Breastfeeding and PPD update

CJ over at Light and Momentary writes:

Hey, how are you?  Did you see this study about bfing and PPD?

http://www.internationalbreastfeedingjournal.com/content/2/1/6

The EFA info caught my eye since you've recommended EFA supplements to the mothers who read your site.  Here's a quote:

DHA appears to have a role in the prevention of depression, but according to two recent reviews, has no efficacy in treatment of depression when used alone [67, 69]. In the Adelaide Mothers' and Babies' Iron Trial, a 1% increase in plasma DHA was related to a 59% decrease in depressive symptoms postpartum [57]. In a large population study, women who consumed high amounts of seafood during pregnancy and had high levels of DHA in the milk had lower rates of postpartum depression [70].

DHA may have another effect that could help prevent depression postpartum. In a study of infant sleep, mothers with high levels of DHA during pregnancy had babies who exhibited a more mature sleep pattern in the first few days of life [71]. The investigators examined the ratio of quiet to active sleep using a monitor placed beneath the crib mattress. A higher percentage of quiet sleep is characteristic of older babies, and is considered a more mature sleep pattern. Babies whose mothers had high levels of DHA during pregnancy exhibited more mature sleep patterns as neonates. The investigators concluded that babies of high-DHA mothers had more mature central nervous systems than babies of mothers who were low in DHA. Although this was not study of depression per se, babies with more mature sleep patterns also allow mothers to get more uninterrupted sleep – and this could have an indirect effect on their mothers' mental health [71].

Really interesting. I posted this as soon as she sent it to me, so I haven't had a chance to really dig into the study. Anyone want to start commenting, and then I'll join in once I've really looked at it?

Comments

[kelli]

I am SO glad you posted this! I had posted about this myself awhile ago - the link between essential fats and depression was fascinating to me. However, you have a far greater reach reader-wise than I do so I am very excited to see the information getting out there!

I have had episodes of mild/moderate depression throughout my life. I was VERY scared of postpartum depression and did all the research about ways to "prevent" it (as much as it can be "prevented). By pure, sheer coincidence before I had even gotten pregnant, I started taking flaxseed and eating more fish - for other reasons than depression - just lifestyle, primarily. My husband is South Indian, so fish is a big part of our diet. (I did kick up my intake of flaxseed while taking my prenatal vitamins simply because taking the two together eased my stomach)

Reading articles linking the depression/essential fatty acids relationship was a total V8 Moment for me and I do wonder if my intake of essential fatty acids didn't contribute to why I didn't suffer anything more than the typical Baby Blues.

Regarding infant sleep, I am not sure what to say about that. My 19 month old son has always been a solid night sleeper, but we co-slept for the first 11 months or so. However, he's still a horrible nap taker. Most of my angst and tears over sleeping issues have been around the lack of naps, not night-time sleep.

Total Tangential: Flaxseed also has properties which enables the skin to have more elasticity. Makes me wonder if that's why I have yet to get stretch marks, even with my 2nd pregnancy (even though my mom AND sister got stretch marks and even though I got stretch marks years and years back when I gained some weight)

[hedra]

Interesting that they say that Flax Seed Oil (or the ALA in it) has NO impact on depression. That may be useful to note somewhere... though they only cite one study on that. And I like that they include a listing of the brands of supplements that are tested and verified for purity (which happily includes the brand I use).

Really cool article - so many interesting points! I like the carefulness of the content - like where they noted that while reduced sleep in certain patterns increases daytime pain (which then cycles around and messes with sleep), cosleeping doesn't do that, even though the same pattern of sleep disruption occurs. Thinking back, the last time I was 'so tired I HURT' was when I wasn't cosleeping, back with my first. I've been equally wiped out at times (especially with the twins), but that overall body ache, bone-deep, nope! Huh. Hadn't noticed that until I read it.

