Pregnancy & Postpartum Mood
Pregnancy & Postpartum Mood
Depression and Anxiety
Research has shown that up to 33% of women experience clinical anxiety or depression at some point during pregnancy. Yet some studies indicate that fewer than 20% seek treatment, and that treatment is often inadequate. Anxiety and depression in pregnancy increases the risk of postpartum anxiety and depression. Support for maternal central nervous system (CNS) changes during this period requires focus on managing maternal mood for the overall well-being of both mother and baby.
Standard of Care
Pregnant women with psychiatric illnesses are often treated with antidepressant drugs. As an example, studies of pregnant women in Europe have found that antidepressants were used by approximately 3% and in the United States by 8%, yet Information about the risks of antidepressant drugs during pregnancy comes from low to moderate quality studies. The risks of untreated moderate to severe maternal major depression, to both the mother and fetus, often outweigh the risks associated with antidepressants.
GrowBaby Care
Nourish
Go Anti-inflammatory-In a systematic review, researchers found an association between proinflammatory diets and the risk of depressive symptoms or a diagnosis of depression. Adopting an anti-inflammatory diet & cooking/preparing foods to decrease oxidation may be an effective and preventative way to reduce risk of developing depression.
Support natural antioxidant defenses, such as superoxide dismutase and glutathione-refer to the heartburn section for more food and nutrient ideas to support glutathione production.
Herbs/Spices in Diet: Particularly rosemary and turmeric (curcumin). In an RCT, curcumin dosed at 1,000 mg daily was found to be more effective than 20mg Prozac at managing depression.
Limit exogenous toxic exposure by purchasing foods organically when you can
Limit processed foods-whole foods contain compounds that protect against inflammation in a way that processed foods increase inflammatory response.
Increase plant-based food intake.
Decrease advanced glycation end product (AGE) exposure by applying specific cooking methods
AGEs are inflammatory glycoproteins that are naturally occurring in foods and are produced depending on the cooking method
High temperature and low moisture consistently and strongly drive AGE formation in foods
Preparation with an acidic-base/acidic-marinades such as citrus or vinegar limits AGE generation during the cooking process
Frying, broiling, grilling, and roasting yielded more AGEs compared to boiling, poaching, stewing, and steaming
Vegetables, fish, legumes, fruits, and whole grains are best choices to reduce intake of AGEs
Support your Gut-Brain Connection
Serotonin levels are affected by diet, which is particularly important because 80% of the body’s serotonin production occurs in the cells of the gut.
Serotonin is a calming neurotransmitter that helps you relax and digest, sleep, and feel re-assured when anxiety hits. There are essential nutrients (meaning you have to eat them your body can’t make them) that are required for serotonin production. Focus on these nutrient co-factors will support your next Zen moment and great night’s sleep.
An increase in the ratio of tryptophan to phenylalanine and leucine will increase serotonin levels.
Foods with this favorable ratio include: dates, papayas, and bananas.
Nutrients that Support Serotonin Production
Tryptophan: pumpkin and squash seeds, lamb, chicken, turkey, pork, tuna, oats, white beans, and eggs.
Vitamin B6 (Pyridoxal-5-Phosphate): is crucial for the conversion of 5-HTP to serotonin. Food sources include:
Vitamin C: black currant, red bell pepper, kiwi, guava, green bell pepper, orange, strawberries, papaya, broccoli, kale.
Methylfolate (5-methyltetrahydrofolate): liver (duck, goose, turkey, chicken, beef), mung beans, chickpeas, spearmint, pinto beans, great northern beans, lentils, black beans, fava beans, kidney beans. In a June 2012 study researchers found that a higher serum folate level may be associated with a decreased risk of depressive symptoms.
Vitamin D hormone activates the gene that makes the enzyme tryptophan hydroxylase 2 (TPH2), converting the essential amino acid tryptophan to serotonin in the brain.17
Magnesium: seaweed (agar), herbs, spices, bran, pumpkin seeds, cocoa, flaxseeds, Brazil nuts, sunflower seeds, sesame seeds.
Colors
Blue/Purple and Black Foods
○ Proanthocyanidin is a phytonutrient found in blue/purple pigmented fruits and vegetables.
