Levels of n-3 and n-6 Fatty Acids in Maternal Erythrocytes during Pregnancy and in Human Milk and Its Association with Perinatal Mental Health

Association of serum fatty acid pattern with depression in U.S. adults: analysis of NHANES 2011-2012

BACKGROUND

Exposure to different concentration levels of fatty acids (FAs) may have an impact on depression. However, previous studies using individual FAs may not reflect the performance of mixtures of various FAs, and the associations of FA patterns with depression remain unclear.

METHODS

We conducted the cross-sectional analysis in 792 adults aged 18 and older with available serum FAs and depression screening data in the National Health and Nutrition Examination Survey (NHANES) 2011-2012. The serum concentrations of thirty FAs were measured using gas chromatography-mass spectrometry and their percentage compositions were subsequently calculated. Depression was defined as the Patient Health Questionnaire-9 score ≥ 10. We employed principal component analysis to derive serum FA patterns. We examined the association between these patterns and depression in the overall population and various subgroups through survey-weighted logistic regression.

RESULTS

Four distinct patterns of serum FAs were identified: 'high eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); low docosatetraenoic acid (DTA) and docosapentaenoic acid (DPA) n-6', 'high long-chain saturated FA and long chain FA', 'low median-chain saturated FA and myristoleic acid' and 'low capric acid and lauric acid; high gamma-linolenic acid (GLA) and stearidonic acid (SDA)' pattern. Individuals in the high tertile of 'high EPA and DHA; low DTA and DPA n-6' pattern score had 0.46 (95% CI: 0.22, 0.93) lower odds of developing depression compared to individuals in the lowest tertile after adjusting for confounders such as age, sex, physical activity and total energy intake, etc. The odds ratio (OR) of depression was increased in the population with the highest tertile of 'low capric acid and lauric acid; high GLA and SDA' pattern (OR: 2.45, 95% CI: 1.24, 4.83). In subgroup analyses, we observed that the association between 'high EPA and DHA; low DTA and DPA n-6' and depression persisted among specific demographic and lifestyle subgroups, including females, non-Mexican Americans, non-obese, those aged over 60 years, smokers and drinkers. Similarly, 'low capric acid and lauric acid; high GLA and SDA' showed stable associations in female, non-Mexican Americans and smokers.

CONCLUSIONS

Serum FA patterns are associated with depression, and their relationships vary across sex, race, BMI, age, smoking and drinking subgroups, highlighting the importance of considering specific FA patterns within these demographic and lifestyle categories. Utilization of combined FA administration may serve as a mitigation measure against depression in these specific populations.

Analysis of factors related to postpartum depression in pregnancy-induced hypertension syndrome patients and construction and evaluation of nomograms

BACKGROUND

It is positive to integrate and evaluate the risk factors for postpartum depression in patients with pregnancy-induced hypertension syndrome and to detect high-risk patients as early as possible, which has application value for the clinical development of personalized prevention programs and prognosis of patients.

AIM

To analyze factors related to postpartum depression in patients with pregnancy-induced hypertension and construct and evaluate a nomogram model.

METHODS

The clinical data of 276 patients with pregnancy-induced hypertension admitted to Huzhou Maternity and Child Health Care Hospital between January 2017 and April 2022 were retrospectively analyzed. We evaluated the depression incidence at 6 wk postpartum. The depression group included patients with postpartum depression, and the remainder were in the non-depression group. Multivariate logistic regression analysis and the LASSO regression model were applied to analyze the factors related to postpartum depression in patients with pregnancy-induced hypertension. After that, a risk prediction model nomogram was constructed and evaluated.

RESULTS

Multivariate logistic regression analysis showed that vitamin A deficiency (VAD) during pregnancy and puerperium, family history of hypertension, maternal intestinal flora imbalance, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) were independent risk factors for postpartum depression in patients with pregnancy-induced hypertension (P < 0.05). We constructed the nomogram model based on these five risk factors. The area under the curve, specificity, and sensitivity of the model in predicting postpartum depression in patients with pregnancy-induced hypertension was 0.867 (95% confidence interval: 0.828-0.935), 0.676, and 0.889, respectively. The average absolute error was 0.037 (Hosmer-Lemeshow test χ2 = 10.739, P = 0.217).

CONCLUSION

VAD during pregnancy and puerperium, family history of hypertension, maternal intestinal flora imbalance, EPA, and DHA affect postpartum depression in patients with pregnancy-induced hypertension.