The other thing I note is that reducing stress in the mother (any source) is a priority and first approach in this article. Interestingly, I was just reading Soranus' Gynecology (Soranus was a 2nd Century AD Greek OB/GYN) for fun while my email sloooowly downloaded this morning (yeah, I read that for fun - it is FASCINATING), and was struck once again by how much of the advice in there for pregnancy, labor, and postpartum is directed at reducing stress - emotional and physical. Regular massages (as often as daily for the first and last trimester), light walking or even being carried outdoors with very gradual increase in exercise amounts, comfortable non-restrictive clothing, a variety of easily digested foods, rapid application of remedies for any kind of discomfort, and very specific and forceful instruction to prevent emotionally distressing situations for the woman... Ah, the pampering (hey, I'd love someone to pour warmed olive oil over light linen cloths on my belly during labor, too!)... as much as Soranus got it wrong (the chorion and the amnion ARE two different membranes; and some of the reasoning for the advice... um... okay, so they didn't have microscopes!), it seems the degree to which he insisted on regular exercise (outside), a balanced diet (heavy on folate, iron, and EFAs and wide on variety without requiring anyone to eat more than was comfortable), and stress-relief regimens (the daily massage thing... yeah, I want that in our medical plan as a requirement!) were right on the money. It is funny, because he deeply believed that while pregnancy was a necessary, natural, and useful state, it wasn't 'healthful' in the sense that pregnancy is EXTREMELY HARD on the physical and mental state of the mother. Therefore the mother should be cared for as if she were somewhat ill - not because pregnancy was an illness (as our medical system often treats it), but because it just was hard on the physiology of even the most healthy and fit women. And hey, here in this article they pretty much say the same thing - that pregnancy induces inflammation and behaviors consistant with illness, even though it isn't an illness.

Pretty cool how much they knew back then. Granted, picking out what was hooey from correct is an exercise in hindsight, but still amazing that what we're proving now, had been observed ages ago and recognized for truth then, too.

Also HIGHLY interesting to me in this article is the info that breastfeeding protects the baby from the depression of the mother. This hasn't been highlighted in past studies I've seen - they've just said that depression is contagious to the baby-- maternal depression generates infant depression. MAN, very useful and reassuring to see that the brain scans showed that breastfeeding protected the kids from that. Makes me feel better about not (DUH, sigh) noticing that I was depressed for weeks on end! It would be useful to see how much breastfeeding affects that... is it any, some, what aspects beyond the speculation that the interactions differ and therefore the results differ? Needs more research.

I'm bookmarking this article, because it covers so much good ground. :)

[Nancy]

Fascinating article! I am glad I have at least been taking a daily EPA-DHA supplement (Trader Joes!) throughout my twin pregnancy. It is a little weak on the EPA (300mg compared to the 1000mg recommended in the article), but is ok on DHA (200mg). I do not like fish, so I do not get these naturally, but a supplement is better than nothing, right?

I so look forward to meeting these little babies in another 5-7 weeks and get started with breastfeeding -- I will still be on the lookout for PPD, but thanks to Moxies site, at least I know what to look for.

[Suzie Q]

Thank you, thank you, thank you! I am 21 weeks along with baby #1, already feeling more than a little down at times, and so am fairly concerned about the possibility of developing PPD; to find that list of tested supplements is a great resource that will help me help myself (and my little one). Great reference, as usual.

[hedra]

Hey, Nancy, if you add in some of the O-3 enhanced eggs, you'll be right up there on the total needs (which may be higher with twins, since we're talking 'used for eye and brain development'). Just buy a dozen a week - it doesn't take long to go through them, at least not the way I was eating! Egglands Best are moderately enhanced (~100 mg/egg), and taste REALLY good, and most of the mid-range enhanced (150-200 mg/egg) are decent (some of the way-higher-numbers enhanced eggs are icky tasting). I couldn't get enough of the egglands ones - pretty much ate 4 a day for a good while. Cholesterol is also used in building their brains, so don't fret about that for the time being!

I highly encourage the o-3 for multiples moms - the prostaglandin suppression may be one of the BIG BIG bonuses for twins-plus - holds off labor when the system is pretty stressed.

I made it to 38 w 3 d with my twins (6 lbs 10 oz and 7 lbs 6 oz!). WOO! Worth the *oof* of carrying all 14 lbs of them that long, to be able to just walk out of the hospital with them the day after they were born (okay, that also presupposes no c-section, but hey, the O-3 suppresses inflammation, maybe it will help surgically if you end up there). Good luck! And definitely boost the O-3 value, even if you can't stomach the extra supplements. Just adding the o-3-enhanced eggs helps extend gestation 6 days for twins, not just singletons (that was from a study by Dr. Barbara Luke, by the way).

