Nutrients and Postpartum Mental Health

In this 2021 study, 41 new mothers were given dietary flavonoids daily for 2 weeks. Foods rich in flavonoids have so far demonstrated positive effects on mood among healthy children, adolescents, and adults. This study tested flavonoids on mothers within 0-12 months of giving birth to a child since the postnatal period is a particularly vulnerable time for changes in mood and developing disorders such as postnatal depression. The treatment randomization ensured that some women participated in the flavonoid intervention, while others did not make any additions to their diet. At the 2-week time point, the flavonoid intervention group reported significantly lower state anxiety and higher perceived quality of physical health. These results suggest that regular consumption of flavonoid-containing foods may improve mothers’ anxiety and perceived quality of life in the postnatal period. If these findings are replicated, ingesting dietary flavonoids may be an effective strategy for enhancing maternal mood and possibly for preventing the onset or severity of symptoms in postnatal psychological disorders. [NPID: flavonoids, intervention, diet, nutrition, dietary flavonoids, mood, postnatal mood, pregnancy, childbirth, postnatal depression]

This 2018 review investigated the connection between the microbiome and perinatal mood and anxiety disorders (PMAD). During the perinatal period, imbalances in systems can occur resulting in depressive and anxiety symptoms. To understand the mechanisms underlying perinatal mood and anxiety disorders, it may be useful exploring the relationship between the microbiome, the immune system, and the stress system. A systematic literature search was conducted to find articles reporting maternal mood, stress, or anxious and depressive behavior in women in their perinatal phase (the period between pregnancy and one-year postpartum). The review only included studies that analyzed measures of maternal microbiome including manipulations of the microbiome through prebiotics, probiotics, or interventions with microbial byproducts. The reviewers found some important themes among these research studies, including the importance of studying the maternal microbiome and measures of stress, anxiety, and depression. It appears that scientists need to start using multi-hit models to determine the multiple mechanisms behind perinatal mood and anxiety disorders. [NPID: perinatal mood and anxiety disorder, PMAD, pregnancy, postpartum, review, microbiome, immune system, stress system, mental health, maternal health]

This 2020 review focuses on the health-related events associated with different levels of omega-3 fatty acids during pregnancy and discusses the target omega-3 index result for optimal outcome. Although many recommend pregnant women to take 200mg docosahexaenoic acid (DHA) supplements every day, Von Schacky argues that plasma levels of DHA don’t always correlate with the amounts consumed. Moreover, the mean omega-3 index among pregnant women in Germany (where premature birth is a major health issue) was below the target range suggested for cardiovascular disease (8–11%), although people were supplementing with EPA and DHA. But individual trials and certain meta-analyses have claimed that prevalence of premature birth and other health problems in the mother and child can be reduced by increased intake of EPA and DHA. This review also goes on to note that overconsumption and very high levels of these fatty acids (EPA and DHA) may result in health issues such as bleeding, prolonged gestation, and even premature birth. Finally, the evidence suggests that aiming for the target range for the Omega-3 Index of 8–11% might be important in pregnancy and lactation. [NPID: postpartum mental health, nutrients in pregnancy, pregnancy, DHA, EPA, omega-3s, fatty acids, lactation]

This review conducted by Hsu et al. (2018) evaluated the effect of supplementation with omega-3 polyunsaturated fatty acid on depression during pregnancy or in postpartum depression directly after childbirth. In addition to studies that measured dietary intake and plasma and/or milk levels of omega-3 fatty acids, the reviewers selected several trials demonstrating the impact of omega-3 fatty acids supplements on pregnant or postpartum women with depression. One of the risk factors of postpartum depression is omega-3 fatty acid deficiency, which becomes depleted quickly during pregnancy and lactation. Some studies reported associations between neuroinflammation (elevated proinflammatory cytokines) and aberrant neurotransmission (low serotonergic transmission activity) with risk of developing postpartum depression. There is evidence that supplementation with eicosapentaenoic acid (EPA)-rich oil can reduce depression during pregnancy as well as postpartum depression following childbirth. It was also highlighted that long-term treatment with DHA-enriched oil may be effective in reducing postpartum depression risk in healthy women but may not be as effective in lactating women. But when this oil was taken throughout pregnancy and even after childbirth, no beneficial effect was observed. To summarize, dietary supplementation with omega-3 fatty acids rich in EPA during pregnancy or postpartum reduces symptoms related to depression, while DHA supplementation reduces the risk of postpartum depression when administered to healthy pregnant women. [NPID: postpartum mental health, nutrients in pregnancy, pregnancy, omega-3s, polyunsaturated fatty acids, fatty acids, plasma, milk levels, omega-3s, neuroinflammation, proinflammatory cytokines, postpartum depression, lactation, EPA, DHA]

