Perinatal Mood Disorders and the Importance of Postpartum Nutrition

Written by: Ryah Nabielski, MS, RDN

Let’s talk about the elephant in the room: postpartum depression. The new term for postpartum depression is perinatal depression because it can occur during and after pregnancy. It is the most common complication of the perinatal period, affecting 10 to 20% of women and contributing to maternal mortality rates. 

In previous articles about prenatal and postpartum nutrition, we discussed how the postpartum period is a time of nutrient depletion from pregnancy and greater nutrition needs because of breastfeeding and healing from delivery. Nutrient depletion strains mental health, but restoring nutrition supports mental health and, in some cases, helps prevent perinatal depression and other mood disorders. 

Yet despite all this, perinatal depression is still hard to discuss, and women don’t receive adequate screening within the healthcare system. The more we know about maternal mental health, the more we can help ourselves and each other. 

Keep reading to learn more about: 

• The baby blues
• Perinatal mood and anxiety disorders
• Perinatal depression 
• Asking for help
• Nutrition for maternal mental health

Let’s get started! 

The Baby Blues 

During pregnancy, estrogen and progesterone levels are at an all-time high. Then, as soon as the placenta is delivered, hormone levels come crashing down. Up to 85% of women experience this rapid hormonal change with exhaustion, worry, crying, and mild mood changes related to adjusting to a new life. It’s called the baby blues and is totally normal. 

The baby blues aren’t depression; mood changes don’t impair mothering. Typically, the blues subside after about two weeks. 

Perinatal Mood and Anxiety Disorders

If the baby blues don’t subside and symptoms progress, it’s important to check in with your doctor. Perinatal Mood and Anxiety Disorders (PMADs) are the collection of mental health issues that can arise during pregnancy, postpartum, or both. Symptoms may appear up to a year after delivery, peaking around two to six months postpartum. Women may experience PMADs after pregnancy loss or with weaning also. 

PMADs include:

• Perinatal depression (commonly referred to as postpartum depression)
• Perinatal anxiety
• Perinatal obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Postpartum psychosis

Although rare, postpartum psychosis is a psychiatric emergency, affecting one or two mothers out of every thousand births. It’s characterized by confusion, mood changes, and abnormal thoughts and behaviors, affecting a mother’s ability to care for her child safely. 

Perinatal Depression 

Perinatal depression is the most common of the PMADs, affecting one out of every seven mothers. 

Symptoms of perinatal depression include: 

• Hopelessness, guilt, and shame
• Loss of pleasure in favorite things or activities
• Loss of interest in the baby
• Changes in appetite and sleep
• Anger or irritability
• Sadness and crying 
• Decreased maternal functioning 
• Possible thoughts of harming yourself or the baby

First-time moms have a 7.3% higher risk of perinatal depression. Women with a history of perinatal depression have a 50% chance of having it again with subsequent pregnancies. 

Other risk factors include:

• Nutrition status and nutrient deficiencies
• Thyroid imbalances
• Diabetes
• Family history of depression
• Lack of support
• Financial or relationship stress
• Complications with fertility, pregnancy, delivery, breastfeeding, or newborn health
• Major life events such as loss, moving, or divorce

In addition, perinatal depression affects dads too. In up to 3% of couples, both the mother and father experience depression during the perinatal period.  

Perinatal depression puts both the mother and baby at risk. For the mother, suicide is a significant contributor to maternal mortality. For the baby, the mother’s depression affects brain health, emotional development, and mental health later in life. 

How to Get Help for Perinatal Mood Issues 

Most new moms have a follow-up appointment six or eight weeks after giving birth, receive exercise clearance, and that’s that. Our healthcare system undoubtedly needs to do a better job at screening new parents for PMADs. And some changes are being made, such as maternal mental health screenings at pediatrician appointments. 

But unfortunately, you may need to be the one to advocate for yourself. It can be hard to reach out when you are in the thick of PMADs, but if you can confide in just one person, they can help you take steps to see your doctor, find a therapist, and get the care you need. 

You don’t have to suffer; there are tools and treatments for PMADs.

For more information and resources, check out Postpartum Support International. The phone number for the suicide crisis line is 988. 

Perinatal Nutrition for Mental Health 

Nutrition is a powerful tool for supporting mental health during any life phase, particularly the perinatal period. It’s important to note that nutrition shouldn’t replace other treatments, but you can address nutrition concurrently. 

A 2020 review published in Maternal and Child Health suggests “a balanced maternal diet with an emphasis on fruits, vegetables, fish, grains, legumes, and herbs could be a potential option for helping reduce the incidence of [perinatal depression].” 

Here are some specific strategies for supporting perinatal mood and mental health:

• Eat a whole food diet. This means choosing whole, unprocessed food while minimizing ultra-processed, packaged items. Choose foods from various categories as mentioned above, making sure to eat enough protein, healthy fats, and colorful plants. It’s not a time for dieting or restriction; instead, focus on nutrient-dense choices to help heal the body and rebuild nutrient stores. Strategies to balance blood sugar help with symptom management as well. 

• Support gut health. Gut health influences brain health via the gut-brain axis. Changes in the microbiome may contribute to anxiety, depression, and other PMADs symptoms. To learn more about gut health and specific probiotic and prebiotic foods to include in the diet, please read How to Improve Your Gut Health. 

• Optimize omega-3s. EPA and DHA are essential omega-3 fats for mental health; they help reduce inflammation in the brain and support healthy brain structure and function. EPA and DHA are found primarily in cold-water fish. You’ll need around three servings of low-mercury options weekly, such as wild salmon, herring, sardines, anchovies, and Alaskan cod. 

In addition, consider taking an omega-3 supplement, such as Twenty2 Nutrition Omega-3 Fish Oil, during and after pregnancy to reduce the risk of perinatal depression and depressive symptoms. Of course, please consult with your healthcare provider for personalized guidance. 

• Don’t stop your prenatal. It’s easy to prioritize your prenatal vitamins before and during pregnancy, but once the baby comes, this habit may fall away. Don’t let it! Your prenatal contains essential micronutrients that you need more of during the postpartum time. 

For example, women with anemia during pregnancy or postpartum have an increased risk of perinatal depression. Iron deficiency is a common nutrient deficiency during and after pregnancy because of the expanded blood volume during pregnancy and blood loss during delivery. Iron deficiency is the most common cause of anemia, but it can also result from vitamin B12 or folate deficiency.

So, keep taking your prenatal or try Twenty2 Nutrition Prenatal/Women’s Multivitamin, which contains iron, folate, vitamin B12, and other critical brain and mental health nutrients. It’s your perinatal insurance policy! 

Perinatal depression and PMADs are more common than many realize. The more we understand the risks of the vulnerable perinatal period and talk about PMADs, the more we normalize asking for help. While nutrition isn’t the only factor to consider, it’s a powerful foundation to preserve and protect mental health.  

This article is for educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider before beginning a new supplement, especially if you are pregnant, take medication, or have a medical condition. 

Ryah Nabielski, MS, RDN is a Registered Dietitian, functional nutritionist, writer, and recipe creator. Ryah helps clients use a natural, food-as-medicine approach to improve fertility, pregnancy, hormone balance, autoimmunity, and discover a healthy relationship with food and body. Learn more about Ryah and her private practice at econutrition.co. 

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