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Correlation between postpartum depression and omega-3, micronutrients
Abstract
In recent years, attention has been called to the link between nutrition and mental health. Postpartum depression is an important depressive disorder which often arises 6 to 12 weeks after giving birth and can happen at any time within one year. Postpartum depression prevalence is around 20% worldwide. Genetic predisposition and environmental factors, as well as certain social, psychological and biological factors constitute risk factors for postpartum depression. While malnutrition is among the biological factors, there is a correlation between nutrients such as folic acid, vitamin B₁₂, vitamin D, iron, selenium, zinc, and n-3 fatty acids and psychological state. The nutrients that claim most attention relating to postpartum depression are n-3 essential fatty acids. Insufficient intake of n-3, folic acid, vitamins B and iron is observed in pregnant women. Failing to meet the needs of the mother due to malnutrition during pregnancy can increase the risk of depleting the body’s nutrient reserves and developing postpartum. This risk factor needs to be kept in check by determining and keeping track of the nutrient needs of the mother during the perinatal period.
... Iron is a mineral used in the diet during pregnancy (or postpartum period) to support fetal development and growth (e.g., brain growth) and to prevent certain diseases (e.g., anemia) in pregnant women, and it can be obtained from pork, animal liver, flowering cabbage, etc. [61,62]. According to relevant statistical data, iron deficiency is common among women (as accounts for 50% worldwide, and postpartum women account for the majority), and there is a correlation between postpartum hemoglobin concentration and postpartum iron status and PPD, based on several previous studies on postpartum mothers who did not consume enough iron in their diet and significantly developed symptoms (e.g., depression, anxiety, etc.) [106,107]. Besides, not only does iron play a necessary role in regulating brain functions (e.g., the regulation of neurotransmitter catabolism and hormones), it is also a part of the formation of many essential proteins and enzymes, and cofactors (e.g., hemoglobin, neurotransmitter synthase, etc.). Hence, in light of the physiological and biochemical functions of iron mentioned above, some studies have begun to examine the impact of iron deficiency on women's mental health, and have found that deficiency of iron and hemoglobin can have devastating effects on psychological aspects (as leading to depression) following biochemical tests in many PPD women. ...
... What's more, several lines of evidence from some studies have pointed out that due to the physiological functions of Se is of vital importance in brain function (e.g., metabolic processes in the brain), which makes it an effective nutrient for preventing the happening of the PPD during pregnancy. Also, relevant statistics from those studies have further suggested that Se is beneficial for women during pregnancy to prevent PPD since pregnant women generally tend to have lower serum Se concentrations [107]. Thus far, a recent prospective study has explored that intake of Se from the daily diet (as dietary patterns include foods like bread made from kinds of wheat rich in Se) does not appear to affect plasma Se concentrations, but increased intake of Se from Se-rich foods does have a potential reduced effect on the incidence of PPD (as although the mechanism and conclusion are not fully determined) [115]. ...
... In addition, the effect of vitamin B9 and B12 on cardiovascular inflammation during amino acid conversion, the effect of vitamins B6, B9, and B12 on hormone synthesis, and lower levels of vitamin B9 in people with depressive symptoms, all have the potential to relate to B vitamins to the occurrence of depression have been suggested by several further studies. However, the previous evidence for the effect of these B vitamins on PPD is not significant, as most of these studies have found no association between vitamin B6, B9 and B12 and PPD (although a small number of studies have identified a possible association between vitamin B2 and PPD, the relevant data evidence is insufficient) [107,113]. Recent studies confirmed the decision PPD nutritional factors include folic acid and vitamin B12, and also cohort studies such as those conducted by Yan et al. have indicated that long-term intake of vitamin B9 (as from supplements) during pregnancy (as more than 6 months) can reduce the prevalence of PPD (as the long-term use of folate can significantly improve the levels of folic acid in women to activate the antidepressant related folate's physiological function). In addition, combining with the data from related studies' conclusions and the biochemical mechanisms of folate in depression mentioned above, intake enough level of vitamin B9 during pregnancy can be a potentially effective intervention in the management of PPD. ...
Postpartum anxiety and depression are prevalent disorders. This study aimed to determine the effects of zinc and magnesium supplements on depressive symptoms and anxiety in postpartum women referred to three governmental, educational hospitals in Tabriz, Iran during 2014–2015. In this triple-blind, randomized, controlled clinical trial, the participants were randomly assigned to the zinc sulfate, magnesium sulfate, and placebo groups (n = 33 per group). The intervention groups received 27-mg zinc sulfate tablet or 320-mg magnesium sulfate per day for 8 weeks, whereas the control group received a placebo tablet each day during the same period. The Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory were completed before and 8 weeks after the intervention. Blood samples were drawn from each participant to determine serum levels of zinc and magnesium before intervention at 48 hours after delivery. Also, a 24-hour dietary questionnaire was used during the first and last three days of the intervention. Adjusting for baseline scores as well as zinc and magnesium serum levels, no significant difference was observed between groups eight weeks after delivery in mean scores of depressive symptoms (p = .553), state anxiety (p = .995), and trait anxiety (p = .234). This study concluded magnesium and zinc did not reduce postpartum anxiety and depressive symptoms.
Purpose:
Evaluating early iron supplementation in non-anemic mothers with postpartum depression (PPD).
Methods:
This randomized, double-blind, placebo-controlled trial evaluated 70 mothers with PPD. One week after delivery, the mothers were randomly allocated in the iron-treated (50 mg elemental iron/daily) and placebo-treated groups. After 6 weeks, the improvement of PPD symptoms was compared between the groups.
Results:
Ferritin significantly increased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.09). After intervention, ferritin was higher in the iron-treated group (medians: 78.2 vs. 37 mg/dl, p = 0.01). The rate of iron deficiency significantly decreased in the iron-treated group (p = 0.009), but not in the placebo group (p = 0.4). After intervention, the rate of iron deficiency was higher in the placebo group (31.4 vs. 8.5 %, p = 0.01). The Edinburgh Postnatal Depression Scale (EPDS) score significantly decreased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.13). After intervention, the EPDS score was lower in the iron-treated group (medians 9 vs. 12, p = 0.01). The improvement rate for PPD was significantly higher in the iron-treated group (42.8 vs. 20 %, p = 0.03). After intervention, mothers with continued PPD had lower ferritin than the improved mothers (41.8 vs. 67 mg/dl, p = 0.03). Mothers with continued depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p = 0.02).
Conclusions:
Early iron supplementation in mothers with PPD significantly improves the iron stores and causes a significant improvement in PPD with a 42.8 % improvement rate during 6 weeks. Continued PPD might be related to the lower postpartum ferritin levels in untreated mothers.
Epidemiological studies have provided evidence of an association between vitamin D insufficiency and depression and other mood disorders, and a role for vitamin D in various brain functions has been suggested. We hypothesized that low vitamin D status during pregnancy might increase the risk of postpartum depression (PPD). The objective of the study was thus to determine whether low vitamin D status during pregnancy was associated with postpartum depression. In a case-control study nested in the Danish National Birth Cohort, we measured late pregnancy serum concentrations of 25[OH]D3 in 605 women with PPD and 875 controls. Odds ratios [OR) for PPD were calculated for six levels of 25[OH]D3. Overall, we found no association between vitamin D concentrations and risk of PPD (p = 0.08). Compared with women with vitamin D concentrations between 50 and 79 nmol/L, the adjusted odds ratios for PPD were 1.35 (95% CI: 0.64; 2.85), 0.83 (CI: 0.50; 1.39) and 1.13 (CI: 0.84; 1.51) among women with vitamin D concentrations < 15 nmol/L, 15-24 nmol/L and 25-49 nmol/L, respectively, and 1.53 (CI: 1.04; 2.26) and 1.89 (CI: 1.06; 3.37) among women with vitamin D concentrations of 80-99 nmol/L and ≥ 100 nmol/L, respectively. In an additional analysis among women with sufficient vitamin D (≥ 50 nmol/L), we observed a significant positive association between vitamin D concentrations and PPD. Our results did not support an association between low maternal vitamin D concentrations during pregnancy and risk of PPD. Instead, an increased risk of PPD was found among women with the highest vitamin D concentrations.
