Nau Te Whatu Māori: Exploring depression, social support, weight and healthcare discrimination during pregnancy

Abstract

Previous research has established that obesity and depression are increasing public health concerns and are shown to predict a number of medical health conditions during and after pregnancy. Recent studies have proposed that obesity may be a risk factor for post-natal depression. The co-morbid impact of depression and obesity may therefore create a particularly high-risk group, which supports the notion for increased antenatal research to explore how depressive symptoms and excessive weight gain may be related. However, there is a paucity of research examining this relationship, particularly with those who may suffer disproportionately from both health outcomes, such as hapū Māori women. In Aotearoa (New Zealand), there are marked health inequities for Māori women and their newborn children when compared with non-Māori women. These avoidable, non- biological health differences also lends support for research that seeks to understand healthcare experiences for Māori by addressing basic causes such as discrimination. This was a cross-sectional, mixed methods, Kaupapa Māori study which examined depressive symptoms, body mass-index (BMI), social support and experiences of healthcare discrimination for Māori and non- Māori women during pregnancy. Seventy- three participants were recruited through established networks, mainstream (Western-based) and Kaupapa Māori health providers. Two participants also participated in semi-structured interviews. Quantitative results showed that higher pre-pregnancy BMI was related to increased depressive symptoms in pregnancy, and this relationship was moderated by high social support. A positive correlation was observed between high suburb deprivation and BMI. No significant ethnic group differences were observed in depression, social support, or perceived discrimination. Qualitative results illustrated a disparity between the complexity of participants’ lives and current antenatal care services. Wairuatanga/spirituality was one element that was observed but there were also other mismatches centring on poverty, whānau support, housing and narrow understandings of health. While significant differences in perceived discrimination and depression were not demonstrated, it does not necessarily mean that this is not plausible. The methodological limitations associated with both may have impeded results. Future research may yield different results by measuring other, more prevalent, forms of discrimination. The noteworthy findings pertaining to antenatal depression including its prevalence and link to weight supports the call for future research which explores its link to post-partum depression and/or the efficacy of antenatal screening measures and Kaupapa Māori maternity services.