Maternal supplementation with small-quantity lipid-based nutrient supplements during pregnancy and lactation does not reduce depressive symptoms at 6 months postpartum in Ghanaian women: a randomized controlled trial

Harriet Okronipa, Seth Adu-Afarwuah, Anna Lartey, Per Ashorn, Stephen A Vosti, Rebecca R Young, Kathryn G Dewey, Harriet Okronipa, Seth Adu-Afarwuah, Anna Lartey, Per Ashorn, Stephen A Vosti, Rebecca R Young, Kathryn G Dewey

Abstract

We examined the impact on depression at 6 months postpartum of maternal supplementation with small-quantity lipid-based nutrient supplement (SQ-LNS) compared to supplementation with iron and folic acid (IFA) or multiple micronutrients (MMN). In this partially double-blinded randomized controlled trial, pregnant women ≤20 weeks gestation (n = 1320) were recruited from antenatal clinics and randomly assigned to receive either (1) SQ-LNS during pregnancy and for 6 months postpartum, or (2) IFA during pregnancy only, or (3) MMN during pregnancy and for 6 months postpartum. Maternal depressive symptoms were measured at 6 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were considered to show symptoms of depression. One thousand one hundred fifty-one women were included in this analysis (LNS = 382, IFA = 387 and MMN = 382). Characteristics of the three groups were similar at baseline, and there were no significant differences between women who were included in the analysis (n = 1151) and those who were not (n = 169). At 6 months postpartum, 13% of the women overall showed symptoms of depression, and this did not differ by group (LNS = 13.1%, IFA = 11.2% and MMN = 14.7%. P = 0.36). The median (25, 75 percentile) EPDS score did not differ by group (LNS 4.0 (1.0, 8.0), IFA 4.0 (1.0, 8.0), MMN 5.0 (2.0, 9.0), P transformed = 0.13). Adjustment for covariates did not alter these findings. Maternal supplementation with SQ-LNS compared to MMN or IFA did not affect postnatal depressive symptoms in this sample of Ghanaian women.

Trial registration: ClinicalTrials.gov NCT00970866.

Keywords: Ghana; Lipid-based nutrient supplements; Postpartum depression.

Conflict of interest statement

Funding

This study is funded by a grant to the University of California, Davis, from the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the institutional review boards of the University of California, Davis; Ghana Health Service; and University of Ghana Noguchi Memorial Institute for Medical Research.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Study profile. The IFA group received 60 mg iron plus 400 mg folic acid. The MMN group received 1–2 Recommended Dietary Allowances of 18 vitamins and minerals (including 20 mg iron). The LNS group received SQ-LNS with the same micronutrients as the MMN group, plus another four minerals (Ca, P, K and Mg), as well as macronutrients. All three supplements were intended for daily consumption. IFA iron and folic acid, SQ-LNS small-quantity lipid-based nutrient supplement, MMN multiple micronutrients

