Maternal depression is a serious mental health condition and does not only affect the mental health of the mother, but also the physical health of her children. One meta-analysis found that up to 19% of women in developed countries experienced an episode of depression in the 3-month prenatal period (Gavin et al., 2005).

More specifically, maternal depression has been associated with childhood obesity. A study conducted by Gross et al. (2013) found that mothers who had experienced depressive symptoms were likely to demonstrate ‘obesity-promoting practices’, which resulted in their children being classed as either overweight or obese. These practices included stopping breastfeeding early, increased television viewing and lower physical activity in their children (Burdette et al., 2003, Dennis & McQueen, 2009, Fernald et al., 2008).

Recently, Lampard, Franckle & Davison (2014) have conducted a systematic review, which aimed to look at the prospective association between maternal depression and childhood obesity.

Methods

The authors carried out the review using PRISMA guidelines. They searched a reasonable range of databases to find eligible studies published before 2 January 2013. Reference lists of relevant review articles and research studies were also searched.

257 unique citations were identified and were excluded if both authors identified the study as not meeting the inclusion criteria (n=242). Also 15 full-text articles of retained citations were independently examined by the authors which satisfied the inclusion criteria, which were subsequently included in the review (n=9).

Studies met the inclusion criteria if they were:

• In English
• Published since 1980 with full text available
• Reported a quantitative analysis of the association between maternal depression (independent variable) and an indicator of excess child weight (dependent variable)
• Included overweight or obesity status with a BMI z-score percentile, or an alternative adiposity measure (measure of fat that is found in adipose tissue) e.g. skinfold thickness
• Measured maternal depression using a validated questionnaire at any period following childbirth
• Included children aged between 2-18 years at outcome assessment
• Utilised a prospective study design with a minimum of one year follow-up

Two authors independently extracted data from all included studies and discrepancies between authors were reconciled. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale for cohort studies (Wells et al., 1996). Quality ratings were used to identify potential sources of bias and methodological areas that were poorly addressed in the included studies.

The following data was extracted: study setting and population, design, sample size, length of follow-up, measurement of exposure and outcome and results.

Nine prospective studies were included and examined the prospective association between maternal depression and child overweight (n=6), obesity (n=2) using a BMI z-score or percentile (n=5) or alternative adiposity indicators (n=3).

Studies were conducted in the US (n=5), Denmark (n=1), the Netherlands (n=1), Brazil (n=1) and one study included multiple European centres (n=1). Three out of five US studies used data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development.

Two studies examined gender specific results. Maternal depression was mainly measured within the first 6 months after childbirth (n=6) but was also examined as a unique predictor later in childhood (n=2). Three studies combined exposure across different developmental periods.

Results

Results were examined separately for episodic depression (diagnosed at a single measurement occasion) and chronic depression (diagnosed on multiple measurement occasions). Mixed results were found for the relationship between episodic depression and indicators of child adiposity. Chronic depression, but not episodic depression, was associated with greater risk for child overweight.

• All six studies that tested the association between episodic maternal depression and risk for child overweight or obesity failed to observe an effect. This may be due to parenting practices not being sustained enough to influence child weight over time

• However, results from this review suggest chronic depression may influence child overweight. This supports previous findings that link maternal depression to child weight throughout parenting practices, including diet, screen behaviours and physical activity. This makes sense, as prolonged depression would affect these childhood behaviour variables in the longer term

• Three studies observed a positive association between episodic maternal depression and overall adiposity/BMI z-score. However, the three remaining studies failed to observe an association

Heterogeneity existed in the results, but they did not systematically differ, in terms of timing measurements of the variables.

The inconsistencies in findings suggest that there may be additional factors that modify this association. For example, authors suggested that maternal depression may influence child overweight via its influence on parenting practices and child behaviour related to feeding and physical activity. The Duarte et al. (2012) study analysed in this review supports this hypothesis, as they found that boys in grade 5 with unhealthy eating habits mediated the relationship between maternal depression in kindergarten and greater BMI z-score at grade 5. Further research is needed to clarify the mechanisms of this association.

Conclusions

The authors concluded:

In summary, we identified mixed findings for the association between maternal depression and child weight outcomes. Importantly preliminary evidence suggests that chronic maternal depression, but not episodic depression, may increase risk for child overweight. 

Limitations

• Not all important outcomes were considered. Other major outcomes, such as childhood depression, quality of life, wellbeing etc. could have been investigated. This is because being exposed to parenting by a mother with depression could lead to a number of psychological problems developing as well as obvious physical ones (i.e. being overweight), and the systematic review did not explore this
• The authors were unable to conduct a meta-analysis of the quantitative data due to the heterogeneity between studies
• There were inadequate descriptions of attrition rates and loss at follow-up in several studies. This is especially important as authors may be under-estimating the association between maternal depression and child weight outcomes and loss at follow-up. Future studies should consider the influence of attrition rate on the results
• Lastly, all studies utilised self-report measures to ascertain childhood exposure to maternal depression. Young children may have blurred memories of the age at which they were exposed to maternal depression. Moreover no studies used instruments to diagnose clinical depression

• 

  The included studies were too variable for a meta-analysis to be carried out

Summary

This is the first systematic review to investigate the prospective association between exposure to maternal depression and child excess weight across the span of childhood development.

The results suggest that initiatives to prevent childhood obesity should be targeted at the mother, including identifying, involving and supporting mothers experiencing chronic depression.

There is a clear need for future research, as this field of research is still in its infancy. Longer follow-ups are needed to identify the long term effect of maternal exposure into adolescence and adulthood. Furthermore, researchers should explore other mediating and moderating factors that could influence and explain the relationship between maternal depression and child weight outcomes including parenting practices and available resources. The results from this systematic review could contribute towards important insights for obesity prevention efforts.

Links 

Lampard, A.M. Frankcle, R.L. & Davison K.K. (2014). Maternal Depression and Childhood Obesity: A Systematic Review. Preventative Medicine, 59, 60-67. [PubMed abstract]

Gross, R.S., Velazco, N.K., Briggs, B.D. & Racine, A. (2013). Maternal Depressive Symptoms and Child Obesity in Low-Income Urban Families. Academic Pediatrics, 13(4), 356-363. [PubMed abstract]

Burdette, H.L., Whitaker, R.C., Kahn, R.S. &Harvey-Berino, J. (2003). Association of maternal obesity and depressive symptoms with television-viewing time in low-income preschool children. Archives of Pediatrics & Adolescent Medicine, 157, 894-899. [PubMed abstract]

Dennis, C.L., McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics 123, 736–751. [PubMed abstract]

Duarte, C.S. Shen S., Wu, P & Must, A. (2012). Maternal depression and child BMI: longitudinal findings from a US sample. Pediatric Obesity, 7, 124-133. [PubMed abstract]

Fernald, L.C.H., Jones-Smith, J.C., Ozer, E.J., Neufeld, L.M., DiGirolamo, A.M. (2008). Maternal depressive symptoms and physical activity in very low-income children. Journal of Developmental & Behavioural Pediatrics, 29, 385-393. [PubMed abstract]

Gavin, N.I., Gaynes, B.N., Lohr, K.N., Meltzer-Brody, S., Gartlehner, G., Swinson, T. (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics & Gynecology, 106, 1071-1083. [PubMed abstract]

Wells, G., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, M., Tugwell, P. (1996).  The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-analyses. Ottawa Hospital Research Institute, Ottawa.