Research Methods and Analysis

Part A

1. What is the PICO-S for this study?

Population: The population of the study is women with obesity or who are overweight at the beginning of pregnancy.

Intervention/Exposure: The women under study were exposed to antenatal or post-partum mental disorders.

Comparison: Normal weight women

Outcome: The findings of the study indicate that obese women had notably higher chances of having antenatal depression compared to normal-weight women in the control group same as overweight women. Women with obesity also showed considerably higher chances of depression than overweight women, giving evidence of a dose-response relationship. Based on high-quality studies, the median prevalence of high post-partum depression symptoms was between 13% for obese women and 9.9% for women with normal weight. It was established that there were higher chances of post-partum depression among obese and overweight women than among normal-weight women. It was established that obese and overweight women had significantly higher chances of post-partum depression than women with normal weight. Moreover, obese women had considerably higher odds of post-partum depression than overweight women. Evidence showed a high risk of other types of mental disorder among women with obesity, such as anxiety, bipolar disorder, and binge eating. However, there was inadequate research to conclude about these diagnoses.

Study Design/Setting: the design used in the article was a systematic meta-analysis. It analyzed five databases, including, EMBASE, MEDLINE, CINAHL, PsyINFO, and MIDRIS maternal.

• List the Inclusion and External criteria for this study.

Inclusion Criteria: studies were included in the meta-analysis if they evaluated antenatal (at any stage of pregnancy) or post-partum (within a year following delivery) mental disorder in overweight or obese women at the beginning of pregnancy.

Exclusion criteria: studies were excluded from the review if they could not obtain or extract data for obese and overweight women disjointedly from women with normal-weight.

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Part B: Screening Studies Exercise

Part B assesses your understanding of study selection. You will need to use the studies in the Document Folder (Articles) to complete Part B.

1. In Table Below are 10 Articles. For Each Article Carry Out a Title and Abstract Screening and Indicate Whether It Would Be Included or Excluded from a Full Assessment Based on This Screening (i.e. Do not Read the Full Text)

Article	Include or exclude from full-text assessment based on Tittle and Abstract screen?	Reason for Inclusion/exclusion
Example- Rando et al. (2004) Relationship between the nutritional and psychological status of Pregnant adolescent and non-adolescents in Brazil	Include	Assesses ante-natal trait anxiety and appears to report data on weight changes over time and body mass index.
Sebire et al. (2001). Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London	Include	The study examines maternal and foetal risks associated with being obesity during pregnancy
Da Rocha & Kac (2012). High dietary ratio of omega-6 to omega-3 polyunsaturated acids during pregnancy and prevalence of post-partum depression.	Include	The article appears to report data on the association between post-partum depression and food that could lead to obesity or overweight in women.
Fowles et al. (2011). Eating at fast-food restaurants and dietary quality in low-income pregnant women.	Exclude	The article does not include information on how fast-food impact body weight and mental health of pregnant women.
Walker et al. (2006). The trajectory of weight changes in the first 6 weeks post-partum.	Include	Investigates post-partum weight change during the first 6 weeks and its correlation with psychological variables.
Kabir et al. (2008). Depression, weight gain, and low birth weight adolescent delivery: Do somatic symptoms strengthen or weaken the relationship?	Exclude	The study lacks data on maternal body weight during pregnancy that could be the contributing factor of depression.
Gavin et al. (2009). Maternal depressive symptoms, depression, and psychiatric medication use in relation to risk of preterm delivery	Exclude	Although the article investigates maternal depression and medication use in pregnancy, it does not include data on body weight associated with maternal depression.
Brown & Avery (2012). Healthy weight management during pregnancy: What advice and information is being provided.	Exclude	The article does not investigate the relationship between overweight and obese and mental disorder
Sohail & Muazzam (2012). Correlates of disordered eating behavior among pregnant women.	Exclude	The article investigates factors impacting disordered eating, but it does not show it they are related to mental health and weight gain.
Scott (2012). Parenting quality and children’s mental health: Biological mechanisms and psychological interventions	Exclude	It investigates how parenting affects children development and their mental health. It lacks data on maternal weight during pregnancy and how it affects mental health.
Freeman (2008). Perinatal psychiatry: Risk factors, treatment data, and specific challenges for clinical researchers	Exclude	The article asses how pregnancy affects psychology of women. However, it does not explore how it is associated with body weight.

