqbal, Summiya Ahmad, Muhammad Hussain and Pauline Emmett. Inadequate Dietary Intake in Women with Antenatal Psychological Distress: A Population Based Study in Pakistan. Journal of Food and Nutrition Research. 2014; 2(12):1021-1028. doi: 10.12691/jfnr-2-12-25

Abstract

This study examined the relationship of psychological distress with dietary intake of food groups, energy, macronutrients and micronutrients among pregnant women from Peshawar, Pakistan. A total of 230 pregnant women who attended antenatal care between September 2011 and December 2012, were enrolled. Psychological symptoms were assessed using Depression, Anxiety and Stress scales (DASS-42). Respondents were dichotomized into psychologically distressed (with DAS symptoms) and non-distressed groups (without DAS symptoms) based on the cut-off values for each set of symptoms of depression, anxiety and stress. Data on dietary intake, emotional support and demographic-socioeconomic characteristics were collected using pre-tested questionnaires. A total of 45% (n=104) of the respondents reported mild to severe symptoms of psychological distress. Overall, compared to women without DAS symptoms, distressed women had a tendency to consume less variety of foods, and had lower intakes of some key food groups (milk, meat and fruit). Mean dietary intake of fibre was higher in the distressed group than those without DAS symptoms (adjusted p<0.001); this was probably due to the higher intake of vegetables in this group. Mean dietary intake of calcium, iron, vitamin B3 and food variety score (FVS) were lower in distressed women (p<0.05) even after adjustment. The presence of antenatal DAS symptoms was significantly associated with low dietary diversity (below the median of FVS) (Adjusted OR = 1.98; 95% CI 1.12; 3.47). Family income and partner’s emotional support during pregnancy were also associated with low dietary diversity. There is evidence that, in comparison to women without DAS symptoms, distressed women had lower dietary intakes of animal foods and some essential micronutrients with less dietary diversity. There is a need to develop policies focusing on maternal antenatal psychological health across the globe, particularly in developing countries where the burden of maternal and infant morbidity and mortality is ever increasing.

