Diet and Maternal Mental Health

This 2020 systematic review investigated whether mental health of pregnant women may adversely affect their diet or the inverse idea that poor nutritional intake during pregnancy may predispose women to mental health issues. Thirteen peer-reviews articles published between 2000 and 2018 evaluating the relationship between antenatal and postnatal depression with dietary intake were included in this review: of which 5 were cohort studies (including two birth studies) and 8 cross-sectional studies accumulating data from a total of 12,742 individuals. After splitting the studies into five groups - those that analysed all nutrients, micronutrients, dietary patterns, dietary behaviors and intake of fish and vegetables - the “Healthy Eating Index”, indeficiencies of calcium, iron and folate were all found to be associated with maternal depression. Whereas, the studies exploring the association of depression with dietary patterns found a protective association of "Health Conscious", "Healthy" and "Brazilian" diet patterns with maternal depression. In a diet behavior study, predictors of depressive symptoms in the late postpartum period (after childbirth) were found to be prenatal (before birth) and early postpartum eating attitudes and BMI. The writers point out that lifestyle risk factors could be an important contributor to maternal depression.

This 2019 systematic review aimed to assess the evidence for the association between dietary patterns and perinatal anxiety and depression (PAAD). The ten studies included in this review (of which six were cohort and four were cross-sectional designed) were deemed to possess good methodological quality using the Newcastle-Ottowa Scale (NOS). The following dietary patterns were examined in these studies: the Western (10); healthy (9); and traditional (7). The healthy pattern was inversely associated with prenatal and postpartum anxiety and prenatal depression. Although no significant association could be found between Western diet and PAAD, the traditional Japanese dietary pattern, the traditional Indian-confinement dietary pattern, the United Kingdom traditional dietary and the traditional Brazilian dietary pattern were associated with a lower risk of prenatal depression, postpartum depression, prenatal anxiety and postpartum anxiety, respectively (although the quality of evidence is suggested to be very low - low). It is concluded that while the healthy dietary pattern was negatively linked to PAAD, further studies will be required to better evaluate associations between dietary meal patterns and PAAD.

This prospective cohort from 2015 examined 207 healthy pregnant women in Brazil to determine if there is a correlation between pre-pregnancy dietary patterns and variations in anxiety symptoms from mid-pregnancy to early postpartum. The women were examined at 5-13, 20-26, and 30-36 gestational weeks, and once at 30-45 days postpartum (tests included State-Trait Anxiety Inventory to evaluate anxiety symptoms and food frequency questionnaire for dietary intake). The subject population could be divided based on their pre-pregnancy dietary patterns: common-Brazilian (mainly rice and beans); healthy (mostly fruits, vegetables, fish and tea); and processed. The mean anxiety symptom scores for the second trimester, third trimester and postpartum were 40.4, 40.5 and 37.2 respectively. When accounting for gestational age, the rate of variation of the State-Trait Anxiety Inventory score was 0.535 (95% CI -0.035 to 1.107; P=0.066). Statistically significant evidence was found negatively linking both the common-Brazilian (p=0.021) and healthy eating pattern (p=0.029) with prospective changes in anxiety. Vilela et. al (2015) claim that high adherence to the common-Brazilian or healthy dietary patterns was negatively associated with higher anxiety symptom scores from mid-pregnancy to early postpartum in this group of Brazilian women.

This 2020 systematic review retrieved data from existing published studies (search ranging from 1835-2020) and examined the association between maternal postpartum diet and postpartum depression (PPD). Of the 931 relevant articles identified, 6 met the eligibility criteria, of which 4 were cross-sectional and 2 were cohort designed. All but one study found at least one inverse association, linking greater adherence to a healthy diet during the postpartum period with fewer PPD symptoms. Although the researchers state their want for further longitudinal and intervention studies to confirm this, a balanced maternal diet with a focus on fruits, vegetables, fish, grains, legumes and herbs is suggested to possibly reduce the incidence of PPD. This review provides evidence that the postnatal diet could have an effect on postpartum depression symptoms.

Due to past research in non-pregnant and pregnant populations suggesting depression may influence diet during pregnancy which has a significant impact on the health of both offspring and mother, this 2020 study investigated the relationship between prenatal depression and diet quality during pregnancy overall and by race/ethnicity, as well as explored the correlation between prenatal depression and the 12 Healthy Eating Index 2010 dietary components. Avalos et. al (2020) provides us with a secondary analysis of a cohort study of Kaiser Permanente Northern California women (1160 pregnant participants) entering prenatal care between October 2011 and April 2013. One-hundred and fifty nine (14%) subjects were found to suffer from prenatal depression, who were 2 times more likely to have diets of poor quality compared with women without prenatal depression after adjusting for potential confounders. Women with prenatal depression consumed more empty calories (solid fats, added sugars, alcohol [p = 0.01]), less greens and beans (p<0.05), fewer total fruit (p<0.01), and whole fruit (p<0.01), compared with those not depressed while pregnant. Differences emerged by race/ethnicity as hispanic women with prenatal depression were 166% more likely to have poor diet quality compared to those Hispanic women without diagnosed depression. These findings suggest that women with prenatal depression are at higher risk of having a poor diet compared with ladies without prenatal depression, and the relationship is more prominent among Hispanic women. The writers suggest nutrition counseling interventions for women with depression with consideration for different cultures and that targets limiting empty calories from solid fats, alcohol, and added sugar, as well as encouraging the consumption of greens, beans and fruits.