2. In Table 2 Below Are 5 Articles. These Articles Were All Excluded from the Review Based on a Full Text Assessment. Read Each Article and Give a Brief Explanation of the Likely Main Reason(s) for Exclusion. You Can Write This in Note Form, or Bullet Points. An Example Has Been Provided. Write Your Answers in the Table. (20 marks)

Article	Reason for Exclusion based on full text assessment
Example – Li et al. (2012) Health-related quality of life among pregnant women with and without depression in Hubei, China	Does not report weight data/BMI at start of pregnancy – participants took part once at any point between 1st – 40th week of pregnancy and self-reported weight at the time of participation only
Hollingsworth et al. (2012). The association between maltreatment in childhood and pre-pregnancy obesity in women attending an antenatal clinic in Australia.	It does not report on mental health data after pregnancy but on childhood mental history. There is no available data regarding other factors such as weight during childhood.
Gaysina et al. (2011). Results from a British birth cohort show symptoms of depression and anxiety and change in body mass index from adolescence to adulthood.	The article does not consider data regarding the body mass index of pregnant women, but that of adolescents and adults from 15 to 53 years.
Walker et al. (2012). Ethnic-specific weight-loss interventions for low-income post-partum women: Findings and lessons.	It does not provide data on the correlation between weight loss and the mental health of pregnant women.
Berg et al. (2011) Factors associated with binge eating disorder in pregnancy.	It does not include data on the effects of binge eating disorder on pregnant women’s maternal body weight and mental health.
Magriples (2009) The effects of obesity and weight gain in young women on obstetric outcomes	The study does not provide data on the outcome of mental health associated with obesity and excess weight gain in pregnancy.

Part C: Meta-analysis Statistics

Look at the forest plot in figure 3: pooled odds of post-partum depression in obese women compared with normal-weight controls.

Answer the following questions:

1. List the Individual Studies in Figure 3 Forest Plot that Report Statistically Significant Odds Ratios.

Ban 2012, Bombard 2012, Ertel 2012, Matihasevich 2010, Sandaram 2012, Uriquia 2012, Van Poppel 2012, Walker 2004. Whether the horizontal lines of the plot forest cross the “line of null effect” is important in each study. When the horizontal lines cross the null effect line, it means that the null values are within the level of confidence and thus, they could be the true value. That means any line representing a study that cuts across the null effect line shows a statistically insignificant outcome.

• What is the Pooled Effect Estimate for the Figure 3 Forest Plot? Briefly Summarize What This Estimate Tells You in the Context of this Review.

1.30 is the point estimate when all the individual studies are combined and averaged. The horizontal point of the plotted diamond indicates statistically significant ratio for the combined studies. The estimate indicates the pooled odds of post-partum depression in obese women when it is contrasted against women of normal weight. It tells of the effect size of post-partum depression on obese and normal-weight women. 

• Comment on the Heterogeneity Between Results for the Figure 3 Comparison. Consider How the Authors Addressed Heterogeneity in the Overall Meta-Analysis.

The Heterogeneity Between the Results is Indicated by I2, which is 49.0%. Since 49% is Less Than 50% Shows that the Studies are Consistent. Therefore, the Conclusions Drawn from the Meta-analysis Forest Plan Reliable.

The authors addressed heterogeneity through ensuring that the data taken out from the reports was accurate, which sometimes was not the case. The authors also conducted a subgroup analysis or meta-regression. To reduce heterogeneity, authors were asked if the identified articles’ abstracts were available in peer-reviewed journals, and they requested for unprocessed data when the published studies did not present information in the needed format. Heterogeneity was investigated using I² statistic, and the authors avoided pooled approximations in case of large heterogeneity. Since heterogeneity was too high for pulling the prevalence, the authors used data from studies of high quality to determine the median prevalence estimations.

References

Brown, A., & Avery, A. (2012). Healthy weight management during pregnancy: What advice and information is being provided: Healthy weight management during pregnancy. Journal of Human Nutrition and Dietetics, 25(4), 378-387. https://doi.org/10.1111/j.1365-277x.2012.01231.x

Da, R. C. M., & Kac, G. (2012). High dietary ratio of omega-6 to omega-3 polyunsaturated acids during pregnancy and prevalence of post-partum depression. Maternal and Child Nutrition, 8(1), 36-48. https://doi.org/10.1111/j.1740-8709.2010.00256.x

Donofry, S. D., Germeroth, L. J., Kolko, C. R. P., Venditti, E. M., & Levine, M. D. (2020). Correlates of physical activity engagement among pregnant women with overweight and obesity. Women’s Health Issues, 30(5), 393-400.

Fowles, E., Timmerman, G., Bryant, M., & Kim, S. H. (2011). Eating at fast-food restaurants and dietary quality in low-income pregnant women. Western Journal of Nursing Research, 33(5), 630-651. https://doi.org/10.1177/0193945910389083

Freeman, M. P. (2008). Perinatal psychiatry: Risk factors, treatment data, and specific challenges for clinical researchers. Journal of Clinical Psychiatry, 69(4), 633-634.

Gavin, A. R., Holzman, C., Siefert, K., & Tian, Y. (2009). Maternal depressive symptoms, depression, and psychiatric medication use in relation to risk of preterm delivery. Women’s Health Issues, 19(5), 325-334. https://doi.org/10.1016/j.whi.2009.05.004

Gaysina, D., Richards, M., Kuh, D., Hardy, R., Hotopf, M., & Colman, I. (2011). Symptoms of depression and anxiety, and change in body mass index from adolescence to adulthood: Results from a British birth cohort. Psychological Medicine, 41(1), 175-184. https://doi.org/10.1017/s0033291710000346