Effects of evening primrose oil on prevention of postpartum grief in primiparous women: A clinical double-blind randomized controlled trial

Document Type : Original Article


1 M.Sc. of Midwifery, Faculty of Medicine, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran.

2 Instructor, Department of Statistics and Epidemiology, School of Health, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran.

3 M.Sc. of Midwifery, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran.

4 PhD in Community Nutrition, Menopause Research Center, School of Nursing and Midwifery, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran.


Introduction: Evening primrose is one of the medicinal herbs with good effects which has been used in the treatment of multiple physical and mental problems and no side effects of its oral consumption has not been reported so far; therefore this study was performed with aim to evaluate the effects of evening primrose oilon prevention of postpartum grief in primiparous women referred to Ahvaz health centers.
Methods: This clinical double-blind randomized trial was conducted on 132 primiparous women referred to Ahvaz health centers in 2012-2013. The subjects were randomly divided into two groups of 66 cases to receive a daily dose of 1 gr of evening primrose oil capsule or similar placebo gelatin capsule from the beginning of 37th weeks of pregnancy up to two weeks after delivery. The samples were assessed by Edinburg standard questionnaire on days of 4, 10 and 14 after delivery. Data were analyzed by SPSS software (version 20), and independent t-test, Chi-square and repeated measures analysis test. P<0.05 was considered significant.     
Results: There was statistically significant difference between the two groups regarding the risk of the postpartum grief, so that the risk of postpartum grief was lower in the intervention group than the placebo group (P=0.0001). The mean score of Edinburgh test in intervention group was significantly less compared to the control group on postpartum 4th day (p = 0.0001), 10th day (p = 0.001), and 14th day (p = 0.08).
Conclusion: The use of evening primrose oil is effective to prevent postpartum grief.


