Omega-3 Fatty Acids Reduce Incidence of Post-Partum Depression

A little background on what are omega fatty acids is warranted. The term omega, as it relates to fatty acids, refers to the terminal carbon atom farthest from the functional carboxylic acid group (–COOH). The designation of a polyunsaturated fatty acid (PUFA) as an omega-3 fatty acid, for example, defines the position of the first site of unsaturation (carbon-carbon double bond) relative to the omega end of that fatty acid. This is often designated as the "n" end of the fatty acid and thus, an omega-3 fatty acid can be designated as an n-3 fatty acid.

An omega-3 fatty acid, such as alpha-linolenic acid (ALA; an essential fatty acid), which harbors three carbon-carbon double bonds, has a site of unsaturation between the third and fourth carbons from the omega end. A common source of ALA is flax seed or flax seed oil.

There are four major omega-3 fatty acids that are synthesized from precursor fatty acids, or ingested in foods, and then used by the body. The omega-3 fatty acids are ALA, eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA). Although humans can theoretically make EPA and DHA from ALA the efficiency is very low in females and near non-existent in males. Therefore, dietary sources represent the best ways to acquire these two critically important PUFA. The best animal sources are chicken eggs, cold water fish, and krill with krill oil being the best source. For vegetarians and vegans the blue green algae (a biomass of cyanobacteria), spirulina, is a great source of both EPA and DHA. There are also many companies that use engineer algae to produce high concentrations of EPA and DHA.

The metabolic and clinical significances of the omega-3 PUFA are due to the ability of these lipids to directly exert effects on numerous biologically important pathways. In addition to the direct action of the omega-3 fatty acids EPA and DHA, and also to some extent DPA, there are numerous metabolites of these fatty acids that are classified as bioactive lipids.

The omega-3 fatty acids DHA and EPA have also been shown to be important for normal brain development and function. Several studies have demonstrated that DHA is essential for proper development of the prenatal and postnatal central nervous system. The benefits of EPA appear to be in its effects on behavior and mood. In clinical studies with DHA and EPA there has been good data demonstrating benefit in treating attention deficit hyperactivity disorder (ADHD), autism, dyspraxia (motor skills disorder), dyslexia, and aggression. In patients with affective disorders consumption of DHA and EPA has confirmed benefits in major depressive disorder and bipolar disorder.

In addition, some studies have demonstrated promising results in treatment of schizophrenia with some minor benefits in patients with borderline personality disorder. Although originally purported to have positive effects in children with autism or autism spectrum disorder, recent clinical studies have shown that omega-3 PUFA supplementation does not have any positive effect on these disorders. Of significance to these effects of EPA and DHA on cognition, mood and behavior is the fact that administration of omega-3 fatty acid containing phospholipids (such as those present in Krill oils) are significantly better than omega-3 containing triglycerides such as those that predominate in fish oils.

Several studies have shown a link between depressive symptoms and modifiable nutritional risk factors, especially poor omega-3 PUFA status. A new study, published in the journal, Prostaglandins, Leukotrienes, and Essential Fatty Acids, has demonstrated that the consumption of omega-3 PUFA during pregnancy and afterward can help reduce the risk for post-partum depression:

Higher n-3 polyunsaturated fatty acid status during early pregnancy is associated with lower risk for depression at 12 months postpartum: The NuPED study

The NuPED (Nutrition during Pregnancy and Early Development) study, is a prospective cohort study conducted in Johannesburg, South Africa.

The women who were included in the NuPED study were aged 18-39 years, <18 weeks of gestation with singleton pregnancies, proficient in local languages, born in South Africa or neighboring countries, and residents of Johannesburg for at least 12 months. Women who were excluded from the study were those who reported using illicit drugs, were smoking, or had been diagnosed with a non-communicable disease such as diabetes, renal disease, high cholesterol, and hypertension, an infectious disease such as tuberculosis and hepatitis, or a serious illness such as cancer, lupus or psychosis.

The primary outcome measure for this study was perinatal depression at six time points: early pregnancy (<18 weeks of gestation), mid-pregnancy (±22 weeks), late pregnancy (±36 weeks), and at 6 weeks, 6 months, and 12 months postpartum. Depression was assessed using the interviewer administered Edinburgh Postnatal Depression Scale (EPDS).

Lipid profiles were assessed by analyzing total fatty acid composition of phospholipids present in red blood cells. These lipid profiles were expressed by the amount of three specific fatty acids (ALA, EPA, and DHA), the ratio of omega-6 to omega-3 fatty acids (arachidonic acid is the major omega-6 PUFA), an the omega-3 index.

With respect to the measure of depression, 5% of the study participants experienced depression during pregnancy and at 12 months postpartum. With respect to postpartum

depression, 3% of women experiencing depression at 6 months postpartum also experienced depression at 12 months postpartum.

With respect to fatty acid composition the study identified four major patterns defined as high saturated fatty acids (Pattern 1); low DHA and omega-6 PUFA, and high trans-fatty acids (Pattern 2); high ALA, EPA, docosapentaenoic acid (DPA: an omega-3 (PUFA), and gamma-linolenic acid (GLA: an omega-6 PUFA) (Pattern 3); and high omega-3 PUFA (Pattern 4).

Results from this study indicated that a higher level of omega-3 PUFA, detected by analysis of red blood cell lipid profiles, during early pregnancy may lower the risk for perinatal depression at 12 months postpartum. These results also suggested that depression occurring at 12 months postpartum might be particularly sensitive to PUFA status in early pregnancy,

which is likely to reflect habitual intake.

TAKE HOME: Beyond the myriad reasons for adding omega-3 PUFA to ones diet, particularly EPA and DHA, this study indicates that consuming these during and after pregnancy is likely to exert positive mental health outcomes.