Author's School

Brown School

Author's Department

Social Work

Language

English (en)

Date of Award

Fall 9-2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Lora Iannotti

Committee Members

Derek Brown; Larelle Bookhart; Lora Iannotti; Mary Kimmel; Rachel Tabak; Shannon Lenze

Abstract

The relationship between the food environment, intake, and health is complex. The purpose of this study was to evaluate if food environments in proximity to Black pregnant women in the St. Louis Metropolitan Area were associated with prenatal eating habits and if these eating habits were associated with the risk of developing depressive symptoms in pregnancy and postpartum. The study also aimed to understand if there was a relationship between prenatal eating habits and the decision to breastfeed and if the onset of postpartum depressive symptoms has any effect on this relationship. Due to the importance of nutrient-dense, anti-inflammatory foods on maternal mental health and breastfeeding intention, select foods high in critical nutrients with anti-inflammatory properties are included in aims one, two, and three. Aim one was to evaluate the relationship between the distance and density of residential food environments and prenatal dietary intake of nutrient-dense, anti-inflammatory foods in Black American participants. Aim two was to evaluate if daily prenatal intake of nutrient-dense, anti-inflammatory foods moderates the relationship between neuroinflammation biomarkers and prenatal depressive symptom onset and severity in Black American participants. Aim three was to evaluate if postpartum depressive symptom frequency and severity moderates the relationship between daily prenatal intake of nutrient-dense, anti-inflammatory foods and breastfeeding outcomes at four months postpartum. The study was a secondary analysis of the multi-wave, longitudinal eLABE study, which consists of 395 pregnant women aged 18 years or older without known pregnancy complications or substance use during pregnancy. Participants included in the current study identified as Black Americans (n=245, 67%), completed the National Institutes of Health (NIH) National Cancer Institute (NCI) Diet History Questionnaire II (DHQ-II) in pregnancy, the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy and postpartum, and the CDC Infant Feeding Practices Study II questionnaire (IFQ-R) at four months postpartum. The results of this study indicated that living closer to fast-food restaurants and further from grocery stores in pregnancy was associated with prenatal legume intake; prenatal legume intake moderated the independent effects of neuroinflammation biomarker TNF-α on the onset of “feeling anxious or worried for no good reason;” and the frequency of “feeling sad and miserable” at four months postpartum moderated the independent effects of daily prenatal citrus, melon, and berry intake on breastfeeding outcomes. The results suggest that food environments and intake are associated with perinatal depression determinants and outcomes in a sample of Black American women living in the St. Louis Metropolitan Area. Therefore, the identification of determinants and interventions that can effectively reduce perinatal depressive symptoms among Black Americans is critical. The current study identified legumes as a potential moderator of a key determinant in the pathology of perinatal depression, and future research is needed to identify if adequate and sustainable legume uptake moderates prenatal and postpartum outcomes of perinatal depression.

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