This multi-ethnic Asian cohort published in 2018 aimed to characterise dietary patterns during the “confinement period” (the first month after giving birth) and then examine their associations with postpartum depression (PPD) and anxiety (PPA). 3-day food diaries recorded dietary intakes of 490 women in the first month postpartum, and at the 3-month postpartum mark, participants completed the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) to indicate depressive and anxiety symptoms (higher the score, the more symptoms). Four dietary patterns were identified: Traditional-Chinese-Confinement diet, Traditional-Indian-Confinement diet, Eat-Out diet and Soup-Vegetables-Fruits diet. The Traditional-Indian-Confinement diet was associated with less PPD symptoms and showed a non-significant link with reduced probable PPD, and the Soup-Vegetables-Fruits diet was associated with less PPA symptoms. The findings therefore included adherence to the traditional-Indian-confinement diet (composed of herbs and legumes) and Soup-Vegetables-Fruit diets (high in fruits, vegetables and fish) during the postpartum period were associated with fewer PPD and PPA symptoms, respectively.

This 2019 Chinese study recruited 1659 participants in Tianjin, studying the subjects’ diet using food frequency questionnaires and assessing their depressive symptoms at 6-12 weeks postpartum (after giving birth), to investigate the association between dietary patterns and incidence of postpartum depression among Chinese women. Six dietary habits were identified among the pregnant women including beverage, vegetable, cereal-meat, nut-fruit, egg and seafood patterns. The highest tertile (T3) of the nut-fruit pattern was significantly associated with reduced risk of postpartum depression (OR = 0.74; p = 0.02) while the T3 of the seafood eating habit was also associated with fewer incidences of postpartum depression (OR = 0.753; p = 0.033). This present study therefore found that an adequate dose of fruits, nuts, and seafood is important for postpartum women in China.

This 2011 study retrieved data from the prospective mother-child cohort ‘Rhea’ study set in Crete, Greece between 2007-2010 (529 female participants) to identify and describe the dietary patterns of the pregnant women and investigate whether dietary habits during pregnancy is related to postpartum depression. The Edinburgh Postpartum Depression Scale (EPDS) was used to examine depressive symptoms at 8-10 weeks postpartum. During pregnancy, the ladies completed food frequency questionnaires to identify the two dietary patterns ‘health conscious’- which was characterised by vegetables, fruits, pulses, nuts, dairy products, fish and olive oil - and the ‘Western’ eating pattern. High adherence to a ‘health conscious’ diet was associated with lower EPDS scores (highest vs lowest tertile; p = 0.02). Women in the second or third tertile of the ‘health conscious’ dietary pattern were about 50% less likely to exhibit a high number of PPD symptoms (EPDS ≥ 13) compared with those in the lowest tertile. Additional longitudinal studies and trials are wanted to confirm these findings but Chatzi et. al (2011) discovered that a healthy diet during pregnancy is associated with a decreased risk of developing postpartum depression

Vilela et. al in 2014 published this study identifying dietary patterns before pregnancy and examining their association with depressive symptoms suffered during pregnancy. This time 248 healthy pregnant women were followed at 5-13, 20-26, and 30-36 gestational weeks, reporting dietary intake through the use of food frequency questionnaires (between 5-13 gestational weeks) and also undergoing evaluation of depressive symptoms during 3 follow-up pregnancy points using the Edinburgh Postnatal Depressive Scale (EPDS). Three prepregnancy dietary patterns were identified: common-Brazilian, healthy, and processed. The healthy dietary pattern was inversely associated with depressive symptoms (p = 0.011). Mean depressive symptom scores were 9.0 (95% CI: 8.4, 9.6), 7.2 (95% CI: 6.5, 7.8), and 7.0 (95% CI: 6.4, 7.7) for trimesters 1, 2, and 3, respectively. This current study found that high adherence to the healthy dietary pattern before pregnancy was associated with lower EPDS scores during pregnancy in women from Rio de Janeiro, Brazil.

Nutritional deficiencies and maternal depression: associations and interventions in lower and middle-income countries: a systematic review of literature