Correlation between postpartum depression and omega-3, micronutrients


  • Meltem Mermer Department of Nutrition, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
  • Nevin Şanlıer Department of Nutrition and Dietetics, Biruni University Faculty of Health Science, Istanbul, Turkey



Depression, Mineral, Omega-3, Postpartum, Vitamin


In recent years, attention has been called to the link between nutrition and mental health. Postpartum depression is an important depressive disorder which often arises 6 to 12 weeks after giving birth and can happen at any time within one year. Postpartum depression prevalence is around 20% worldwide. Genetic predisposition and environmental factors, as well as certain social, psychological and biological factors constitute risk factors for postpartum depression. While malnutrition is among the biological factors, there is a correlation between nutrients such as folic acid, vitamin B₁₂, vitamin D, iron, selenium, zinc, and n-3 fatty acids and psychological state. The nutrients that claim most attention relating to postpartum depression are n-3 essential fatty acids. Insufficient intake of n-3, folic acid, vitamins B and iron is observed in pregnant women. Failing to meet the needs of the mother due to malnutrition during pregnancy can increase the risk of depleting the body’s nutrient reserves and developing postpartum. This risk factor needs to be kept in check by determining and keeping track of the nutrient needs of the mother during the perinatal period.


Çalık KY, Aktaş S. Depression in pregnancy: prevalence, risk factors and treatment. Current Approaches in Psychiatry. 2011;3:142-62.

Leung BM, Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link-a review of the literature. J Am Dietetic Assoc. 2009;109:1566-75.

Tissot H, Favez N, Frascarolo-Moutinot F, Despland JN. Assessing postpartum depression: Evidences for the need of multiple methods. Eu Rev Applied Psychol. 2015;65:61-6.

World Health Organization. Maternal mental health. Available at

Maimburg RD, Væth M. Postpartum depression among first-time mothers–results from a parallel randomised trial. Sexual and Reproductive Healthcare. 2015;6:95-100.

Baker L, Cross S, Greaver L, Wei G, Lewis R, Corps HS. Prevalence of postpartum depression in a native American population. Maternal Child Health J. 2005;9:21-5.

Ross LE, Evans SG, Sellers EM, Romach MK. Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Arch Women's Mental Health. 2003;6:51-7.

da Rocha CM, Kac G. High dietary ratio of omega‐6 to omega‐3 polyunsaturated acids during pregnancy and prevalence of post‐partum depression. Maternal Child Nutrition. 2012;8:36-48.

Markhus MW, Skotheim S, Graff IE, Frøyland L, Braarud HC, Stormark KM, et al. Low omega-3 index in pregnancy is a possible biological risk factor for postpartum depression. PloS One. 2013;8:e67617.

Stewart DE, Robertson E, Dennis CL, Grace SL, Wallington T. Postpartum depression: literature review of risk factors and interventions. Toronto: University Health Network Women’s Health Program for Toronto Public Health. 2003

Kaplan BJ, Crawford S, Field C, Simpson JSA. Vitamins, minerals and mood: A scientific review. Psychol Bull. 2007;133:747-60.

Mahan LK, Escott-Stump S, Krause MV. Krause's food and nutrition therapy. 13th ed. Elsevier Saunders; 2012:357.

Gogus U, Smith C. n‐3 Omega fatty acids: a review of current knowledge. Int J Food Sci Tech. 2010;45:417-36.

Su KP, Huang SY, Chiu CC, Shen WW. Omega-3 fatty acids in major depressive disorder: a preliminary double-blind, placebo-controlled trial. Eu Neuropsychopharmacol. 2003;13:267-71.

Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine and Pharmacotherapy. 2002;56(8):365-79.

Otto SJ, De Groot RH, Hornstra G. Increased risk of postpartum depressive symptoms is associated with slower normalization after pregnancy of the functional docosahexaenoic acid status. Prostaglandins Leukot Essent Fatty Acids. 2003;69:237-43.

Hibbeln JR. Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord. 2002;69:15-29.

Llorente AM, Jensen CL, Voigt RG, Fraley JK, Berretta MC, Heird WC. Effect of maternal docosahexaenoic acid supplementation on postpartum depression and information processing. Am J Obstet Gynecol. 2003;188:1348-53.

Marangell LB, Martinez JM, Zboyan HA, Puryear LJ. Omega‐3 fatty acids for the prevention of postpartum depression: Negative data from a preliminary, open‐label pilot study. Depression Anxiety. 2004;19:20-3.

Zittermann, A. Vitamin D in preventive medicine: are we ignoring the evidence?. Br J Nutr. 2003;89:552-72.

Eyles D, Smith S, Kinobe R, Hewison M, McGrath JJ. Distribution of the vitamin D receptor and 1 alpha-hydroxylase in human brain. J Chem Neu. 2005;29:21-30.

