Diet and depression during pregnancy and postpartum

Many mums experience a roller coaster of emotions during pregnancy and postpartum, and the mood swings can be quite intense (1). Your mental well-being may suffer if all your thoughts circle around worry and fear, and the fatigue you experience can change the relationships you have with your partner and others

For some, pregnancy and postpartum are not like living life in a rose-coloured bubble and it can be a much darker period of time in their lives. Pregnancy and birth cause major hormonal and psychological changes to your body (1). Therefore, it is natural to experience negative feelings or feel generally down.

Throughout your pregnancy and the postpartum period, it is important to keep checking up on your mood and well-being. Feeling blue for a long time can be a sign of depression. If you have felt unhappy or anxious for several weeks and find it difficult to feel joy, even if nothing in your life was really out of place, you might have depression (1). Despite how you might be feeling, you may be able to take care of the house and your baby without too much difficulty, but you might do so almost robotically and focus solely on getting the tasks done.

Symptoms of perinatal depression can start either during pregnancy or after birth.

 Symptoms of depression include (1) :

• Tiredness which is not alleviated by sleeping
• Feeling blue and finding it difficult to feel joy
• Changes in appetite
• Difficulty concentrating
• Fear and panic
• Irritability and restlessness
• Insomnia and difficulty relaxing
• Feelings of guilt
• Feelings of worry

It is important to differentiate between normal low mood and depression, so you can get the right kind of treatment (2). Early access to help is crucial for both the parent and the baby. The first line of treatment for perinatal and postnatal depression is psychotherapy and sometimes medication. Diet can also help to reduce the risk of depression or alleviate symptoms (3,4).

Perinatal or postnatal depression can have a significant impact on the mum’s diet and eating habits. Sometimes the depression itself can either increase or decrease appetite, but also the other symptoms of depression such as lack of motivation and tiredness can make it much more difficult to get through the day.

Going to the supermarket or cooking can feel like an insurmountable task. The changes to your routine that come with pregnancy or a newborn baby can also make it seem almost impossible to focus on your own diet. However, a diet that supports a healthy body and mind does not have to be complicated. Small changes and showing compassion for yourself go a long way. Receiving support from your partner or others can have a significant impact on making sure that you can still stick to the diet changes if the depression gets worse.

Learn more: Is THIS Level of Exhaustion Normal? Postnatal Depletion Might Be to Blame

The importance of diet with depression – things to note during early pregnancy or even before getting pregnant

Depression is caused by various things, which include genetic, biological, psychological, and social factors (3,4). A balanced and healthy diet has been noted to potentially prevent depression. Some preliminary studies have shown that a Mediterranean diet reduces the risk of depression (5), while some other dietary choices have been linked to the increased likelihood of depression.

Mediterranean diet

The Mediterranean diet focuses on the quality of fats and uses a lot of vegetables. In a nutshell, a Mediterranean diet has (6)

• plenty of vegetables, pulses, fruit, fish, vegetable oils (especially olive oil), nuts, and wholegrain
• less meat, sugar, and white wheat

A core element of the Mediterranean diet is the balance of different fatty acids which can reduce the risk of depression and have a positive impact on general health (5). Healthy polyunsaturated fats can be obtained by increasing the use of fish, vegetable oils, and nuts. You can reduce the intake of unhealthy saturated fats by decreasing the use of meat and fat-containing dairy.

Folate and vitamin B12

Folate and vitamin B12 deficiencies have been shown to increase the risk of depression (7). Group B vitamins are vital in the preparation of serotonin and other neurotransmitters important for mental health, so a deficiency can prohibit the normal production of these neurotransmitters and therefore increase the likelihood of depression.

Ensuring a sufficient intake of folate is essential during pregnancy, as it has a crucial role in closing off the baby’s neural tube (8,9) Taking a supplement is usually recommended even before pregnancy, as it is often difficult to get enough folate through your diet (9). Supplements commonly use the synthetic form of folate called folic acid. You can also get folate from foods such as vegetables, beans, fruit, berries, and whole grains (9).

Vitamin B12 works together with folate and increases its absorbency (8). Therefore, not getting enough vitamin B12 can be a cause of folate deficiency. Vitamin B12 can be gained from animal products, such as liver, eggs, fish, meat, and dairy. If you are a vegan, you should use a vitamin B12 supplement. It is important to ensure that you get enough of both of these vitamins even prior to falling pregnant, as well as during and after pregnancy to decrease the risk of postnatal depression and to support the healthy development of the baby.

