Mamas on Bedrest: Fish Oil for The Prevention of Post Partum Depression

November 11th, 2011

Click to take the postpartum depression survey conducted by Case Western Reserve University http://filer.case.edu/~axp335/postpartdep.htm Thank you very much for your consideration.

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November 14, 2011 kicks off the week long Living Self Care Challenge. Mamas on Bedrest & Beyond has joined forces with Dr. Diane SanfordThe Real Mom Expert, Post Partum Progress, My Post Partum Voice, Pregnancy.org and others to encourage mamas to put their own self care on the top of their “To Do” lists.  For one week, the Living Self Care Blog will offer tips and suggestions to mamas on how to find ways to carve out a little “me time”. Participants will be eligible for prizes for their participation.

In honor of the Self Care Challenge and in an effort to raise awareness of post partum mood disorders, post partum depression in particular, I present to you now some very interesting information from one of my favorite researchers, Dr. Kathleen Kendall-Tackett. Dr. Kendall-Tackett, is a health psychologist and also an International Board Certified Lactation Consultant (IBCLC). As previously stated on this blog Dr. Kendall-Tackett has done extensive research on the effects of chronic stress and depression on preterm labor and post partum health. Much of her work is posted on her websites UppityScienceChick.com and BreastfeedingMadeSimple.com. Here, we highlight Dr. Kendall-Tackett’s findings on the effectiveness of fish oils as a prevention for post partum depression.

In a 2007 article published on the La Leche League’s Website Dr. Kendall-Tackett discusses the role that inflammation plays in post partum depression.

When we are faced with threat, our bodies have a number of mechanisms designed to protect our lives. Three interrelated systems respond: catecholamine, hypothalamic-pituitary-adrenal (HPA) axis, and the immune system. The catecholamine system (the fight-or-flight response) releases three neurotransmitters (chemical substances that transmit nerve impulses): norepinephrine, epinephrine, and dopamine. The HPA axis also releases several hormones including the stress hormone cortisol. In recent years, researchers have discovered that the immune system also responds to threat by releasing molecules that increase inflammation. These molecules are known as proinflammatory cytokines and they have a causal role in depression. The proinflammatory cytokines that have been identified most consistently in depression are IL-1, IL-6, and TNF-a.

Maes and his colleagues (2000) first identified increased inflammation as being related to depression and anxiety in postpartum women. When inflammation was initially identified as a risk factor for depression, it was generally seen as one of many: one that was comparable to risk factors such as low social support, maternal history of affective (emotional) disorders or trauma, infant illness or prematurity, or low socioeconomic status. More recent research, however, has revealed that stress of all types increases inflammation, and that inflammation is the likely mechanism by which the other risk factors lead to depression. This is true for depression in general and for postpartum depression in particular. These recent studies constitute an important shift in how we think about depression: inflammation is not simply a risk factor; it is the risk factor that underlies all the others.

Pregnant and postpartum women are particularly vulnerable to these effects because their inflammation levels normally rise during the last trimester of pregnancy — a time when they are also at high risk for depression (Kendall-Tackett 2005; 2007). Inflammation serves several important functions in pregnant women including preparing their bodies for labor and protecting them against infection once the baby is born. However, in depressed women, inflammation levels are too high.

Dr. Kendall-Tackett goes on to outline how stress can lead to depression which can lead to preterm birth. She also discusses the particular causes of increased stress in pregnant and post partum women: sleep disturbances, pain and psychological trauma. What new mama isn’t experiencing any one or all of these? The good news is that there are ways to mitigate the risks and reduce the incidences of post partum depression, and Dr. Kendall-Tackett says that fish oils play an important role.

In Can Fats Make You Happy? Dr. Kendall-Tackett discusses the role of fish oils in the prevention and treatment of post partum depression. She explains that in most industrialized nations, we consume far too many Omega 6 Fatty acids (found in vegetable oils and processed foods) and not enough Omega 3 Fatty Acids. Additionally, the Omega 3 fatty acids typically used to fortify foods are Alpha linoleic Acid, a plant based Omega 3 Fatty Acids.  The long chain Omega 3 Fatty Acids docosaheaenoic acid (DHA) and eicosapentaenoic acid (EPA), found in fish, have been found to be more potent in reducing inflammation and in turn, depression. In countries where high fish consumption is the norm, the rates of depression are nearly half what they are in nations where fish is rarely consumed. The problem is further compounded by the fact that many pregnant women are counseled against eating lots of fish during pregnancy due to possible mercury contamination. So Dr. Kendall-Tackett and others recommend that women take Omega 3 (fish oil) supplements.

The recommended doses of Omega 3 Fatty Acids needed to prevent (or at least lower the risk of and reducing the symptoms of post partum depression) are the following:

  • 200mg-400mg of DHA (minimum) daily. This dose may actually prove to be too low. In countries where fish consumption is high, women consume about 1000mg DHA/day.
  • 1000mg EPA for the treatment of depression
  • The US Food and Drug Administration finds Generally Recommended as Safe (GRAS) up to 3000mg/day EPA/DHA

If mamas on bed rest are concerned about their risk for post partum depression-or if they feel they may be depressed, they should first and foremost consult with their health care provider for a complete evaluation. If it is safe to do so and their provider notes no contraindications, mamas may choose to begin taking a fish oil supplement rich in Omega 3 Fatty Acids DHA and EPA. Mamas should be sure that their supplements are contaminant free and are manufactured using proper (Pharmaceutical) manufacturing practices to ensure that the proper amounts of fatty acids are contained in each supplement.

Here is Fish oil Supplement Mamas on Bedrest has found that meets all of the aforementioned criteria.

What’s your take on fish oils? Share your questions and experiences in the comments section below. To keep the discussion going, chat with us on twitter (@mamasonbedrest) or on our Facebook Page. To receive our blog as soon as it is published, subscribe via RSS feed. Simply click the orange circle on the top of this page, the upper right hand corner.

Mamas on Bedrest: Low Levels of Omega 3’s May Increase Post Partum Depression

December 3rd, 2012

I am increasingly encouraged by the amount of attention supposed “alternative” therapies are getting in medical research. As we have previously reported on this blog, Fish Oil May Be Useful in Treating Post Partum Depression.  On November 26, 2012, Med Scape reported on new research out of Canada that suggests that low levels of Omega 3 Fatty Acids, i.e. fish oil, may decrease the risk of developing post partum depression (PPD).

Gabriel Shapiro, MPH/PhD candidate and colleagues from the University of Montreal and the Centre de Recherche du CHU Sainte-Justine, Montreal, Canada, report that the review shows several carefully conducted studies that indicate an association between the serotonin transporter (5-HTT) genotype and PPD.

Now what does that mean in plain language?

“The literature shows that there could be a link between pregnancy, omega-3, and the chemical reaction that enables serotonin, a mood regulator, to be released into our brains (causing a decreased uptake of serotonin). Many women could bring their omega-3 intake to recommended levels (and perhaps reduce their risk for developing PPD).”

The 5-HTT gene regulates serotin uptake in the brain. This gene is the target of selective serotonin reuptake inhibitors (antidepressants such as Prozac, Paxil and others) in reducing and eliminating depressive symptoms.  

When trying to assess biological factors for the development of PPD (Marital Stress, low Socioeconomic status and stressful life events are the major psychosocial causes), they noted the activation of the 5HTT gene. Drawing from previous research in the literature, the researchers decided to look at the 5 HTT gene in conjunction with Omega 3 Fatty acids. What researchers have noted is that women who have low levels of Omega 3 fatty acids are more likely to develop PPD than their counterparts with higher levels of Omega 3 Fatty acids.

The Canadian researchers noted that  docosahexaenoic acid (DHA), is an important building block of the central nervous system (CNS) in infants. If it is not available in sufficient levels during pregnancy and lactation, there can be serious negative effects for both the child and mother later on.

While researchers here in the US are slow to accept reports that Omega 3 Fatty acids do impact a woman’s risk of developing PPD, Canada has an entire webpage outlining the benefits and proposed doses.  Although the research is promising, here in the US, physicians, researchers and health care advocates (me!) are stopping short of recommending that pregnant women routinely take Omega 3 fatty acids during pregnancy. If you are considering adding Omega 3 Fatty Acids to your diet while you are pregnant, we highly recommend that you discuss this with your health care provider.

Everyone agrees that more research needs to be done to better understand the exact role and mechanism of action of Omega 3 Fatty Acids in the treatment of prevention of PPD. However, it’s really great to contemplate that we may be able to help women prevent post partum depression and reduce the severity of symptoms in those women who develop post partum depression by simply adding fish oil to their dietary regimen.

Reference

Emerging Risk Factors for Postpartum Depression: Serotonin Transporter Genotype and Omega-3 Fatty Acid Status

Gabriel D Shapiro, MPH (PhD Candidate); William D Fraser, MD, MSc, FRCSC; Jean R Séguin, PhD. Canadian Journal of Psychiatry. 2012;57:704-712

Mamas on Bedrest: Care for your legs to prevent blood clots

May 23rd, 2014

Greetings Mamas!!

TGIF and Happy Memorial Day weekend! This weekend marks the official start of summer in many areas of the northerm hemisphere. As promised, below you will find resources for taking great care of your legs to prevent blood clots from forming while on bed rest. I am giving a HUGE shout out to Mama on Bedrest Sarah for posing the following question to me on our community Facebook Page:

“Any suggestions as alternatives for compression stockings? I can’t do anything that increases abdominal pressure but can’t afford the compression stockings. I do get up several times a day but only to get water and use the bathroom. But I’m still worried about dvt.”

This is a FANTASTIC question and one that all Mamas on Bedrest should be concerned about. Pregnancy in and of itself increases a woman’s risk of developing a blood clot in her legs due to elevated levels of estrogen which enhance blood clotting. (Same thing they worry about when women are on the pill!) Add in bed rest inactivity and Mamas on Bedrest are prime candidates for deep venous thrombosis (DVT) or blood clots to form in the legs and then travel to the heart, lungs or brain to do deadly damage.

Sarah was prescribed compression stockings and that is an excellent recommendation-except they are expensive. Compression stockings can cost anywhere from about $80 on up. They are typically only available by prescription. So what is Sarah and other Mamas like her to do?

1. Exercises. I produced an entire video blog showing how to do leg exercises on bed rest as well as how to massage the lower legs.

2. Massage. While rubbing your own legs is good, Oh much better it feels to have someone do it for you! If your partner is willing, have him/her gently massage your lower legs. (see vlog for details). If you have access to a prenatal massage therapist in your area, or a really good massage therapist who knows lymphatic drainage techniques, a professional massage would be even better!

3. Support hose. Now I can’t speak for other areas of the country, but it is heating up here in Texas and the thought of wearing compression stockings or even support hose is daunting. However, if they are lifesaving-what’s a bit of heat? Sarah mentioned that she could not afford the compression stockings. However, she could do the next best things and wear support hose. These do place a bit of a squeeze on the legs, but not nearly the amount of pressure Compression stockings do. Hence, they are cheaper. Good brands that I know of are Gold Toe and Jobst. I highly recommend ordering products from Special Addition Maternity and Nursing boutique here in Austin if you can’t find products in your locale. They have an entire online shop and you can actually call and they can help you get fitted OVER THE PHONE!!! They can tell you (or a friend or family member) how to measure your legs and then help you select products that will suit your needs and purse!

4. Drink plenty of water. Contrary to what you may be thinking, Staying hydrated will actually help reduce swelling. You body won’t feel like it needs water and hold onto water so tightly (i.e. swell). Also, lowering or avoiding salt altogether is also helpful.

5. Make sure your prenatal supplements are really working for you and your legs in particular. Leg cramps, restless legs and blood clots are all very common during pregnancy. When you have the proper balance of vitamins and minerals in your diet, you are less likely to experience these leg problems or you will experience them to a lesser degree. To avoid leg cramps, restless leg syndrome and blood clots, make sure you have plenty of the following nutrients in your diet:

Calcium. Calcium aids in muscle relaxation allowing certain molecules into your muscle tissue.

Magnesium. Like Calcium, magnesium also aids in muscle relaxation and works in concert with Calcium. Many vitamins will include both minerals either in a 2 to l ratio (Calcium to Magnesium) or will have the minerals present in equal amounts.

Vitamin D. Vitamin D aids in calcium absorption as well as decreases overall inflammation that may be occurring. While many prenatal vitamins contain vitamin D, few if any meet the newly suggested requirements of up to 4000IU recommended by the March of Dimes and the Institute of Medicine for pregnant women.

Fish Oils-Fish oils contain essential Omega 3 and Omega 6 Fatty Acids which help prevent blood clots. However, if you have any sort of clotting disorder or bleeding disorder, you may need to avoid this supplement. Check with your doctor to see if it is safe for you to take fish oils.

Was this information helpful to you? If so, let me know in the comments section below. Do you have other tips and solutions to leg problems during pregnancy? Submit those in the comments section below as well. If you have specific questions, feel free to e-mail me at info@mamasonbedrest.com. If you want to discuss more, you can schedule a Complimentary 30min Bedrest Breakthrough session. 

Be well Mamas and Happy Memorial Day (In the US!!)