Association between anxiety, depression and gestational weight gain in pregnant women living with HIV and without HIV in Cape Town, South Africa

Dinnie, Yushra

Association between anxiety, depression and gestational weight gain in pregnant women living with HIV and without HIV in Cape Town, South Africa

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Maternal anxiety and depression are linked to adverse outcomes like low birth weight and preterm birth. Additionally, gestational weight gain (GWG) is associated with neurodevelopmental and metabolic dysfunctions in offspring. Women living with HIV (WLHIV) face additional challenges from HIV and socioeconomic factors, potentially affecting mental health and GWG. However, limited data exist on the prevalence and association of mental health conditions with GWG by HIV status. This study addresses this gap to inform interventions for improving maternal and fetal health in resource-limited settings. Methods: The study enrolled pregnant WLHIV and without HIV recruited from primary healthcare facilities in Cape Town, South Africa. Anxiety was screened using the Generalised Anxiety scale (GAD-7), and depression was measured using the 10-item Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) in early (<16 weeks) and late (32–36 weeks) pregnancy. GWG was assessed as the average weekly rate of weight gain (kg/week) between the second and third trimesters, following Institute of Medicine (IOM) guidelines. Linear regression was used to examine continuous GWG, while modified Poisson regression analysed categorical GWG outcomes. Results: Among 1594 participants (42% WLHIV), the median age of 29 years. Obesity was prevalent in nearly half the participants, with a median BMI of 29 kg/m² (IQR: 25.0 – 34.0). Anxiety prevalence was 6.4% in early and 3.2% in late pregnancy, while depression rates were 20.01% and 11.23%, respectively. Anxiety and depression were more common in women without HIV compared to WLHIV at both time points, with anxiety showing higher rates in women without HIV (early 58.82%, late 68.63%) compared to WLHIV (early 41.18%, late 31.37%). Depression followed a similar pattern (early 59.25%, late 58.42% in women without HIV vs. early 40.75%, late 43.58% in WLHIV). Median gestational weight gain (GWG) was 0.30 kg/week, with 41.41% of participants experiencing low GWG and 41.22% excessive GWG. Low GWG was more prevalent among WLHIV (20.20%), while excessive GWG was more common in women without HIV (27.35%). Neither crude nor adjusted models found significant associations between anxiety, depression, and GWG. Conclusions: The study found a high burden of depression and anxiety during pregnancy, and elevated rates of GWG outside IOM recommendations in both WLHIV and without HIV. Although no associations were observed for these two public health problems, these findings highlight the need for mental health screening and GWG monitoring in antenatal care clinics, especially in low-income populations, to improve maternal and fetal outcomes.