Thirteen percent of new mothers suffer from postpartum depression (PPD) making it the most common complication of childbirth. In the nonpregnant population, there is a positive relationship between obesity and symptoms of depression. Additionally, prenatal stress and prenatal depression are significant risk factors for PPD. The purpose of this study was to test a biobehavioral model of the relationship between pre-pregnancy body mass index (BMI) and symptoms of depression at four weeks

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... m. It was hypothesized that pre-pregnancy BMI is positively associated with symptoms of depression at four weeks postpartum and mediated by third trimester proinflammatory markers (IL-6, TNF-α, and leptin) and biobehavioral markers of stress (symptoms of depression, perceived stress, and cortisol). An integrated model of the Psychoneuroimmunological Framework and the Transactional Model of Stress and Coping guided the study. A secondary analysis of data from a longitudinal, biobehavioral repeated measures study of women during the third trimester of pregnancy through six months postpartum was conducted. Descriptive statistics, correlations using Pearson's r, principal component analysis, and path analysis with principal component (PC) variables were used to iteratively test the model. Correlation analysis findings included a small correlation between pre-pregnancy BMI and IL-6 (r=0.22, p=0.018), a medium iv correlation between pre-pregnancy BMI and leptin (r=0.43, p=0.000), a high medium correlation between third trimester Edinburg Postnatal Depression Scale (EPDS) scores and EPDS scores at four weeks postpartum (r=0.48, p=0.000) as well as between third trimester Perceived Stress Scale (PSS) scores and EPDS scores at four weeks postpartum (r=0.49, p=0.000). Path analysis findings included a strong effect from the stress PC to EPDS scores at four weeks postpartum (standardized coefficient = .53, p<0.001). There was a very small, statistically insignificant total effect of pre-pregnancy BMI on EPDS scores at four weeks postpartum (standardized coefficient = .058). These findings emphasize the need for a paradigm shift in perinatal care from reactionary care to preventative care with risk screening for PPD beginning in the preconceptual period or the first trimester of pregnancy. Future research is indicated to investigate the feasibility of perceived stress as measured by the PSS as a predictor of symptoms of PPD. The form and content of this abstract are approved. I recommend its publication. Approved: Nancy K. Lowe v DEDICATION "The good life is a process, not a state of being. It is a direction, not a destination." These are the words of Carl Rogers and I have come to hold them true over the past few years. What I believed to be a final destination has become a direction for my future path in both the art and science of nursing. I want to dedicate this work to my husband John K. Ruyak who has always understood my desire to improve the health of women and children and particularly my passion for the sacred miracle of birth. Without his unconditional love and constant presence by my side the journey would have been impossible. I also want to dedicate this work to my sons John, Patrick, and Ryan. For many years we have all been students together and their support of my dreams has meant the world. I want to thank my dear friend Elizabeth Scott-Smith, RN, an inspiration to all maternal-child health nurses. She lent an ear many evenings and unfailingly supported me through both the highs and the lows of this process. Finally, I dedicate this to all the women who suffer postpartum depression in silence. You are not alone. vi ACKNOWLEDGMENTS I would like to acknowledge several individuals without whom this work would not have been possible. This investigation was a secondary analysis of data from an RO1