Depression is a common disorder affecting 10-15% women in the postpartum period. Postpartum depression can disrupt early mother-infant interaction, and constitutes a risk factor for early child development. Recently, attention has been drawn to the hypothesis that a low intake of seafood in pregnancy can be a risk factor for postpartum depression. Seafood is a unique dietary source of the marine omega-3 fatty acids and is a natural part of a healthy balanced diet that is especially important during pregnancy.
In a community based prospective cohort in a municipality in Western Norway, we investigated both nutritional and psychological risk factors for postpartum depression. The source population was all women who were pregnant within the period November 2009 - June 2011. The fatty acid status in red blood cells was assessed in the 28(th) gestation week and participants were screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) three months after delivery. The aim of the present study was to investigate if a low omega-3 index in pregnancy is a possible risk factor for postpartum depression.
In a simple regression model, the omega-3 index was associated with the EPDS score in a nonlinear inverse manner with an R square of 19. Thus, the low omega-3 index explained 19% of the variance in the EPDS score. The DPA content, DHA content, omega-3 index, omega-3/omega-6 ratio, total HUFA score, and the omega-3 HUFA score were all inversely correlated with the EPDS score. The EPDS scores of participants in the lowest omega-3 index quartile were significantly different to the three other omega-3 index quartiles.
In this study population, a low omega-3 index in late pregnancy was associated with higher depression score three months postpartum.
Objective This study examined longitudinal relationships between maternal red-cell folate status and dietary intakes of vitamins B(6), B(12) and folate before and during pregnancy and subsequent postpartum depressive symptoms.Study design and setting Within a cohort study of women aged 20-34 years (the Southampton Women's Survey) dietary data were obtained before pregnancy and at 11 and 34 weeks' gestation. Red-cell folate was measured before pregnancy and at 11 weeks' gestation. We derived relative risks of postpartum depressive symptoms using an Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 13 administered from 6 months to 1 year postpartum.Results No significant differences were found between those with postpartum depressive symptoms (n = 905) and those without (n = 1951) in relation to red-cell folate concentration or dietary intake of folate, vitamin B(12) and vitamin B(6), before or during pregnancy. A prior history of mental illness (relative risk (RR) 1.83; 95% confidence interval (CI) 1.53-2.19) was associated with postpartum depressive symptoms, and women who breastfed until 6 months were less likely to experience postpartum depressive symptoms (RR 0.68; 95% CI 0.55-0.84).Conclusion This study suggests that folate status and dietary folate, B(6) and B(12) intakes before and during pregnancy are not associated with postpartum depressive symptoms. A history of mental illness, however, was a strong risk factor.
Postpartum depression (PPD) is a major depressive disorder that most often emerges within 6 to 12 weeks of delivery, but can happen any time up to 1 year after birth. In developed countries, the incidence of postnatal depression is about 10-15% in adult women depending upon the diagnostic criteria, timing of screening and screening instruments used. Mothers with depressive symptoms have been found to have more complex behavioral contacts with their children; this situation can damage family relationships, and even leads to infanticide. Various pathophysiologies are proposed for postpartum depression: Nutritional deficiencies, iron deficiency anemia, rapid decrease in the levels of reproductive hormones following delivery, alterations in hypothalamic-pituitary-adernocortical mechanism and alterations in neurotransmitter levels. Among pathophysiologies of postpartum depression, the role of trace elements is highlighted. The purpose of this review is to assess the role of trace elements including zinc, magnesium, iron and copper in PPD. Zinc as a trace element has the second highest concentration of all transition metals in the brain, and its deficiency is associated with behavioral disturbances. Lower zinc blood concentration was found in women with postpartum depression. Another trace element, magnesium, also influences the nervous system via its actions on the release and metabolism of neurotransmitters. Various studies have focused on antidepressant-like effects of magnesium and its deficiency has been reported in depression. Depletion of magnesium stores during pregnancy is hypothesized to be the cause of postpartum depression. Iron deficiency is the most common single nutrient deficiency in the world. There is an association between anemia and depressive disorders. Copper has been recognized as an essential element for many years. Iron also plays a vital role in neurological disorders and its levels are relevant to postpartum depression. Involvement of trace elements can be seen in pathophysiologies of PPD in different ways. Therefore, trace element supplementation can be an alternative treatment for patients with PPD.
Maternal iron status is thought to be related to postpartum depressive symptoms. The purpose of the present study was to evaluate the relationship between pre- and postnatal maternal iron status and depressive symptoms in pilot (n = 137) and confirmatory (n = 567) samples of Chinese women. Iron status was evaluated at mid- and late pregnancy and 3 days postpartum. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal postpartum depression 24-48 hours after delivery and 6 weeks later. In the pilot sample, correlations between early- and late-pregnancy maternal Hb and EPDS scores at 6 weeks were r = 0.07 and -0.01, respectively (nonsignificant). In the confirmatory sample, the correlations between maternal iron measures (Hb, MCV, ZPP, ferritin, sTfR, and sTfR Index) in mid- or late pregnancy or 3 days postpartum and EPDS scores shortly after delivery or at 6 weeks were also low (r values < 0.10). EPDS scores in anemic and nonanemic mothers did not differ, regardless of sample or timing of maternal iron status assessment. In addition, women with or without possible PPD were similar in iron status in both samples. Thus, there was no relationship between maternal iron status and postpartum depression in these samples.
Depression in pregnancy is a common psychiatric disorder affecting health of both the mother and the unborn child. The prevalence of depression and depressive symptoms during pregnancy ranges from 12% to 36%. Genetic, psychological, biological, environmental and hormonal factors comprise the predisposing factors for development of depression. Depression in pregnancy may cause such pregnancy and obstetrical complications as preterm delivery, preeclampsia, difficult birth, increased need for surgical intervention during delivery, smaller fetus compared to the gestational age, newborns with low birth weights and low apgar scores. It is also important due to its potential to increase the risk of suicide attempts and postpartum depression. Depression seen at an early period of the pregnancy affects both the mother and the fetus negatively in the long run. Therefore, early diagnosis of depression and its treatment will decrease the prospective risks for both parts. Health care staff play a key role in the early detection of the risk groups inclined to the gestational depression, in the prevention and treatment of depression. With the present work, we aimed at revising the diagnosis of the depression in pregnancy, its prevalence, risk factors for mother and fetus, its prevention and treatment during pregnancy.
Postpartum depression is a common complication of childbirth, and its prevention is an important public-health issue because of its negative effects on mother, infant, and family. The present randomized, double-blind, placebo-controlled trial was conducted to examine the effect of prenatal selenium supplementation on the postpartum depression level in Iranian women.