  1. Mohtashami JA, Noghani F. Textbook of community psychiatry. Tehran: Jamenegar Press; 2008. (Persian).
  2. Mosalanejad L. Motherhood and mental health. Tehran: Light Book Press; 2004. (Persian).
  3. Bagherzadeh R, Zahmatkeshan N, Moatamed N, Khorramroudi R, Ganjoo M. Prevalence of maternal blues, postpartum depression and their correlation with premenstrual syndrome in women referred to health centers affiliated to Bushehr University of Medical Sciences. Iran J Obstet Gynecol Infertil 2009; 12(3):9-15. (Persian).
  4. Mosallanegad L, Gahanmiri L, Ashkani H. Assessing post-partum blue in women referring to maternity clinic in Shiraz-2004. Jahrom Med J 2005; 2(2):22-7. (Persian).
  5. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams obstetrics. 24th ed. New York: McGraw hill; 2014. P. 1434.
  6. Petrou S, Cooper P, Murray L, Davidson LL. Economic costs of post-natal depression in a high-risk British cohort. Br J Psychiatry 2002; 181:505-12
  7. Faisal-Cury A, Rossi Menezes P, Tedesco JA, Kahalle S, Zugaib M. Maternity “blue” prevalence and risk factors. Spanish J Psychol 2008; 11(2):593-9.
  8. Kaplan HI. Sadocks BJ. Comprehensive textbook of psychiatry. 8th ed. Philadelphia: Lippincott Williams &Wilkins; 2003.
  9. Sadock BJ, Sadock VA. Synopsis of psychiatry. Philadelphia: Lippincott Williams &Wilkins; 2007.
  10. Kleeb B, Ragerh C. Influence of prophylactic in formation on the frequency of baby blues. Zeitschrift Geburt Neonatal 2005; 209(1):22-8.
  11. Murray L, Halligan SL, Adams G, Patterson P, Goodyer IM. Socioemotional development in adolescents at risk for depression: the role of maternal depression and attachment style. Dev Psychopathol 2006; 18(2):489-516.
  12. Ghojazadeh M, Mohamadrezaei Z. Study of relationship between some predisposing factors and postpartum depression. J Ardabil Univ Med Sci 2008; 8(1):54-61. (Persian).
  13. Janati Yadalalah KN. Psychiatric in nursing. Tehran: Community Oriented; 2005. (Persian).
  14. Salamat S, Ismail KM, O’Brien S. Premenstrual syndrome. Obstet Gynaecol Reprod Med 2008; 18(2):29-32.
  15. Hossein SS. Herbs and medical plants. India: World Nutrition; 2013.
  16. Kamalipour M, Akhoundzadeh SH, Rezazadeh S. Herbal Medicines in the treatment of depression and anxiety. J Med Planets 2008; 1(25):1-7. (Persian).
  17. Cohen B. Herbs and natural supplements: an evidence-based guide. London: Churchill Livingstone; 2010.
  18. Saki M, Jariani M, Saki K, Delfan B, Tarahi M, Gholami M. Effects of evening primrose oil on depression disorders on patients at the psycho-neurological clinic of Khoramabad. J Ilam Univ Med Sci 2009; 16(4):47-56. (Persian).
  19. Hakkarainen R, Partonen T, Haukka J, Virtamo J, Albanes D, Lönnqvist J. Is low dietary intake of omega-3 fatty acids associated with depression? Am J Psychiatry 2004; 161(3):567-9.
  20. Nemetes H, Nemets B, Apter A, Bracha Z, Belmaker RH. Omege-3 treatment of childhood depression: a controlled double-blind pilot study. Am J Psychiatry 2006; 163(6):1098-100.
  21. Cardina C. Encyclopedia of dietary supplements. Ref User Serv Quart 2005; 45(1):80-1.
  22. National Toxicology Program. Supporting nomination for toxicological evaluation by the national toxicology program. New York: NTP National Toxicology Program; 2009.
  23. Grist RD, Ridge M. Re: Menopause and HRT. Br Columb Med J 2002; 44(1):9.
  24. Lin PY, Su KP. A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of omega-3 fatty acids. J Clin Psychiatry 2007; 68(7):1056-61.
  25. Logan AC. Omega-3 fatty acid and major depression: a primer for the mental health professional. Lip Health Dies 2004; 3(1):25.
  26. Logan AC. Neurobehavioral aspects of omega-3 fatty acids: possible mechanisms and therapeutic value in major depression. Altern Med Rev 2003; 8(4):410-25.
  27. Liorente 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(5):1348-53.
  28. Adewuya AO. The maternity blues in Western Nigerian women: prevalence and risk factors. Am J Obstet Gynecol 2005; 193(4):1522-5.
  29. Nemets B, Stahl Z, Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. Am J Psychiatry 2002; 159(3):477-9.
  30. Bayles B, Usatine R. Evening primrose oil. Am Fam Phys 2009; 80(12):1405-8.
  31. Preeclampsia: preventing preeclampsia. NHS Choices Homepage. Available at: URL: www.nhs.uk; 2009.
  32. Wanjirw MW. Using medication and therapy to manage postpartum depression. Atlanta: WebMD LLC; 2010.
  33. Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale-preliminary report. Psychopharmacol Bull 1973; 9(1):13-27.
  34. Najarian B, Davoudi I. Construction and Validation of SCL-25 (short form for SCL- 90-R). J Psychol 2001; 5(2):136-49. (Persian).
  35. Goldberg DP, Hillier VF. A scaled version of general health questionnaire. Psychol Med 1979; 9:131-45.
  36. Dennis CL. Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh postnatal depression scale? J Affect Disord 2004; 78(2):163-9.
  37. de Salud SM, de Madrid C, de Sanidad C. Use of health care resources and loss of productivity in patients with depressive disorders seen in Primary Care: INTERDEP Study. Actas Esp Psiquiatr 2014; 42(6):281-91.
  38. Lopresti AL. A review of nutrient treatments for pediatric depression. J Affect Disord 2015; 181:24-32.
  39. Grosso G, Galvano F, Marventano S, Malaguarnera M, Bucolo C, Drago F, et al. Omega-3 fatty acids and depression: scientific evidence and biological mechanisms. Oxid Med Cell Longev 2014; 2014:313570.
  40. Kyrozis A, Psaltopoulou T, Stathopoulos P, Trichopoulos D, Vassilopoulos D, Trichopoulou A. Dietary lipids and geriatric depression scale score among elders: the EPIC-Greece cohort. J Psychiatr Res 2009; 43(8):763-9.
  41. Trebaticka J, Hradecna Z, Bohmer F, Vavakova M, Waczulikova I, Garaiova I, et al. Emulsified omega-3 fatty-acids modulate the symptoms of depressive disorder in children and adolescents: a pilot study. Child Adolesc Psychiatry Ment Health 2017; 11:30.
  42. Astorg P, Couthouis A, Bertrais S, Arnault N, Meneton P, Guesnet P, et al. Association of fish and long-chain n-3 polyunsaturated fatty acid intakes with the occurrence of depressive episodes in middle-aged French men and women. Prostaglandins Leukot Essent Fatty Acids 2008; 78(3):171-82.
  43. Sanchez-Villagas A, Henriquez P, Figueiras A, Ortuno F, Lahortiga F, Martinez-Gonzalez MA: Long chain omega-3 fatty acids intake, fish consumption and mental disorders in the SUN cohort study. Eur J Nutr 2007; 46(6):337-46.
  44. Fahami F, Asali Z,  Aslani A, Fathizadeh N. A comparative study on the effects of Hypericum Perforatum and passion flower on the menopausal symptoms of women referring to Isfahan city health care centers. Iran J Nurs Midwifery Res 2010; 15(4):202-7.
  45. Gallagher S. Omega 3 oils and pregnancy. Midwifery Today Int Midwife 2004; 69:26-31.
  46. Deacon G, Kettle C, Hayes D, Dennis C, Tucci J. Omega 3 polyunsaturated fatty acids and the treatment of depression. Crit Rev Food Sci Nutr 2017; 57(1):212-23.
  47. Su KP, Matsuoka Y, Pae CU. Omega-3 polyunsaturated fatty acids in prevention of mood and anxiety disorders. Clin Psychopharmacol Neurosci 2015; 13(2):129-37.
  48. Mcnamara RK. Role of omega-3 fatty acids in the etiology, treatment, and prevention of depression: current status and future directions. J Nutr Intermed Metab 2016; 5:96-106.