Do elevated symptoms of depression predict adherence and outcomes in the UPBEAT randomised controlled trial of a lifestyle intervention for obese pregnant women?
Do elevated symptoms of depression predict adherence and outcomes in the UPBEAT randomised controlled trial of a lifestyle intervention for obese pregnant women?
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DOI：
10.1186/s12884-018-2004-x
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发表时间：
2018-09-18
影响因子：
3.1
通讯作者：
UPBEAT consortium
中科院分区：
文献类型：
--
作者：
Molyneaux E;Begum S;Briley AL;Seed PT;Howard LM;Poston L;UPBEAT consortium
对肥胖孕妇的生活方式干预已经进行了广泛的研究，但对低依从性或不良结局的预测因子知之甚少。本研究评估了肥胖孕妇行为干预的大型RCT中产前抑郁症状升高与妊娠期糖尿病、依从性和妊娠期体重增加之间的前瞻性关联。还检查了干预对随访时抑郁症状的影响。UPBEAT随机对照试验将1555名肥胖孕妇随机分组，接受饮食和体力活动生活方式干预或标准护理。在基线（妊娠15+ 0-18+ 6周）和随访（妊娠27+ 0-28+ 6周）时，使用爱丁堡产后抑郁量表评估产前抑郁症状。在妊娠27+ 0-28+ 6周时通过口服葡萄糖耐量试验评估妊娠糖尿病。依从性预先定义为接受8次干预治疗中的至少5次。妊娠期体重增加计算为妊娠前体重（估计为测量的基线体重减去1.25 kg）与妊娠34+ 0-36+ 0周末次测量体重之间的差异。由于某些变量存在大量缺失数据，因此使用多重插补来插补缺失数据。从这些分析的样本中排除妊娠27+ 0-28+ 6周时不再妊娠的女性。在多重插补后，1526名妇女被纳入这些分析; 797名（52.2%）有完整的数据。13.4%的妇女在基线时有产前抑郁症状加重。没有证据表明产前抑郁状态与妊娠期糖尿病之间存在关联（调整OR 0.80，95%CI 0.52 - 1.22，p = 0.30），依从性（校正OR 1.16，95%CI 0.63至2.15，p = 0.63）或妊娠期体重增加（校正回归系数0.52，95%CI -0.26至1.29，p = 0.19）。干预与随访时抑郁症状的变化无关（回归系数0.003，95%CI -0.49至0.49，p = 0.99）。在完整的病例分析中获得了类似的结果。在这项针对肥胖孕妇的生活方式干预的大型随机对照试验中，产前抑郁症状升高并不能预测妊娠期糖尿病、依从性或妊娠期体重增加。干预也没有影响随访时的抑郁症状。不应将抑郁症状加重的肥胖孕妇排除在生活方式干预之外。ISRCTN89971375。2008年11月28日注册。本文的在线版本（10.1186/s12884-018-2004-x）包含补充材料，可供授权用户使用。
Lifestyle interventions for obese pregnant women have been widely researched but little is known about predictors of low adherence or poor outcomes. This study evaluated the prospective associations between elevated symptoms of antenatal depression and gestational diabetes, adherence and gestational weight gain in a large RCT of a behavioural intervention for obese pregnant women. The effect of the intervention on symptoms of depression at follow-up was also examined. The UPBEAT RCT randomised 1555 obese pregnant women to receive a dietary and physical activity lifestyle intervention or standard care. Symptoms of antenatal depression were assessed with the Edinburgh Postnatal Depression Scale at baseline (15+ 0–18+ 6 weeks’ gestation) and follow-up (27+ 0–28+ 6 weeks’ gestation). Gestational diabetes was assessed with an oral glucose tolerance test at 27+ 0–28+ 6 weeks’ gestation. Adherence was pre-defined as receiving at least 5 of 8 intervention sessions. Gestational weight gain was calculated as the difference between pre-pregnancy weight (estimated as measured baseline weight minus 1.25 kg) and last measured weight at 34+ 0–36+ 0 weeks’ gestation. Due to substantial missing data in certain variables, multiple imputation was used to impute missing data. Women who were no longer pregnant at 27+ 0–28+ 6 weeks’ gestation were excluded from the sample for these analyses. One thousand five-hundered twenty-six women were included in these analyses following multiple imputation; 797 (52.2%) had complete data. 13.4% had elevated symptoms of antenatal depression at baseline. There was no evidence for associations between antenatal depression status and gestational diabetes (adjusted OR 0.80, 95%CI 0.52 to 1.22, p = 0.30), adherence (adjusted OR 1.16, 95%CI 0.63 to 2.15, p = 0.63) or gestational weight gain (adjusted regression coefficient 0.52, 95%CI -0.26 to 1.29, p = 0.19). The intervention was not associated with change in depressive symptoms at follow-up (regression coefficient 0.003, 95%CI -0.49 to 0.49, p = 0.99). Similar results were obtained in complete case analyses. Elevated symptoms of antenatal depression did not predict gestational diabetes, adherence or gestational weight gain in this large RCT of a lifestyle intervention for obese pregnant women. The intervention also did not influence symptoms of depression at follow-up. Obese pregnant women with elevated symptoms of depression should not be excluded from lifestyle interventions. ISRCTN89971375. Registered 28 November 2008. The online version of this article (10.1186/s12884-018-2004-x) contains supplementary material, which is available to authorized users.
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影响因子：
3.1
作者：
Briley AL;Barr S;Badger S;Bell R;Croker H;Godfrey KM;Holmes B;Kinnunen TI;Nelson SM;Oteng-Ntim E;Patel N;Robson SC;Sandall J;Sanders T;Sattar N;Seed PT;Wardle J;Poston L
通讯作者：
Poston L
影响因子：
9.8
作者：
Renault, Kristina M.;Norgaard, Kirsten;Secher, Niels J.
通讯作者：
Secher, Niels J.
DOI：
10.1080/02646838.2015.1118021
发表时间：
2016-03-14
影响因子：
2.5
作者：
Hill, Briony;Skouteris, Helen;McPhie, Skye
通讯作者：
McPhie, Skye
影响因子：
6.6
作者：
Molyneaux, E.;Pasupathy, D.;Howard, L. M.
通讯作者：
Howard, L. M.
影响因子：
4.9
作者：
Bogaerts, A. F. L.;Devlieger, R.;van den Bergh, B. R. H.
通讯作者：
van den Bergh, B. R. H.