References

    1. Adewuya AO, et al. Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women. J Psychiatr Pract. 2005;11(5):353–358. doi: 10.1097/00131746-200509000-00009.
    1. Adu-Afarwuah S et al (2015) Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana. Am J Clin Nutr 101(4):835–846
    1. Adu-Afarwuah S, et al. Small-quantity, lipid-based nutrient supplements provided to women during pregnancy and 6 mo postpartum and to their infants from 6 mo of age increase the mean attained length of 18-mo-old children in semi-urban Ghana: a randomized controlled trial. Am J Clin Nutr. 2016;104(3):797–808. doi: 10.3945/ajcn.116.134692.
    1. Appleton KM, et al. Effects of n–3 long-chain polyunsaturated fatty acids on depressed mood: systematic review of published trials. Am J Clin Nutr. 2006;84(6):1308–1316.
    1. Arimond M, et al. Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: experience from the International Lipid-Based Nutrient Supplements (iLiNS) Project. Matern Child Nutr. 2013;11:31–61. doi: 10.1111/mcn.12049.
    1. Beard JL, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135(2):267–272.
    1. Beck CT. Predictors of postpartum depression: an update. Nurs Res. 2001;50(5):275–285. doi: 10.1097/00006199-200109000-00004.
    1. Bodnar LM, Wisner KL. Nutrition and depression: implications for improving mental health among childbearing-aged women. Biol Psychiatry. 2005;58(9):679–685. doi: 10.1016/j.biopsych.2005.05.009.
    1. Carlezon WA, Jr, et al. Antidepressant-like effects of uridine and omega-3 fatty acids are potentiated by combined treatment in rats. Biol Psychiatry. 2005;57(4):343–350. doi: 10.1016/j.biopsych.2004.11.038.
    1. Chibanda D, et al. Validation of the Edinburgh Postnatal Depression Scale among women in a high HIV prevalence area in urban Zimbabwe. Arch Womens Mental Health. 2010;13(3):201–206. doi: 10.1007/s00737-009-0073-6.
    1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10 item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–786. doi: 10.1192/bjp.150.6.782.
    1. Delion S, et al. α-Linolenic acid dietary deficiency alters age-related changes of dopaminergic and serotoninergic neurotransmission in the rat frontal cortex. J Neurochem. 1996;66(4):1582–1591. doi: 10.1046/j.1471-4159.1996.66041582.x.
    1. Ekuklu G, et al. Prevalence of postpartum depression in Edirne, Turkey, and related factors. J Reprod Med. 2004;49(11):908–914.
    1. Fisher J, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90(2):139. doi: 10.2471/BLT.11.091850.
    1. Frith AL, et al. Micronutrient supplementation affects maternal-infant feeding interactions and maternal distress in Bangladesh. Am J Clin Nutr. 2009;90(1):141–148. doi: 10.3945/ajcn.2008.26817.
    1. Grosso G et al (2014) Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials. PLoS One 9(5)
    1. Henderson JJ, et al. Impact of postnatal depression on breastfeeding duration. Birth. 2003;30(3):175–180. doi: 10.1046/j.1523-536X.2003.00242.x.
    1. Lawrie TA et al (1998) Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women. S Afr Med J 88 (10): 1340–1344
    1. Leung BMY, Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link—a review of the literature. J Am Diet Assoc. 2009;109(9):1566–1575. doi: 10.1016/j.jada.2009.06.368.
    1. Michaelsen KF, et al. Food sources and intake of n-6 and n-3 fatty acids in low-income countries with emphasis on infants, young children (6–24 months), and pregnant and lactating women. Matern Child Nutr. 2011;7:124–140. doi: 10.1111/j.1740-8709.2011.00302.x.
    1. Murray L, et al. The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. Child Dev. 1996;67(5):2512–2526. doi: 10.2307/1131637.
    1. Nguyen PH, et al. Micronutrient supplementation may reduce symptoms of depression in Guatemalan women. Arch Latinoam Nutr. 2009;59(3):278–286.
    1. Nhiwatiwa S, Patel V, Acuda W. Predicting postnatal mental disorder with a screening questionnaire: a prospective cohort study from Zimbabwe. J Epidemiol Community Health. 1998;52(4):262–266. doi: 10.1136/jech.52.4.262.
    1. O’Hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry. 1996;8(1):37–54. doi: 10.3109/09540269609037816.
    1. Oaks BM, et al. Effects of a lipid-based nutrient supplement during pregnancy and lactation on maternal plasma fatty acid status and lipid profile: results of two randomized controlled trials. Prostaglandins Leukot Essent Fat Acids. 2017;117:28. doi: 10.1016/j.plefa.2017.01.007.
    1. Okronipa HET, et al. Postnatal depression symptoms are associated with increased diarrhea among infants of HIV-positive Ghanaian mothers. AIDS Behav. 2012;16(8):2216–2225. doi: 10.1007/s10461-012-0153-x.
    1. Patel V, Rodrigues M, DeSouza N. Gender, poverty, and postnatal depression: a study of mothers in Goa, India. Am J Psychiatr. 2002;159(1):43–47. doi: 10.1176/appi.ajp.159.1.43.
    1. Prado EL, et al. The effect of maternal multiple micronutrient supplementation on cognition and mood during pregnancy and postpartum in Indonesia: a randomized trial. PLoS One. 2012;7(3):e32519. doi: 10.1371/journal.pone.0032519.
    1. Rahman A, et al. Maternal depression increases infant risk of diarrhoeal illness: –a cohort study. Arch Dis Child. 2007;92(1):24–28. doi: 10.1136/adc.2005.086579.
    1. Stewart Robert C et al (2016) The impact of maternal diet fortification with lipid-based nutrient supplements on postpartum depression in rural Malawi: a randomised-controlled trial. Matern Child Nutr 13(2). doi:10.1111/mcn.12299
    1. Sublette EM, et al. Meta-analysis of the effects of eicosapentaenoic acid (EPA) in clinical trials in depression. J Clin Psychiatry. 2011;72(12):1577–1584. doi: 10.4088/JCP.10m06634.
    1. Uwakwe R. Affective (depressive) morbidity in puerperal Nigerian women: validation of the Edinburgh postnatal depression scale. Acta Psychiatr Scand. 2003;107(4):251–259. doi: 10.1034/j.1600-0447.2003.02477.x.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera