Poorer mental health and sleep quality are associated with greater self-reported reward-related eating during pregnancy and postpartum: an observational cohort study

BACKGROUND: Depression, stress, and poor-quality sleep are common during pregnancy and postpartum, but the relationship of these factors with reward-related eating is not well understood. This observational cohort study examines associations of depression, stress, and sleep quality with self-reported reward-related eating in pregnancy and postpartum. METHODS: Participants were enrolled at < 12 weeks gestation and followed through 1 year postpartum. Self-reported measures obtained at baseline and 23–31 weeks postpartum included the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Pittsburgh Sleep Quality Index; reward-related eating measures included the Power of Food Scale (assessing hedonic hunger), modified Yale Food Addiction Scale (assessing addictive-like eating), and frequency and intensity of cravings. Linear and logistic regression models estimated associations of depressive symptoms, stress, and sleep quality with reward-related eating during pregnancy and postpartum, as well as change in each predictor with change in outcome. RESULTS: During pregnancy, greater depressive symptoms (β ± SE = 0.03 ± 0.01, p < .01), higher stress (0.03 ± 0.01, p < .01), and worse sleep quality (0.03 ± 0.01, p = 0.03) were associated with greater hedonic hunger. Similarly, greater depressive symptoms (OR = 1.08, 95% CI: 1.02, 1.14, p = .01), higher stress (OR = 1.09, 95% CI: 1.04, 1.14, p = <.01), and worse sleep quality (OR = 1.09, 95% CI: 1.00, 1.18, p = .04) were associated with greater odds of addictive-like eating. These associations were also significant in postpartum except that sleep quality was not associated with hedonic hunger. Greater depressive symptoms (β ± SE = 0.06 ± 0.02, p < .01; 0.08 ± 0.02, p = <.01), higher stress (0.04 ± 0.01, p < .01; 0.06 ± 0.02, p < .01), and worse sleep quality (0.11 ± 0.03, p < .01; 0.13 ± 0.03, p < .01) during pregnancy were associated with stronger and more frequent cravings, respectively. Increased depressive symptoms from pregnancy to postpartum was associated with increased hedonic hunger (β ± SE = 1.17 ± 0.57, p = 0.01) and addictive-like eating (0.88 ± 0.33, p = 0.01), and increased stress was associated with increased hedonic hunger (1.71 ± 0.76, p = 0.02). Change in stress was not associated with change in addictive-like eating and change in sleep quality was not associated with change in either hedonic hunger or addictive-like eating. CONCLUSIONS: Greater depressive symptoms, perceived stress, and poorer sleep quality are associated with greater self-reported reward-related eating during pregnancy and postpartum, suggesting that efforts to improve diet during and after pregnancy may benefit from addressing mental health and sleep. TRIAL REGISTRATION: Clinicaltrials.gov Registration ID – NCT02217462. Date of registration – August 13, 2014 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12966-021-01124-9.