1. Kelsey Moran, Depaul University MENP 2017
Impact of Socioeconomic Status on Prenatal Nutrition and Postpartum depression
Kelsey Moran, Depaul University MENP 2017
Research Advisors: Young-Mi Lee, DNSc, RN & Linda Graf, CNM, WHNP-C, DNP
Major Themes
Themes Contributing to Socioeconomic Status and Postpartum Depression
Lack of Prenatal Care:
Early prenatal care can provide the necessary information to the mother and effect changes for nutrition-related and behavioral-risk factors impacting mother and baby.
Socioeconomic disparities in the use of prenatal care exist even when care is available.
It has been determined that women are more likely to receive inadequate prenatal care if they have a lower income
Food Deserts:
Defined as “urban neighborhoods and rural towns without ready access to fresh, healthy, and affordable food”
A lower socioeconomic is correlated with a higher likelihood of living in a food desert.
The demands of pregnancy and caring for an infant along with the daily stress of food scarcity can increase a person’s vulnerability to postpartum depression.
Nutrients Contributing to Postpartum Depression
Folic Acid:
During pregnancy, the demand for folate is increased
Without folic acid supplementation, serum folate decreases gradually after the 5th month of pregnancy and remains low several months postpartum
No evidence that folic acid supplementation in pregnancy was associated with changes in depression score up to 8 months postpartum.
Omega Fatty Acids:
The prevalence of postpartum depression was 2.5 times greater among women whose dietary ratio of omega-6/omega-3 in the first trimester of pregnancy was greater than 9:1.
Lower maternal omega-3 index in late pregnancy (week 28) was associated with higher levels of depressive symptoms postpartum in a simple nonlinear regression model.
Vitamin D:
Numerous studies have suggested that there is an association between low level early pregnancy Vitamin D levels and postpartum depressive symptoms.
A longitudinal study found that there was evidence that low Vitamin D levels in early pregnancy (12-20 weeks) are significantly associated with higher depression symptom scores for women who are already at a risk for depression.
However, low Vitamin D levels at any point the pregnancy did not have an impact on postpartum depressive symptoms.
Selenium:
Low-intake of selenium has been associated with almost a three-fold increase in the likelihood of major depressive disorder
An increase in selenium intake and social support decreased the odds of postpartum depressive symptoms.
Discussion
There is evidence that socioeconomic status can impact the likelihood of developing postpartum depression. Socioeconomic status does play a role in nutritional deficit, and there are four key nutrients that have been examined as factors that contribute to postpartum depression: folic acid, omega fatty acids, Vitamin D and selenium. Although there is previous research demonstrating a relationship between the nutrients and postpartum depressive symptoms, it is unclear how much of each nutrient is needed to significantly decrease postpartum depression risks. Although this fact is unclear, nutrition does play a crucial role. .
Background
Postpartum depression (PPD) is the most common complication of childbirth, affecting 11-20% of women who give birth each year. Women suffering from PPD may experience feelings of guilt, worthlessness, and anxiety related to birth, and may think of suicide or harm towards their baby. Nutrition plays a key role in the onset, severity, and duration of general depression. Recent studies suggest poor diet not only effects one’s physical health, but is very dangerous for mental health as well. Although nutritional deficiencies can be prevalent among all Americans, they disproportionately affect low-income individuals. There is currently a knowledge gap regarding postpartum depression causation in low-income women. It is important to understand the cause of postpartum depression in order to provide appropriate intervention strategies.
Nursing Implications
It is valuable to identify the relationship between nutrition and postpartum depression, so that nurses can provide prenatal care and education to women and communities. A better understanding of how nutrition may impact postpartum depression in low socioeconomic populations will allow an appropriate intervention strategy to be created. With increased community health nursing strategies, nurses will be better able to provide culturally-competent care for patients living in low-socioeconomic areas. In addition, nurses will be better aware how who to screen for risk factors related to postpartum depression. By creating better screening tools, they will be able to provide adequate resources to the communities.
Purpose
This integrative review aims to determine the effects of socioeconomic status on nutrition and its relationship leading to postpartum depression for low-income women. Research objectives include: to determine if the impact of socioeconomic status causes a nutritional deficit which leads to postpartum depression and to identify the relationship between nutrition and postpartum depression among low-income women.
Methods
Research Design
This study is an integrative review of the literature. Literature was compiled from a variety of different peer-reviewed journals.
Search Methods
A computerized search of the literature was employed using Cumulative Index to Nursing and Health Literature (CINAHL), PsycINFO, Pubmed and Academic Search Complete. To search each database, multiple term groupings were used. Search terms included: postpartum depression, PPD, nutrition, socioeconomic status, SES, and low-income.
Data Analysis and Synthesis
The data collected from 16 research articles were converted into two tables. Table 1 addressed if the impact of socioeconomic status causes a nutritional deficit which leads to postpartum depression. Table 2 addressed the relationship between nutrition and postpartum depression among low-income women. Once all the articles had been grouped and variables abstracted, common themes were identified. The final phase of data analysis included drawing relationships between nutrition, socioeconomic status and postpartum depression.
Conclusion
It cannot be determined if nutrition is the only contributing factor to postpartum depression, due to the multitude of risk factors most women experience who have been diagnosed with postpartum depression. It also cannot be determined which nutrient plays a more significant role in developing postpartum depression, or if it is a combination of certain nutrients. Overall, it is imperative that future research be conducted to determine the effects of prenatal nutrients on postpartum depression. By identifying the relationship between socioeconomic status, nutrition, and postpartum depression, prevention programs may be designed to better care for low-income women.
References
Ellsworth-Bowers, E.R. & Corwin, E.J. (2013). Nutrition and the psychoneuroimmunology of postpartum depression. Nutrition Research Reviews, 25(1):
Hogg-Kollars, S., Mortimore, D. & Snow, S. (2011). Nutrition health issues in self-reported postpartum depression. Gastroenterology and Hepatology, 4(3):
Leung, B.M., Kaplan, B.J., Field, C.J., Tough, S., Eliasziw, M., Gomez, M.F., McCargar, L.J & Gagnon, L. (2013). Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort. BMC pregnancy childbirth, 13(2): 1-11.