A total of 166 primigravid pregnant women in the first trimester of pregnancy, were randomized to receive 100 μg of selenium (n = 83) or a placebo (n = 83) per day until delivery. The symptoms of postpartum depression were evaluated during the eight weeks following delivery by means of the Edinburgh Postnatal Depression Scale (EPDS). Serum selenium concentrations were measured at baseline and at the end of study.
There was no significant difference in demographic characteristics and perceived social support between the selenium and control groups at baseline (p > 0.05). There were 22 drop-outs in the selenium-supplemented group and 19 in the placebo group. Forty-four women in the selenium group and 41 women in the placebo group completed the trial and the EPDS questionnaire. Selenium supplementation was associated with a significant increase in mean serum selenium concentration at term (p < 0.001) but remained unchanged in the control group. The mean EPDS score in the selenium group was significantly lower than that of the control group (p < 0.05).
These findings suggest that supplementation with selenium during pregnancy might be an effective approach for the prevention of postpartum depression.
Iron is an essential micronutrient, as it is required for adequate erythropoietic function, oxidative metabolism and cellular immune responses. Although the absorption of dietary iron (1-2 mg/d) is regulated tightly, it is just balanced with losses. Therefore, internal turnover of iron is essential to meet the requirements for erythropoiesis (20-30 mg/d). Increased iron requirements, limited external supply, and increased blood loss may lead to iron deficiency (ID) and iron-deficiency anemia. Hepcidin, which is made primarily in hepatocytes in response to liver iron levels, inflammation, hypoxia and anemia, is the main iron regulatory hormone. Once secreted into the circulation, hepcidin binds ferroportin on enterocytes and macrophages, which triggers its internalization and lysosomal degradation. Thus, in chronic inflammation, the excess of hepcidin decreases iron absorption and prevents iron recycling, which results in hypoferremia and iron-restricted erythropoiesis, despite normal iron stores (functional ID), and anemia of chronic disease (ACD), which can evolve to ACD plus true ID (ACD + ID). In contrast, low hepcidin expression may lead to iron overload, and vice versa. Laboratory tests provide evidence of iron depletion in the body, or reflect iron-deficient red cell production. The appropriate combination of these laboratory tests help to establish a correct diagnosis of ID status and anemia.
The purpose of this review is to examine the role of nutrition in perinatal depression. Perinatal (maternal) depression refers to major and minor episodes during pregnancy (termed antenatal) and/or within the first 12 months after delivery (termed postpartum or postnatal). Prevalence of antenatal depression can be as high as 20%, while approximately 12% to 16% of women experience postpartum depression. These are probably conservative estimates, as cases of maternal depression are underreported or underdiagnosed. Risk factors for depression include genetic predisposition and environmental factors, as well as a number of social, psychological, and biological factors. One biological factor given increasing consideration is inadequate nutrition. Credible links between nutrient deficiency and mood have been reported for folate, vitamin B-12, calcium, iron, selenium, zinc, and n-3 fatty acids. For maternal depression, the nutrient that has received the most attention from nutrition researchers has been the n-3 essential fatty acids. Numerous studies, such as randomized controlled trials, cohort studies, and ecological studies, have found a positive association between low n-3 levels and a higher incidence of maternal depression. In addition, nutrient inadequacies in pregnant women who consume a typical western diet might be much more common than researchers and clinicians realize. A number of studies have reported inadequate intakes of n-3, folate, B vitamins, iron, and calcium in pregnant women. Depletion of nutrient reserves throughout pregnancy can increase a woman's risk for maternal depression.
Selenium (Se), a nutritionally essential trace element with known antioxidant potential, protects the brain from oxidative damage in various models of neurodegeneration. Intracerebroventricular-streptozotocin (ICV-STZ) in rats causes impairment of brain glucose and energy metabolism along with oxidative damage and cholinergic dysfunction, and provides a relevant model for sporadic dementia of Alzheimer's type (SDAT). The present study demonstrates the therapeutic efficacy of Se on cognitive deficits and oxidative damage in ICV-STZ in rats. Male Wistar rats were pre-treated with sodium selenite, a salt of Se (0.1 mg/kg; body weight) for 7 days and then were injected bilaterally with ICV-STZ (3 mg/kg), while sham rats received the same volume of vehicle. After two ICV-STZ infusions, rats were tested for memory deficits in passive avoidance and Morris water maze (MWM) tests and then were sacrificed for biochemical and histopathological assays. ICV-STZ-infused rats showed significant loss in learning and memory ability, which were significantly improved by Se supplementation. A significant increase in thio-barbituric acid reactive species (TBARS), protein carbonyl (PC) and a significant decrease in reduced glutathione (GSH), antioxidant enzymes (glutathione peroxidase [GPx] and glutathione reductase [GR]) and adenosine triphosphate (ATP) in the hippocampus and cerebral cortex and choline acetyltransferase (ChAT) in hippocampus were observed in ICV-STZ rats. Se supplementation significantly ameliorated all alterations induced by ICV-STZ in rats. Our study reveals that Se, as a powerful antioxidant, prevents cognitive deficits, oxidative damage and morphological changes in the ICV-STZ rats. Thus, it may have a therapeutic value for the treatment of SDAT.
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Vitamin D is metabolised by a hepatic 25-hydroxylase into 25-hydroxyvitamin D (25(OH)D) and by a renal 1alpha-hydroxylase into the vitamin D hormone calcitriol. Calcitriol receptors are present in more than thirty different tissues. Apart from the kidney, several tissues also possess the enzyme 1alpha-hydroxylase, which is able to use circulating 25(OH)D as a substrate. Serum levels of 25(OH)D are the best indicator to assess vitamin D deficiency, insufficiency, hypovitaminosis, adequacy, and toxicity. European children and young adults often have circulating 25(OH)D levels in the insufficiency range during wintertime. Elderly subjects have mean 25(OH)D levels in the insufficiency range throughout the year. In institutionalized subjects 25(OH)D levels are often in the deficiency range. There is now general agreement that a low vitamin D status is involved in the pathogenesis of osteoporosis. Moreover, vitamin D insufficiency can lead to a disturbed muscle function. Epidemiological data also indicate a low vitamin D status in tuberculosis, rheumatoid arthritis, multiple sclerosis, inflammatory bowel diseases, hypertension, and specific types of cancer. Some intervention trials have demonstrated that supplementation with vitamin D or its metabolites is able: (i) to reduce blood pressure in hypertensive patients; (ii) to improve blood glucose levels in diabetics; (iii) to improve symptoms of rheumatoid arthritis and multiple sclerosis. The oral dose necessary to achieve adequate serum 25(OH)D levels is probably much higher than the current recommendations of 5-15 microg/d.
To compare the risk of postpartum depression among nulliparous women enrolled in a structured antenatal programme, with nulliparous women allocated to standard care as well as to identify obstetric characteristics in women at risk of developing postpartum depression.
A randomised controlled trial involving 1193 Danish nulliparous women. A total of 603 women attended the "Ready for Child program" and 590 received standard care. Data were collected from the ongoing local birth cohort at Aarhus University Hospital and from questionnaires mailed to the women attending the study.
No difference in postpartum depression was found between those who attended the intervention group and the reference group. Overall, being at risk of postpartum depression was associated with preterm birth, unscheduled caesarean section, low Apgar score, lack of pain relief during labour, experienced low attendance of the midwife in the delivery room, unprepared for hospital discharge, none or minor breastfeeding in the early postpartum period, insufficient knowledge about breastfeeding, poor or fair self-rated mental health, and uncertain or weak attachment to the newborn child.
