Low levels of omega-3 polyunsaturated fatty acids (PUFA) may moderately increase women's risk of developing postpartum depression (PPD), a literature review suggests.
Gabriel Shapiro, MPH, and colleagues from the University of Montreal and the Centre de Recherche du CHU Sainte-Justine, Montreal, Canada, report that the review shows several carefully conducted studies that indicate an association between the serotonin transporter (5-HTT) genotype and PPD.
"The literature shows that there could be a link between pregnancy, omega-3, and the chemical reaction that enables serotonin, a mood regulator, to be released into our brains. And many women could bring their omega-3 intake to recommended levels," they said in a release.
The 5-HTT gene modulates the reuptake of 5-HT at brain synapses and is the main neurobiologic feature of depression. The 5-HTT gene is also the target of selective serotonin reuptake inhibitors.
Several studies that investigated depressive symptoms after delivery showed a significant positive association between depressive symptoms and either 5-HTT expression levels at 8 weeks postpartum or the presence of the short allele carrier status of the 5-HTT gene and PPD.
"Few studies have studied by the 5-HTT gene and omega-3 together, so what we see are 2 parallel links in both of these literatures, and there is a link between omega-3 fatty acids and either depression or PPD," principal investigator Jean Séguin, PhD, Centre de Recherche du CHU Sainte-Justine, told Medscape Medical News.
"So the link with 5-HTT is the one we are going to look into further to see if supplementing women with proper nutrition would attenuate the risk," he added
The study is published in the November issue of the Canadian Journal of Psychiatry.
Social Risk Factors
Social risk factors that predict PPD include a strained marital relationship, low social support, and stress life events. A family history of depression or mood disorders is also implicated in the development of PDD.
Beyond social influences, one key environmental factor may be nutrition, so the researchers focused on the 5-HTT genotype and omega-3 PUFA status.
Omega-3 and omega-6 fatty acids are the 2 main families of essential fatty acids, but the omega-3 fatty acid, docosahexaenoic acid (DHA), is an important building block of the central nervous system (CNS) in infants.
Its availability during pregnancy and lactation may also influence maternal mental health and, later, childhood developmental outcomes.
As for omega-3 fatty acids and PPD, the authors note that omega-3 fatty acids directly affect brain activities, including neurotransmitter uptake.
Because omega-3 fatty acids stores are transferred from the mother to the fetus during gestation and lactation, levels of maternal omega-3 fatty acids decline during pregnancy and remain low at least 6 weeks into the postpartum period.
Intake of omega-3 fatty acids in the North American diet in general is already well below recommended levels, and this is particularly true for pregnant women.
In fact, the investigators estimate that it would take a 4-fold increase in fish consumption to bring intake of several key fatty acids up to recommended levels.
Results of intervention studies in general have not demonstrated any benefits of omega-3 fatty acid supplementation during pregnancy for the prevention or treatment of perinatal depression.
On the other hand, Dr. Séguin and colleagues would disagree, suggesting that clinical trials of omega-3 supplementation in patients with major depressive disorder have demonstrated clinical benefit, even if this benefit is only moderate.
The Montreal group also suggest that if pregnant women are unsure if they are getting enough omega-3 in their diet or if they are at risk for PDD, they should discuss these issues with their family doctor or obstetrician.
Health Canada, a federal department in Canada responsible for helping Canadians maintain and improve their health, has a Web site with a special section on omega-3 intake for pregnant women.
Need to Learn More
Nada Stotland, MD, past president of the American Psychiatric Association, Rush Medical College, Chicago, Illinois, told Medscape Medical News that the "study is important, but it's also very clear that we need to learn more about this possible link between omega-3 fatty acids and PPD."
Dr. Stotland noted that the authors themselves are suggesting there may be a link between low levels of omega-3 fatty acids and the risk for PDD, but they conclude only that this is a very fertile area for further study.
"We don't want to make people who suffer from PDD think that if only they had eaten differently, all would have been well," Dr. Stotland emphasized.
On the other hand, any intervention that could decrease the rate and severity of PDD "would be a big boon to everybody — not only to mothers but to their children and families as well."
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