Maternal stress is associated with higher protein-bound amino acid concentrations in human milk

Background

Maternal stress in the postpartum period affects not only the mother but also her newborn child, who is at increased risk of developing metabolic and mental disorders later in life. The mechanisms by which stress is transmitted to the infant are not yet fully understood. Human milk (HM) is a potential candidate as maternal stress affects various components of HM, e.g., fat and immunoglobulin concentrations. To date, it is unknown whether maternal stress also affects the amino acids (AAs) in HM, even though this nutrient is of extreme importance to child health and development. This study aimed to investigate whether and how maternal stress is associated with the AA composition of HM.

Methods

In this observational cohort study (Amsterdam, The Netherlands), lactating women were recruited in two study groups: a high-stress (HS) group; women whose child was hospitalized (n = 24), and a control (CTL) group; women who gave birth to a healthy child (n = 73). HM was collected three times a day, on postpartum days 10, 17, and 24. Perceived psychological stress was measured using validated questionnaires, while biological stress measures were based on hair, saliva, and HM cortisol concentrations. HM protein-bound and free AAs were analyzed by liquid chromatography and compared between groups.

Results

Maternal perceived stress scores were higher in the HS group (p < 0.01). The concentrations of protein-bound AAs in HM were higher in the HS group compared to the CTL group (p = 0.028) and were positively associated with HM cortisol concentrations (p = 0.024). The concentrations of free AAs did not differ between study groups and were unrelated to cortisol concentrations.

Conclusion

Findings from this prospective cohort study suggest that maternal stress in the postpartum period is associated with an altered human milk amino acid composition, which could play a role in the transmission of maternal stress effects to her child. The physiological implications of these stress-induced changes for infant development await future research.

The impact of docosahexaenoic acid on maternal mental health: scoping review

Introduction

Docosahexaenoic acid (DHA) is a polyunsaturated essential fatty acid from the omega-3 series that appears to be key to perinatal mental health. For this, the aim of this review is to evaluate the effect of DHA on maternal mental health during pregnancy and lactation with respect to depression and anxiety. The present scoping review was carried out following the methodology of Arksey and O'Malley (2005). The selection of studies was carried out in accordance with PRISMA by means of systematic searches in the PubMed, Scopus, PsycINFO and Medline databases. The results classified according to the effectiveness of DHA. In most (n = 9) of the 14 studies finally included, DHA plasma levels with or without other polyunsaturated omega-3 fatty acids were significantly lower in pregnant women with depressive and anxiety symptoms. However, no study reported a beneficial effect of DHA on mental health during the postpartum period. The majority used detection method was the Edinburgh Postpartum Depression Scale (n = 11). The prevalence of depressive symptoms ranged between 5.9 % and 50 %. As a conclusion, although more research is needed in this area, these exploratory results suggest that DHA could play an important role in preventing the pathogenesis of depression and anxiety during gestation.

DHA supplementation and pregnancy complications

Docosahexaenoic acid (DHA) supplementation is recommended for women during pregnancy because of its neurological, visual, and cognitive effects. Previous studies have suggested that DHA supplementation during pregnancy may prevent and treat certain pregnancy complications. However, there are contradictions in the current related studies, and the specific mechanism by which DHA acts remains unclear. This review summarizes the research on the relationship between DHA intake during pregnancy and preeclampsia, gestational diabetes mellitus, preterm birth, intrauterine growth restriction, and postpartum depression. Furthermore, we explore the impact of DHA intake during pregnancy on the prediction, prevention, and treatment of pregnancy complications as well as its impact on offspring neurodevelopment. Our results suggest that there is limited and controversial evidence for the protective effect of DHA intake on pregnancy complications, with the exception of preterm birth and gestational diabetes mellitus. However, additional DHA supplementation may improve long-term neurodevelopmental outcomes in the offspring of women with pregnancy complications.

Postpartum dietary intake, depression and the concentration of docosahexaenoic acid in mature breast milk in Wuhan, China

Background: Docosahexaenoic acid (DHA, C22:6) is an important fatty acid in breast milk and is essential for infantile growth and cognitive development. However, the factors that affect the DHA concentration in breast milk have not been completely clarified. Objective: This study aimed to characterize the composition of breast milk fatty acids and to identify maternal factors associated with breast milk DHA concentration in postpartum women in Wuhan, China. Methods: In this cross-sectional study, we analyzed milk fatty acids in 115 lactating women at 30-120 days postpartum using GC-MS. Maternal sociodemographic, health and other information were collected using a self-reported questionnaire. Maternal dietary intake information was collected through a 24-hour dietary recall method. Postpartum depression status was identified using the Edinburgh Postnatal Depression Scale (EPDS). Results: The mean DHA proportion in breast milk was 0.49%. The multivariate regression model showed that the milk DHA proportion was positively associated with maternal aquatic product intake (β = 0.183, 95%CI: 0.052, 0.314) and DHA supplement use (β = 0.146, 95%CI: 0.108, 0.185), and negatively associated with postpartum depression status (β = -0.122, 95%CI: -0.243, -0.002) after adjustment for several maternal and infant factors. Conclusion: Increasing maternal aquatic product intake and DHA supplement use and improving postpartum depression status may increase DHA concentration in breast milk in lactating women.

