In Asia, maternal diet in the first month after birth, also called the 'confinement diet', is influenced by tradition and culture.
Based on this, GUSTO researchers set out to characterise dietary patterns during the confinement period among multi-ethnic Asian study subjects, and assess their links to postpartum depression and anxiety.
Diet and depression
Using three-day food diaries, they studied the dietary intakes of 490 women in the first month after giving birth, and determined their dietary patterns with factor analysis.
The women also completed the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) three months after giving birth (with higher scores indicating greater depressive and anxiety symptoms).
The researchers subsequently noted four dietary patterns: Traditional Chinese confinement diet, traditional Indian Confinement diet, eat-out diet and soup-vegetables-fruits diet.
The traditional Indian confinement diet (high in herbs and legumes) was found to be associated with fewer postpartum depression symptoms, possibly due to its anti-inflammatory and neuroprotective properties.
Legumes and pulses, and ethnic bread such as chapatti, thosai, idli, and naan are also part of the diet and are rich in B vitamins, which are "crucial for the synthesis of monoamine neurotransmitters", and might have "helped to establish protection against postpartum depression symptoms".
The soup-vegetables-fruit — which also included a high intake of fish — was associated with fewer postpartum anxiety symptoms.
This diet may have protected against postpartum anxiety by regulating oxidative damage and providing neural protection, thanks to the high antioxidant content of fruits and vegetables.
Fish intake also provides omega-3 fatty acids, which are vital to "maintaining the fluidity and permeability of neuronal membranes, regulating the function and metabolism of serotonin", and possess anti-inflammatory and antioxidant characteristics.
These observations applied regardless of the participants’ ethnicity. For the other two diets, however, no such associations were observed.
Strengths and weaknesses
The researchers wrote that this was the "first prospective study" to assess Asian dietary patterns among a multi-ethnic study population during the confinement period, and to find links between postnatal diet and mental health outcomes.
However, the results may not have been representative of (the) Singapore population, due to the study's small sample size.
Additionally, the Asian context of the study means it cannot be extrapolated to other populations, and may make comparisons with results from other studies difficult.
In conclusion, they wrote: "The traditional Indian confinement diet was inversely associated with symptoms of postpartum depression, while the soup-vegetables-fruits diet was shown to be protective against postpartum anxiety symptoms.
"We provided further evidence that postnatal diet could have an effect on postpartum mental health, and hypothesize that a balanced diet with emphasis on fruits, vegetables, fish, and legumes during (the) first month postpartum could be a potential preventive measure against postpartum mental health disorders. Further studies are warranted to confirm these findings."
"Prospective Associations of Maternal Dietary Patterns and Postpartum Mental Health in a Multi-Ethnic Asian Cohort: The Growing up in Singapore towards Healthy Outcomes (GUSTO) Study"
Authors: Cherlyen Teo, et al.
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