| Using a national continuing population-based survey known as Pregnancy Risk Assessment Monitoring System (PRAMS), this study sought to determine the role that PNC utilization plays in the relationship between pre-pregnancy BMI and PPD symptoms. Two years of data, 2004 and 2005 were analyzed among women from 16 states. Two specific aims were examined: (1) the association between pre-pregnancy BMI and PPD symptoms, and (2) the association between pre-pregnancy BMI and PPD symptoms after considering PNC utilization as a moderating variable. It was predicted for the first specific aim that the odds for PPD symptoms would increase as pre-pregnancy BMI increased. For the second objective, it was predicted that the association from the first specific aim would carry over and remain the same (e.g., obese pre-pregnancy BMI would have the highest odds for PPD symptoms), but that within each pre-pregnancy BMI group, the odds for PPD symptoms would decrease as PNC utilization increased (within obese pre--pregnancy BMI, inadequate PNC would have higher odds than intermediate PNC). The general premise for PNC utilization acting as a moderating variable in this study was that PNC can help address the changes that occur during pregnancy with regards to pre-pregnancy BMI (as a biological and psychosocial stressor). Thus, delivering PNC incorporating nutrition, weight and shape changes, and addressing a woman's concerns about her weight and shape would in-turn, reduce the odds of PPD symptoms.;Since the sample used in this study included women from all pregnancy risk statuses, two risk-adjustment approaches were carried out to identify an association between pre-pregnancy BMI and PPD symptoms, and a moderating effect of PNC. One approach included all women in the dataset and used statistical analyses to risk-adjust for pregnancy risk status, and the other approach modified the design of the study by truncating the population of women to include healthy pregnancies only. Results initially showed an association between obesity and PPD symptoms, and PNC and PPD symptoms among the bivariate and multivariate analyses. However, the inclusion of a variety of control variables into the multivariate models removed these associations. Overall, for both approaches, there was no indication of a moderating effect of PNC utilization. However, results from the analyses showed that many of the women were significantly affected by a variety of medical and obstetric problems, many of which were high-risk. It is recommended that future research investigate the possible association of these problems with PPD symptoms. For practice, it is suggested that PNC providers identify the medical and obstetric problems faced by their patients, focus on both the physical and the potential psychosocial consequences of those problems, and establish suitable interventions accordingly. |