This 2019 review examined the link between anemia and/or iron deficiency with postpartum depression (depression during the period immediately after childbirth). Iron deficiency and anemia are common in women during pregnancy and postpartum due to blood loss and increase in demand. But many women may also enter pregnancy with low iron stores. After identifying and analyzing 17 studies (randomized-controlled trials and observational studies) that assessed the impact of anemia, iron-deficiency, and iron supplementation on the risk of postpartum depression, Wassef et al. discovered that most studies (8 out of 10) observed higher prevalence of postpartum depression in anemic women. Low levels of ferritin (blood protein that contains iron) in the postpartum period, but not during pregnancy, was associated with elevated risk of postpartum depression. This risk was reduced by supplementing with iron during the postpartum period (indicated by 4 out of 5 studies) but administration during pregnancy did not provide protection from depression. While additional studies should hopefully confirm this association, it is deduced that anaemia and/or iron deficiency may contribute to postpartum depression in at-risk women. [NPID: postpartum mental health, nutrients in pregnancy, pregnancy, anemia, iron, postpartum depression, blood loss, ferritin]

Sparling et al. (2017) speculate that women may be at risk of developing depression particularly during the perinatal period (immediately after childbirth) because of the depletion of nutrients caused by pregnancy and lactation. This review summarized the evidence on whether the nutrient levels of women in the perinatal period influence the risk of developing depression. Twenty-four articles were included, representing a total population of 14,262 subjects. Fourteen studies indicated correlations between lower levels of folate, vitamin D, iron, selenium, zinc, fats, and fatty acids with perinatal depression. According to two studies, perinatal depression was associated with higher concentrations of nutrients, while 8 studies did not identify any interrelation. Although low risk of bias was reported by 10 studies, the causal relationship between nutritional biomarkers and perinatal depression cannot be confirmed considering the limitations in methodology and heterogeneity of these studies’ approaches and results. Additional research is required. [NPID: postpartum mental health, nutrients in pregnancy, pregnancy, depression, perinatal depression, lactation, nutrients, folate, vitamin D, iron, selenium, zinc, fats, fatty acids]

While the effectiveness of omega-3 fatty acids in major depressive disorder (MDD) has been established, Zhang et al. (2020) point out the lack of data on the safety and efficacy of its mono-therapeutic use in perinatal depression (depression in new mothers following birth of newborn). This meta-analysis included 8 randomized placebo-controlled trials (totaling 638 participants) that analyzed the efficacy and safety of omega-3 fatty acid monotherapy in perinatal women with depressive symptoms. There is reason to believe that omega-3 fatty acids significantly affect perinatal depression, particularly when considering omega-3 with a higher ratio of EPA/DHA (≥1.5) in both mild-to-moderate antenatal and postpartum depression. Safety was not found to be an issue, with low occurrence rates and no significant difference in prevalence of gastrointestinal and neurologic problems between the omega-3 and placebo groups. Moreover, there was no evidence of publication bias. This meta-analysis suggests that omega-3 fatty acids significantly enhance depressive symptoms in perinatal women regardless of timing (during pregnancy or following birth) and are well tolerated. Another notable point was that this omega-3 response was linked to higher EPA ratio in omega-3 formula and mild-to-moderate depression. [NPID: postpartum mental health, nutrients in pregnancy, pregnancy, omega-3s, MDD, major depressive disorder, perinatal depression, depression, postpartum depression, fatty acids, EPA, DHA]