The Relationship between Diet and Postpartum Depression in Postpartum Women in Tabriz

Document Type : Original Article


1 M.Sc. student of Midwifery, Students Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

2 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

3 Associate Professor, Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

4 Ph.D. Student of Research-Centered, Tabriz Health Services Management Research Center, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

5 Associate Professor, Road Traffic Injury Research Center, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran


Introduction: According to the World Health Organization, depression will be the second most prevalent disease after ischemic heart diseases by the year 2020. Postpartum depression as a major depressive episode has devastating impacts on the health of the mother, the infant, and even the entire family.
Methods: This cross-sectional study was performed in 2014 on 95 postpartum women aged 18 years and older in health centers in Tabriz, Iran, 8 weeks after delivery. Eligible subjects were entered into the study using the convenience sampling method. Demographic, Edinburgh Postnatal Depression Scale and 24-hour dietary recall questionnaires were completed by participants for 3 days that included one working and 2 non-working days, which were then averaged. Mothers with a score of 12 or higher were considered depressed. The data was analyzed using SPSS (ver. 20) and neural networks were used to determine the association between diet and depression and contribution of each of these factors.
Results: Mean of depression score was 7.1 (SD 4.4). 83 mothers (87.4%) had Edinburg scores lower than 12. Based on findings from neural networks, Omega 3 (25%), Cholesterol (32%), Polyunsaturated Fatty Acids (PUFA) (36%), and Omega 6 (42%) had smaller shares in increasing the Edinburg scores, in comparison with Zinc (61%), Magnesium (78%), and Saturated fatty acids (90%).   
Conclusion: Since Omega 3, Cholesterol, Polyunsaturated Fatty Acids, and Omega 6 intake factors had the smallest shares in increasing the postpartum depression score, they can be recommended in diets.