Vitamin D

Vitamin D is a fat-soluble vitamin which can be obtained from food in small quantities, but most of it is made by the skin when it is exposed to the sun’s UVB rays (10). In food, vitamin D is mostly found in fatty fish, but in many countries, vitamin D is added to dairy products and spreads.

Vitamin D is important for bone health and supports the normal function of muscles, the nervous system, and the immune system (11). It plays an important role in many brain functions, and vitamin D deficiency is connected to an increased risk of depression (11,13). Several studies have proven that vitamin D deficiency is connected to perinatal depression (12,13).

Vitamin D absorbency is affected by exposure to sunlight, skin colour, age, and diet. Overdose of vitamin D is possible, so overusing supplements is not recommended (11). The recommendation for pregnant and breastfeeding women is 10 to 15 µg per day throughout the year (11,14). As vitamin D deficiency is connected to the risk of depression, it is recommended you get enough vitamin D as early as when planning for a pregnancy.

Learn more: Tired of feeling tired? Low Ferritin levels could be to blame

How can you treat depression through diet?

As mentioned earlier, the main treatments for perinatal depression are psychotherapy and, in some cases, medicine (4). However, the symptoms of depression can be alleviated through diet and certain eating habits.

The main thing is to ensure that food and eating do not cause any extra stress to your life. Semi-processed food products, ready meals, frozen vegetables, and supermarket deliveries can all ease the burden meal planning has on your life. The main goal is to ensure that you get enough energy and nutrients, especially during pregnancy, recovery from birth, and breastfeeding.

Lean more: Why Dad's Nutrition and Lifestyle is Just as Important to Family Planning as Mum's

Routines help to establish regular mealtimes

Expectant and new mums struggling with depression should, where possible, aim to create some daily routines (15). Regular mealtimes help in obtaining enough energy and nutrients from food and keeping blood sugar levels steady. Low blood sugar in itself has a negative impact on mood (16). The main goal in treating the symptoms of depression through diet is to eat regularly, the contents of the plate only come second.

If you already have regular mealtimes, you can start to think about the contents of your diet, but only within the limits of your mental wellbeing. Similarly to prevention of depression, the foods that treat the symptoms of depression include vegetables, fruit, berries, and foods rich in unsaturated fats such as fish, vegetable oils, nuts, and seeds.

Learn more: Benefits of Working Out While Pregnant

You can take care of your mental health by taking care of your gut

In the last few years, gut health has been proven to be connected to mental health (17). More studies are still needed, but the preliminary results already show that by taking care of your gut health can also have a positive impact on your mental wellbeing. Some studies have already been done on the gut microbes and mental health of pregnant women, and these have shown that especially fibre and certain nutrients like vitamin Bs have an effect on the mental health of pregnant women (17,18). While more studies are still required, these results already can be used as a motivation to take care of your gut health by eating various vegetables, fruit, berries, and wholegrain products rich in fibre.

Showing compassion to yourself supports you during depression

It is important to remember that diet and eating should not be causing you extra stress during your depression. Be compassionate to yourself when it comes to your diet, and never feel guilty about eating. A diet supportive of mental wellbeing consists of all types of food. If your diet is filled with foods that have a mostly negative impact on your health, such as cakes, sweets, crisps, and fast food, try to focus on creating a regular schedule for meals and add in some healthy foods, such as vegetables and fruit. Do not prohibit any foods from yourself, as it has a negative impact on creating a healthy relationship with food. Show compassion to yourself and hold your own hand rather than grab yourself by the neck.

The story behind your depression is unique and depression has a different effect on diet for everyone. It is possible that depression and any medications used to treat it can increase or decrease appetite, and the symptoms of depression all have their own impacts. Everyone’s life, energy levels, support network, medication, and environment are unique, and therefore the treatment can look different for everyone, also when it comes to diet. The most important take from this is that you should not feel guilty about being depressed, and you should seek treatment earlier rather than later. If you have any questions about diet and depression, you can contact a professional dietician to obtain help and guidelines specifically tailored for you. Remember that your mental wellbeing is just as important as your physical health.

