Baby blues vs PPD

The baby blues only last a few days to a couple of weeks after you give birth. You may experience mood swings, anxiety, irritability, feeling overwhelmed, crying, an inability to concentrate, and sleep problems, symptoms that are tied to a dramatic drop in hormones directly after giving birth. But the baby blues go away on their own. The symptoms of PPD can be similar, but are more extreme and last longer; they can include difficulty bonding with your baby, withdrawing from friends and family, overwhelming fatigue, loss of interest in things you used to enjoy, intense anger, hopelessness, feelings of worthlessness, shame, or guilt, severe anxiety, and thoughts of harming yourself or your baby.¹ Untreated PPD is not only harmful for the mother, but may affect the child’s cognitive and emotional development and can also increase the child’s risk of depression and anxiety later in life.²

It is estimated that one in seven women experience PPD, but that number is likely much higher because as many as half of women with PPD go undiagnosed.³ Researchers are still trying to elucidate the exact biological mechanisms behind PPD, but studies are pointing to a combination of increased inflammation after childbirth, a drastic drop in sex hormones, and micronutrient deficiencies (including the B vitamins, vitamin D, magnesium, and omega-3 fats) as some common causes.⁴

While it’s important to seek professional help if you think you may be suffering from PPD, there are ways you can support your body and mind throughout your pregnancy (the earlier you start, the better), and through the transition from pregnancy to motherhood.

Make Nourishing Your Body & Brain with Healthy Food a Priority

It’s no secret that the food you eat plays a monumental role in how you feel, mentally and physically, and one of the first things you likely do when you find out you’re pregnant is adopt healthier eating habits, for yourself and your baby. It’s especially important to stick to those healthy eating habits post-partum—growing a baby is hard work and can deplete the mother of essential nutrients, especially if she has low levels prior to becoming pregnant. There is also a significant increase in pro-inflammatory molecules after giving birth.⁵ This affects whole-body health, including mental health, making it critical to prioritize nourishing your post-partum body with nutrient-dense food.

It is becoming increasingly clear that inflammation plays a role in a variety of mental health disorders, including PPD, and diet can be a major driver of inflammation.⁶ A study published in 2022 looking at the diets of 293 breastfeeding women found that those who consumed the most pro-inflammatory foods (like ultra-processed foods, omega-6 fats, sugar, and refined grains) had a greater risk of having PPD compared to the women who consumed the least amount. The study also found that reducing the amount of pro-inflammatory foods in the diet can reduce the risk of PPD by nearly 50 percent.⁷ Another 2022 study found that adherence to a Mediterranean-type diet while pregnant was associated with lower levels of PPD and women with an “optimal Mediterranean Diet adherence” were about 72 percent less likely to have PPD. Other research found that women with a “healthy” diet during pregnancy had a 50 percent reduced risk of depressive symptoms eight to 10 weeks after birth. The ”healthy” diet observed included vegetables, fruits, nuts, beans, fish and seafood, olive oil, and dairy products, in essence, a Mediterranean-style diet.⁸

Avoiding ultra-processed foods and eating plenty of nutrient-dense and fiber-rich vegetables, healthy fats, and sufficient protein will also support your body while it finds its pre-pregnancy hormonal balance, which is in an upheaval post-partum.

5 Key Supplements to Take Post-Partum

Postnatal Multivitamin

Pregnancy, and then nursing, take a lot from the mother’s nutrient reserves. Breastfeeding in particular increases a woman’s nutritional requirements. One 2021 study concluded that lactating mothers were at risk of micronutrient deficiency and that nutrient intakes were lower than the recommended amounts in up to 70 percent of the mothers.⁹ A quality postnatal multivitamin is formulated specifically for the nutrient needs of the post-partum and lactating body and, along with a healthy diet, can help restore your nutrient reserves.

Omega-3s

The importance of the omega-3 fats EPA and DHA during pregnancy and the post-partum period cannot be overstated. A fetus requires high amounts of these omega-3 fats for normal development, particularly in the third trimester when large amounts of DHA are required for brain growth. Producing milk to feed your baby also requires large amounts of DHA. During the third trimester and lactation maternal levels steadily decline; research has found that DHA levels in particular can decrease in the mother by as much as 50 percent during pregnancy and that low levels are related to a higher risk of PPD.¹⁰ A 2020 meta-analysis including eight randomized placebo-controlled trials including 638 women found that omega-3 supplementation (EPA + DHA) significantly improved depressive symptoms in women, whether they were pregnant or post-partum, and was well tolerated. The doses used in the studies varied from 1 to 6 grams (for severe PPD) daily.¹¹

Vitamin B6

If you are taking a postnatal multivitamin, it should also contain the B-complex vitamins, however, there is one B vitamin that you may consider taking extra doses of: vitamin B6. This B vitamin is a cofactor in the production of serotonin and low levels have been implicated in PPD. A 2021 study set out to investigate the effects of B6 supplementation on the prevention of PPD among mothers who were at a higher risk. Eighty-one pregnant women were divided into two groups: treatment group or placebo group. The women in the treatment group took 80 mg of B6 daily, in two divided doses, starting in the 28^th week of pregnancy and continuing until they gave birth. They were then instructed to take 40 mg of B6 daily for one month after delivery. The results showed that B6 had “a positive effect on reducing postpartum depression scores among mothers at risk for PPD.”¹²

