The data collection of the cohort started in 2004 including 4287 children born in Pelotas (Brazil) by the time of the perinatal interview.20
By the 48-month follow-up, anthropometric information was collected from 3792 children and maternal depression was evaluated in 3748 mothers. At the age of 48 months, the prevalence of underweight was 1.7%; stunting, 3.6%; wasting, 0.6%; and overweight, 12.2%. Maternal depression at 48 months was observed in 17.9% of mothers. Longitudinal data analysis, from the 12-, 24-, and 48-month visits, revealed that 69.9% of the mothers were never depressed, 25.4% were depressed at 1 or 2 visits, and 4.7% presented long-lasting depression (at the 3 visits).
The distribution of anthropometric indices according to maternal characteristics is shown on . Family income and maternal schooling were associated to children's growth on a linear fashion. Prevalence of underweight and stunting was higher in children of mothers with non-white skin color. Prevalence of stunting in children of adolescent mothers was more than twice as high as in children of mothers ≥34 years old. The higher the maternal parity, the higher the prevalence of underweight and stunting. Pre-pregnancy maternal BMI was inversely associated to underweight, stunting, and wasting. Children from mothers who smoked during pregnancy had a prevalence of stunting twice as high as that observed in children from non-smoking mothers.
Anthropometric indices at 48 months of age according to the maternal characteristics
Family income, maternal schooling, and maternal pre-pregnancy BMI were directly associated with children's overweight, and maternal parity was inversely related (). Prevalence of overweight was higher in children of non-smoking mothers than in children of mothers who smoked during pregnancy.
Maternal depression history was positively associated with underweight and stunting (). Prevalence of underweight in children whose mothers had long-lasting depression was 3 times higher than the prevalence in children from never-depressed mothers (3.6% and 1.2%, respectively). The same was observed in relation to stunting: prevalence in children from mothers with long-lasting depression was 5.9% compared with 3.1% in children from mothers who were never depressed. Maternal depression was not associated with child's overweight.
Mean W/A, H/A, and W/H z-scores in children from mothers who were never depressed were 0.465 (±1.227), -0.0829 (±1.048), and 0.740 (±1.174), respectively. For children of mothers depressed at 1 or 2 visits, the correspondent mean z-scores were 0.252 (± 1.220), -0.271 (± 1.101), and 0.624 (± 1.160), and for children whose mothers presented long-lasting depression, the values were 0.227 (±1.242), -0.325 (±1.066), and 0.693 (±1.284), respectively. For all the anthropometric indices, means according to the 3-exposure status were statistically different.
LBW and preterm birth were associated with increased prevalence of underweight, stunting, and wasting at 4 years of age (). Being hospitalized during the first year of life resulted in a 2- to 3-fold higher proportion of growth deficits. Highest prevalence of wasting was observed in children who were never breastfed. LBW or preterm birth decreased the probability of being overweight at the age of 4 years.
Anthropometric indices at 48 months of age according to the child characteristics
The adjusted analyses focused on the relation between maternal depression and anthropometric indices at 48 months (). After adjustment, maternal depression was not associated with any of the investigated anthropometric indices (). Interaction between maternal depression and family income was tested with the Mantel-Haenszel test, and the result was statistically non-significant. Despite the lack of association, the highest odds ratios for underweight, wasting, and overweight were observed in children from mothers with long-lasting depression.
Adjusted odds ratios for anthropometric indices at 48 months of age, according to maternal depression status (EPDS ≥13)
When anthropometric outcomes were analyzed as continuous variables, the effect of long-lasting maternal depression was statistically significant in crude analyses: -0.239 (±0.098) points in W/A (P < .001), -0.242 (±0.085) in H/A (P < .001), and -0.047 (±0.094) in W/H z-score (P = .04). After allowing for family income, maternal schooling, and parity, the association lost statistical significance: -0.046 (±0.097) for W/A z-score (P = .2), -0.049 (±0.083) for H/A z-score (P= .4), and 0.059 (0.094) for W/H z-score (P = .5).
To compare only mothers from the extreme categories of the exposure, post hoc analyses were conducted to estimate the effect of being a child from a mother with EPDS ≥13 in all 3 visits against being a child of a mother with EPDS <5 (n= 575) in all 3 visits. The observed odds for being exposed to a chronically depressed mother were 3.0-, 2.0-, 2.0-, and 1.3-times higher for children with underweight, stunting, wasting, and overweight than the odds for children from mothers with EPDS <5 in all 3 visits (very similar to the odds observed in the analyses aforementioned).