World Mental Health Day was recognized earlier this month on October 10, which makes it a great time to highlight how nutrients can help perinatal mental health! Perinatal is defined as the time during pregnancy and during postpartum.
BABY BLUES VS. PMADS
When we think of mental health concerns during the perinatal period, one of the first things that are often discussed is the “baby blues.” The “baby blues” can occur after birth as your body is adjusting to hormonal changes and the changes of being a new mom (such as experiencing sleep disturbances from caring for your newborn), and affects up to 80% of new moms. Your mood during this time is generally happy with times of weepiness, irritability, and uncertainty.
The “baby blues” can last up to two weeks after giving birth and is commonly mistaken for perinatal mood and anxiety disorders (PMADs). These symptoms typically resolve themselves, but proper treatment should be found if they do not. If you continue to experience symptoms past two weeks postpartum, it may be a sign of PMADs. It is commonly misconceived that PMADs only occur right after delivery, but signs and symptoms can start as early as pregnancy or even a few months after birth and last up to four years if not treated properly.
Anxiety, depression, OCD, bipolar disorder, post-traumatic stress disorder, and psychosis experienced during pregnancy and postpartum are all considered perinatal mood and anxiety disorders. During pregnancy and postpartum, the body undergoes hormonal, physical, mental, emotional, and nutritional changes. With all these rapid changes, a lot can influence a mother’s mental health, including her diet. It should be noted that nutrition does not cure PMADs and should not be the only component of treating PMADs. Nutrition should not replace medical care but can supplement the healing process.
Which nutrients can help support mental health and physical well-being? Let’s dive into that next!
Omega-3 Fatty Acids
Omega-3 fatty acids can be broken down into three classifications: DHA, EPA, and ALA. DHA and EPA help to reduce inflammation and help regulate neurotransmitters in the brain. ALA can be converted into EPA and then to DHA in the body, but it should be noted that the conversion is very low.
DHA and EPA are found in oily fish, whereas ALA is found in plant sources like walnuts, olives, olive oil, and chia seeds. Eating oily fish is better at supplying the necessary DHA and EPA for your body.
When pregnant, your omega-3 fatty acid stores can become depleted because of the demands of your growing baby. Having enough omega-3 fatty acids in the blood has been shown to help reduce the risk of postpartum depression. It is vital to ensure that you are eating or supplementing with adequate amounts.
Omega-6 fatty acids are another classification of fatty acids. These have the opposite effect of omega-3 fatty acids and can cause inflammation in the body. Having heightened inflammation in the body could increase the mother’s risk for mental health issues. Omega-6 fatty acids are generally found in vegetable oils and some nuts and seeds. Reducing the intake of vegetable oils can help eliminate extra inflammation.
How to Increase Your Intake of Omega-3 Fatty Acids:
- Consume oily fish, like salmon, trout, or sardines, at least 2 times per week.
- Supplement with high-quality omega-3 supplements that contain both EPA and DHA.
- Swap out vegetable oils for olive oil or high-quality, animal-based fats.
Vitamin D, the sun vitamin, helps with the immune system, inflammation, and blood sugar regulation. A deficiency in Vitamin D can impact estrogen and serotonin levels. Serotonin is often called the ‘happy’ hormone because increased levels can help boost a person’s mood. Low serotonin levels can cause depressive symptoms, so having enough vitamin D can decrease the risk of PMADs.
Adequate amounts of Vitamin D are essential during pregnancy and lactation. Vitamin D stores are heavily utilized during pregnancy to support the development of your baby’s kidneys, heart, and nervous system. Adequate amounts of Vitamin D are also needed to absorb calcium and phosphorus, which allows your baby to build strong bones and teeth! Taking sufficient amounts of Vitamin D continues to be important during lactation to support your health as the mom (including your mental health) and healthy bone development in your baby.
Additional supplementation beyond a prenatal vitamin should be taken, as most prenatal vitamins do not have enough. Asking your provider for a 25-hydroxy vitamin D test during pregnancy and lactation is recommended to assess your body’s current Vitamin D status and determine your supplementation needs.
3 Ways to Increase Your Vitamin D Levels:
- Get outside for 30 minutes a day around midday.
