The Relationship Between BMI, and Depression, Anxiety and Stress Represented by the Physiologic Indicators of Vagal Response and Blood Pressure

Purpose: The purpose of this study was to determine the relationship between body mass index (BMI), and depression, anxiety and stress represented by the physiologic indicators of vagal response and blood pressure. Depression, anxiety and stress are precursors for numerous poor outcomes that may be associated with physiologic changes in the autonomic vagal response that often result in perinatal complications. However, it is unclear why some women experiencing adversity remain resilient and have positive perinatal outcomes in spite of an over-abundance of life circumstances. Individuals with attenuated response to life obstacles may exhibit a lack of physiologic adaptability in response to psychosocial factors, and may lack the self- regulatory capacity to adjust rapidly to stressful stimuli. More information is needed about the impact of stress, anxiety and depression on physiologic indicators in obese women, and if there is a difference between pregnant obese and non-obese women to provide appropriate nursing care.

 Methods: This is a comparative group study that took place at clinic associated with a large university. Using a convenience sample of 20 obese and  20 non-obese pregnant women were consented to enter the study. Blood pressure and vagal response assessments were determined followed by study participants completing the questionnaires: Perceived Stress Scale, Prenatal Psychosocial Profile, Depressive Symptoms (CES-D) scale, and the Pregnancy Related Anxiety Scale. Means and standard deviations were obtained for the physiologic indicators and T tests computed to determine significance. The SUM function in SPSS 21 was conducted to score the additive scales of the questionnaires after which Independent samples T tests were used to explore significant findings.  

Results: The mean age for participants was 29.11 years at 25.11 gestational weeks of pregnancy. Participants varied in ethnicity as 12 of the obese women were Hispanic compared to three of the non-obese women. Forty five percent of the study participants had CES-D scores exceeding the threshold score of > 16 equating to depression symptoms as reported in the literature. Non-obese women reported more depressive symptoms (mean = 17.5) and pregnancy related anxiety (mean = 18.3) than obese women (means = 11.6 & 14.6). Systolic and diastolic blood pressures were significantly higher (p.021) for the obese women (mean = 115/72 vs. 107/67). Significant differences in vagal responses were not identified.

Conclusions: .Overall, these results provide preliminary evidence that non-obese women report more depressive symptoms and pregnancy related anxiety than obese women within a sample of healthy, low-risk women. However, further research is necessary to help determine the impact of stress, depression and anxiety on vagal response and blood pressure over time. By investigating the association of stress, anxiety, and depression with physiologic indicators, individually tailored, more effective prevention and treatment strategies can be developed to enable women to achieve healthy perinatal outcomes.