Can Good Nutrition Help Prevent Postpartum Depression? (Part 2: Hormones and Nutrients)

This is Part 2 of my Nutrition and Postpartum Depression series. If you're just joining us, please start with Part 1 here!

In Part 1 of this series, we talked about what postpartum depression is and how it is impacted by lifestyle factors like untreated mental illnesses in pregnancy, physical activity, sleep, social isolation, stress, and skin-to-skin care.

Today, we're going to move on to talk about two other important factors: hormones and nutritional factors (including deficiencies and insufficiencies).

​Hormones
A woman’s hormones are constantly in flux, but there is nothing that changes them quite so dramatically and quickly as pregnancy and childbirth. Many different types of hormones are suspected to play a role here, from adrenal hormones (like cortisol) to placental hormones (like the estrogens and progesterone), thyroid hormones, and peptide hormones (like oxytocin and prolactin).

• Levels of the hormones estrogen and progesterone decrease suddenly and dramatically after childbirth. This by itself is linked to changes in mood because of the impacts on serotonin levels, and this is likely one of the causes of the Baby Blues. Estrogen and progesterone levels can take 3-12 months to return to normal after childbirth.
• Thyroid hormone levels increase during pregnancy, and then decrease following childbirth. Sometimes levels can decrease too much postpartum, which can lead to changes in mood, as well.
• Levels of cortisol, a primary stress hormone, are naturally higher in pregnant women, but should start to decrease gradually after childbirth. However, abnormal or excessively high cortisol levels can happen during pregnancy for some women, or can crop up in the postpartum period, maybe due to trauma, stress, sleeplessness—or maybe causing those things.

Hormone balancing is often going to take time, but a lot of the same lifestyle factors we discussed in the first post actually may be able to modify some of these hormone levels. Some important things to consider include:

• Gentle exercise,
• Stress reduction and adequate sleep,
• Keeping an eye on thyroid hormone levels (this is standard to check during pregnancy, but you might want to talk with your doctor about getting it checked if you are already postpartum).
• And consuming a varied diet with adequate levels of the nutrients we need to produce hormones, which we’ll address next.

Nutrients
Everyone is aware that nutrition is exceptionally important in pregnancy—but sometimes we focus on Baby’s nutritional needs (both during pregnancy and after birth) so much that we might forget about our own nutritional needs in the postpartum period.

Of course, if some women are not meeting their increased nutritional needs during pregnancy, they may have lingering deficiencies that persist into the postpartum period. But we also know that there are substantial changes that occur in mom’s nutrient status because of childbirth itself, the healing process, breastfeeding, stopping the prenatal vitamin (as many women do immediately after childbirth), and poorer dietary quality in the struggle that is postpartum life.

Some nutrients that I primarily focus on with my clients are:

• Omega-3s. You hear a lot about DHA, a specific type of omega-3 found in fish oil, during pregnancy because it’s vital for Baby’s brain development and mental health, and many women aren’t getting enough. Supplementing DHA is often necessary, especially when mamas have been told to avoid fish because of concerns about mercury. However, for mom, another type of omega-3 fatty acid called EPA might be missing if we’re just relying on DHA supplements for our omega-3s—and often, again, postpartum women stop these supplements altogether. Both EPA and DHA are important during pregnancy and postpartum, and EPA seems to be a standout nutrient when we’re thinking about preventing postpartum depression.
• Vitamin D. Vitamin D is an incredibly important vitamin and hormone in neurological and mental health. We know that one of the signs of vitamin D deficiency can be low mood, and we also know that it’s important in preventing neuroinflammation and supporting neuroplasticity, which is incredibly important in adjusting to postpartum life!
• Zinc. Higher zinc intake seems to buffer the effects of stress, and is also really helpful in managing the inflammation that happens postpartum!
• Choline. You may know that choline is vital for baby’s brain development, but it’s also essential for brain health in mom, as well. On a population scale, higher dietary choline intake is linked to a lower risk of depression, but we do need more research in pregnancy and postpartum. I don’t recommend going out and taking large doses of choline on a daily basis, but SO MANY women aren’t getting enough (some studies suggest 89% of pregnant women aren’t meeting their choline needs), so this is a really important nutrient for us to be aware of.
• Iron. Iron deficiency can cause symptoms of depression in anyone, and anemia both late in pregnancy and postpartum are associated with postpartum depression. However, if you’re already postpartum, this is one to ask your doctor or dietitian to test with a blood draw before starting a supplement, since overconsuming iron supplements can be problematic.
• Amino acids. Most people know that protein is important for their health and are trying to eat enough of it. However, many people on the Standard American Diet get their protein from lower-quality sources, such as high-fat processed meats and refined grains (which contain significantly less protein than whole grains). Add to that the fact that protein digestion and absorption can be impaired for all sorts of reasons, from gastrointestinal issues to acid-blocking medications to stress, not to mention increased protein needs for wound healing postpartum and possibly for lactation… and you can start to see why I do worry about amino acids, the building blocks of protein, in my clients’ diets. To give one important example, in the early postpartum period, there seems to be an especially high need for tryptophan and tyrosine, and if moms aren’t getting enough, it’s possible they may not make enough of certain mood-stabilizing neurotransmitters like serotonin and dopamine.

Obviously, there are a lot of factors to consider here. Diversity in the diet and a balanced, mindful lifestyle can make a big difference in both risk and ability to manage postpartum depression. But there are even MORE factors to consider here.

In our next post, we'll talk about the gut microbiome and inflammation, and how these two factors can play into postpartum depression--and then we'll try to wrap all these bits and pieces of information up into an actionable, doable package.

If you're comfortable sharing with this community, I'd love to hear from you in the comments. Have you ever struggled with postpartum depression, or are you struggling now? What was the most important step you took to help manage your symptoms? 

Erica Golden, RDN, IFNCP

Integrative and functional registered dietitian nutritionist. 
Food therapist.
Nutritional psychiatrist.
Mama.