Garland CF, Garland FC, Gorham ED, Lipkin M, Newmark H, Mohr SB, et al. The role of vitamin D in cancer prevention. Am J Publ Health. 2006;96:252-61.

Murphy PK, Wagner CL. Vitamin D and mood disorders among women: an integrative review. J Midwifery Women’s Health. 2008;53:440-6.

Murphy PK, Mueller M, Hulsey TC, Ebeling MD, Wagner CL. An exploratory study of postpartum depression and vitamin D. J Am Psych Nurses Assoc. 2010;16:170-7.

Fu CW, Liu JT, Tu WJ, Yang JQ, Cao Y. Association between serum 25‐hydroxyvitamin D levels measured 24 hours after delivery and postpartum depression. Int J Obstet Gynaecol 2015;122:1688-94.

Dror DK, Allen LH. Vitamin D inadequacy in pregnancy: biology, outcomes, and interventions. Nutrition Rev. 2010;68:465-77.

Sylvén SM, Papadopoulos FC, Olovsson M, Ekselius L, Poromaa IS, Skalkidou A. Seasonality patterns in postpartum depression. Am J Obstet Gynecol. 2011;204:413-e1.

Sit D, Seltman H, Wisner KL. Seasonal effects on depression risk and suicidal symptoms in postpartum women. Depression Anxiety. 2011;28:400-5.

Robinson M, Whitehouse AJ, Newnham JP, Gorman S, Jacoby P, Holt BJ, et al. Low maternal serum vitamin D during pregnancy and the risk for postpartum depression symptoms. Arch Women's Mental Health. 2014;17:213-9.

Lamb A, Hobel C, Pepkowitz S, Holmquist B, Young D, Wallston K, et al. 763: Vitamin D deficiency and depressive symptoms in the perinatal period: a prospective study. Am J Obstet Gynecol. 2015;212:371.

Nielsen NO, Strøm M, Boyd HA, Andersen EW, Wohlfahrt J, Lundqvist M, et al. Vitamin D status during pregnancy and the risk of subsequent postpartum depression: a case-control study. PloS One. 2013;8:1-8.

Thacher TD, Clarke BL. Vitamin D insufficiency. In: Mayo Clinic Proceedings. Elsevier; 2011;50-60.

Bottiglieri T. Homocysteine and folate metabolism in depression. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29:1103-12.

Behzadi AH, Behbahani AS, Ostovar N. Therapeutic effects of folic acid on ante partum and postpartum depression. Med Hypotheses. 2008;71:313-4.

Morris MS, Fava M, Jacques PF, Selhub J, Rosenberg IH. Depression and folate status in the US population. Psychother Psychosomat. 2003;72:80-7.

Bjelland I, Ueland PM, Vollset SE. Folate and depression. Psychother Psychosomat. 2003;72:59-60.

Paul RT, McDonnell AP, Kelly CB. Folic acid: neurochemistry, metabolism and relationship to depression. Human Psychopharmacol Clin Experiment. 2004;19:477-88.

Blunden CH, Inskip HM, Robinson SM, Cooper C, Godfrey KM, Kendrick TR. Postpartum depressive symptoms: the B-vitamin link. Mental Health Fam Med. 2012;9:5-13.

Hvas AM, Juul S, Bech P, Nexø E. Vitamin B6 level is associated with symptoms of depression. Psychother Psychosom. 2004;73:340-3.

Coppen A, Bolander-Gouaille C. Treatment of depression: Time to consider folic acid and vitamin B12. J Psychopharmacol. 2005;19:59-65.

Miyake Y, Sasaki S, Tanaka K, Yokoyama T, Ohya Y, Fukushima W, et al. Dietary folate and vitamins B12, B6, and B2 intake and the risk of postpartum depression in Japan: the Osaka maternal and child health study. J Affect Disord. 2006;96:133-8.

Kendrick T, Robinson DS. A longitudinal study of blood folate levels and depressive symptoms among young women in the Southampton women’s survey. J Epidemiol Community Health. 2008;62:966-72.

Chong MF, Wong JX, Colega M, Chen LW, van Dam RM, Tan CS, et al. Relationships of maternal folate and vitamin B12 status during pregnancy with perinatal depression: The GUSTO study. J Psych Res. 2014;55:110-6.

Melanson KJ. Nutrition review: relationships of nutrition with depression and anxiety. Am J Lifestyle Med. 2007;1:171-4.

Siwek M, Szewczyk B, Dudek D, Styczeń K, Sowa-Kućma M, Młyniec K, et al. Zinc as a marker of affective disorders. Pharmacologic Reports 2013;65:1512-8.

