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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2018, Vol. 12 Issue (5) : 533-541    https://doi.org/10.1007/s11684-017-0591-y
RESEARCH ARTICLE
Association of maternal depression with dietary intake, growth, and development of preterm infants: a cohort study in Beijing, China
Han Wang1, Hong Zhou1, Yan Zhang1, Yan Wang1(), Jing Sun2,3()
1. Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
2. Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, QLD 4222, Australia
3. School of Medicine, Griffith University, Gold Coast, Queensland, QLD 4222, Australia
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Abstract

This study aimed to explore the association of maternal depression with nutrient intake, growth, and development of preterm infants. A cohort study of 201 infants was conducted in Beijing. Based on the gestational age of an infant and status of the mother, the infants were divided into four groups: non-depression-fullterm (64), non-depression-preterm (70), depression-fullterm (36), and depression-preterm (31). Data on sociodemographic characteristics, nutritional intake, growth, and developmental status of children at 8 months (corrected ages) were collected using a quantitative questionnaire, a 24-Hour Dietary Recall, anthropometric measurements, and the Bayley-III scale. A multivariate analysis was used to evaluate the effects of maternal depression and preterm birth on infant growth and development. The energy, protein, and carbohydrate intake in the depression group was lower than the recommended amounts. The depression preterm groups indicated the lowest Z-scores for length and weight and the lowest Bayley-III scores. Preterm infants of depressed mothers are at high risks of poor growth and development delay.

Keywords maternal depression      preterm      infant      nutrition      growth      development     
Corresponding Author(s): Yan Wang,Jing Sun   
Just Accepted Date: 30 October 2017   Online First Date: 29 November 2017    Issue Date: 29 September 2018
 Cite this article:   
Han Wang,Hong Zhou,Yan Zhang, et al. Association of maternal depression with dietary intake, growth, and development of preterm infants: a cohort study in Beijing, China[J]. Front. Med., 2018, 12(5): 533-541.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0591-y
https://academic.hep.com.cn/fmd/EN/Y2018/V12/I5/533
 Follow-upMissingχ2 or tP
Sample size20159  
Gestational term    
Preterm101 (50.25)29 (49.15)0.020.88
Fullterm100 (49.75)30 (50.85)  
Infant gender, n (%)  0.440.5
Male106 (52.74)34 (57.63)  
Female95 (47.26)25 (42.37)  
1-min Apgar score, x±s9.90±0.419.84±0.440.850.39
5-min Apgar score, x±s9.98±0.149.95±0.221.010.31
10-min Apgar score, x±s9.99±0.129.95±0.221.190.23
Gestational age, weeks, x±s36.26±2.6036.34±3.09-0.170.86
Delivery way    
Vaginal delivery67 (33.33)19 (32.2)0.0260.87
Cesarean delivery134 (66.67)40 (67.8)  
Birthweight, g, x±s2755.6±762.62811.5±849.5-0.480.62
Birth length, cm, x±s47.40±4.5947.40±4.590.010.99
Maternal age, year, x±s30.84±3.8531.08±3.96-0.430.6
Maternal education, year, x±s16.27±2.1915.84±2.451.260.2
Family income (RMB, yuan), n (%)  1.790.4
<100 00081 (40.3)29 (49.15)  
100 001-200 000103 (51.24)27 (45.76)  
>200 00017 (8.46)3 (5.08)  
Total score of EPDS7.69±2.617.79±2.99-0.260.8
<9134 (66.67)38 (64.41)  
9–1034 (16.92)13 (22.03)  
11–1227 (13.43)6 (10.17)  
≥136 (2.99)2 (3.39)  
Tab.1  Characteristics of the followed sample and missing sample
VariablesFullterm (100/130)*Preterm (101/130) *χ2 or FP
Non-depression
(64/82) *
Depression
(36/48) *
Non-depression
(70/90) *
Depression
(31/40) *
Infant gender, n (%)
Male33 (51.56)19 (52.78)37 (52.86)17 (54.84)χ2 = 0.090.99
Female31 (48.44)17 (47.22)33 (47.14)14 (45.16)
1-min Apgar score, x±s9.98±0.139.97±0.179.81±0.559.84±0.58F = 2.560.06
5-min Apgar score, x±s10.00±0.0010.00±0.009.97±0.179.94±0.25F = 1.830.14
10-min Apgar score, x±s10.00±0.0010.00±0.009.99±0.129.94±0.25F = 2.270.08
Gestational age, week, x±s38.86±1.0038.92±1.0234.59±1.64ab34.29±1.82abχ2 = 83.64<0.01
Delivery way
Vaginal delivery25 (39.06)17 (47.22)20 (28.57)5 (16.13)abχ2 = 8.910.03
Cesarean delivery39 (60.94)19 (52.78)50 (71.43)26 (83.87)
Birthweight, g, x±s3375.94±421.133317.78±367.772195.57±528.06ab2086.45±557.84abF = 106.05<0.01
