Abstract Body: Background: Postpartum weight retention (PPWR), even among women with normal prepregnancy BMI, is linked to worsening cardiovascular (CV) risk factors as soon as 5 years post-delivery, increasing risk for midlife CV disease. Depression or anxiety at any point during pregnancy may contribute to the development of CV risk factors postpartum, including PPWR. Little is known about the impact of mood in early pregnancy on PPWR, especially among individuals with prepregnancy overweight/obesity. This is a significant gap given the treatability of mood disorders.

Hypothesis: Women who experienced symptoms of depression or anxiety in early pregnancy are more likely to experience PPWR compared to those who do not.

Methods: Data from participants in a randomized control trial of a mobile health dietary intervention (n=453) were analyzed to examine the association between early pregnancy (10-16 weeks gestation) mood and 6-month PPWR (>105% of prepregnancy weight). Depression and anxiety were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and its 3-item anxiety subscale. Logistic regression was conducted, including a moderation analysis for intervention and control membership, controlling for BMI, socioeconomic factors, and age. Continuous EPDS scores were used in the model to assess subclinical and clinical symptoms.

Results: 15% of participants experienced PPWR. Rates of clinically significant depressive symptoms (EPDS score ≥ 13) were 10.6% and 8% in the intervention and control groups, respectively. Rates of clinically significant anxiety symptoms (EPDS anxiety subscale ≥ 6) were 17.1% and 16% in the intervention and control groups, respectively. Overall, higher EPDS scores were associated with increased odds of PPWR (OR = 1.226, p = 0.015). However, compared to control participants, intervention participants with higher EPDS scores had lower odds of PPWR (OR = 0.704, p = .038). Contrary to our hypothesis, higher EPDS anxiety subscale scores were associated with lower odds of PPWR (OR = 0.678, p = 0.024).

Conclusion: Depression is an important target for mitigating the onset of pregnancy-associated CV risk factors like PPWR. Future studies should investigate early prenatal interventions that target mental health broadly to address subclinical symptoms. Given the intervention mitigated the effect of depression on PPWR, mobile health may be a feasible approach. More research is needed to clarify the role of prenatal anxiety in PPWR and CV risk.