Higher n-3 polyunsaturated fatty acid status during early pregnancy is associated with lower risk for depression at 12 months postpartum: The NuPED study

Perinatal depression can negatively affect the health of the mother and her offspring. N-3 polyunsaturated fatty acids (PUFA) may play a role in the aetiology of depression. Therefore, we investigated the association of n-3 PUFA status during early pregnancy with perinatal depression among women living in urban Johannesburg, South Africa. For this prospective analysis, we analysed red blood cell (RBC) total phospholipid fatty acid (FA) composition (% of total FA) of 242 pregnant women at <18 weeks' gestation. We used the Edinburgh Postnatal Depression Scale (EPDS) to identify women at risk for depression (EPDS score ≥9) at <18, 22 and 36 weeks' gestation, and at 6 and 12 months postpartum. RBC EPA status was negatively (β=-0.22, p<0.05), and the AA/EPA ratio positively (β=0.24, p<0.05) associated with EPDS scores at 12 months postpartum. Higher RBC DHA and n-3 index were further associated with lower odds (OR=0.56 [95% CI: 0.32-0.91]; OR=0.63 [95% CI: 0.39-0.94]), while higher n-6/n-3 PUFA and AA/EPA ratios early in pregnancy were associated with higher odds for depression at 12 months postpartum ((OR=2.34 [95% CI: 1.12-4.97]; OR=1.02 [95% CI: 1.00-1.05]). Our results suggest that women with a higher RBC n-3 PUFA status during early pregnancy may be at lower risk for depression at 12 months postpartum.

Omega-3 fatty acid intake during pregnancy and risk of infant maltreatment: a nationwide birth cohort - the Japan Environment and Children's Study

BACKGROUND

Intake of omega-3 polyunsaturated fatty acids (PUFAs) has favorable effects, including reducing violent and aggressive behaviors, but its association with infant maltreatment is unknown. We therefore tested the hypothesis that maternal intake of omega-3 PUFAs is associated with a lower risk of infant maltreatment.

METHODS

Participants were 92 191 mothers involved in the ongoing Japan Environment and Children's Study. Omega-3 PUFA intake during pregnancy was measured using a food frequency questionnaire. Infant maltreatment was assessed using a self-reported questionnaire administered at 1 and 6 months postpartum.

RESULTS

Analysis using the lowest quintile of intake as a reference revealed that the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for cases of 'hitting' decreased as quintiles increased, with values for the second to fifth quintiles of 0.93 (95% CI 0.77-1.13), 0.79 (95% CI 0.64-0.97), 0.78 (95% CI 0.64-0.96), and 0.72 (95% CI 0.59-0.89), respectively. Adjusted ORs (95% CIs) for 'shaking very hard' at 6 months were 0.87 (0.73-1.04), 0.81 (0.67-0.97), 0.73 (0.61-0.89), and 0.78 (0.65-0.94), respectively. Adjusted ORs for 'leaving alone at home' for the second to fifth quintiles were 0.92 (0.87-0.98), 0.91 (0.86-0.97), 0.94 (0.88-0.99), and 0.85 (0.80-0.90), respectively.

CONCLUSIONS

Higher maternal intake of omega-3 PUFAs during pregnancy was associated with fewer cases of hitting and violent shaking and leaving the child alone at home, implying a lower risk of infant maltreatment. Our results indicate the potential applicability of omega-3 PUFAs in reducing infant maltreatment.

Maternal stress in the postpartum period is associated with altered human milk fatty acid composition

BACKGROUND & AIMS

Maternal stress in the postpartum period affects not only the mother, but also her newborn child who is at increased risk for a wide range of disorders later in life. The mechanisms underlying transmission of maternal stress to the child remain elusive. Human milk (HM) is a potential candidate and is an important source of fatty acid (FA), which are crucial for child (neuro)development. This study aims to investigate whether maternal psychological and biological stress influences HM FA composition over the first month postpartum.

