Food and Maternal Mental Health

 

What we eat can affect how our bodies feel more than just physiologically. Research over the years has investigated the impact of food, supplements, and food scarcity on mental health, including the effects on postpartum depression and other perinatal mood and anxiety disorders (PMADs).

 

Historically, many cultures thought that the first 40 days postpartum were crucial to support the mother; to stave off illnesses including mental ones. One major way this was accomplished was by providing the mother with plenty of nutritive meals. Even though today can be more chaotic, and you may not have a huge network of support to bring you food, there are ways you can try to develop a nutrition plan to help postpartum recovery.

 

Though it maybe not necessary to take specific supplements before you are pregnant1 (with the exception of zinc perhaps), during pregnancy it is essential to make sure that you are getting a good balance of nutrients, and not just for the baby’s development.

 

A “healthy” diet is made up of appropriate portions of fruits, veggies, whole grains, and fish while an “unhealthy” diet is full of refined grains, sweets, fast foods, and energy drinks. The “unhealthy” diet, besides being linked to a host of problems like obesity, has also been associated with increased depressive symptoms and signs at 32 weeks.8

 

It is also important to make sure you are eating enough food, because food insecurity during the postpartum period can lead to maternal depression.2 5 In other words, though it may not be truly necessary to “eat for two” while pregnant, you do need to make sure you are getting the right amount of nutrients for your body, even after birth, when your body is trying to recover. And after your baby is born, it’s important to avoid aggressively cutting calories to get back your body (unless discussed with your doctor).

 

As for what supplements are most important to decrease the PMADs risk, the research studies haven’t come to an agreement. However, it appears that traditional western diets as well as those deficient in n-3 fatty acids are most strongly related to increased prevalence of PPD, especially among low-income individuals.4 7

 

This general lack of concrete answers as to what is needed in our diets may be because nutrition is a complex problem and doesn’t lend itself to simple solutions. Instead, we need to find more holistic approaches to nutrition because as we go through the drastic physical and emotional changes of birth, our bodies need a balance of a lot of different supplements/nutrients to help our mental health. This idea, that it’s more important to have supplementation broadly, is supported by a multitude of studies. Some studies looked at a select few supplements (like fatty acid-rich lipid based nutrient supplements, iron-folate, and multiple-micronutrient capsules) and found that women taking any one of the three had no difference in symptoms from the others.3

 

However, zinc intake appears to be supportive against psychological stress.6 Newer studies found that after birth, moms have low zinc levels but high levels of a protein called C-reactive protein (CRP). Postpartum depression was found to be fairly accurately predicted if the mother had prenatal depression, fatigue, low zinc levels and high CRP.10 Given that women with a history of anxiety, depression, and PMS were seen to have low zinc levels, maybe taking a zinc supplement during the pre-pregnancy stage could help reduce the risk of postpartum depression later.

 

Lastly, probiotics have been making a headway in research. Women taking Lactobacillus rhamnosus (found in some types of kombucha, kefir, etc) have been found in to have lower depression and anxiety rates.9 In general, reviews being published are pretty excited about the potential of probiotics to help reduce depressive symptoms, specifically looking at the effects of probiotics on the “gut-brain axis”.11 This will definitely be a topic to keep a look out for and discuss with your doctor in the coming years, as probiotics have fewer side effects than many front-line medications, or may be useful to take in conjunction with those medications.

 

Our takeaway should be that though there isn’t a concise guideline for the best foods and supplements pregnant ladies/mothers should consume to prevent PMADs, it does seem that what you eat may have an effect on your risk levels. Because of this we should strive to eat “healthier” and make sure to talk with a doctor to check to see if you are deficient in any crucial nutrients, especially zinc, and start asking about the benefits of probiotic supplements.

 

In the meantime, below is a guideline that may help you start-off. It focuses on nutrient-dense foods such as:

Colorful vegetables and fruits: leafy greens, cabbage, broccoli, berries, citrus, cranberries

Healthy proteins: bone broths, grass-fed beef, low-mercury fish

Healthy fats: avocados and extra-virgin olive oil

Healthy grains: quinoa, oats, millet, rice

Probiotic foods: yogurt, kombucha, sauerkraut, kefir

 

Antioxidant-rich fruits and veggies are important for reducing inflammation, which has been linked with postpartum depression.12 Bone broth helps provide collagen, which we need to help with all sorts of healing and tissue repair. It and other proteins also help keep blood sugar balanced.

