Antenatal depression affects 15-21 percent of pregnant women worldwide, affecting birth outcomes and child development, and increasing the risk of postnatal depression.
Current treatments, such as therapy, may not be available, and antidepressants may pose risks to the infant’s development.
Research over the past two decades has shown that poor nutrition is a risk factor for mental health problems, and a longitudinal study found that most pregnant women in New Zealand are not following nutritional guidelines, with only 3% meeting recommendations for all food groups.
Another cohort study conducted in Brazil showed that ultra-processed foods (UPF) accounted for at least 30 percent of daily dietary energy during pregnancy, replacing healthier options.
UPF is chemically manufactured, contains additives to extend its shelf life, added sugar and salt, and importantly, is low in essential micronutrients (vitamins and minerals).
Consumption of these foods is a concern because poor dietary intake during pregnancy has been linked to poor mental health outcomes in children, including depression, anxiety, hyperactivity and inattention.
Increasing nutrients in the maternal diet and reducing UPF intake may improve the mental health of the mother and the next generation. Good nutrition may have lifelong benefits for the offspring.
However, there are multiple factors that may mean that changing your diet alone is not enough to address mental health issues. Supplementing with additional nutrients is also important to address your nutritional needs during pregnancy.
Micronutrients in the treatment of depression
Our previous research suggests that micronutrient supplements for depression may also be effective outside of pregnancy.
However, to date, there have been no published randomized controlled trials specifically designed to evaluate the efficacy and safety of a broad range of micronutrients on antenatal depression and overall functioning.
The NUTRIMUM trial, conducted from 2017 to 2022, enrolled 88 women in their third trimester of pregnancy who reported moderate depression. They were randomly assigned to receive either 12 capsules of a broad-spectrum micronutrient supplement (four tablets three times a day) or a placebo containing iodine and riboflavin for 12 weeks.
Micronutrient intakes were generally between the recommended dietary intakes and tolerable upper levels.
According to clinician assessment, the micronutrients significantly improved overall psychological functioning compared to placebo. The results take into account all changes recorded based on self-assessment and clinician observation. This includes sleep, mood regulation, coping, anxiety and side effects.
Both groups reported similar reductions in depression symptoms; more than three-quarters of participants were in remission at the end of the study. But 69 percent of those in the micronutrient group rated their improvement as “much” or “very much,” compared with 39 percent in the placebo group.
Participants who received the micronutrients experienced greater improvements in sleep and general daily functioning compared to those who received a placebo. There were no differences between groups in measures of stress, anxiety, or quality of life.
Importantly, there were no differences between groups in reported side effects and both groups reported reduced suicidal thoughts over the course of the study.Blood tests confirmed increased vitamin levels (vitamins C, D, and B12) and reduced deficiencies in the micronutrient group.
Micronutrients were particularly effective for women with chronic mental illnesses and those who had previously taken psychiatric medications. Women with milder symptoms improved with or without micronutrients, suggesting that general care and monitoring may be sufficient for some women.
The benefits of micronutrients are comparable to psychotherapy, but with less contact. There are no randomized controlled trials of antidepressants to compare these results.
Retention in the study was good (81 percent) and compliance was excellent (90 percent).
Beyond maternal mental health
We followed infants whose mothers participated in the NUTRIMUM trial (and therefore were exposed to micronutrients during pregnancy) for 12 months, along with infants from the general New Zealand population.
This second group of infants, selected from the general population, included a small subgroup who received antidepressants for the treatment of antenatal depression.
We assessed each infant’s neurobehavioral development within the first 4 weeks of life and their temperament through the first year of life.
These observational follow-up studies showed that micronutrients had a positive effect on the baby’s ability to regulate their behavior. These results were comparable to or better than those of a normal pregnancy and better than antidepressant treatment.
Babies exposed to micronutrients during pregnancy were significantly better able to respond to external stimuli, had a better ability to block them out while sleeping, and showed less signs of stress and better muscle tone than babies who were not exposed to the micronutrients.
They also had a better ability to interact with their environment, regulated their emotional states better and had fewer abnormal muscle reflexes than babies who were given antidepressants during pregnancy.
What’s reassuring is that the micronutrients had no adverse effect on the infants’ temperament.
These findings highlight the potential of micronutrients as a safe and effective alternative to traditional drug treatments for antenatal depression.
The prenatal environment lays the foundation for a child’s future. Further research into the benefits of micronutrient supplementation can help build confidence in its effectiveness in treating perinatal (from the start of pregnancy to the first year of life) mental health issues, helping to provide future generations with a better start in life.
The authors would like to acknowledge the contributions of Dr. Hayley Bradley to this research project.
Julia J. Rackridge, Professor of Psychology, University of Canterbury; Elena Molchanova, Professor of Statistics, University of Canterbury; Roger Mulder, Professor of Psychiatry, University of Otago; Siobhan A. Campbell, Intern Psychologist and Research Fellow, Te Puna Toiora (Mental Health and Nutrition Research Institute), University of Canterbury.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