Birth length, cm, x±s50.67±1.4850.14±1.1744.46±4.83ab43.84±4.12abF = 55.68<0.01
Maternal age, year, x±s31.23±3.4130.12±3.1231.13±4.6330.26±3.55F = 1.000.39
Maternal education, year, x±s16.60±1.6816.06±2.2916.05±2.2116.29±2.95F = 0.580.56
Family income (RMB, yuan), n (%)
<100 00018 (32.14)8 (25.81)22 (31.88)7 (22.58)χ2 = 7.090.31
100001–200 00020 (35.71)16 (51.61)28 (40.58)9 (29.03)
>200 00018 (32.14)7 (22.58)19 (27.54)15 (48.39)
EPDS score within postpartum 3 days (x±s)6.16±1.6310.67±1.55a6.27±1.56b10.61±1.52acF = 117.86<0.01
<964 (100)070 (100)0
9–10020 (55.56)014 (45.16)
11–12012 (33.33)015 (48.39)
≥1304 (11.11)02 (6.45)  
Tab.2  Demographic and anthropometric measurements of infants
VariablesFullterm (100)Preterm (101)
Non-Depression (64)Depression (36)Non-Depression (70)Depression (31)
Energy (kJ)3040.64±794.282685.25±967.18a3109.25±1040.57b2649.80±1162.85ac
Protein (g)20.57±7.9517.39±7.33a22.55±8.28b17.85±8.50c
Fat (g)31.33±9.3627.14±11.85a32.67±12.20b28.81±14.49
Carbohydrate (g)91.95±28.1583.58±29.6390.30±30.9476.57±34.11ac
Diet fiber (g)1.42±1.411.55±1.241.38±1.241.32±1.10
Cholesterol (g)282.56±228.29289.92±224.31221.54±185.72236.62±171.87
Ash (g)2.45±1.132.44±1.291.77±1.20ab1.71±0.97ab
Vitamin A (μgREsd)431.12±296.82456.03±399.30500.09±236.20443.71±240.70
Tot carotene (μg)406.45±655.13437.12±709.63307.32±402.33278.12±293.12
Thiamin (mg)0.41±0.270.34±0.230.55±0.29ab0.43±0.26c
Riboflavin (mg)0.71±0.340.63±0.330.84±0.39ab0.68±0.36c
Niacin (μg)4.69±2.673.77±2.355.96±2.94ab4.47±2.66c
Vitamin C (mg)60.67±26.5657.80±28.5469.27±30.51ab55.36±29.06c
Vitamin E (mg)9.43±10.297.93±8.3016.18±11.02ab12.33±10.22 bc
Calcium (mg)530.82±318.26488.32±285.05680.18±325.28ab588.04±236.54
Phosphorus (mg)467.28±347.91375.88±285.57664.61±372.77ab492.86±321.22c
Potassium (mg)531.69±458.17426.28±337.40784.08±469.20ab549.72±409.60c
Sodium (mg)119.31±120.08133.20±173.83233.30±206.28ab131.48±111.93c
Magnesium (mg)202.78±88.21179.33±89.62133.96±64.71ab140.09±80.96ab
Iron (mg)7.07±4.876.98±4.559.76±4.77ab9.07±4.72ab
Zinc (mg)4.49±1.784.22±2.425.48±2.59ab4.47±2.54c
Selenium (μg)12.95±10.3810.42±8.2417.47±8.58ab13.03±8.54c
Copper (mg)0.51±0.280.60±0.510.64±0.27a0.52±0.29c
Manganese (mg)0.47±0.510.49±0.470.45±0.350.47±0.68
Retinol (mg)298.76±256.56310.56±389.21390.03±231.37a349.16±217.96
Tab.3  Energy and nutrient intake among 4 groups at 8 corrected months age (%)
VariablesFullterm (100)Preterm (101) 
Non-depression (64)Depression (36)Non-depression (64)Depression (36)
Energy99.04±31.8187.11±34.16101.61±36.25b93.01±38.43
Protein102.86±39.7586.96±36.66a112.73±41.40b89.27±42.48ac
Carbohydrate108.18±33.1298.33±34.85106.23±36.4090.08±40.13ac
Vitamin A123.18±84.80130.30±114.08142.88±67.48126.77±68.77
Thiamin135.40±90.59114.88±77.65181.76±96.86ab142.26±87.25c
Riboflavin142.03±68.22126.16±65.43168.43±77.51ab136.56±71.48c
Niacin156.44±89.05125.51±78.42198.55±98.09ab149.11±88.63c
Vitamin C151.67±66.39144.51±71.36173.18±76.28b138.39±72.66c
Vitamin E235.66±257.26198.31±207.51404.46±275.49ab308.32±255.44bc
Calcium212.33±127.30195.33±114.02272.07±130.11ab235.21±94.62
Phosphorus259.60±193.28208.82±158.65369.23±207.10ab273.81±178.46c
Potassium96.67±83.3077.51±61.35142.56±85.31ab99.95±74.47c
Sodium34.09±34.3138.06±49.6666.66±58.94ab37.57±31.98c
Magnesium311.97±135.71275.89±137.87206.09±99.56ab215.52±124.56ab
Iron70.70±48.7069.81±45.5497.58±47.74ab90.65±47.18ab
Zinc128.27±50.94120.55±69.27156.57±74.01ab127.81±72.44c
Selenium64.77±51.8852.08±41.1987.37±42.90ab65.15±42.68c
Copper170.40±92.02201.65±170.76214.67±90.84a172.77±97.22c
Manganese67.01±72.4370.19±67.5163.58±49.5767.54±96.66
Tab.4  Mean intake of energy and nutrients compared with the RNI in infants at 8 months corrected age among four groups (%)
VariablesFullterm (100)Preterm (101)
Non-depression (64)Depression (36)Non-depression (70)Depression (31)
Weight Z-score1.14±0.931.16±1.001.04±1.070.31±1.20abc
Length Z-score0.86±1.050.93±1.010.66±1.170.35±1.13ab
Cognitive composite score105.82±9.87105.21±8.36105.83±9.60101.61±8.10abc
Motor composite score102.41±8.99100.01±9.39100.92±7.5996.52±9.75abc
Tab.5  Comparison of growth and development in infants at 8 months corrected age among four groups
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