Mackenzie GG, Zago MP, Aimo L, Oteiza PI. Zinc deficiency in neuronal biology. IUBMB Life. 2007;59:299-307.

Ellsworth-Bowers ER, Corwin EJ. Nutrition and the psychoneuroimmunology of postpartum depression. Nutrition Res Rev. 2012;25:180.

Irmisch G, Schlaefke D, Richter J. Zinc and fatty acids in depression. Neurochem Res. 2010;35:1376-83.

Wójcik J, Dudek D, Schlegel-Zawadzka M, Grabowska M, Marcinek A, Florek E, et al. Antepartum/postpartum depressive symptoms and serum zinc and magnesium levels. Pharmacol Rep. 2006;58:571-6.

Nowak G, Siwek M, Dudek D, Ziêba A, Pilc A. Effect of zinc supplementation on antidepressant therapy in unipolar depression: a preliminary placebo-controlled study. Polish J Pharmacol. 2003;55:1143-8.

Fard FE, Mirghafourvand M, Mohammad-Alizadeh Charandabi S, Farshbaf-Khalili A, Javadzadeh Y, Asgharian H. Effects of zinc and magnesium supplements on postpartum depression and anxiety: A randomized controlled clinical trial. Women Health. 2016;13:1-14.

World Health Organization. Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. 2001.

Etebary S, Nikseresht S, Sadeghipour HR, Zarrindast MR. Postpartum depression and role of serum trace elements. Iranian J Psychol. 2010;5:40-6.

Brownlie T, Utermohlen V, Hinton PS, Giordano C, Haas JD. Marginal iron deficiency without anemia impairs aerobic adaptation among previously untrained women. Am J Clin Nutr. 2002;75:734-42.

Albacar G, Sans T, Martín-Santos R, García-Esteve L, Guillamat R, Sanjuan J, et al. An association between plasma ferritin concentrations measured 48 hours after delivery and postpartum depression. J Affect Disord. 2011;131:136-42.

Muñoz M, Villar I, García-Erce JA. An update on iron physiology. World J Gastroenterol. 2009;15:4617-26.

Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72:257-64.

Corwın EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133:4139-42.

Sheikh M, Hantoushzadeh S, Shariat M, Farahani Z, Ebrahiminasab O. The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial. Eu J Nutr. 2017;56(2):901-8.

Armony-Sivan R, Shao J, Li M, Zhao G, Zhao Z, Xu G, et al. No relationship between maternal iron status and postpartum depression in two samples in China. J Pregnancy. 2012;2012.

Chen J, Berry MJ. Selenium and selenoproteins in the brain and brain diseases. J Neurochem. 2003;86:1-2.

Bodnar LM, Wisner KL. Nutrition and depression: implications for improving mental health among childbearing-aged women. Biologic Psych. 2005;58:679-85.

Pasco JA, Jacka FN, Williams LJ, Evans-Cleverdon M, Brennan SL, Kotowicz MA, et al. Dietary selenium and major depression: a nested case-control study. Complement Ther Med. 2012;20:119-23.

Ishrat T, Parveen K, Khan MM, Khuwaja G, Khan MB, Yousuf S, et al. Selenium prevents cognitive decline and oxidative damage in rat model of streptozotocin-induced experimental dementia of Alzheimer's type. Brain Res. 2009;1281:117-27.

Ferrer E, Alegrı́a A, Barberá R, Farré R, Lagarda MJ, Monleon J. Whole blood selenium content in pregnant women. Sci Total Environ. 1999;227:139-43.

Mihailovic M, Cvetkovic M, Ljubic A, Kosanovic M, Nedeljkovic S, Jovanovic I, et al. Selenium and malondialdehyde content and glutathione peroxidase activity in maternal and umbilical cord blood and amniotic fluid. Biol Trace Elem Res. 2000;73:47-54.

Mokhber N, Namjoo M, Tara F, Boskabadi H, Rayman MP, Ghayour-Mobarhan M et al. Effect of supplementation with selenium on postpartum depression: a randomized double-blind placebo-controlled trial. J Maternal-Fetal Neonatal Med. 2011;24:104-8.

Loyke HF. Effects of elements in human blood pressure control. Biol Trace Elem Res. 2002;85:193-209.

Nahar Z, Azad MA, Rahman MA, Rahman MA, Bari W, Islam SN, et al. Comparative analysis of serum manganese, zinc, calcium, copper and magnesium level in panic disorder patients. Biological Trace Element Res. 2010;133:284-90.

Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006;67:362-70.

Derom ML, Sayón-Orea C, Martínez-Ortega JM, Martínez-González MA. Magnesium and depression: a systematic review. Nutritional Neurosci. 2013;16:191-206.






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