Sources:

(1) Odottavan äidin käsikirja (2020). Mieliala synnytyksen jälkeen. Terveyskirjasto Duodecim 2020. https://www.terveyskirjasto.fi/odk00098 (accessed 28.5.2022)

(2) Odottavan äidin käsikirja (2020). Mielen herkistyminen raskausaikana. Terveyskirjasto Duodecim 2020. https://www.terveyskirjasto.fi/odk00097/mielen-herkistyminen-raskausaikana (accessed 28.5.2022)

(3) Leung, B MY, Kaplan B J (2009). Perinatal depression: prevalence, risks, and the nutrition link - a review of the literature. American Dietetic Association 2009; 109(9):1566-1575. 

(4) Depressio. Käypä hoito -suositus (2021). Suomalaisen Lääkäriseuran Duodecimin ja Suomen Psykiatriyhdistys ry:n asettama työryhmä. Helsinki: Suomalainen Lääkäriseura Duodecim, 2021. www.kaypahoito.fi (accessed 28.5.2022).

(5) Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A (2009). Association of the Mediterranean Dietary Pattern with the Incidence of Depression. The Seguimiento Universidad de Navarra/University of Navarra Follow-up (SUN) Cohort. Arch Gen Psychiatry 2009;66(10):1090– 1098.

(6) Antikainen A, Schwab U (2020). Välimeren ruokavalio, terveyttä edistävä pohjoismainen ruokavalio, kasvisruokavalio ja vähähiilihydraattinen ruokavalio. Lääkärikirja Duodecim 2020. https://www.terveyskirjasto.fi/dlk01271 (accessed 28.5.2022)

(7) Seppälä J, Kauppinen A, Kautiainen H, Vanhala M, Koponen H (2014). Masennus ja ruokavalio. Lääketieteellinen aikakausikirja Duodecim 2014; 130:902–9.

(8) Freese R, Voutilainen E (2012). Vitamiinit ja kivennäisaineet sekä muut ravinnon yhdisteet. Kirjassa: Aro A, Mutanen M, Uusitupa M. Ravitsemustiede. Helsinki: Kustannus Oy Duodecim 2012, s. 88–167.

(9) Tiitinen A (2022). Foolihapon käyttö raskauden aikana. Lääkärikirja Duodecim 2022. https://www.terveyskirjasto.fi/dlk01135 (accessed 29.5.2022)

(10) Paakkari I (2022). D-vitamiini. Lääkärikirja Duodecim 2022. https://www.terveyskirjasto.fi/dlk01044 (accessed 28.5.2022)

(11) National Institutes of Health (2021). Vitamin D, Fact Sheet for Consumers. NIH National Institutes of Health, Office of Dietary Supplements 2021. https://ods.od.nih.gov/factsheets/VitaminD-Consumer/ (accessed 28.5.2022)

(12) Amini S, Jafarirad S, Amani R (2018). Postpartum depression and vitamin D: A systematic review. Critical Reviews in Food Science and Nutrition 2018; 1-7.

(13) Williams J A, Romero V C, Clinton C M, Vazquez D M, Marcus S M, Chilimigras J L, Hamilton S E, Allbaugh L J, Vahratian A M, Schrader R M, Mozurkewich E L (2016). Vitamin D levels and perinatal depressive symptoms in women at risk: a secondary analysis of the mothers, omega-3, and mental health study. BMC Pregnancy and Childbirth 2016; 16:203.

(14) Nordic Council of Ministers. Nordic Nutrition Recommendations 2012. Kööpenhamina: Narayana Press 2014.

(15) Hertzberg T (2022). Synnytyksen jälkeinen masennus. Lääkärikirja Duodecim 2022. https://www.terveyskirjasto.fi/dlk00505#s5 (accessed 28.5.2022)

(16) Mustajoki P (2019). Alhainen verensokeri (hypoglykemia). Lääkärikirja Duodecim 2019. https://www.terveyskirjasto.fi/dlk00886 (accessed 28.5.2022)

(17) Butler M I, Mörkl S, Sandhu K V, Cryan J F, Dinan T G (2019). The Gut Microbiome and Mental Health: What Should We Tell Our Patients? The Canadian Journal of Psychiatry 2019;64(11):747-760.

(18) Yelverton C A, Rafferty A A, Moore R L, Byrne D F, Mehegan J, Cotter P D, Van Sinderen D, Murphy E F, Killeen S L, McAuliffe F M (2022). Diet and mental health in pregnancy: Nutrients of importance based on large observational cohort data. Nutrition 2022;96:1-7.