○ Higher intake is associated with lower rates of depression, and it is estimated that 88% of Americans do not get enough blue/purple compounds.
○ The antidepressant benefit of proanthocyanidin may be associated with the central monoaminergic neurotransmitter systems
Food Sources: grapes, blueberries, black currants, black chokeberries
MOVEMENT to increase Endorphins and BDNF
Physical exercise during pregnancy reduces the level of depression and its incidence in pregnant women. Exercise-has been shown to stabilize and improve mood and sleep quality since it helps to produce endorphins, which are chemicals produced by the brain that makes you feel happy.
Yoga: 2X weekly yoga decreases depression, anxiety and perceived stress, and enhances immune function in pregnancy.
Get outside: Exposure to natural green (park) and blue (ocean) environments can lower stress and improve mood. Even in urban environments exposure to the outdoors improves stress response.
Brain Derived Neurotropic Factor (BDNF): There is a consistent relationship between low serum BDNF and depression, and though limited, some data indicate that relationships between low serum BDNF and depression symptoms are also observed during pregnancy and postpartum. Current data demonstrate a clear trajectory of change in serum BDNF across the perinatal period, with considerable declines from the 1st through 3rd trimesters and a subsequent increase at postpartum.
● BDNF significantly increases in response to exercise.
● Aerobic exercise of moderate to high intensity levels seems to have a positive effect on levels of serum brain derived neurotrophic factor.
Pregnancy recommendations: Mild-moderate activity when possible (5/7 days a week for at least 30 minutes. Some women who maintain moderate-high level of fitness preconception can continue to maintain that level of fitness during pregnancy.
Postpartum recommendations: In the case of a healthy pregnancy and vaginal delivery, exercise can begin soon after, as mother feels ready. In the case of a cesarean birth or other complications, it depends on the individual, and checking in with your primary care provider is recommended.
Restore
CHOOSE YOUR TIME: Consistent sleep time every night can cue your body for sleep. We recognize that many things that impact this, such as multiple young children. However, focus on a sleep time from 10-11P every night.
AVOID STIMULANTS: Limit all caffeine intake to the first part of the day
FIND THE LIGHT: Melatonin is a hormone that is secreted from the pineal gland around 9PM every night. Light is an important regulator of melatonin production. Allow natural sunlight to hit the back of your eye during the day to support sleep at night.
REMOVE THE BLUE (light that is): Remove screen (tablets, phones, televisions, computers) exposure 1-hour before bedtime. Exposure to light during the body's biological night reduces melatonin production and release.
EMPTY IT OUT: Stomach emptying slows down in pregnancy and eating too close to bedtime can impact sleep. Limit eating large meals to 3 hours before bedtime. Snacks are appropriate following your last meal of the day, as low blood sugar can also cause wakefulness.
COOL IT DOWN: Basal body temperature changes are normal in pregnancy. Sleeping hot usually means not sleeping well. Cool down your room with AC, turn on a fan, or open a window to improve your rest.
AROMATHERAPY: Readily available aromatherapy treatments appear to be an effective way to promote sleep and improve sleep quality
Relax
MEDITATE YOUR MIND: Mindfulness training during pregnancy may effectively reduce pregnancy-related anxiety and worry
BREATHING: Relaxation breathing techniques show beneficial effects on reducing perceived stressin pregnant women
PRACTICING GRATITUDE: Gratitude-based intervention has the potential to reduce stress in pregnancy
MASSAGE & AROMATHERAPY: Aromatherapy massage (lavender essential oil) could significantly decrease stress and enhance immune function in pregnant women
Relate
We live in a time when connection can be an illusion. Likes, shares, and impressions reflect a transient moment in the mind-but one that powerfully alters the neurochemical response in the brain. Think of social media and screen time as a cookie-something you may crave, is satisfying when you eat it, but leaves your blood sugar crashing, your mood inconsistent, your energy depleted, yet needing & wanting more. It tricks you! We are innately built to cherish companionship, friendship, and community. Reach out to a real-live-person. Simply put, there is no better way to restore than to relate to one another. Sit within 3 feet of a person you love and that loves you-your heart frequencies will sync. Yes, being together is that powerful.