The findings suggest that a short general antenatal programme in pregnancy may not be sufficient to prevent postpartum depression six weeks after birth. However, there are several risk factors during the birth process and the early postpartum period that can help identify women at risk for developing depression.
Copyright © 2015 Elsevier B.V. All rights reserved.
Introduction.- Different methods and instruments are frequently used to measure postpartum depression (PPD) in research, e.g. PPD-specific scales, DSM-based diagnostic interviews and rating scales assessing general depression. However, it is unsure whether these measures would lead to the same results, e.g. in the identification of "depressed" women or in their relations to third variables. Objective(s). - We compared different measures of PPD and their relations with a third variable, namely the mothers' marital satisfaction. Method. - We recruited 65 mothers to take part in a study about the impact of PPD on the development of early family relations. Maternal PPD was assessed with multiple methods (i) a PPD-specific scale, (ii) a DSM-based diagnostic interviews and (iii) a rating scale designed to assess the severity of depressive symptoms. We assessed mothers' marital satisfaction with the Marital Adjustment Test (MAT). Results. - Results showed weak overlap between PPD-specific scale and DSM-based diagnosis of PPD, and modest correlations between the PPD-specific scale and the general depression rating scale. Only the score on the PPD-specific scale could predict marital satisfaction. Conclusion. - As we found discrepancies between different measures of PPD, we suggest being cautious in the choice of measures and using multiple methods to measure PPD in a comprehensive way.
Objective
To assess the possible relationship between serum levels of 25[OH]D (25-hydroxyvitamin D) collected 24 hours after delivery and postpartum depression in a Chinese cohort sample.DesignCohort study.SettingOne city hospital in Beijing, China.PopulationWomen delivering a full-term, singleton, live-born infant at one city hospital in Beijing between August 2013 and November 2013.Methods
Women were enrolled immediately postpartum. A blood sample was obtained 24–48 hours after childbirth to test serum levels of 25[OH]D. Participation consisted of a visit to an obstetric unit 3 months after delivery.Main outcome measureAt 3 months' postpartum, women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measure was a prespecified EPDS score of ≥12.ResultsDuring the study period, 323 women were admitted. In all, 248 agreed to enrol and 213 completed 3 months' follow-up (21 were lost to follow-up and 14 withdrew). Of the 213 women who were included, 26 (12.2%) were considered to meet criteria for postpartum depression. Serum 25[OH]D levels in women with no postpartum depression were significantly higher than those in women with postpartum depression (P < 0.0001). Based on the receiver operating characteristic curve, the optimal cutoff value for serum 25[OH]D level as an indicator for screening for postpartum depression was estimated to be 10.2 ng/ml, with an area under the curve of 0.801 (95%CI 0.704–0.896). In multivariate analysis, there was an increased risk of postpartum depression associated with 25[OH]D levels ≤10.2 ng/ml (OR 7.17, 95%CI 3.81–12.94; P < 0.0001) after adjusting for possible confounders.Conclusion
Our study demonstrated that lower serum 25[OH]D levels were associated with postpartum depression. This association was independent of other possible variables.
Studies in the general population have proposed links between nutrition and depression, but less is known about the perinatal period. Depletion of nutrient reserves throughout pregnancy and delayed postpartum repletion could increase the risk of perinatal depression. We examined the relationships of plasma folate and vitamin B12 concentrations during pregnancy with perinatal depression. At 26th-28th weeks of gestation, plasma folate and vitamin B12 were measured in women from the GUSTO mother-offspring cohort study in Singapore. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS) during the same period and at 3-month postpartum. EPDS scores of ≥15 during pregnancy or ≥13 at postpartum were indicative of probable depression. Of 709 women, 7.2% (n = 51) were identified with probable antenatal depression and 10.4% (n = 74) with probable postnatal depression. Plasma folate concentrations were significantly lower in those with probable antenatal depression than those without (mean ± SD; 27.3 ± 13.8 vs 40.4 ± 36.5 nmol/L; p = 0.011). No difference in folate concentrations was observed in those with and without probable postnatal depression. In adjusted regression models, the likelihood of probable antenatal depression decreases by 0.69 for every unit variation (increase) in folate (OR = 0.69 per SD increase in folate; 95% CI: 0.52, 0.94). Plasma vitamin B12 concentrations were not associated with perinatal depression. Lower plasma folate status during pregnancy was associated with antenatal depression, but not with postnatal depression. Replication in other studies is needed to determine the direction of causality between low folate and antenatal depression.
NCT01174875.
Pregnancy is a time of vulnerability for vitamin D insufficiency, and there is an emerging literature associating low levels of 25(OH)-vitamin D with depressive symptoms. However, the link between 25(OH)-vitamin D status in pregnancy and altered risk of postnatal depressive symptoms has not been examined. We hypothesise that low levels of 25(OH)-vitamin D in maternal serum during pregnancy will be associated with a higher incidence of postpartum depressive symptoms. We prospectively collected sera at 18 weeks gestation from 796 pregnant women in Perth (1989-1992) who were enrolled in the Western Australian Pregnancy Cohort (Raine) Study and measured levels of 25(OH)-vitamin D. Women reported postnatal depressive symptoms at 3 days post-delivery. Women in the lowest quartile for 25(OH)-vitamin D status were more likely to report a higher level of postnatal depression symptoms than women who were in the highest quartile for vitamin D, even after accounting for a range of confounding variables including season of birth, body mass index and sociodemographic factors. Low vitamin D during pregnancy is a risk factor for the development of postpartum depression symptoms.
Depression is considered as a chronic and recurring illness with functional impairment, significant disability, morbidity and mortality. Despite the extensive research carried out on depression, its pathophysiology is still poorly understood. An important problem concerning research into depressive disorder is the lack of biological markers which could improve diagnosis or indicate a risk of developing depression or risk of relapse. Several reports indicated decreased zinc concentrations and even its deficit in clinical depression, so the measurement of the concentration of this element in the blood of patients was suggested as a useful and specific clinical marker of depression. The reported results indicated that the serum zinc level might be a marker of depression as a state (state marker) in treatment responsive patients. However, in drug-resistant depression a decreased concentration of zinc may be a marker of traits (trait marker). It seems, however, that the measurement of the concentrations of zinc might be in the future a component of the battery of tests; of markers of immune activation and oxidative stress rather than itself alone.
Although research on relationships of nutrition with depression and anxiety is very limited, both biological plausibility and existing empirical evidence lend strong support to causal links, especially between diet and depression. Clinical deficiencies of several vitamins and minerals result in depression. Nutrients that have received particular attention with relation to depression include omega-3 fatty acids, folate, cobalamin, and zinc. Antioxidant nutrients are other potentially beneficial dietary factors that should be investigated. Body weight issues may be related to depression and anxiety in very complex ways. Dietary strategies to prevent and treat depression are inexpensive and low risk and therefore warrant consideration in future research and clinical applications.
INTRODUCTION: The incidence of depression is increasing worldwide. Much is still unknown about the possible role of magnesium in depression prevention and treatment. Magnesium has an effect on biological and transduction pathways implicated in the pathophysiology of depression. The possible role of magnesium in depression prevention and treatment remains unclear. OBJECTIVES: We systematically reviewed the possible links between magnesium and depression in humans. METHODS: Twenty-one cross-sectional studies, three intervention trials, one prospective study, one case only study, and one case series study were included based on specific selection criteria. RESULTS: A higher intake of dietary magnesium seems to be associated with lower depression symptoms though reverse causality cannot be excluded. The results assessing the association between blood and cerebrospinal fluid magnesium and depression are inconclusive. DISCUSSION: Magnesium seems to be effective in the treatment of depression but data are scarce and incongruous. Disturbance in magnesium metabolism might be related to depression. Oral magnesium supplementation may prevent depression and might be used as an adjunctive therapy. However, more interventional and prospective studies are needed in order to further evaluate the benefits of magnesium intake and supplementation for depression.
