Original article The Association Between Ante- and Postnatal Depressive Symptoms and Obesity in Both Mother and Child: A Systematic Review of the Literature Jeannette Milgrom, BSc (Hons), PhD a, * , Helen Skouteris, PhD b , Tamara Worotniuk, MPsych (Clin) b , Adele Henwood, BA, Grad Dip (Psych) b , Lauren Bruce, BA, Grad Dip (Psych) b a Psychological Sciences, University of Melbourne, Melbourne, Australia b School of Psychology, Deakin University, Melbourne, Australia Article history: Received 1 August 2011; Received in revised form 6 December 2011; Accepted 12 December 2011 abstract Aim: The aim of this paper was to review the literature reporting on the relationship between ante- and postnatal maternal depressive symptoms and both maternal and childhood obesity. Method: Articles were sourced from Medline, PsychInfo, Health Source: Nursing/Academic Edition, Academic Search Premiere, and CINAHL. The search was limited to English papers published between January 2000 and June 2011 with key search terms including a combination of maternal, ante- and postnatal depression, obesity, and child. After screening, this resulted in 14 articles, 9 that addressed maternal depressive symptoms and maternal obesity and 5 that focused on maternal depressive symptoms and childhood obesity. GRADE guidelines were used to assess the quality of evidence on two outcomes: Maternal overweight/obesity (body mass index [BMI]) and childhood overweight/obesity (BMI). Results: Nine studies examined the association between postnatal depressive symptoms and maternal obesity; three were cross-sectional and six were longitudinal. None of the cross-sectional studies that examined the association between postnatal depressive symptoms and maternal obesity (BMI) reported a significant positive association. In contrast, of the six studies that used a longitudinal design, three found an association between depressive symptoms and maternal BMI. Five studies were found examining ante- and postnatal depressive symptoms and childhood obesity, four longitudinal and one cross-sectional. Three found a positive associationdthe cross-sectional study and two longitudinal studies. The quality of the evidence for the two outcomesdmaternal and childhood obesitydwas low. Conclusion: Research addressing perinatal maternal depressive symptoms and maternal obesity, as well as research addressing perinatal maternal depressive symptoms and childhood obesity, is limited, is of low quality as a body of evidence, and thus far findings have been inconclusive. Further longitudinal and prospective research, incorporating objective measures of BMI and validated measures of depression, is warranted. Copyright Ó 2012 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc. Introduction Approximately 16% of women experience depressive symp- toms in the perinatal period (during pregnancy and/or post- natally; Milgrom et al., 2008). The impact of depression on a woman is significant and wide-ranging. Symptoms of depres- sion are debilitating and include depressed mood, lack of plea- sure or interest, loss of energy, feelings of worthlessness, diminished concentration, and indecisiveness. Although it is not clear which comes first, maternal postnatal depression may be associated with maternal obesity (Hawkins & Law, 2006); a self- perpetuating cycle of low mood, inactivity, and high calorie intake is clearly implicated in a large stratum of comorbid sufferers. Further, we know that maternal postnatal depressive symptoms are associated with compromised child development, particularly impairment in child cognitive functioning and in mother–child relationships (Berlin et al., 2007; Halligan, Murray, Martins, & Cooper, 2007; Hay et al., 2001; Milgrom, Westley, & Gemmill, 2004); however, there has been very little explora- tion of how maternal depression beginning perinatally impacts on child unhealthy weight gain, in particular childhood obesity. It is possible that the impaired mother–infant relationships that commonly accompany maternal depression play a role in child weight gain. Maternal responsiveness is recognized to influence the capacity of the infant to develop self-regulation and maternal behavior may also be implicated in feeding practices and weight * Correspondence to: Professor Jeannette Milgrom, Psychological Sciences, University of Melbourne. Phone: þ613 9496 4009; fax: þ613 9496 4148. E-mail address: jeannette.milgrom@austin.org.au (J. Milgrom). www.whijournal.com 1049-3867/$ - see front matter Copyright Ó 2012 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc. doi:10.1016/j.whi.2011.12.001 Women's Health Issues 22-3 (2012) e319–e328