- Supplement with at least 4000IU during pregnancy and 6700-7000IU during lactation.
- Eat fatty fish, liver, eggs, and fortified foods.
*Sunlight and supplementation are better than food sources*
Zinc helps to create and maintain the proper functioning of serotonin. It also supports nutrient absorption, the immune system, and thyroid function. Research shows that low levels of zinc increase feelings of depression and anger; therefore, eating Zinc rich foods and supplementation can reduce the risk for those symptoms.
Zinc also helps to counteract copper in the body. During pregnancy, copper levels are higher than at any other time. The proper balance of zinc and copper can help with PMAD symptoms.
Moms who are vegans or vegetarians, have food aversions to shellfish or meat, or have experienced severe morning sickness or hyperemesis during pregnancy are at higher risk for a zinc deficiency. Asking your provider to test your Zinc levels can be beneficial in determining the appropriate amount needed for supplementation.
How to Increase Your Zinc Intake:
- Eat oysters, red meats, clams, sunflower seeds, and beans.
- Take a Zinc bisglycinate supplement of 25mg per day.
Iron helps to increase blood volume and support thyroid function. It is also seen to help support your mood. Iron needs during pregnancy increase, so there is a greater need for consuming iron-rich foods. 50% of women of childbearing age are iron deficient before pregnancy.
Getting your iron levels assessed before or at the beginning of pregnancy can be beneficial to determine whether supplementation is appropriate. Ask your provider to do a comprehensive iron panel before or during early pregnancy. This includes ferritin, total iron-binding capacity (TIBC)/transferrin, unsaturated iron-binding capacity (UIBC), transferrin saturation, serum iron, and C-reactive protein (CRP). To reassess iron levels during pregnancy and postpartum, testing hematocrit, hemoglobin, and ferritin would be adequate to know your iron status. Iron needs change during these different stages, so adjustment of supplementation may be needed.
Vegans, vegetarians, and moms with food aversions to meat are at a higher risk for iron deficiency.
How to Increase Your Iron Intake:
- Animal Foods: red meat, liver, oysters, dark poultry meat
- Plant Foods: lentils, broccoli, and dark leafy greens (eat these with vitamin C to help increase absorption)
- Use a cast iron pan when cooking.
- If supplementation is needed, take it at a different time than your prenatal.
Probiotics are live bacteria that live in your intestines and provide health benefits. They enhance mineral absorption, promote immune system health, and synthesize vitamin K, folate, and biotin. Although probiotics are live bacteria, there is no evidence they are unsafe to take or consume during pregnancy.
Three specific strains of probiotics shown to help with mental health include Lactobacillus rhamnosus, Bifidobacterium longum, and Lactobacillus helveticus.
Lactobacillis rhamnosus is proven to help perinatal mental health. This strain helps to reduce stress by lowering cortisol, the primary stress hormone, and improves GABA neurotransmission, an inhibitory neurotransmitter for the central nervous system. Lactobacillis rhamnosus is often added to dairy products.
Bifidobacterium longum enhances calmness by decreasing anxiety indices and improving cognitive function. It is naturally found in fermented dairy products and fermented vegetables.
Lactobacillus helveticus improves mood by decreasing neuroinflammation and increasing serotonin. As mentioned previously, serotonin is considered the ‘happy’ hormone, as an increase in serotonin production leads to an improved mood. Lactobacillus helveticus is commonly used to produce certain cheeses but is also found naturally in various probiotic foods!
Additionally, it is important to consume prebiotics with probiotics. Prebiotics are food for the probiotics. Breastmilk acts as both a prebiotic and probiotic for your baby!
How to Increase Your Probiotic Intake:
- Fermented Dairy Foods: Yogurt with live cultures, buttermilk, cottage cheese, Kiefer
- Other Fermented Foods: Soy, tempeh, miso, sauerkraut, kimchi
- Prebiotic Food Sources: Onion, garlic, wheat, barley, rye, legumes
- Take a probiotic supplement containing Lactobacillus rhamnosus, Bifidobacterium longum, and Lactobacillus helveticus.