Postpartum depression (PPD) is a relatively common and often severe mood disorder that develops in women after childbirth. The aetiology of PPD is unclear, although there is emerging evidence to suggest a psychoneuroimmune connection. Additionally, deficiencies in n-3 PUFA, B vitamins, vitamin D and trace minerals have been implicated. This paper reviews evidence for a link between micronutrient status and PPD, analysing the potential contribution of each micronutrient to psychoneuroimmunological mechanisms of PPD. Articles related to PPD and women's levels of n-3 PUFA, B vitamins, vitamin D and the trace minerals Zn and Se were reviewed. Findings suggest that while n-3 PUFA levels have been shown to vary inversely with PPD and link with psychoneuroimmunology, there is mixed evidence regarding the ability of n-3 PUFA to prevent or treat PPD. B vitamin status is not clearly linked to PPD, even though it seems to vary inversely with depression in non-perinatal populations and may have an impact on immunity. Vitamin D and the trace minerals Zn and Se are linked to PPD and psychoneuroimmunology by intriguing, but small, studies. Overall, evidence suggests that certain micronutrient deficiencies contribute to the development of PPD, possibly through psychoneuroimmunological mechanisms. Developing a better understanding of these mechanisms is important for guiding future research, clinical practice and health education regarding PPD.
The very long chain polyunsaturated fatty acids (PUFAs) (C18–C22) and n-3 Omega PUFAs are apparently widely accepted as a part of modern nutrition because of their beneficial effects on metabolism. Most significantly, the reported protective effect of the n-3 omega fatty acids in relation to cardiovascular inflammatory diseases and cancer has led people to consider these fatty acids more beneficial than other dietary supplements. Unfortunately, there is a lack of studies relating to the physical performance increasing effect in sports diets, cholesterol-reducing effect in meat technology, effects on human serum profile, the application dose and the side effects with/without omega-6 PUFAs, which has left us with several crucial unanswered questions. We still do not know the correct dose of n-3 omega and the correct ratio of n-3 omega to n-6 omega or their possible contraindications when combined with drugs, other foods and herbal supplements. Another reported aspect of n-3 omega PUFAs is that they protect and even enhance the effect in medical treatment of important diseases such as Alzheimer’s, multiple sclerosis and cancer. These reports led to PUFAs becoming one of the most accepted and consumed food supplements. Despite this weight of evidence and the considerable current use, there is still a need for studies, which will determine whether the n-3 omega fatty acids are in fact important functional supplements with no adverse effects. This review will attempt to outline the current position of n-3 omega fatty acids in the field of clinical nutrition and healthcare and outline the studies needed to determine whether there are significant advantages in taking them as food supplement without any adverse effects.
Observational studies suggest association between low concentrations of omega-3 family fatty acids and greater risk for post-partum depression (PPD). The objective was to investigate the effect of unbalanced dietary intake of omega-6/omega-3 ratio >9:1 in the prevalence for PPD. The study comprises a prospective cohort with four waves of follow-up during pregnancy and one following delivery. PPD was evaluated according to the Edinburgh Post-partum Depression Scale (PPD ≥ 11) in 106 puerperae between 2005 and 2007, in Rio de Janeiro, Brazil. Independent variables included socio-demographic, obstetric, pre-pregnancy body mass index (BMI) and dietary intake data, which were obtained by means of a food frequency questionnaire in the first trimester of pregnancy. Statistical analysis involved calculation of PPD prevalence and multivariate Poisson regression with robust variance. PPD prevalence amounted to 26.4% [n = 28; confidence interval (CI) 95%: 18.0-34.8], and higher prevalences of PPD were observed in women who consumed an omega-6/omega-3 ratio >9:1 (60.0%) and in those with pre-pregnancy BMI <18.5 kg/m(2) (66.7%). These variables held as factors associated to PPD in the multivariate model, elevating the chances of occurrence of the outcome in 2.50 (CI 95%: 1.21-5.14) and 4.01 times (CI 95%: 1.96-8.20), respectively. Analyses were adjusted for age, schooling, pre-pregnancy BMI, lipids consumption and time elapsed since delivery. It verified an association between omega-6/omega-3 ratio above 9:1, the levels recommended by the Institute of Medicine, and the prevalence of PPD. These results add to the evidence regarding the importance of omega-6 and omega-3 fatty acids in the regulation of mental health mechanisms.
Low levels of serum 25-hydroxyvitamin D (25[OH]D), a reliable measurement of vitamin D, have been implicated in several mood disorders. To date, studies exploring the relationship between vitamin D and postpartum depression are absent from the literature.
To determine whether a relationship exists between symptoms associated with postpartum depression and vitamin D levels and to determine if serum 25(OH) D levels can predict the incidence of symptoms associated with postpartum depression.
An exploratory, descriptive study using a convenience sample of 97 postpartum women attending seven monthly visits. Women provided serum 25(OH)D samples and completed the Edinburgh Postpartum Depression Scale (EPDS) at each visit.
A significant relationship over time was found between low 25(OH)D levels and high EPDS scores, indicative of postpartum depression.
Future rigorous studies investigating vitamin D and postpartum depression are warranted with larger sample sizes using confirmatory methods to diagnose postpartum depression.
Postpartum depression (PPD) is the most common complication of childbirth. Suicide is a leading cause of maternal death in the first postpartum year. Depressed mothers often have suicidal ideation (SI). Depression and suicidality may vary across the seasons. Previous studies of seasonality and PPD were relatively small or encumbered by study design constraints. We examined the possible relationship between seasonality, depression, and SI in 9,339 new mothers.
From 2006 to 2010, the investigators screened women within 4-6 weeks postpartum with the Edinburgh Postnatal Depression Scale (EPDS). We used spectral analysis to explore seasonal variation in risk for depression and suicidality.
The study team screened 9,339 new mothers, of whom 1,316 (14%) women had positive depression scores (EPDS≥10) which suggest PPD risk; 294 (3%) women had SI (item 10≥1). A positive EPDS was associated significantly with SI. PPD risk varied significantly across 12-months-risk was highest in December. We detected no seasonal variation in SI.
Effects of seasonal light variation may contribute to increased risk for depressive symptoms. Suicidality could be related to maternal depression but not seasonal variation.
Vitamin D deficiency, which classically manifests as bone disease (either rickets or osteomalacia), is characterized by impaired bone mineralization. More recently, the term vitamin D insufficiency has been used to describe low levels of serum 25-hydroxyvitamin D that may be associated with other disease outcomes. Reliance on a single cutoff value to define vitamin D deficiency or insufficiency is problematic because of the wide individual variability of the functional effects of vitamin D and interaction with calcium intakes. In adults, vitamin D supplementation reduces the risk of fractures and falls. The evidence for other purported beneficial effects of vitamin D is primarily based on observational studies. We selected studies with the strongest level of evidence for clinical decision making related to vitamin D and health outcomes from our personal libraries of the vitamin D literature and from a search of the PubMed database using the term vitamin D in combination with the following terms related to the potential nonskeletal benefits of vitamin D: mortality, cardiovascular, diabetes mellitus, cancer, multiple sclerosis, allergy, asthma, infection, depression, psychiatric, and pain. Conclusive demonstration of these benefits awaits the outcome of controlled clinical trials.
