Evaluation of the relationship between depression, anxiety, stress and nutritional status in pregnant women with and without constipation

Pregnancy is a risky period that begins with fertilization and consists of three trimesters during which many physiological, psychological, and metabolic changes occur for both the expectant mother and the fetus. During this period, changes in the endocrine, musculoskeletal, reproductive, and gastrointestinal systems help the mother and fetus adapt to this stage, but some side effects may also occur. Nutrition is extremely important during this time for both the mother and the fetus, as it ensures that the expectant mother goes through the process comfortably and healthily, supports the adequate and balanced growth of the fetus, and helps minimize or prevent possible side effects. Symptoms observed in pregnant women include nausea, vomiting, food cravings, constipation, depression, anxiety, and stress, which may result from the adaptation process of pregnancy as well as being in mutual interaction with gut health. In this study, the relationship between depression, anxiety, stress, and nutritional status of pregnant women with and without constipation was examined, and how these conditions were affected by general characteristics, anthropometric measurements, and physical activity features of the participants was evaluated. In order to investigate the relationship between constipation status and mood of the pregnant women participating in the study, a face-to-face questionnaire was applied. The questionnaire included questions regarding participants' general information, health information and lifestyle habits, nutritional habits, defecation patterns, physical activity features, anthropometric measurements, biochemical findings, and the Depression Anxiety Stress Scale-21 (DASS-21). A total of 38 (50%) pregnant women with constipation and 38 (50%) without constipation, aged between 18–49 years, were included in the study. Among the pregnant women with constipation, 26 (68.4%) were in the second trimester and 12 (31.6%) were in the third trimester, while in the control group, 19 (50%) were in the second trimester and 19 (50%) were in the third trimester. In the study group, the frequency of defecation was as follows: 42.1% had defecation three times per week, 26.3% once every two days, 31.6% once per day, and 0% twice per day. In the control group, these rates were 2.6%, 5.3%, 63.2%, and 28.9%, respectively, which was statistically significant (p<0.05). Regarding the feeling of incomplete evacuation, 73.7% of pregnant women in the study group responded "yes" and 26.3% "no," whereas in the control group these rates were 7.9% and 92.1%, respectively, showing a significant difference (p<0.05). In the study group, 94.7% of the pregnant women had hard stool consistency and 5.3% had soft stool, whereas in the control group these rates were 5.3% and 94.7%, respectively, showing a significant difference (p<0.05). When the risk levels of depression, anxiety, and stress factors were examined, the majority of pregnant women in the study group were found to be above the risk threshold in stress and anxiety levels; however, the difference was not statistically significant (p>0.05). The daily fat intake of pregnant women in the study group was found to be significantly higher among those with depression scores below 5 (92.7 ± 49.83 g) compared to those with depression scores of 5 and above (61.4 ± 28.33 g) (p<0.05). Similarly, the daily vitamin A intake of pregnant women in the study group was significantly higher among those with depression scores below 5 (1254.6 ± 661.68 µg) compared to those with depression scores of 5 and above (611.3 ± 354.63 µg) (p<0.05). As a result of the study, insights were obtained regarding the relationship between depression, anxiety, stress, and nutritional status of the study and control groups. Anxiety and stress scores were found to be higher in pregnant women experiencing constipation compared to those without constipation. According to the results of this study, it is considered important to implement education and planning in order to prevent or alleviate the metabolic and psychological problems experienced by pregnant women.