Keywords:
dietary diversity psychological distress pregnancy Pakistan

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Hurley KM, Caulfield LE, Sacoo LM, Costigan KA, Dipietro JA. Psychosocial influences in dietary patterns during pregnancy. J Am Diet Assoc 2005; 105: 963-6.
[2]	Dohrenwend BP, Shrout PE, Egri G, Mendelsohn FS. Nonspecific psychological distress and other dimensions of psychopathology: Measures for use in the general population. Arc General Psychiat 1980; 37 (11): 1229-36.
[3]	Kim HW. Associations of Dietary Intake Levels with Ante-natal Depression in Pregnant Women. Korean J Women’s Health Nursing 2011; 17 (3): 256-64.
[4]	Chatzi L, Melaki V, Sarri K, Apostolaki I, Roumeliotaki T, Georgiou V, Vassilaki M, Koutis A, Bitsios P, Kogevinas M. Dietary patterns during pregnancy and the risk of postpartum depression: the mother-child ‘Rhea’ cohort in Crete, Greece. Pub Health Nutr 2011; 14 (9): 1663-70.
[5]	Hwang JY, Lee SE, Kim SH, Chung HW, Kim WY. Psychological distress is associated with inadequate dietary intake in Vietnamese marriage immigrant women in Korea. J Am Dietetic Assoc 2010; 110 (5): 779-85.
[6]	DiPietro JA, Millet S, Costigan K, Gurewitsch E, Caulfield L. Psychosocial influences on weight gain attitudes and behaviors during pregnancy. J Am Dietetic Assoc 2003; 103: 1314-9.
[7]	Ministry of Finance, Government of Pakistan, Islamabad (http://www.finance.gov.pk/survey/chapter_10/16_Population.pdf) Visited on 3rd September 2013.
[8]	Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: Systematic review. BMJ 2004; 328 (7443): 794-9
[9]	Zahidie A, Kazi A, Fatmi Z, Bhatti MT, Dureshahwar S. Social environment and depression among pregnant women in rural areas of Sind, Pakistan. J Pak Med Assoc 2011; 61 (12): 1183-9.
[10]	Hamirani MM, Sultana A, Ibrahim Z, Iqbal H, Sultana S. Frequency of prenatal depression in second and third trimesters of pregnancy in Karachi: A hospital based study. J Liaquat Uni Med and Health Sci 2006; 5 (3): 106-9.
[11]	Lovibond SH & Lovibond PF. Manual for the Depression Anxiety Stress Scales, 2nd Ed. 1995; Psychology Foundation of Australia, Sydney-Australia.
[12]	Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Therapy 1995; 33: 335-43.
[13]	Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Therapy 1997; 35: 79-89.
[14]	Lydon K, Dunne FP, Owens L, Avalos G, Sarma KM, O'Connor C, Nestor L, McGuire BE. Psychological stress associated with diabetes during pregnancy: A pilot study." Irish Med J 2012; 105 (5) Suppl: 26-8.
[15]	Yelland J, Sutherland G, Brown SJ. Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women." BMC Public Health 2010; 10 (1): 771-82.
[16]	Mohammad KI, Gamble J, Creedy DK. Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women. Midwifery 2011; 27 (6): e238-e245.
[17]	Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951; 16 (3): 297-34.
[18]	Hussain T. Proximate composition mineral and vitamin content of food. In: Food composition table for Pakistan, Revised edition. Islamabad: Ministry of Planning and Development. Government of Pakistan; 2001.
[19]	Food and Agriculture Organization (FAO). Guidelines for measuring household and individual dietary diversity. 2nd Version. Rome, Italy: 2007.
[20]	Kitamura T, Yoshida K, Okano T, Kinoshita K, Hayashi M, Toyoda N, Ito M, Kudo N, Tada K, Kanazawa K, Sakumoto K, Satoh S, Furukawa T, Nakano H. Multicentre prospective study of perinatal depression in Japan: Incidence and correlates of antenatal depression and postnatal depression. Arch Womens Ment Health 2006; 9: 121-30.
[21]	Qiao YX, Wang J, Li J, Ablat A. The prevalence and related risk factors of anxiety and depression symptoms among Chinese pregnant women in Shanghai. Aust NZJ Obstet Gynaecol 2009; 49: 185-90.
[22]	Britton JR. Pre‐discharge anxiety among mothers of well newborns: Prevalence and correlates. Acta paediatr 2005; 94 (12): 1771-6.
[23]	Bener A, Gerber LM, Sheikh J. Prevalence of psychiatric disorders and associated risk factors in women during their postpartum period: A major public health problem and global comparison. Int J Women's health 2012; 4: 191-200.
[24]	Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, Le Roux I, Mbewu N, Rotheram-Borus MJ. Depressed mood in pregnancy: Prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health 2011; 8: 9.
[25]	Senturk V, Abas M, Berksun O, Stewart R. Social support and antenatal depression in extended and nuclear family environments in Turkey: A cross-sectional survey. BMC psychiatry 2011; 11 (1): 48-53.
[26]	Macht M. How emotions affect eating: A five way model. Appetite 2008; 50: 1-11.
[27]	Djuric Z, Cadwell WF, Heilbrun LK, Venkatramanamoorthy R, Dereski MO, Lan R, Casey RJ. Relationships of psychosocial factors to dietary intakes of preadolescent girls from diverse backgrounds. Maternal child nutr 2006; 2 (2): 79-90.
[28]	Walker LO, Cooney AT, Riggs MW. Psychosocial and demographic factors related to health behavior in the 1st trimester. J Obstet Gyn Neonatal Nursing 1999; 28 (6): 606-14.
[29]	George GC, Hanss-Nuss H, Milani TJ, Freeland-Graves JH. Food choices of low-income women during pregnancy and postpartum. J Am Diet Assoc 2005; 105 (6): 899-907.
[30]	Mirsanjari M, Muda WAMW, Ahmad A, Othman MS, Mirsanjari MM. Diversity of Nutrient Intake in Pregnant Women with Different Nutritional Behaviors. Presented in ‘International Conference on Nutrition and Food Sciences’, Singapore. IPCBEE 2012; 39: 153-8.
[31]	Golding J, Steer C, Emmett P, Davis JM, Hibbeln J. High levels of depressive symptoms in pregnancy with low omega-3 fatty acid intake from fish. Epidemiology 2009; 20:598-603.
[32]	Dos Santos Vaz J, Kac G, Emmett P, Davis JM, Golding J, Hibbeln JR. Dietary patterns, n-3 fatty acids intake from seafood and high levels of anxiety symptoms during pregnancy: findings from the Avon Longitudinal Study of Parents and Children. PLoS ONE 2013 8(7): e67671.
[33]	McCann BS, Warnick GR, Knopp RH. Changes in plasma lipids and dietary intake accompanying shifts in perceived workload and stress. Psychosom Med 1990; 52 (1): 97-108.
[34]	Wardle J, Steptoe A, Oliver G, Lipsey Z. Stress, dietary restraint and food intake. J Psychosom Res 2000; 48 (2): 195-202.
[35]	Habhab S, Sheldon JP, Loeb RC. The relationship between stress, dietary restraint, and food preferences in women. Appetite 2009; 52 (2): 437-44.
[36]	Hyun WJ, Lee JY, Kwak CS. Dietary intakes and psychological stress of pregnant women in Taejon in relation to neonatal birth weight. Korean J Comm Nutr 1997; 2: 169-78.
[37]	Bae HS, Kim SY, Ahn HS, Cho YK. Comparison of nutrient intake, life style variables, and pregnancy outcomes by the depression degree of pregnant women. Nutr Res Prac 2010; 4 (4): 323-31.
[38]	Bodnar LM, Wisner KL. Nutrition and depression: implications for improving mental health among childbearing-aged women. Biolog psychiatry 2005; 58 (9): 679-85.
[39]	Fowles E, Gabrielson M. First trimester predictors of diet and infant birth weight in low-income pregnant women. J Community Health Nurs 2005; 22 (2): 117-30.
[40]	Le Port A, Gueguen A, Kesse-Guyot E, Melchior M, Lemogne C, Nabi H, Goldberg M, Zins M, Czernichow S. Association between dietary patterns and depressive symptoms over time: A 10-year follow-up study of the GAZEL cohort. PloS One 2012; 7: e51593.
[41]	Saha D. Socio-economic behaviour of Pukhtun tribe. Global Vision Publishing House, 2006.
[42]	Jafar TH, Chaturvedi N, Gul A, Khan AQ, Schmid CH, Levey AS. Ethnic differences and determinants of proteinuria among South Asian subgroups in Pakistan. Kidney Int 2003; 64 (4): 1437-44.
[43]	Steyn NP, Nel JH, Nantel G, Kennedy G, Labadarios D. Food variety and dietary diversity scores in children: Are they good indicators of dietary adequacy? Public Heal Nutr 2006; 9 (5): 644-650.
[44]	Bartley KA, Underwood BA, Deckelbaum RJ. A life cycle micronutrient perspective for women's health. Am J Clinical Nutr 2005; 81 (5): 1188S-93S.