Iron

Women lose blood during childbirth, with an average loss of 300 mL, but it can be as much as 500 mL or more, putting them at risk for anemia, a condition in which the blood doesn’t have enough oxygen-carrying red blood cells. Post-partum anemia is associated with emotional instability, reduced cognitive function, and depression and anemia during pregnancy and post-partum can significantly increase the risk of PPD.^{13 14} Iron is a component of hemoglobin, a substance in red blood cells that enables them to carry oxygen throughout the body and also plays a role in neurotransmitter synthesis, including dopamine.¹⁵ The results of a 2022 meta-analysis that included 27 studies showed that anemic women were nearly twice as likely to experience symptoms of depression compared to non-anemic women and that the anemic mothers were less responsive to and had more negative feelings toward their children. It also found that iron supplementation significantly increased iron and hemoglobin levels with a corresponding “significant” reduction in depression scores.¹⁶ The World Health Organization recommends that new mothers should be screened for anemia and that iron supplementation should be a part of a woman’s postnatal care.¹⁷ Follow dosage instructions on the label.

Post-partum depression is a serious illness. If you believe you might be suffering from PPD, reach out to family, friends, a therapist, and/or your doctor. Consider making an appointment with your local Natural Grocers’ Nutritional Health Coach (NHC) to support you with nutritional guidance. Seek out the help you deserve.

References

1. Mayo Clinic, “Postpartum depression.” https://www.mayoclinic.org/diseases-conditions/postpartum-depression/sy…
2. Worthen RJ, Beurel E. “Inflammatory and neurodegenerative pathophysiology implicated in postpartum depression.’ Neurobiology of Disease, April 2022, vol. 165 https://doi.org/10.1016/j.nbd.2022.105646
3. Sudhanthar S, Sheikh ZE, Thakur K. Postpartum depression screening: are we doing a competent job? BMJ Open Qual. 2019 Oct 13;8(4):e000616. doi: 10.1136/bmjoq-2018-000616. 
4. Hsu MC, Tung CY, Chen HE. Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: Putative mechanism and recommendation. J Affect Disord. 2018 Oct 1;238:47-61. doi: 10.1016/j.jad.2018.05.018.
5. Christian LM, Porter K. Longitudinal changes in serum proinflammatory markers across pregnancy and postpartum: effects of maternal body mass index. Cytokine. 2014 Dec;70(2):134-40. doi: 10.1016/j.cyto.2014.06.018. 
6. Worthen RJ, Beurel E. “Inflammatory and neurodegenerative pathophysiology implicated in postpartum depression.’ Neurobiology of Disease, April 2022, vol. 165 https://doi.org/10.1016/j.nbd.2022.105646
7. Zou H, Sun M, Liu Y, Xi Y, Xiang C, Yong C, Liang J, Huo J, Lin Q, Deng J. Relationship between Dietary Inflammatory Index and Postpartum Depression in Exclusively Breastfeeding Women. Nutrients. 2022; 14(23):5006. https://doi.org/10.3390/nu14235006
8. Flor-Alemany M, Migueles JH, Alemany-Arrebola I, Aparicio VA, Baena-García L. Exercise, Mediterranean Diet Adherence or Both during Pregnancy to Prevent Postpartum Depression—GESTAFIT Trial Secondary Analyses. International Journal of Environmental Research and Public Health. 2022; 19(21):14450. https://doi.org/10.3390/ijerph192114450
9. Dumrongwongsiri O, Chongviriyaphan N, Chatvutinun S, Phoonlabdacha P, Sangcakul A, Siripinyanond A, Suthutvoravut U. Dietary Intake and Milk Micronutrient Levels in Lactating Women with Full and Partial Breastfeeding. Matern Child Health J. 2021 Jun;25(6):991-997. doi: 10.1007/s10995-020-03049-4. 
10. Hsu MC, Tung CY, Chen HE. Omega-3 polyunsaturated fatty acid supplementation in prevention and treatment of maternal depression: Putative mechanism and recommendation. J Affect Disord. 2018 Oct 1;238:47-61. doi: 10.1016/j.jad.2018.05.018.
11. Zhang, MM., Zou, Y., Li, SM. et al. The efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trials. Transl Psychiatry 10, 193 (2020). https://doi.org/10.1038/s41398-020-00886-3
12. Khodadad M, Bahadoran P, Kheirabadi GR, Sabzghabaee AM. Can Vitamin B6 Help to Prevent Postpartum Depression? A Randomized Controlled Trial. Int J Prev Med. 2021 Oct 19;12:136. doi: 10.4103/ijpvm.IJPVM_240_19. 
13. Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol. 2011 Nov;90(11):1247-53. doi: 10.1007/s00277-011-1279-z.
14. Azami M, Badfar G, Khalighi Z, Qasemi P, Shohani M, Soleymani A, Abbasalizadeh S. The association between anemia and postpartum depression: A systematic review and meta-analysis. Caspian J Intern Med. 2019 Spring;10(2):115-124. doi: 10.22088/cjim.10.2.
15. Etebary S, Nikseresht S, Sadeghipour HR, Zarrindast MR. Postpartum depression and role of serum trace elements. Iran J Psychiatry. 2010 Spring;5(2):40-6. 
16. Moya, E., Phiri, N., Choko, A.T. et al. Effect of postpartum anaemia on maternal health-related quality of life: a systematic review and meta-analysis. BMC Public Health 22, 364 (2022). https://doi.org/10.1186/s12889-022-12710-2
17. World Health Organization, 2016. “Iron Supplementation in Postpartum Women.” https://apps.who.int/iris/bitstream/handle/10665/249242/9789241549585-e…