There’s no doubt that the cause of postpartum depression is multifactorial. We can’t point a finger at any one cause.
What we do know for certain is that mom’s nutrition plays a key role in building and regulating her hormones. Which means that her nutrition also affects her neurotransmitters and ultimately her mood. We need to ensure that a mom’s diet provides her with essential nutrients she needs to optimize her own nutrition stores (during and after her pregnancy). If a mom becomes deficient in nutrients during her pregnancy we need to replenish these nutrients and “fill up her tank”. Focusing on nutrient- dense foods and using specific supplements can help reduce her risk and/or some of the symptoms of postpartum depression.
Why might a mom be nutrient-deficient?
A baby’s body is built from mom’s the food mom eats as well as her nutrient reserves. If there’s not enough nutrients to go around for both mom and baby, baby’s needs always comes first, potentially leaving mom depleted. Hence, pregnant women have increased calorie and nutrient needs in order to keep both her, and baby, healthy.
Here are potential reasons why mom may be nutrient-deficient in the postpartum period:
- Mom enters pregnancy nutrient-deficient due to years of calorie restriction or a less than optimal diet.
- Increased nutrient demands during pregnancy, childbirth, postpartum healing, and nursing
- Less than optimal diet postpartum
- Mom’s use of medications (including SSRIs)
Looking at this list, all moms fall into at least one of these categories. Pregnancy, childbirth, postpartum healing, and nursing all have significant nutrient demands. If mom enters pregnancy nutrient-deficient (due to years of calorie restriction or a less than optimal diet) she has to pay extra special attention to her diet during/after pregnancy. Even if a mom has been consuming a whole-foods diet prior to getting pregnant, she still needs to work hard to ensure she’s restocking her own nutrient stores and may easily become nutrient-depleted due to the stress and demands of motherhood.
Depleting her nutrient reserves throughout pregnancy and failing to recover these reserves postpartum may increase a woman’s risk of depression. Are you starting to see why so many mom’s may be dealing with symptoms of postpartum depression, mood and anxiety disorders? There’s a lot to think about!
What nutrient deficiencies may contribute to the development of postpartum depression?
Throughout scientific literature, there are common nutrient deficiencies that have been implicated in depression. These nutrients frequently become depleted during pregnancy and may play a role in the development of postpartum depression:
- Essential fatty acids (EPA/DHA)
- Vitamin D
- B-vitamins (specifically B6, B9, B12)
- Trace minerals (specifically zinc, iron, and selenium)
Essential fatty acids (EPA/DHA)
The omega-3 fatty acids EPA and DHA are the most well-researched nutrients when it comes postpartum depression and nutrient depletion. Early observational studies consistently show that serum and dietary omega-3 fatty acid levels are low in depressed patients. Countries with lower omega-3 fatty acid consumption have higher rates of depression. As supplementing individuals who have major depressive disorder with fish oil has shown to be effective, the American Psychiatric Association recommends supplementation as a standard of care.
EPA/DHA are essential fatty acids, meaning we need to consume them in our diet in order to have enough. In fact, maternal stores of DHA can be reduced by 50% during pregnancy and not return to pre-pregnancy levels until 6 months postpartum. Since a baby’s brain is composed of 60% fat, this is pretty important. If a mom isn’t consuming at least 12 oz of fatty fish each week, she will want to make sure she supplements with a high-quality fish oil supplement.
Food sources: Wild salmon, sardine, herring, mackerel, algae
*While there are plant sources of omega-3 fatty acids (like flaxseeds and walnuts), the conversion of these sources into EPA/DHA are low, making consumption of fatty fish or fish/algae oil supplementation necessary.
While there has been a limited focus of study on the postpartum population, cross-sectional studies show low serum levels of vitamin D have been associated with depressive symptoms. In some studies, supplementing with high-dose vitamin D has show significant improvement in mood.
Ideally we’d get enough vitamin D through sun exposure and food; however, most of us aren’t outside enough and the small amount in food makes this goal difficult to reach. There are also a variety of factors that influence our body’s ability to produce vitamin D such as the climate you live in, your skin tone, using SPF, or limiting sunlight. At least 50% of Americans are vitamin D deficient. Because your baby can only use what resources mom has available, some newborns have no detectable levels of vitamin D in their blood when they are born. We really need to ensure sufficient vitamin D levels for the health of both mom and baby.
Food sources: Fatty fish, liver, eggs
*Your best bet is to get your vitamin D levels checked before, during, and after your pregnancy (and supplement accordingly). Shoot for a blood range of 40-70 ng/mL.
While there are few studies that have investigated the relationship between B vitamins and postpartum depression, depression in the general population has been linked to low levels of B vitamins. B12 is often correlated with depression in elder populations, while B9 shows correlation with depression in adult and adolescent populations. One theory behind this is that low levels of B6, B9, and B12 may cause decreased synthesis of the neurotransmitters serotonin, dopamine, and noradrenaline. All of which play a role in mood regulation.
It’s also known that pregnancy, stress, and high sugar intake (sound familiar?) deplete B-vitamin. Since B-vitamins are water-soluble (are not stored long term) mom needs to make sure she’s consuming and absorbing adequate amounts of foods high in B-vitamins every day. Vegetarian and Vegan moms need to pay even more attention to their diet to ensure sufficient intake.
Food sources: Animal protein (fish, eggs, poultry, pork), dairy, beans, fruits and vegetables
Trace minerals (Zinc, iron, selenium)
Women’s bodies are depleted of minerals during pregnancy, childbirth, and lactation due to the transfer of minerals to the fetus and blood loss.
While trace minerals are easy to find in the diet, the increased demands on mom’s body may make her susceptible to deficiency. Deficiencies in these minerals have been associated with depression and mood disorders. Some studies suggest that supplementation of these nutrients during pregnancy may be an effective approach for the prevention of postpartum depression.
Food sources of zinc: red meat, seeds, beans
Food sources of iron: red meat, liver, oysters
Food sources of selenium: meat, fish, brazil nuts
I highly recommend moms stay on their prenatal vitamin for at least a few months postpartum (more, if nursing). This helps mom meet the nutritional demands (including B-vitamins and trace minerals) associated with postpartum healing while replenishing and maintaining mom’s nutrient stores.
For a more objective look at what mom may be deficient in, I highly recommend micronutrient testing. This is something I do with my coaching clients.
While the current evidence on diet and supplementation isn’t strong enough to safely prevent or treat postpartum depression, moms can still use this information to optimize their diet during pregnancy and postpartum. Having a feeling of control, especially if a mom has experienced postpartum depression in a previous pregnancy, can be really encouraging. Consuming adequate dietary sources of these nutrients won’t do any harm, but may significantly help mom and baby feel their best. It’s worth a shot!
Please remember that diet and supplementation alone may not be enough to prevent or treat postpartum depression, mood, and anxiety disorders. Make sure you enlist support from friends, family members, and neighbors to get you through this tough time. The postpartum period is difficult for all new moms, but if you’re experiencing excessive anxiety, fatigue, recurrent thoughts of death or suicide, difficulty concentration and making decisions, lack of interest in past hobbies, or feelings of guilt or worthlessness, please seek help from a professional. I’m happy to help refer you to someone and/or provide you with additional resources.