Nutritional Factors Affecting Postpartum Depression
Lia M. Nightingale, PhD
Assistant Professor, Division of Life Sciences,
Palmer College of Chiropractic,
1000 Brady Street, Davenport, IA 52803, USA.
Pregnancy and lactation represent a period of substantial physiological changes for the mother and increased nutritional requirements to meet these adjustments. A number of nutritional depletions occur during pregnancy. Serum concentrations of iron and folate take months before they normalize to pre-pregnancy levels. Additionally, many micronutrients required during pregnancy interfere with each other, making absorption difficult. Postpartum depression is the primary complication of childbirth, possibly caused by several nutritional and non-nutritional factors. The current review highlights the impact nutrition may have on the etiology of this debilitating disorder, most notably on prevention of inflammation and maintenance of a healthy central nervous system. The most notable nutritional deficiencies associated with postpartum depression include omega-3 fatty acids, folate, iron, and zinc; however, supplementation trials for prevention of postpartum depression are severely lacking. Practical recommendations are given to minimize micronutrient interference and reduce the risk of postpartum depression.
Key Words: postpartum depression, nutrition, diet, folate, essential fatty acids, iron, zinc
From the Full-Text Article:
Depression is the second leading cause of disability for those of reproductive age.  Although all forms of depression are devastating, postpartum depression (PPD) has long-lasting consequences for all family members involved. Postpartum depression is the most common complication of childbirth, defined as having major or minor depressive episodes that occur within 12 months after delivery. [2, 3] Postpartum depression has been associated with impaired mother-child interactions, poorer child development, and more violent behavior in children with mothers displaying PPD. [4-6]
Pregnancy is a time of increased nutritional requirements to support fetal growth and development. There are several lines of thought concerning the cause of PPD, including the link between nutritional intake and risk of depression. Therefore, the goal of this review is to examine maternal depletion of nutrients, assess whether these nutritional factors may play a role in PPD, and summarize simple recommendations to implement in practice.
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According to the Agency for Healthcare Research and Quality (AHRQ), PPD prevalence peaks around 12 weeks post delivery with 12.9% of new mothers having bouts of major and minor depression.  The same study estimated that up to 19.2% of new mothers may have major or minor depression in the first 3 months postpartum, with 7.1% having a major depressive episode. Interestingly, international prevalence rates of PPD are higher than those reported in the United States. Published rates include 27.6% in Japan,  34.7% in South Africa,  and 40% in Costa Rica. 
Nearly 50% of mothers with this affective disorder are not diagnosed;  thus, screening is essential to diagnosis. Many self-reporting tools have been designed and evaluated to identify PPD including the Postpartum Depression Screening Scale (PDSS), Edinburgh Postpartum Depression Scale (EPDS), 9-item Patient Health Questionnaire (PHQ-9), and 2-item Patient Health Questionnaire (PHQ-2).