Maternal Lipid‐based Nutrient Supplements (LNS) Did Not Reduce Depressive Symptoms During Pregnancy and Lactation in Rural Bangladesh

Abstract

BackgroundMaternal depression is a major global burden affecting not only women but also their children. Maternal intake and serum levels of polyunsaturated fatty acids have been inconsistently associated with reduced perinatal depression.ObjectiveWe aimed to determine the effects of lipid‐based nutrient supplement (LNS), containing macro and micronutrients, including essential fatty acids (4.6 g of linoleic acid and 0.6 g of alpha‐linolenic acid), on maternal depressive symptoms at 36 weeks of gestation and 6 months postpartum.MethodsWe conducted a cluster‐randomized effectiveness trial in Bangladesh (the Rang‐Din Nutrition Study), where women received either iron & folic acid (IFA) or LNS during pregnancy and the first three or six months postpartum, respectively. Maternal depressive symptoms were assessed by trained interviewers using a validated Bangla version of the Edinburgh Postnatal Depression Scale (EPDS‐B) at 36 weeks of gestation (n=2937) and 6 months postpartum (n=3510) at local antenatal clinics. Outcomes included the EPDS score (range: 0–30) and prevalence of depressive symptoms, defined as an EPDS score ≥10.ResultsOverall median (interquartile range) EPDS scores were 2 (0–4) and 1(0–3) at 36 weeks of gestation and 6 months postpartum, respectively. Prevalence of reported maternal depressive symptoms was low in this population (2.1% at 36 weeks of gestation and 2.7% at 6 months postpartum). Cluster‐adjusted intention‐to‐treat analyses indicated no significant differences by treatment group in EPDS scores (square root back transformed Means ± SEs; 36 weeks of gestation: 1.4 ± 0.1 vs 1.5 ± 0.1 in the LNS and IFA groups, respectively, p=0.22; 6 months postpartum: 1.2 ± 0.1 vs 1.3 ± 0.1 in the LNS and IFA groups, respectively, p=0.12) or prevalence of depressive symptoms (36 weeks of gestation: 2.5% in the LNS and 2.0% in the IFA group, p=0.42; 6 months postpartum: 2.8% in the LNS and 2.6% in the IFA group, p=0.68). Per‐protocol analysis including only those who consumed the supplements regularly indicated lower EPDS scores in the LNS compared to the IFA group at 36 weeks of gestation (1.2 ± 0.1 vs 1.5 ± 0.1, respectively, p=0.01). No other significant differences by treatment group were observed in per‐protocol results.ConclusionIn Bangladesh, maternal LNS did not show an effect on reported depressive symptoms in late pregnancy and at 6 months postpartum. Reports of depressive symptoms in this population were less common than in other populations in Bangladesh, which may have limited our ability to detect effects of LNS.Support or Funding InformationU.S. Agency for International Development (USAID)'s Food and Nutrition Technical Assistance (FANTA) III Project, managed by FHI 360.