Iron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear.
To evaluate whether iron status 48 h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD.
This was a prospective cohort study of depression-free women studied in the postpartum period.
Women who give birth at obstetric units in several general hospitals in Spain.
A subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism.
We evaluated depressive symptoms at 48 h, 8 weeks and 32 weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48 h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CCRP.
Overall, the women in the study had low iron concentrations (8.8 ± 6.9 μmol/L) and low TfS (12.6 ± 9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32 week postpartum period; these women also had a lower ferritin concentration (15.4 ± 12.7 μg/L vs. 21.6 ± 13.5 μg/L, P = 0.002). A strong association between ferritin and PPD was observed (odds ratio = 3.73, 95% CI: 1.84-7.56; P = 0.0001 for ferritin cutoff value of 7.26 μg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD.
These findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation.
A high prevalence of maternal vitamin D inadequacy during pregnancy and at delivery has been demonstrated in various ethnic populations living at different latitudes. Because placental transfer of 25(OH)D is the major source of vitamin D to the developing human fetus, there is growing concern about adverse health impacts that hypovitaminosis D during pregnancy may have on the mother as well as the offspring in utero, in infancy, and later in life. While there is lack of consensus regarding the optimal circulating 25(OH)D concentration in pregnancy, it is evident that prior levels used to establish intake recommendations and vitamin D content of prenatal vitamin supplements were too conservative. This review summarizes vitamin D metabolism in the perinatal period, examines evidence regarding outcomes of insufficiency in the mother and offspring, discusses risk factors and prevalence of insufficiency, and considers strategies for public health intervention.
Polyunsaturated Fatty acids (PUFAs) seem to be helpful in the therapy of depression. Zinc (Zn) may be one co-factor contributing to their antidepressive effect. Zn acts lipid protective and is a constituent of fatty acid metabolism enzymes. In animals, an antidepressive effect of Zn was already demonstrated. Therefore, if and how Zn and PUFAs correlate in depressive patients or in individuals from the general population was investigated. Blood samples were collected from 88 depressive in-patients and 88 volunteers from the general population matched for age-group and gender (each 32 men and 56 women, 21–70 years) for measurement of Zn (colorimetric) and of 12 fatty acids (FAs) (by capillary gas-chromatography). Severity of depression in patients was assessed by Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS). Zn concentration was independent of age, gender and body-mass-index and significantly correlated with the severity of depression measured by BDI (r = 0.26; P = 0.034) in depressive patients,. HDRS was inversely correlated with gammalinolenic acid concentration (r = −0.24; P = 0.029). Median serum Zn concentration in depressive patients did not differ from control individuals. Zn was correlated with myristic acid concentration (r = 0.22; P r = −0.26; P
Lower blood folate levels have been associated with depression in cross-sectional surveys, but no studies have examined the relationship prospectively to determine whether the relationship is causal. A follow-up study was designed to examine whether lower blood folate levels predict incident depressive symptoms.
Women aged 20-34 years registered in general practices in Southampton, UK, were asked to participate. Baseline assessment included the general health questionnaire (GHQ-12) measure of anxiety and depression, and socioeconomic factors, diet, smoking and alcohol intake. Two years later, participants' general practice (GP) records were examined for evidence of incident symptoms of depression.
At baseline, 5051 women completed the GHQ-12 and had red cell folate levels measured, of whom 1588 (31.4%) scored above the threshold for case level symptoms of anxiety and depression on the GHQ-12. Two years later, GP records for 3996 (79.1%) were examined, but 1264 with baseline evidence of depression were excluded from follow-up analysis. Incident depressive symptoms were recorded for 307 (11.2%) of the remaining 2732. Lower red cell folate levels were associated with caseness on the GHQ-12 (adjusted prevalence ratio 0.99 per 100 nmol/l red cell folate, 95% CI 0.98 to 1.00). No relationship was found between red cell folate levels and incident depressive symptoms over 2 years (adjusted hazard ratio 1.00, 95% CI 0.97 to 1.03).
Low folate levels were not associated with subsequent depressive symptoms. This suggests that lower blood folate levels may be a consequence rather than a cause of depressive symptoms.
This integrative review evaluates research studies that investigated the association between vitamin D and mood disorders affecting women to determine whether further research comparing these variables is warranted. A literature search using CINAHL, PsycINFO, MEDLINE, and PubMed databases was conducted to locate peer-reviewed mood disorder research studies that measured serum 25-hydroxyvitamin D (25[OH]D) levels. Four of six studies reviewed imparted significant results, with all four showing an association between low 25(OH)D levels and higher incidences of four mood disorders: premenstrual syndrome, seasonal affective disorder, non-specified mood disorder, and major depressive disorder. This review indicates a possible biochemical mechanism occurring between vitamin D and mood disorders affecting women, warranting further studies of these variables using rigorous methodologies.
The selenium content in the blood of pregnant women in the Valencian Community, Spain was determined until the end of gestation in order to assess its evolution and detect possible differences in relation to the values corresponding to non-pregnant women of fertile age. A total of 158 blood samples were obtained from 137 pregnant women. Samples were classified as: (a) first; (b) second; and (c) third trimester. Selenium was determined by a flow injection hydride atomic absorption spectrometric method (Seronorm whole blood was used as a quality control check). The selenium values obtained for the three trimesters followed a Gaussian distribution. The intervals for mean found were: (a) 75.7-85.5 micrograms/l; (b) 72.6-81.4 micrograms/l; and (c) 69.9-77.5 micrograms/l. Although a tendency to decrease was observed, no statistical significant differences between the three trimesters of the gestational period were observed. When we compare the values obtained with the blood selenium content of women of fertile age in the Valencian community (87.8-98.8 micrograms/l) by using an ANOVA test, statistically significant differences are found between the selenium values of women of fertile age and those corresponding to pregnant women. The differences, however, are very small and can be partially explained by the level of hemodilution during pregnancy, however, reference values of blood selenium contents in pregnant women should be taken into account.
Iron requirements are greater in pregnancy than in the nonpregnant state. Although iron requirements are reduced in the first trimester because of the absence of menstruation, they rise steadily thereafter; the total requirement of a 55-kg woman is approximately 1000 mg. Translated into daily needs, the requirement is approximately 0.8 mg Fe in the first trimester, between 4 and 5 mg in the second trimester, and >6 mg in the third trimester. Absorptive behavior changes accordingly: a reduction in iron absorption in the first trimester is followed by a progressive rise in absorption throughout the remainder of pregnancy. The amounts that can be absorbed from even an optimal diet, however, are less than the iron requirements in later pregnancy and a woman must enter pregnancy with iron stores of >/=300 mg if she is to meet her requirements fully. This is more than most women possess, especially in developing countries. Results of controlled studies indicate that the deficit can be met by supplementation, but inadequacies in health care delivery systems have limited the effectiveness of larger-scale interventions. Attempts to improve compliance include the use of a supplement of ferrous sulfate in a hydrocolloid matrix (gastric delivery system, or GDS) and the use of intermittent supplementation. Another approach is intermittent, preventive supplementation aimed at improving the iron status of all women of childbearing age. Like all supplementation strategies, however, this approach has the drawback of depending on delivery systems and good compliance. On a long-term basis, iron fortification offers the most cost-effective option for the future.
