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

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.