The Relationship between Remnant Cholesterol and Maternal Depression and Pregnancy Stress in the Second Trimester

Background Limited research currently exists on the relationship between remnant cholesterol (RC) and maternal depression as well as pregnancy stress. Objective To explore the relationship between factors such as RC and maternal depression and pregnancy stress in the second trimester, providing a scientific foundation for clinical identification and intervention strategies. Methods Pregnant women in early pregnancy (6 to 13+6 weeks of gestation) who attended regular prenatal check-ups at the Obstetrics Department of the Second Affiliated Hospital of Xinjiang Medical University from June 2020 to April 2024 were recruited as study participants. A longitudinal study design was adopted to collect baseline data and blood lipid indicators of pregnant women, followed up until the second trimester, and used the Edinburgh Postpartum Depression Scale (EPDS) and Pregnancy Pressure Scale (PPS) to evaluate the depression and stress of pregnant women. Multi-factor Logistic regression analysis was used to construct a prediction model for maternal depression and pregnancy stress. In order to further determine the factors that have the greatest impact on the outcome, the random forest (RF) algorithm was used to build the model again, and the SHAP tool was used to visually analyze the RF model results. Results This study followed 403 pregnant women from the first trimester to the second trimester, with 323 valid responses collected, resulting in a follow-up loss rate of 19.9%. After excluding inaccurate baseline data, 279 pregnant women were included in the final analysis. Results indicated that the incidence of depression was 38.7% (108/279), and the incidence of pregnancy stress was 20.8% (58/279). RC levels were significantly higher in pregnant women with depression and pregnancy stress than in those without (P<0.05). Multivariate Logistic regression identified pregnancy planning (OR=0.441, 95%CI=0.251-0.775), breakfast frequency (OR=5.086, 95%CI=2.105-12.270), and RC (OR=2.759, 95%CI=1.157-6.580) as significant factors influencing depression during the second trimester (P<0.05). Additionally, taking a midday rest (OR=0.513, 95%CI=0.276-0.953) and RC (OR=3.747, 95%CI=1.519-9.246) were significant factors associated with pregnancy stress (P<0.05). The SHAP analysis indicated that RC was the most influential factor affecting maternal depression and pregnancy stress in the second trimester. Conclusion Elevated RC levels may increase the risk of depression and stress-related events in pregnant women during the second trimester. Future research involving larger cohort studies or clinical trials is necessary to confirm these findings and elucidate causal relationships.