 

After talking to your doctor, you may want to ask if you can get your supplements through foods rather than pills. A great resource for learning about what types of foods have what vitamins and other nutrients is an article by Dr. Alejandra Carrasco on Mind Body Green. She mentions food sources for magnesium, selenium, iodine, zinc, folate, iron, vitamin B12, B vitamins, vitamin D, vitamin C, vitamin A, essential fatty acids, proteins, and collagen.

 

Next make sure you are drinking enough water. Childbirth involved losing a lot of blood and as your body changes back to a non-pregnant state, you will need water to replenish it. This is even more crucial if you are also breastfeeding.

 

And lastly, try to have only sparing amounts of highly inflammatory foods like desserts that include refined sugars (white sugar, corn syrup, etc). Also try not to consume too much honey or maple syrup.

 

References

 

  1. Nguyen PH, DiGirolamo AM, Gonzalez-Casanova I, Pham H, Hao W, Nguyen H, Truong TV, Nguyen S, Harding KB, Reinhart GA, Martorell R, Ramakrishnan U. Impact of preconceptional micronutrient supplementation on maternal mental health during pregnancy and postpartum: results from a randomized controlled trial in Vietnam. BMC Women’s Health 2017 June 17; 17: 44

 

  1. Nagata JM, Gomberg S, Hagan MJ, Heyman MB, Wojcicki JM. Food insecurity is associated with maternal depression and pervasive developmental symptoms in low-income Latino households. Journal of Hunger & Environmental Nutrition. 2018 Feb 20.

 

  1. Stewart RC, Ashorn P, Umar E, Dewey KG, Ashorn U, Creed F, Rahman A, Tomenson B, Prado EL, Maleta K. The impact of maternal diet fortification with lipid-based nutrient supplements on postpartum depression in rural Malawi: a randomised-controlled trial. Maternal & Child Nutrition. 2016 Apr 5; 13(2).

 

  1. Leung BMY, Kaplan BJ. Perinatal Depression: Prevalence, Risks, and the Nutrition Link – A Review of the Literature. Journal of the American Dietetic Association. 2009 Sept; 109(9): 1566-1575.

 

  1. Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ. Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa. Social Science & Medicine. 2016 Feb; 151: 67-77.

 

  1. Roy A, Evers SE, Avison WR, Campbell MK. Higher zinc intake buffers the impact of stress on depressive symptoms in pregnancy. Nutrition Research; 30(1): 695-704.

 

  1. Moran K. Impact of Socioeconomic Status on Prenatal Nutrition and Postpartum Depression. The Grace Peterson Nursing Research Colloquium. 2017.

 

  1. Baskin R, Hill B, Jacka FN, O’Neil A, Skouteris H. Antenatal dietary patterns and depressive symptoms during pregnancy and early post-partum. Maternal & Child Nutrition. 2016 Jan 3; 13(1)

 

  1. Slykerman RF, Hood F, Wickens K, Thompson JMD, Barthow C, Murphy R, Kang J, Rowden J, Stone P, Crane J, Stanley T, Abels P, Purdie G, Maude R, Mitchell EA. Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial. EBioMedicine. 2017 Oct; 24: 159-165.

 

  1. Roomruangwong C, Kanchanatawan B, Sirivichayakul S, Mahieu B, Nowak G, Maes M. Lower Serum Zinc and Higher CRP Strongly Predict Prenatal Depression and Physic-Somatic Symptoms, Which All Together Predict Postnatal Depressive Symptoms. Molecular Neurobiology. 2017 Mar; 54(2): 1500-1512.

 

  1. Wallace CJK, Milev R. The effects of probiotics on depressive symptoms in humans: a systematic review.

 

12. Bränn E, Fransson E, White RA, Papadopoulos FC, Edvinsson Å, Kamali-Moghaddam M, Cunningham JL, Sundström-Poromaa I, Skalkidou A. Inflammatory markers in women with postpartum depressive symptoms. Journal of Neuroscience Research. 2018 Sept 5.

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