Placenta tissue may be a major source of lipid peroxidation products in pregnancy. It was proven that placental peroxidation activity increases with gestation. Selenium (Se), as an essential constituent of glutathione peroxidase (GSH-Px), takes part in the reduction of hydrogen peroxides and lipid peroxides. Malondialdehyde (MDA) is a major breakdown product split off from lipid peroxides. In this study, Se and MDA content and GSH-Px activity were measured in blood and plasma taken from 20 apparently healthy nonpregnant women between 19 and 38 yr of age and from 115 unselected pregnant women between 17 and 45 yr of age (35 in the first trimester, 22 in the second trimester, 38 in the third trimester, and 20 within 2 d of delivery). Samples of umbilical cord blood and amniotic fluid were taken from women in the second and third trimesters and at delivery. The Se content was measured by atomic absorption spectrometry (AAS), plasma MDA concentration by thiobarbituric acid reaction, and Se-dependent GSH-Px spectrometrically. Blood and plasma Se contents of nonpregnant women were below those considered adequate, indicating low selenium intake. In comparison to nonpregnant women, pregnant women had significantly decreased whole-blood and plasma Se levels in the second and third trimesters and at delivery. The significant drop of whole-blood SeGSH-Px activity was observed in the first trimester of pregnancy and its lower activity was maintained until delivery. A significant drop in plasma SeGSH-Px activity occurred in the second trimester and attained the minimal level at delivery. The Se level and SeGSH-Px activity in maternal and umbilical cord blood were at similar levels. Amniotic-fluid SeGSH-Px activity was nondetectable or exceptionally low and its Se content remained unchanged during pregnancy. Plasma levels of MDA were significantly decreased in the second and third trimesters and at delivery. The fetal blood plasma at birth had a lower MDA level compared to the levels of MDA of their mothers at delivery. A low, but significant inverse correlation existed between blood SeGSH-Px activity and plasma MDA content and between plasma Se and plasma MDA contents during pregnancy. A significant decrease of Se and SeGSH-Px activities (antioxidant enzyme) in both blood and plasma suggests a possible drop in total antioxidant status during pregnancy. Elevated MDA plasma levels might be the result of increased lipid peroxidation in placental tissue during pregnancy. Index Entries: Selenium; glutathione peroxidase; malondialdehyde; pregnancy; umbilical cord blood; amniotic fluid.
Iron deficiency without anemia has been shown to reduce both muscle-tissue oxidative capacity and endurance in animals. However, the consequences of iron deficiency in humans remain unclear.
We investigated the effects of iron supplementation on adaptation to aerobic training among marginally iron-depleted women. We hypothesized that iron supplementation for 6 wk would significantly improve iron status and maximal oxygen uptake (VO(2)max) after 4 wk of concurrent aerobic training.
Forty-one untrained, iron-depleted, nonanemic women were randomly assigned to receive either 50 mg FeSO(4) or a placebo twice daily for 6 wk in a double-blind trial. All subjects trained on cycle ergometers 5 d/wk for 4 wk, beginning on week 3 of the study.
Six weeks of iron supplementation significantly improved serum ferritin and serum transferrin receptor (sTfR) concentrations and transferrin saturation without affecting hemoglobin concentrations or hematocrit. Average VO(2)max and maximal respiratory exchange ratio improved in both the placebo and iron groups after training; however, the iron group experienced significantly greater improvements in VO(2)max. Both iron-status and fitness outcomes were analyzed after stratifying by baseline sTfR concentration (> and < or = 8.0 mg/L), which showed that the previously observed treatment effects were due to iron-status and fitness improvements among subjects with poor baseline iron status.
Our findings strongly suggest that iron deficiency without anemia but with elevated sTfR status impairs aerobic adaptation among previously untrained women and that this can be corrected with iron supplementation.
This review enumerates and discusses the elements involved in the control of human blood pressure via a historical evolutionary form. The older and most recent element literature presentations were researched using MEDLINE and a manual review of documents cited. Independent data extraction and cross-referencing was performed. Of the 28 known elements that can influence blood pressure, 15 were found to be involved in human blood pressure regulation. The elements were divided into four groups: electrolyte, composed of sodium, potassium, calcium, and magnesium; metal, which included zinc, copper, and iron; toxic, made up of lead, mercury, cadmium, barium, thallium, arsenic; miscellaneous (lithium and selenium). Evolutionary historical data, possible mechanisms of actions, and interactions between elements that have been shown to influence blood pressure are discussed. Controversy exists over the therapeutic use of elements to alter blood pressure but is absent in the case of the toxic group where preventive control is a proven public health matter. The significance of these 15 elements in the regulation of human blood pressure has been established and ongoing studies will continue to reinforce their influence and importance.
Mothers selectively transfer docosahexaenoic acid (DHA) to their fetuses to support optimal neurological development during pregnancy. Without sufficient dietary intake, mothers become depleted of DHA and may increase their risk of suffering major depressive symptoms in the postpartum period. We postulated that the DHA content of mothers' milk and seafood consumption would both predict prevalence rates of postpartum depression across countries.
Published prevalence data for postpartum depression were included that used the Edinburgh Postpartum Depression Scale (n=14532 subjects in 41 studies). These data were compared to the DHA, eicosapentaenoic acid (EPA) and arachidonic acid (AA) content in mothers' milk and to seafood consumption rates in published reports from 23 countries.
Higher concentrations of DHA in mothers' milk (r=-0.84, p<0.0001, n=16 countries) and greater seafood consumption (r=-0.81, p<0.0001, n=22 countries) both predicted lower prevalence rates of postpartum depression in simple and logarithmic models, respectively. The AA and EPA content of mothers' milk were unrelated to postpartum depression prevalence.
These findings do not prove that higher omega-3 status cause lower prevalence rates of postpartum depression. Data on potentially confounding factors were not uniformly available for all countries.
Both lower DHA content in mothers' milk and lower seafood consumption were associated with higher rates of postpartum depression. These results do not appear to be an artifact of cross-national differences in well-established risk factors for postpartum depression. Interventional studies are needed to determine if omega-3 fatty acids can reduce major postpartum depressive symptoms.
Several sources of information suggest that human beings evolved on a diet with a ratio of omega-6 to omega-3 essential fatty acids (EFA) of approximately 1 whereas in Western diets the ratio is 15/1-16.7/1. Western diets are deficient in omega-3 fatty acids, and have excessive amounts of omega-6 fatty acids compared with the diet on which human beings evolved and their genetic patterns were established. Excessive amounts of omega-6 polyunsaturated fatty acids (PUFA) and a very high omega-6/omega-3 ratio, as is found in today's Western diets, promote the pathogenesis of many diseases, including cardiovascular disease, cancer, and inflammatory and autoimmune diseases, whereas increased levels of omega-3 PUFA (a low omega-6/omega-3 ratio) exert suppressive effects. In the secondary prevention of cardiovascular disease, a ratio of 4/1 was associated with a 70% decrease in total mortality. A ratio of 2.5/1 reduced rectal cell proliferation in patients with colorectal cancer, whereas a ratio of 4/1 with the same amount of omega-3 PUFA had no effect. The lower omega-6/omega-3 ratio in women with breast cancer was associated with decreased risk. A ratio of 2-3/1 suppressed inflammation in patients with rheumatoid arthritis, and a ratio of 5/1 had a beneficial effect on patients with asthma, whereas a ratio of 10/1 had adverse consequences. These studies indicate that the optimal ratio may vary with the disease under consideration. This is consistent with the fact that chronic diseases are multigenic and multifactorial. Therefore, it is quite possible that the therapeutic dose of omega-3 fatty acids will depend on the degree of severity of disease resulting from the genetic predisposition. A lower ratio of omega-6/omega-3 fatty acids is more desirable in reducing the risk of many of the chronic diseases of high prevalence in Western societies, as well as in the developing countries, that are being exported to the rest of the world.