  1. World Health Organization. Promoting mental health. Geneva: World Health Organization; 2005.
  2. Miller BJ, Murray L, Beckmann MM, Kent T, Macfarlane B. Dietary supplements for preventing postnatal depression. Cochrane Database Syst Rev 2013; 10.CD009104.
  3. Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 2012; 90(2):139G-49.
  4. Veisani Y, Sayehmiri K. Prevalence of postpartum depression in Iran - A systematic review and meta-analysis. Iran J Obstet Gynecol Infertil 2012; 15(14):21-9. (Persian).
  5. Etebary S, Nikseresht S, Sadeghipour HR, Zarrindast MR. Postpartum depression and role of serum trace elements. Iran J Psychiatry 2010; 5(2):40-6.
  6. Spinelli MG. Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psychiatry 2004; 161(9):1548-57.
  7. Leung BM, Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link--a review of the literature. J Am Diet Assoc 2009; 109(9):1566-75.
  8. Bloch M, Rotenberg N, Koren D, Klein E. Risk factors for early postpartum depressive symptoms. Gen Hosp Psychiatry 2006; 28(1):3-8.
  9. Beckley EH, Finn DA. Inhibition of progesterone metabolism mimics the effect of progesterone withdrawal on forced swim test immobility. Pharmacol Biochem Behav 2007; 87(4):412-9.
  10. Bloch M, Rotenberg N, Koren D, Klein E. Risk factors associated with the development of postpartum mood disorders. J Affect Disord 2005; 88(1):9-18.
  11. Roux G, Anderson C, Roan C. Postpartum depression, marital dysfunction, and infant outcome: a longitudinal study. J Perinat Educ 2002; 11(4):25–36.
  12. Brockington I. Postpartum psychiatric disorders. Lancet 2004; 363(9405):303-10.
  13. Pope CJ, Xie B, Sharma V, Campbell MK. A prospective study of thoughts of self-harm and suicidal ideation during the postpartum period in women with mood disorders. Arch Womens Ment Health 2013; 16(6):483-8.
  14. Du J, Zhu M, Bao H, Li B, Dong Y, Xiao C, et al. The role of nutrients in protecting mitochondrial function and neurotransmitter signaling: implications for the treatment of depression, PTSD, and suicidal behaviors. Crit Rev Food Sci Nutr 2014; 3:10-8.
  15. Edalati Fard F, Mirghafourvand M, Mohammad Alizadeh Charandabi S, Farshbaf Khalili A. Relationship of zinc and magnesium serum levels with postpartum depression in Tabriz, Iran. Global J Health Sci 2015; 8(11):3-7. (Persian).
  16. Ellsworth-Bowers ER, Corwin EJ. Nutrition and the psychoneuroimmunology of postpartum depression. Nutr Res Rev 2012; 25(1):180-92.
  17. Freund-Levi Y, Basun H, Cederholm T, Faxen-Irving G, Garlind A, Grut M, et al. Omega-3 supplementation in mild to moderate Alzheimer's disease: effects on neuropsychiatric symptoms. Int J Geriatr Psychiatry 2008; 23(2):161-9.
  18. Leung BM, Kaplan BJ, Field CJ, Tough S, Eliasziw M, Gomez MF, et al. Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort. BMC Pregnancy Childbirth 2013; 13:2.
  19. Wojcicki JM, Heyman MB. Maternal omega-3 fatty acid supplementation and risk for perinatal maternal depression. J Matern Fetal Neonatal Med 2011; 24(5):680-6.
  20. Levant B. N-3 (omega-3) Fatty acids in postpartum depression: implications for prevention and treatment. Depress Res Treat 2011; 2011:467349.
  21. Bodnar LM, Wisner KL. Nutrition and depression: implications for improving mental health among childbearing-aged women. Biol Psychiatry 2005; 58(9):679-85.
  22. Haghigi AH, Eslaminik E, Hamedinia M. The effect of eight weeks aerobic training and moderate and high doses green tea consumption on body composition and lipid profile in overweight and obese women. Med J Mashhad Univ Med Sci 2015; 58(7):359-69. (Persian).
  23. Mahan LK, Escott-Stump S, Raymond JL. Krause's food & the nutrition care process. 13th ed. St. Louise: Elsevier Health Sciences; 2012.
  24. Abari Aghdam N. Study of the edinburgh postnatal depression scale in Tabriz. [Master Thesis]. Tabriz, Iran: School of Medicine Islamic Azad University, Tabriz, Branch; 2007.
  25. Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. Vascular depression hypothesis. Arch Gen Psychiatry 1997; 54(10):915-22.
  26. 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(1-3):15-29.
  27. 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(5):1348-53.
  28. Mattes E, McCarthy S, Gong G, van Eekelen JA, Dunstan J, Foster J, et al. Maternal mood scores in mid-pregnancy are related to aspects of neonatal immune function. Brain Behav Immun 2009; 23(3):380-8.
  29. Freeman MP, Davis M, Sinha P, Wisner KL, Hibbeln JR, Gelenberg AJ. Omega-3 fatty acids and supportive psychotherapy for perinatal depression: a randomized placebo-controlled study. J Affect Disord 2008; 110(1-2):142-8.
  30. Rees AM, Austin MP, Parker GB. Omega-3 fatty acids as a treatment for perinatal depression: randomized double-blind placebo-controlled trial. Aust N Z J Psychiatry 2008; 42(3):199-205.
