4. Discussion
depression, overweight or obesity, anxiety, depressive symptoms
We showed a significant increase in anxiety (+13%, In contrast to the STAI-6 (symptoms of anxiety), sense of coherence is a personality trait that indicates the ability to understand, manage and give meaning to situations. It increases resistance to stress and promotes the person’s development [We also found that symptoms of anxiety and low SOC at the start of the next pregnancy were significantly more common in women with less than 6 h of sleep per night. However, studies investigating sleep during the preconception period and its impact on mother and child outcomes are rather scarce [A remarkably high prevalence (49%) of women who experienced higher levels of anxiety (sSTAI-6 ≥ 40) at the start of the next pregnancy was shown. Most importantly, two-thirds of these women had already high levels of anxiety at 6 weeks after childbirth (i.e., during the postpartum period of the previous pregnancy), without improvement at the next pregnancy. Similarly, one-third of women who were not anxious at 6 weeks after childbirth evolved to experience levels of anxiety at the start of the next pregnancy. A possible reason for the high prevalence of levels of anxiety and depression could be the fact that we only included women with excessive GWG in a previous pregnancy, of which more than 50% were women with overweight/obesity. From recent systematic reviews, it is shown that a high maternal BMI is associated with higher levels of anxiety and depression [Women who dropped out of the study were more likely to be living with overweight or obesity before the previous pregnancy and reported worse mental health scores at 6 weeks after childbirth (A statistically significant increase in levels of depression during the interpregnancy period was shown using the GMDS questionnaire. However, this finding was not supported by the EPDS questionnaire, which is a validated and reliable scale to measure depressive symptoms in women after childbirth [The strength of our study was the use of data from a large longitudinal prospective randomized controlled trial. Furthermore, we analyzed four different mental health outcomes. Including SOC and QoL in addition to depression and anxiety provided new insights and added value to the knowledge of the overall concept of mental health [Our study also has some limitations. Firstly, our study included only women with previous excessive GWG, which is, in general, prevalent in 40–50% of women [