Nutrients
Take a high-quality prenatal-A February 2019 study reported that the prenatal vitamin may effectively prevent depression during pregnancy. Make sure your prenatal has methylfolate, iron, vitamin D, fish oil, & B12. Focus on the following nutrients, as well!
Omega-3 Fatty Acids (n-3)
The overwhelming majority of research in the past two decades on dietary fat in the perinatal period has focused on nutritional needs for polyunsaturated fatty acids (PUFA), and docosahexaenoic acid (DHA) and arachidonic acid (AA) have received the most attention. Several studies have shown associations with depression in pregnancy and reduced n-3 status. The Avon Longitudinal Study of Parents and Children found that lower maternal intake of omega-3 from seafood was associated with high levels of depressive symptoms in late pregnancy.
The human CNS is rich in DHA. There is evidence that maternal DHA status is reduced after pregnancy with fetal demand for DHA highest in the 3rd trimester.3 The effects of dietary n–3 (long chain polyunsaturated fatty acids (LCPUFA) on psychiatric disorders has received considerable attention.
DHA has been studied alone and in combination with EPA, and there is evidence that n–3 LCPUFA is more effective when EPA is present along with DHA for maternal depression.
Consider a starting dose of 800 mg DHA and 1.6 grams of EPA, working up to 4 grams daily.
Food Sources: fish oil, fish roe, cod liver oil, mackerel, salmon, anchovy, whitefish, herring, trout (all safe for pregnancy and breastfeeding)
Magnesium Threonate: a supplement form that effectively crosses the blood brain barrier (BBB), ensuring oxytocin, serotonin, and GABA production.
GABA and the neuropeptide oxytocin may have an interactive, if not a synergistic, relationship to alter maternal anxiety.
Low GABA levels can lead to anxiety, which is of particular importance because estimated postpartum anxiety rates are increasing.
Consider a beginning dose* of 200 mg working up to 500 mg of magnesium * more may be needed
Food Sources of Magnesium: seaweed (agar), herbs, spices, bran, pumpkin seeds, cocoa, flaxseeds, Brazil nuts, sunflower seeds, sesame seeds
Niacin (Vitamin B3): Important for the maintenance of cellular integrity and energy production. Deficiencies of niacin may contribute to neuropsychiatric and neurodegenerative disorders.
Food Sources: anchovy, liver (beef, lamb, chicken) peanuts, shiitake mushrooms, sesame seeds, salmon, spirulina
N-Acetyl-Cysteine (NAC): In the open label phase of a RPCT, individuals with moderate depression were given 1 gram BID of NAC. Participants on NAC showed significant improvement in functioning and quality of life after 8-weeks.
Food Sources of Cysteine: egg, sesame, sunflower, beef, cod, tofu, spirulina, soybeans, pork, and whitefish
Probiotics
The gut-brain connection is bridged with the help of probiotics.
In a DBP RCT, healthy subjects were given probiotics (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) or placebo for 30 days. The probiotic group had significantly less anxiety and depression than the controls.
Science Corner
Mood balance is mediated by many things (hello pregnancy and postpartum hormones!), but research is showing us that real AND perceived stress is a major mediating trigger of mood imbalance, especially affecting anxiety and depression. Current research reveals that high amounts of stress experienced by the mother during the gestation period may have adverse outcomes for both the mom and baby and its impact can directly and indirectly have lasting consequences that span many generations. But, stress is a necessary and sometimes helpful part of health! In fact, stress hormones experienced by the mother in pregnancy can directly impact healthy brain development. Follow the suggestions above and rest assured that you are supporting you and baby, all the way!
Antidepressant medication use during pregnancy leads to a small increased risk of miscarriage, a possible small increased risk of congenital cardiac malformations, a small increased risk of preterm birth, a small increased risk of persistent pulmonary hypertension of the newborn (PPHN), and transient neonatal symptoms in up to one-third of neonates.
Sources
1: Pearlstein et al, Best Pract Res Clin Obstet Gynaecol. 2015 Jul;29(5):754-64. doi: 10.1016/j.bpobgyn.2015.04.004. Epub 2015 Apr 17.
2: Healy Smith, M.D., Women's Mental Health Clinic at New York-Presbyterian Hospital, New York City
3: PMID:30699214