METHODS

The Amsterdam Mother's Milk study is a prospective cohort study. We included lactating women who delivered at term with a large range of stress levels: a high stress (HS) group, women whose child was hospitalized for a minimum of 2 days (n=23) and a control (CTL) group, women who gave birth to a healthy child (n=73). HM was collected three times a day at postpartum days 10, 17 and 24. Perceived psychological stress was measured using multiple validated questionnaires, while biological stress measures were based on cortisol in hair, saliva and HM. HM FAs were analyzed by gas-chromatography and compared between groups.

RESULTS

Maternal perceived stress scores were significantly higher in the HS group (p < 0.01), whereas cortisol measurements did not differ between groups. The absolute concentrations of total FA in HM (p=0.023), including the total amount of poly unsaturated fatty acids (PUFAs) (p=0.022) and omega-6 PUFAs (p=0.018), were lower in the HS group compared to the CTL group. Relative values of FAs did not differ between groups.

CONCLUSION

Maternal stress in the first month postpartum was associated with overall lower levels of FA in HM. This possibly indicates a route of transmission of maternal stress signals to the infant. Future research should investigate if these stress-induced changes in HM FAs have consequences for child development.

Omega-3 Polyunsaturated Fatty Acids Supplementation Alleviate Anxiety Rather Than Depressive Symptoms Among First-Diagnosed, Drug-Naïve Major Depressive Disorder Patients: A Randomized Clinical Trial

Background

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) augmentation of antidepressants has shown great potential in the prevention and treatment of major depressive disorders (MDD).

Objective

To investigate the effect of n-3 PUFAs plus venlafaxine in patients with first-diagnosed, drug-naïve depression.

Method

A total of 72 outpatients with first-diagnosed depression were recruited. The daily dose of 2.4 g/day n-3 PUFAs or placebo plus venlafaxine was used for over 12 weeks. The outcomes were assessed by the Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), Beck depression inventory (BDI), and Self-rating anxiety scale (SAS).

Results

Both groups exhibited improvement on clinical characteristics at week 4 and week 12 compared with baseline. The rate of responders for anxiety in n-3 PUFAs group (44.44%) was significantly higher than that in placebo group (21.21%) at week 4 (χ² = 4.182, p = 0.041), while week 12 did not show a difference (χ² = 0.900, p = 0.343). The rate of responders for depression at both week 4 (χ² = 0.261, p = 0.609) and week 12 (χ² = 1.443, p = 0.230) showed no significant difference between two groups. Further analysis found that Childhood Trauma Questionnaire (CTQ) had positive correlation with HAMA (r = 0.301, p = 0.012), SAS (r = 0.246, p = 0.015), HAMD (r = 0.252, p = 0.038) and BDI (r = 0.233, p = 0.022) with Pearson correlation analysis. Social Support Rating Scale (SSRS) had negative correlation with SAS (r = -0.244, p = 0.015) and BDI (r = -0.365, p = 0.000).

Conclusion

This trial found that n-3 PUFAs supplementation in favor of venlafaxine alleviated the anxiety symptoms rather than depressive symptoms at the early stage of treatment (4 weeks) for first-diagnosed, drug-naïve depressed patients. However, the advantage disappeared in long-term treatment. Furthermore, childhood abuse and social support are closely related to the clinical and biological characteristics of depression. Both childhood trauma and lack of social support might be predictors of poor prognosis in depression.

Clinical Trial Registration

[clinicaltrials.gov], identifier [NCT03295708].

Biosafety evaluation of Nannochloropsis oculata and Schizochytrium sp. oils as novel human milk fat substitutes

The biosafety assessment of novel human milk fat substitutes (HMFs) from microalgae oils of Nannochloropsis oculata and Schizochytrium sp. was evaluated by testing the cytotoxic activity using IEC-6 cells, and by conducting a sub-chronic 28-day dietary study using Sprague-Dawley (SD) suckling rats in this study. The results of the cytotoxic activity of IEC-6 cells treated with HMFs showed no apparent effect on cell viability at the tested concentrations (0-1000 μg mL^-1). For the 28-day sub-chronic study, five rat dietary feeds with 7.5% fat were designed to have the DHA content in the range from 0 to 2.0% using corn oil as a basal oil. After the 28-day treatment, SD rats fed HMFs did not show toxicity signs and adverse effects, based on the results of clinical observation, body weight, food consumption, behavior, hematology, clinical chemistry, and necropsy findings. These results could lead to the conclusion that the inclusion of the new synthesized HMFs into the pre-weaning SD rat diet was acceptable for SD rats and did not exhibit toxic characteristics and adverse features, indicating that the HMFs from microalgal oils were safe and had the potential to be used as a promising feedstock in infant formula.