Prospective Associations of Maternal Dietary Patterns and Postpartum Mental Health in a Multi-Ethnic Asian Cohort: The Growing up in Singapore towards Healthy Outcomes (GUSTO) Study.

Cherlyen Teo,Helen Chen,Wei Pang,Michael Meaney,Keith Godfrey,Yap-Seng Chong,Ling-Wei Chen,Marjorelee Colega,Kok Tan,Ai-Ru Chia,Doris Fok,Mary Chong,Lynette Shek,Fabian Yap

doi:10.3390/nu10030299

Abstract

Diet in the first month postpartum, otherwise known as “the confinement diet” in Asia, has unique characteristics that are influenced by traditions, cultures, and beliefs. We aimed to characterize dietary patterns during confinement period in a multi-ethnic Asian cohort and examined their associations with postpartum depression (PPD) and anxiety (PPA). Dietary intakes of 490 women were ascertained in the first month postpartum using 3-day food diaries and dietary patterns were derived by factor analysis. Participants completed the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) at three months’ postpartum; higher scores are indicative of more depressive and anxiety symptoms, respectively. Four dietary patterns were identified: Traditional-Chinese-Confinement diet, Traditional-Indian-Confinement diet, Eat-Out diet and Soup-Vegetables-Fruits diet. The Traditional-Indian-Confinement diet was associated with less PPD symptoms [β (95% CI) −0.62 (−1.16, −0.09) EPDS score per SD increase in diet score] and a non-significant trend with reduced probable PPD (EPDS scores ≥ 13) [OR (95% CI) 0.56 (0.31, 1.01)]. The Soup-Vegetables-Fruits diet was associated with less PPA symptoms [β (95% CI) −1.49 (−2.56, −0.42) STAI-state score]. No associations were observed for other dietary patterns. Independent of ethnicity, adherence to the Traditional-Indian-Confinement diet that is characterized by intake of herbs and legumes, and Soup-Vegetables-Fruits diet high in fruits, vegetables and fish during the postpartum period were associated with less PPD and PPA symptoms, respectively.

Highlights

Postpartum depression (PPD) and postpartum anxiety (PPA) affect 13–19% [1,2] of women worldwide, respectively
The Traditional-Chinese-Confinement (TCC) diet was characterized by high consumption of traditional dried fruits, herbal tea, rhizomes, Chinese herbs, and foods cooked with wine, alcohol, or vinegar, which are considered “hot” foods and traditionally consumed by mothers who observe the traditional Chinese confinement diet during the 1st month postpartum [26,28,42,43]
Key food groups of Traditional-Indian-Confinement diet, such as Indian herbs and seed herbs, as well as curcumin [51,52] present in curry dishes have previously been reported to be effective in alleviating depressive symptoms via their anti-inflammatory [49,53], neuroprotective [54], serotonergic [55,56], and hypothalamic pituitary adrenal (HPA) regulation effects [57]

Summary

Introduction

Postpartum depression (PPD) and postpartum anxiety (PPA) affect 13–19% [1,2] of women worldwide, respectively The impact of these disorders can range from immediate effects of self-harm, inadequate caregiving practices, reduced breastfeeding, to long-term consequences, such as maternal chronic depression and child temperament, cognitive, and behavioral issues [2,3,4,5]. These disorders often go undiagnosed and untreated due to the lack of awareness of symptoms and the associated stigma [6], preventive measures need to be identified to mitigate their risks. Low levels of nutrients, such as zinc, magnesium, and n-3 fatty acids have been linked to PPD [7,9,10,11,12] and are associated with anxiety in general population and animal studies [13,14,15]

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