[jessica]

"Although this was not study of depression per se, babies with more mature sleep patterns also allow mothers to get more uninterrupted sleep – and this could have an indirect effect on their mothers' mental health."

Um, ya think? A direct effect, I say.

FWIW, I took Primacare prenatals with the DHA/essential fatty acids supplement. My baby was a good sleeper from the start.

[Kait]

I wonder how much of the pregnancy the levels of DHA have to be maintained. I mean, it probably wouldn't help all that much if it was just the last week, and would probably be the most helpful if those levels were maintained throughout the entire time. I just wonder how beneficial it would be to start a supplementation program at a third trimester point.

Also, I wonder if we see and "increase" in PPD in more recent times due to the doctors edicts not to consume more than one serving of fish per week (or so).

[Sprengblingbling]

I took fish oil throughout my pregnancy and while I was BF. Once we stopped BF at a year, we started Jack on his own fish oil.

He was a good night sleeper, but a CRAPPY napper from Day 1. I could get him to nap, but only for 30 minutes at a time. Now though, he's fine. 2-3 hours once a day at 16 months.

Anyway, I had zero PPD. So who knows. But DH is big on fish oil and makes us all take it, so I thank him for any good that comes from it.

I have always had a theory that women who are more prone to PMS-type symptoms, are more prone to developing PPD. I never had any kind of PMS, and no PPD. Could be coincidence though.

[violet Chong]

When I was pregnant I stopped eating sushi, gave up anything with smoked salmon in it and only ate fish'n'chips occassionally. And my baby had me up several times a night until she was one year old. All that sleep deprivation made me depressed.

I wish now I'd taken fish oil supplements - I may not now have bags under my eyes if I had.

[SarcastiCarrie]

For me, fish oil during pregnancy meant burps that tasted like fish oil and indigestion that tasted like fish oil. I took flax seed capsules instead and while nursing, and I think I did it because Moxie told me I wouldn't get a plugged milk duct. So, essential fatty acids all around.

[jesse]

I have read that it takes a lot of work for the body to convert the ALA in flaxseed to DHA and EPA, so it's just more efficient to get DHA/EPA through eating cold water fish or taking fish oil supplements. Is this others' take on it? Or is this just the fish oil supplement industry being good at marketing? Moxie, who always seems to have her facts straight :), is a flaxseed advocate. Thoughts on this?

[Nancy]

[Thanks Hedra for the advice on o-3 eggs!! I'll get those next time I'm at the store! I read Dr Luke's book but overlooked that important fact that o-3s can buy us an extra 6 days!]

[hedra]

Jesse, it really does seem to be easier to get the impact from fish oil. Some people's bodies may be better than others at converting the AHA, but in general, AHA does NOT have the same kind of immediate impact that DHA and EPA have together, directly, as found in fish oil. Or as found in enhanced eggs (where, IIRC, they get the chickens to convert the AHA to DHA and EPA... fed with flax!). Or as found in grass-fed beef/buffalo. Or as found in whatever it is that is used as a vegan alternative (at great price) to fish oil that isn't Flax-based (there's one based on an algae, I think). Flax, good. But not the best main source, IMHO.

Mixing the sources may be the best overall option. Some fish oil or fish, some grass-fed meats, some enhanced eggs, some flax, some walnuts, some canola oil... mmmm... :)

[hedra]

Argh ALA, not AHA... oy.

(Oh, and you're welcome on the eggs idea! It isn't in her book very clearly, because the eggs=6 days research was done AFTER publication. I hear she has a new edition in the works, but since she does SO much research, no idea when exactly that will come out... I'm only moderately a fan of hers, as she's SO into dairy dairy dairy, and hey, I can't tolerate ANY of it... grumble, grumble. I mix Eliz. Noble and Barbara Luke and what overlaps is likely 100% valid, and what doesn't is taken with more salt... :) )

[hedra]

[nancy, you also might find the apmultiples group on yahoo groups interesting - while very attuned to 'being attached' also very practical and experienced, good place to commiserate about the challenges of attachment-orientation (mainly NOT hyper about specifics, but aiming for the concept) with twins-and-up, and breastfeeding two-plus, and maintaining sanity, etc., etc.]