Maternal Diet Quality and Third Trimester Depression: Insights From a Nepali Birth Cohort Study

Maternal diet quality and perinatal depression significantly impact maternal and child health, yet their relationship remains underexplored in low-resource settings. This cross-sectional study examined the association between overall diet quality and risk of depression during the third trimester among 296 pregnant women receiving antenatal care at Dhulikhel Hospital, Nepal (August 2023-January 2024). Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with scores ≥ 12 indicating elevated symptoms. Diet quality was measured using an adapted Nepali version of the 23-item PrimeScreen questionnaire, generating a Prime Diet Quality Score (PDQS) ranging from 0 to 46. Multivariable logistic regression models were used to estimate the association between PDQS and depression risk, adjusting for age, education, ethnicity, occupation, parity, gestational week, physical activity, and pre-pregnancy BMI. The mean PDQS was 24.7 (SD = 3.1), and 22.3% of participants screened positive for depression. Each 1-point increase in PDQS was associated with 16% lower odds of depression (adjusted OR: 0.84; 95% CI: 0.70-0.90; p = 0.002). These findings suggest that higher overall diet quality is associated with a reduced likelihood of third trimester depression. Further longitudinal studies are warranted to assess causality and inform targeted nutritional interventions. If supported by further studies, incorporating brief dietary assessments like PrimeScreen into antenatal care may potentially offer a feasible strategy to identify women with suboptimal diet quality and co-occurring depressive symptoms in low- and middle-income countries.