  31. Makrides M, Gibson RA, McPhee AJ, Yelland L, Quinlivan J, Ryan P, et al. Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trial. JAMA 2010; 304(15):1675-83.
  32. Su KP, Huang SY, Chiu TH, Huang KC, Huang CL, Chang HC, et al. Omega-3 fatty acids for major depressive disorder during pregnancy: results from a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2008; 69(4):644-51.
  33. Freeman MP, Hibbeln JR, Wisner KL, Brumbach BH, Watchman M, Gelenberg AJ. Randomized dose-ranging pilot trial of omega-3 fatty acids for postpartum depression. Acta Psychiatr Scand 2006; 113(1):31-5.
  34. Jans LA, Giltay EJ, Van der Does AJ. The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression. Br J Nutr 2010; 104(11):1577-85.
  35. Adams PB, Lawson S, Sanigorski A, Sinclair AJ. Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids 1996; 31(Suppl):S157-61.
  36. Tiemeier H, van Tuijl HR, Hofman A, Kiliaan AJ, Breteler MM. Plasma fatty acid composition and depression are associated in the elderly: the Rotterdam Study. Am J Clin Nutr 2003; 78(1):40-6.
  37. Szewczyk B, Poleszak E, Wlaz P, Wrobel A, Blicharska E, Cichy A, et al. The involvement of serotonergic system in the antidepressant effect of zinc in the forced swim test. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33(2):323-9.
  38. Ruljancic N, Mihanovic M, Cepelak I, Bakliza A, Curkovic KD. Platelet serotonin and magnesium concentrations in suicidal and non-suicidal depressed patients. Magnes Res 2013; 26(1):9-17.
  39. Szewczyk B, Poleszak E, Sowa-Kućna M, Siwek M, Dudek D, Ryszewska-Pokraśniewicz B, et al. Antidepressant activity of zinc and magnesium in view of the current hypotheses of antidepressant action. Pharmacol Rep 2008; 60(5):588-9.
  40. Sowa-Kucma M, Szewczyk B, Sadlik K, Piekoszewski W, Trela F, Opoka W, et al. Zinc, magnesium and NMDA receptor alterations in the hippocampus of suicide victims. J Affect Disord 2013; 151(3):924-31.
  41. Doboszewska U, Sowa-Kucma M, Mlyniec K, Pochwat B, Holuj M, Ostachowicz B, et al. Zinc deficiency in rats is associated with up-regulation of hippocampal NMDA receptor. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:254-63.
  42. DiGirolamo AM, Ramirez-Zea M. Role of zinc in maternal and child mental health. Am J Clin Nutr 2009; 89(3):940S-5.
  43. Mlyniec K, Budziszewska B, Reczynski W, Doboszewska U, Pilc A, Nowak G. Zinc deficiency alters responsiveness to antidepressant drugs in mice. Pharmacol Rep 2013; 65(3):579-92.
  44. Siwek M, Szewczyk B, Dudek D, Styczen K, Sowa-Kucma M, Mlyniec K, et al. Zinc as a marker of affective disorders. Pharmacol Rep 2013; 65(6):1512-8.
  45. Swardfager W, Herrmann N, Mazereeuw G, Goldberger K, Harimoto T, Lanctot KL. Zinc in depression: a meta-analysis. Biol Psychiatry 2013; 74(12):872-8.
  46. Decollogne S, Tomas A, Lecerf C, Adamowicz E, Seman M. NMDA receptor complex blockade by oral administration of magnesium: comparison with MK-801. Pharmacol Biochem Behav 1997; 58(1):261-8.
  47. Poleszak E, Szewczyk B, Kedzierska E, Wlaz P, Pilc A, Nowak G. Antidepressant- and anxiolytic-like activity of magnesium in mice. Pharmacol Biochem Behav 2004; 78(1):7-12.
  48. Singewald N, Sinner C, Hetzenauer A, Sartori SB, Murck H. Magnesium-deficient diet alters depression- and anxiety-related behavior in mice--influence of desipramine and Hypericum perforatum extract. Neuropharmacology 2004; 47(8):1189-97.
  49. Nikseresht S, Etebary S, Karimian M, Nabavizadeh F, Zarrindast MR, Sadeghipour HR. Acute administration of Zn, Mg, and thiamine improves postpartum depression conditions in mice. Arch Iran Med 2012; 15(5):306-11.
  50. Lloyd HG, Perkins A, Spence I. Effect of magnesium on depression of the monosynaptic reflex induced by 2-chloroadenosine or hypoxia in the isolated spinal cord of neonatal rats. Neurosci Lett 1989; 101(2):175-81.
  51. Islam MR, Ahmed MU, Mitu SA, Islam MS, Rahman GK, Qusar MM, et al. Comparative analysis of serum zinc, copper, manganese, iron, calcium, and magnesium level and complexity of interelement relations in generalized anxiety disorder patients. Biol Trace Elem Res 2013; 154(1):21-7.
  52. Shin JY, Suls J, Martin R. Are cholesterol and depression inversely related? A meta-analysis of the association between two cardiac risk factors. Ann Behav Med 2008; 36(1):33-43.
  53. Troisi A, Moles A, Panepuccia L, Lo Russo D, Palla G, Scucchi S. Serum cholesterol levels and mood symptoms in the postpartum period. Psychiatry Res 2002; 109(3):213-9.
  54. van Dam RM, Schuit AJ, Schouten EG, Vader HL, Pop VJ. Serum cholesterol decline and depression in the postpartum period. J Psychosom Res 1999; 46(4):385-90