High dietary ratio of omega‐6 to omega‐3 polyunsaturated acids during pregnancy and prevalence of post‐partum depression

Abstract

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.

Insufficient intake of alpha-linolenic fatty acid (18:3n-3) during pregnancy and associated factors

“…Compared to another study conducted in Rio de Janeiro, the women in this study presented a less favorable profile, in respect of the intake of alpha-linolenic fatty acid, with a median and interquartile range of 1.63 (1.25-2.19) grams versus 2.1 (1.4-2.6) grams [8]. The background social context is relevant to the intake of these nutrients, possibly through consideration of specific culinary cultures.…”

“…Additionally, studies on outcomes related to the intake of omega-3 fatty acids include the effects on the mother's mental health, with lower intake related to an increased risk of depressive symptoms during gestation [7], and a relationship between a 9:1 ratio of linoleic and alpha-linolenic fatty acids intake and postpartum depression [8]. Docohexanoic acid supplementation during pregnancy was associated with a higher level of attention in children at five years of age [9].…”

Role of Omega-3 Unsaturated Fatty Acids in the Postpartum Depression: Systematic Review and Narrative Synthesis

“…Although heterogeneity among included studies makes it difficult to synthesize the findings, our narrative approach indicates a null benefit of n-3 PUFAs on depressive symptoms postpartum, as only one small pilot trial (Freeman et al, 2006), one weak ecological study (Hibbeln, 2002), and four small cohort and cross-sectional studies (da Rocha & Kac, 2012;De Vriese, Christophe, & Maes, 2003;Markhus et al, 2013;Otto, De Groot, & Hornstra, 2003) reported promising results, whilenone of the RCTs identified in this review showed an association of n-3 PUFAs with a decreased risk for maternal PPD.…”

“…Of the former, six were randomized controlled trials (Doornbos et al, 2009;Freeman et al, 2008;Llorent et al, 2003;Makrides et al, 2010;Mozurkewich et al, 2013;Rees, Austin, & Parker, 2008) and two pilot trials (Freeman et al, 2006;Marangell et al, 2004). The nine observational studies included: one ecological study (Hibbeln, 2002), a cross-sectional study (De Vriese, Christophe, & Maes, 2003), a case-control study (Browne, Scott, & Silvers, 2006), and six cohort studies (da Rocha & Kac, 2012;Markhus et al, 2013;Miyake et al, 2006;Otto, De Groot, & Hornstra, 2003;Parker et al, 2014;Strøm, Mortensen, Halldorsson, Thorsdottir, & Olsen, 2009). The included studies and the results of our quality appraisals are summarized in Table A1, while more detail on the characteristics of the studies is presented in Table A2.…”

Correlation between postpartum depression and omega-3, micronutrients

“…It becomes harder to monitor and to treat this disease, because women often neglect PPD symptoms. 8 It is essential to take preventive measures by defining whether postpartum depression is a separate type of depression and time of detection as well as factors related to prepartum depression. From an etiological point of view, depressive disorders are a heterogeneous group and make up the last stage of many different causal pathways.…”