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Background <p>Whereas underweight and obesity have been reported as risk factors for postpartum depression (PD), in Japan, younger women tend to express a stronger preference to have a lower body mass index (BMI). In this study, we aimed to examine the association between pre-pregnancy BMI categories and PD among Japanese pregnant women, and conducted an exploratory analysis of the mediating roles of adverse birth outcomes.</p> Methods <p>This prospective study included 91,640 pregnant women from the Japan Environment and Children Study. Pre-pregnancy BMI was classified into seven categories: ≤ 16.9&#xa0;kg/m<sup>2</sup> (severe–moderate underweight), 17.0‒18.4&#xa0;kg/m<sup>2</sup> (mild underweight), 18.5‒19.9&#xa0;kg/m<sup>2</sup> (lower-normal), 20.0‒22.9&#xa0;kg/m<sup>2</sup> (mid-normal: reference), 23.0‒24.9&#xa0;kg/m<sup>2</sup> (upper-normal), 25.0‒29.9&#xa0;kg/m<sup>2</sup> (overweight), and ≥ 30&#xa0;kg/m<sup>2</sup> (obesity). PD was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale at 1 and 6&#xa0;months after childbirth (1mo and 6mo, respectively). Potential mediators included adverse birth outcomes, including cesarean delivery, low birth weight, child anomalies, and non-initiation of breastfeeding by 1mo. Logistic regression models estimated adjusted odds ratios, and a causal mediation analysis was conducted to decompose the total effect of pre-pregnancy BMI into natural direct and indirect effects through the candidate mediators.</p> Results <p>Severe–moderate underweight, overweight, and obesity were significantly associated with PD at 1mo and 6mo (1mo: OR = 1.21, 95% confidence interval [CI]: 1.08‒1.35; 6mo: OR = 1.16, 95% CI: 1.03‒1.31), and upper-normal BMI was significantly associated with PD at 1mo (OR = 1.09, 95% CI: 1.02‒1.17). Significant mediating effects of low birth weight were observed among lower BMI categories, child anomalies among higher BMI categories, and non-initiation of breastfeeding among both BMI categories.</p> Conclusions <p>Pre-pregnancy severe‒moderate underweight, overweight, and obesity were significant risk factors for PD at 1mo and 6mo, and an upper-normal BMI was a significant risk factor at 1mo. Low birth weight, child anomalies, and non-initiation of breastfeeding were possible mediators. Pregnant women with severe to moderate underweight, overweight, obesity, and upper-normal BMI are important targets for PD prevention, and possible mediators may indicate PD risk among high-risk groups.</p>

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Relationship between pre-pregnancy body mass index and postpartum depression, and the mediation effects of cesarean delivery, low birth weight, child anomaly, and breastfeeding: a prospective birth cohort in the Japan environment and children’s study

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  • 发表日期：

    2026年5月27日

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  • Yasuaki Saijo,
  • Yukihiro Sato,
  • Hiroyuki Shiotsuki,
  • Tomoki Ishikawa,
  • Eiji Yoshioka,
  • Kentaro Nakanishi,
  • Yasuhito Kato,
  • Ken Nagaya,
  • Satoru Takahashi,
  • Yoshiya Ito,
  • Mariko Itoh,
  • Hiroyoshi Iwata,
  • Takeshi Yamaguchi,
  • Reiko Kishi,
  • Michihiro Kamijima,
  • Shin Yamazaki,
  • Maki Fukami,
  • Chiharu Ota,
  • Koichi Hashimoto,
  • Kenichi Sakurai,
  • Shuichi Ito,
  • Ryoji Shinohara,
  • Hidekuni Inadera,
  • Takeo Nakayama,
  • Ryo Kawasaki,
  • Yasuhiro Takeshima,
  • Hideki Nagashima,
  • Narufumi Suganuma,
  • Mayumi Tsuji,
  • Kimitoshi Nakamura

摘要

Background

Whereas underweight and obesity have been reported as risk factors for postpartum depression (PD), in Japan, younger women tend to express a stronger preference to have a lower body mass index (BMI). In this study, we aimed to examine the association between pre-pregnancy BMI categories and PD among Japanese pregnant women, and conducted an exploratory analysis of the mediating roles of adverse birth outcomes.

Methods

This prospective study included 91,640 pregnant women from the Japan Environment and Children Study. Pre-pregnancy BMI was classified into seven categories: ≤ 16.9 kg/m2 (severe–moderate underweight), 17.0‒18.4 kg/m2 (mild underweight), 18.5‒19.9 kg/m2 (lower-normal), 20.0‒22.9 kg/m2 (mid-normal: reference), 23.0‒24.9 kg/m2 (upper-normal), 25.0‒29.9 kg/m2 (overweight), and ≥ 30 kg/m2 (obesity). PD was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale at 1 and 6 months after childbirth (1mo and 6mo, respectively). Potential mediators included adverse birth outcomes, including cesarean delivery, low birth weight, child anomalies, and non-initiation of breastfeeding by 1mo. Logistic regression models estimated adjusted odds ratios, and a causal mediation analysis was conducted to decompose the total effect of pre-pregnancy BMI into natural direct and indirect effects through the candidate mediators.

Results

Severe–moderate underweight, overweight, and obesity were significantly associated with PD at 1mo and 6mo (1mo: OR = 1.21, 95% confidence interval [CI]: 1.08‒1.35; 6mo: OR = 1.16, 95% CI: 1.03‒1.31), and upper-normal BMI was significantly associated with PD at 1mo (OR = 1.09, 95% CI: 1.02‒1.17). Significant mediating effects of low birth weight were observed among lower BMI categories, child anomalies among higher BMI categories, and non-initiation of breastfeeding among both BMI categories.

Conclusions

Pre-pregnancy severe‒moderate underweight, overweight, and obesity were significant risk factors for PD at 1mo and 6mo, and an upper-normal BMI was a significant risk factor at 1mo. Low birth weight, child anomalies, and non-initiation of breastfeeding were possible mediators. Pregnant women with severe to moderate underweight, overweight, obesity, and upper-normal BMI are important targets for PD prevention, and possible mediators may indicate PD risk among high-risk groups.