EBP Abstract
Appraised by:
Nichole Fields SN, Sabrina Elmi SN, CabbrinaPlainfeather SN, & Fawzia Hassan SN
(NDSU Nursing at Sanford Health, Bismarck, ND)
Clinical Question:
Does the consumption of omega-3 fatty acids during pregnancy reduce postpartum depression symptoms?
Articles:
Freeman, M. P., Davis, M., Sinha, P., Wisner, K. L., Hibbeln, J. R., & Gelehberg, A. J. (2008). Omega-3 fatty acids and supportive psychotherapy for perinatal depression: A randomized placebo-controlled study. Journal of Affective Disorders, 110(1-2), 142-148.
Judge, M. P., Beck, C. T., Durham, H., McKelvey, M. M., & Lammi-Keefe, C. J. (2014). Pilot trial evaluating maternal docosahexaenoic acid consumption during pregnancy: Decreased postpartum depressive symptomatology. International Journal of Nursing Sciences, 339-345.
Markhus, M. W., Skotheim, S., Graff, I. E., Froyland, L., Braarud, H. C., Stormark, K. M., & Malde, M. K. (2013). Low omega-3 index in pregnancy is a possible biological risk factor for postpartum depression. Plos One, 1-15.
Reese, A. M., Austin, M. P., Owwn, C., & Parker, G. (2009). Omega-3 deficiency associated with perinatal depression: Case control study. Psychiatry Research, 166(2-3), 254-259.
Synthesis of Evidence:
A study conducted by Judge, Beck, Durham, McKelveyLammi-Keefe (2014) was to determine if maternal DHA (a type of Omega-3 fatty acid) supplementation is efficacious in reducing symptoms of postpartum depression. The research was a double-blind, randomized, control trial, and did not conclude until six months postpartum. The sample used during this investigation were forty-two maternal-infant dyads between the ages of eight-teen and thirty-five years of age, whom had not given birth in the previous two years, and did report a significant medical history. The participants were randomly and blindly placed in either the placebo group, or intervention group. In order to measure DHA levels maternal venous blood samples were drawn for analysis. Postpartum symptoms were measured using the postpartum depressive symptomatology (PDSS) scale. When the study concluded it was found that postpartum depression symptoms were significantly lower than the placebo group.
Markhus et al., (2013) conducted a prospective cohort study on 72 pregnant women in their 24thweek of gestation, in their communities located outside of Bergen, Norway between November 2009 and June 2011. The purpose of this study was to discover if there is a direct correlation between seafood consumption, mental health and infant development therefore participants consumed seafood, as well as supplements to increase their Omega-3 blood levels. Fasting blood analysis and online questionnaires (which were scored using Edinburgh Postnatal Depression Scale) were used to screen participant’s fatty acid levels and postpartum depression; each individual was tested and screened at 28 weeks gestation, and three, six, and twelve weeks postpartum. This study concluded that a low omega-3 index late in pregnancy was associated with higher depression score three months postpartum (Markhus et al., 2013).
Freeman et al (2008), conducted aexperimental study following 51 women, between the ages of 18-45, with major depressive disorder, over an 8 week period. The women were randomized into groups that were administered supplemental omega-3 fatty acids, or given a placebo; in addition, psychotherapy was provided to the participants. Symptoms were assessed using the Hamilton Rating Scale for Depression and Edinburgh Postnatal Depression Scale biweekly (Freeman et al., 2008). When the study concluded it was found that there was no relationship between major depressive disorder and omega-3 fatty acid intake.
Rees, Austin, Owen, & Parker (2007), recruited 16 depressed and 22 non-depressed women during their third trimester of pregnancy. Blood analysis was used to test the fatty acid level of each group (depressed and non-depressed). Study results quantified women with lower omega-3 levels as being six times more likely to be depressed antenatally, compared to women who had had higher omega-3 levels Rees, Austin, Owen, & Parker (2007).
Three of the four studies agreed with the usage of omega-3 fatty acids during pregnancy to treat the symptoms of postpartum depression. The preponderance of the three studies indicates that fatty acids can be used as a non-pharmacological treatment for postpartum depression, or at least an adjuvant to current treatments.
Bottom Line (findings):
Omega-3 fatty acids may reduce or prevent depressive symptoms during late pregnancy or the postpartum period. This non-pharmacological treatment is affordable, and can easily be added to the diet, or taken in supplemental form, it is also financially attainable, and limits fetal teratogenic exposure.
Implications for Nursing Practice:
Nurses should assess the intake of omega 3 fatty acids in pregnant women and recommend women eat foods high in omega 3 fatty acids.