Folate deficiency and low folate status have been linked in clinic studies to depression, persistent depressive symptoms, and poor antidepressant response. These relationships have not been demonstrated in general populations. This study examined associations between depression and folate status indicators in an ethnically diverse general US population sample aged 15-39 years.
Healthy subjects whose red blood cell (RBC) folate concentrations had been measured were determined to have no depression (n = 2,526), major depression (n = 301), or dysthymia (n = 121) using a diagnostic interview schedule. Serum concentrations of folate and total homocysteine (tHcy) were also measured.
After adjustment for sociodemographic factors, serum vitamin B(12) concentration, alcohol consumption over the past year and current status as to overweight and use of vitamin/mineral supplements, cigarettes and illegal drugs, subjects who met criteria for a lifetime diagnosis of major depression had folate concentrations in serum and RBCs that were lower than those of subjects who had never been depressed. Subjects who met criteria for dysthymia alone had lower RBC folate concentrations than never-depressed subjects, but the serum folate concentrations of the two groups were comparable. Serum tHcy concentration was not related to lifetime depression diagnoses. Low folate status was found to be most characteristic of recently recovered subjects, and a large proportion of such subjects were folate deficient.
Low folate status was detectable in depressed members of the general US population. Folate supplementation may be indicated during the year following a depressive episode.
We investigated the contribution of anxiety symptoms to scores on the Edinburgh Postnatal Depression Scale (EPDS) between 36 weeks gestation and 16 weeks postpartum in 150 women. The 3-item anxiety subscale of the EPDS accounted for 47% of the total score in late pregnancy, and 38% of the total score in the postpartum period. Two categories of anxiety were common in the perinatal period: subsyndromal, situational anxiety (in particular during the last weeks of pregnancy); and clinically significant comorbid anxiety, which was experienced by nearly 50% of clinically depressed pregnant and postpartum women. The close relationship between anxiety and depression raises questions about whether symptoms of anxiety might be more common in the perinatal period than in other depressions. A strong role for anxiety symptoms in postpartum depression, and implications for its etiology and treatment, are discussed.
The purpose of this study was to determine the effect of docosahexaenoic acid supplementation on plasma phospholipid docosahexaenoic acid content and indices of depression and information processing for women who breast-feed.
Mothers who planned to breast-feed their infants were assigned randomly in a double-masked fashion to receive either docosahexaenoic acid (approximately 200 mg/d) or placebo for the first 4 months after the delivery. Major outcome variables included plasma phospholipid fatty acid patterns and scores on a self-rating questionnaire of current depression symptoms. A structured clinical interview of depression, scores on another self-rating questionnaire of depression symptoms, and a laboratory measure of information processing were obtained in subgroups of the total population.
Plasma phospholipid contents of docosahexaenoic acid at baseline were 3.15 +/- 0.78 and 3.31 +/- 0.70 (mg/dL of total fatty acids) in the docosahexaenoic acid and placebo groups, respectively. After 4 months, the plasma phospholipid docosahexaenoic acid content of the docosahexaenoic acid group was 8% higher (3.40 +/- 0.97 mg/dL), whereas that of the placebo group was 31% lower (2.27 +/- 0.87 mg/dL). Despite the higher plasma phospholipid docosahexaenoic acid content of the supplemented group after 4 months, there was no difference between groups in either self-rating or diagnostic measures of depression; information processing scores of the two groups also did not differ.
Docosahexaenoic acid supplementation ( approximately 200 mg/d) for 4 months after the delivery prevented the usual decline in plasma phospholipid docosahexaenoic acid content of women who breastfeed but did not influence self-ratings of depression, diagnostic measures of depression, or information processing.
Over the past three decades, selenium has been intensively investigated as an antioxidant trace element. It is widely distributed throughout the body, but is particularly well maintained in the brain, even upon prolonged dietary selenium deficiency. Changes in selenium concentration in blood and brain have been reported in Alzheimer's disease and brain tumors. The functions of selenium are believed to be carried out by selenoproteins, in which selenium is specifically incorporated as the amino acid, selenocysteine. Several selenoproteins are expressed in brain, but many questions remain about their roles in neuronal function. Glutathione peroxidase has been localized in glial cells, and its expression is increased surrounding the damaged area in Parkinson's disease and occlusive cerebrovascular disease, consistent with its protective role against oxidative damage. Selenoprotein P has been reported to possess antioxidant activities and the ability to promote neuronal cell survival. Recent studies in cell culture and gene knockout models support a function for selenoprotein P in delivery of selenium to the brain. mRNAs for other selenoproteins, including selenoprotein W, thioredoxin reductases, 15-kDa selenoprotein and type 2 iodothyronine deiodinase, are also detected in the brain. Future research directions will surely unravel the important functions of this class of proteins in the brain.
Patients with depression have been extensively reported to be associated with the abnormality of omega-3 polyunsaturated fatty acids (PUFAs), including significantly low eicosapentaenoic acid and docosahexaenoic acid in cell tissue contents (red blood cell membrane, plasma, etc.) and dietary intake. However, more evidence is needed to support its relation. In this study, we conducted an 8-week, double-blind, placebo-controlled trial, comparing omega-3 PUFAs (6.6 g/day) [corrected] with placebo, on the top of the usual treatment, in 28 patients with major depressive disorder. Patients in the omega-3 PUFA group had a significantly decreased score on the 21-item Hamilton Rating Scale for Depression than those in the placebo group (P < 0.001). From the preliminary findings in this study, omega-3 PUFAs could improve the short-term course of illness and were well tolerated in patients with major depressive disorder.
Observational studies suggest an association between a low docosahexaenoic acid (DHA, 22:6n-3) status after pregnancy and the occurrence of postpartum depression. However, a comparison of the actual biochemical plasma DHA status among women with and without postpartum depression has not been reported yet. The contents of DHA and of its status indicator n-6 docosapentaenoic acid (n-6DPA, 22:5n-6) were measured in the plasma phospholipids of 112 women at delivery and 32 weeks postpartum. At this latter time point, the Edinburgh Postnatal Depression Scale (EPDS) questionnaire was completed to measure postpartum depression retrospectively. The EPDS cutoff score of 10 was used to define 'possibly depressed' (EPDS score > or =10) and non-depressed women (EPDS score <10). Odds ratios (OR) were calculated using a multiple logistic regression analysis with the EPDS cutoff score as dependent and fatty acid concentrations and ratio's as explanatory variables, while controlling for different covariables. The results demonstrated that the postpartum increase of the functional DHA status, expressed as the ratio DHA/n-6DPA, was significantly lower in the 'possibly depressed' group compared to the non-depressed group (2.34+/-5.56 versus 4.86+/-5.41, respectively; OR=0.88, P=0.03). Lactating women were not more predisposed than non-lactating women were to develop depressive symptoms. From this observation it seems that the availability of DHA in the postpartum period is less in women developing depressive symptoms. Although further studies are needed for confirmation, increasing the dietary DHA intake during pregnancy and postpartum, seems prudent.