Magnesium helps sleep, relaxation, nerve function, blood sugar stabilization, and calms the nervous system. Magnesium needs during pregnancy are increased to support your baby in regulating body temperature and protein synthesis, which plays an essential role in maintaining nerve and muscle cell potential. Magnesium also helps to reduce the risk of low birth weight, stillbirth, and preeclampsia. Breastmilk also contains Magnesium to support your baby’s bones, heart rhythm, sleep regulation, immune system, bowel regulation, digestive system, and absorbing calcium and vitamin D, so increased amounts during lactation are also necessary. Research has shown that low amounts of Magnesium can be a root cause of postpartum depression.
Magnesium cannot be stored in the body, so daily mineral intake is essential. Supplements come in different forms: Magnesium Citrate, Magnesium Oxide, and Magnesium Glycinate. Magnesium Citrate and Oxide are harder to absorb and can cause digestive discomfort. Magnesium Glycinate is easier absorbed and a more gentle form.
How to Increase your Magnesium Intake:
- Take a 350-400 mg magnesium glycinate supplement during pregnancy and lactation. Remember to take your supplement daily, as it is not stored! Taking Magnesium before bed can improve sleep quality.
- Eat pumpkin seeds, almonds, dark chocolate, and leafy greens.
- Enjoy Epsom salt baths or soak your feet in Epsom salts.
B vitamins (B1, B3, B6, B9, and B12) help manage inflammation, improve memory and energy, are essential for stress resilience, and play an important role in the production of serotonin, dopamine, and noradrenaline. It is seen that low levels of B9, folate, can impact depression in adults.
Like Magnesium, B vitamins are not stored in the body, so daily intake is essential.
How to Increase Your B Vitamin Intake:
- Eat whole grains, eggs, dairy products, legumes, seeds, nuts, and dark leafy greens.
- Continue taking your prenatal vitamin at least 6 months after birth and longer if breastfeeding.
- Ensure your prenatal vitamin contains methylated B vitamins in sufficient amounts, or take a daily (methylated) B vitamin complex to help increase levels.
MENTALLY THRIVING IN MOTHERHOOD
Thriving as a mama is possible! These nutrients can provide you with some support if you are struggling with PMADs, but may not cure all symptoms. Remember that you are not alone this season; utilizing other supportive measures can be very helpful!
T: Use therapy! (i.e. psychotherapy, couples therapy and more)
H: Health indicators (use labs tests to explore the root cause of issues)
R: Reduce inflammation, regulate blood sugar, replenish nutrient stores, and repair the gut
I: Identify ways to be more gentle with yourself, offering yourself grace as you navigate the waters of motherhood and explore your new identity as a mother.
V: Vocalize your needs (Ask for help! Nobody expects you to do this alone!)
E: Exercise and movement (Try taking a short walk, sitting outside, or attending a yoga class!)
During pregnancy, you are growing a human (which is amazing), but it can affect your mental health and nutrient stores. Eating a well-balanced diet and acquiring any necessary supplementation can help ensure that you and your baby are well-nourished and feeling your best. Getting lab work to check your nutrient levels can provide an excellent baseline to help determine which areas of your diet and supplement regimen need more attention. Lastly, share what you are going through with a loved one. It is okay to ask for help and take time for yourself. Your mental health is just as important as your physical health!
If you’re ready to have additional support and nutrition guidance for supporting your mental health when trying to conceive, during pregnancy, or during the postpartum period, apply to work with me and I will reach out to you soon!
- Barmmer, A. (n.d.). Assessing and Managing Iron in Pregnancy. [Webinar] FullWell.
- Dawe, J., McCowan, L., Wilson, J. et al. (2020). Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity. Sci Rep 10, 1291.
- Freidline, M. (2018). Do I need to take extra Vitamin D while I’m pregnant? Inova Newsroom.
- Greunke, S. (2021). Nutrition For Maternal Mental Health. [Webinar]. Women’s Health Nutrition Academy
- Rudolph, M., Graham, A., et al. (2018). Maternal IL-6 during pregnancy can be estimated from newborn brain connectivity and predicts future working memory in offspring. Nature Neuroscience, 21(5), 765-772.