title: Serum n-3 polyunsaturated fatty acids are inversely associated with longitudinal changes in depressive symptoms during pregnancy.
abstract: BACKGROUND
  N-3 polyunsaturated fatty acids (PUFAs) have been hypothesised to be protective for depression during pregnancy. However, there are few data and no consensus regarding this association. In this line, we aim to evaluate if the concentration of n-3 and n-6 PUFAs, and their ratio, are associated with depressive symptoms throughout pregnancy.
  
  
  METHODS
  A prospective cohort of 172 Brazilian women was followed at 5-13th, 20-26th and 30-36th weeks of gestation. The presence of depressive symptoms was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) at each pregnancy trimester. Depression was defined as an EPDS score ≥11. The concentrations of n-3 [α-linolenic acid; eicosapentaenoic acid (EPA); docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA)] and n-6 PUFAs [linoleic acid; γ linolenic acid; eicosadienoic acid; eicosatrienoic acid; arachidonic acid; docosatetraenoic acid and docosapentaenoic acid] were expressed as absolute (μg/ml) values. The total n-6/n-3 ratio was calculated. Statistical analyses were performed using univariate and adjusted random intercept logistic model for each fatty acid (FA) considering the longitudinal nature of data. Covariates were selected as potential confounders based on their biological plausibility of having an association with the concentration of FA and depressive symptoms during pregnancy.
  
  
  RESULTS
  The prevalence of depressive symptoms was high in all pregnancy trimesters (1st = 33.7%; 2nd = 18.9%; 3rd = 17.4%). We did not find differences in means FA concentrations by depressive symptom classification, for each follow-up visit. The women presented a 5% decrease in the odds of having depressive symptoms for each one-week increase in the gestational age. As individual women progressed through pregnancy, higher concentrations of EPA (odds ratio (OR) = 0.92; 95% CI: 0.86-0.99), DHA (OR = 0.96; 95% CI: 0.93-0.99), DPA (OR = 0.87; 95% CI: 0.77-0.99) and total n-3 (OR = 0.98; 95% CI: 0.96-0.99) were associated with a lower odds of depressive symptoms, while higher total n-6/n-3 ratio were associated with greater odds of depressive symptoms (OR = 1.40; 95% CI: 1.09-1.79). We detected a decrease in the probability of depressive symptoms as concentrations of total n-3 FA, α-linolenic acid, DPA, and DHA increased. We also observed a sharper decline for women with initial greater chance of depressive symptoms compared with those with lower chance of having these symptoms.
  
  
  CONCLUSIONS
  We found a high prevalence of depressive symptoms in low-income Brazilian pregnant women and no significant associations between n-6 FA and depressive symptoms. Lower serum concentrations of DHA, EPA and DPA and a higher n-6/n-3 ratio at each pregnancy trimester were associated with higher odds of depressive symptoms throughout pregnancy.
authors.affiliation: National School of Public Health,Oswaldo Cruz Foundation,Rua Leopoldo Bulhões,1480 - Manguinhos,Rio de Janeiro,RJ,Brazil.
authors.forename: T J P
authors.initials: TJ
authors.lastname: Pinto
authors.affiliation: Nutritional Epidemiology Observatory,Department of Social and Applied Nutrition,Institute of Nutrition Josué de Castro,Avenida Carlos Chagas Filho,367/CCS - Bloco J - 2° andar,sala 29.Cidade Universitária - Ilha do Fundão,Rio de Janeiro,RJ,Brazil.
authors.forename: A A F
authors.initials: AA
authors.lastname: Vilela
authors.affiliation: Nutritional Epidemiology Observatory,Department of Social and Applied Nutrition,Institute of Nutrition Josué de Castro,Avenida Carlos Chagas Filho,367/CCS - Bloco J - 2° andar,sala 29.Cidade Universitária - Ilha do Fundão,Rio de Janeiro,RJ,Brazil.
authors.forename: D R
authors.initials: DR
authors.lastname: Farias
authors.affiliation: Nutritional Epidemiology Observatory,Department of Social and Applied Nutrition,Institute of Nutrition Josué de Castro,Avenida Carlos Chagas Filho,367/CCS - Bloco J - 2° andar,sala 29.Cidade Universitária - Ilha do Fundão,Rio de Janeiro,RJ,Brazil.
authors.forename: J
authors.initials: J
authors.lastname: Lepsch
authors.affiliation: National School of Public Health,Oswaldo Cruz Foundation,Rua Leopoldo Bulhões,1480 - Manguinhos,Rio de Janeiro,RJ,Brazil.
authors.forename: G M
authors.initials: GM
authors.lastname: Cunha
authors.affiliation: Nutritional Epidemiology Observatory,Department of Social and Applied Nutrition,Institute of Nutrition Josué de Castro,Avenida Carlos Chagas Filho,367/CCS - Bloco J - 2° andar,sala 29.Cidade Universitária - Ilha do Fundão,Rio de Janeiro,RJ,Brazil.
authors.forename: J S
authors.initials: JS
authors.lastname: Vaz
authors.affiliation: Department of Epidemiology,Mailman School of Public Health,Columbia University,New York NY10032,USA.
authors.forename: P
authors.initials: P
authors.lastname: Factor-Litvak
authors.affiliation: Nutritional Epidemiology Observatory,Department of Social and Applied Nutrition,Institute of Nutrition Josué de Castro,Avenida Carlos Chagas Filho,367/CCS - Bloco J - 2° andar,sala 29.Cidade Universitária - Ilha do Fundão,Rio de Janeiro,RJ,Brazil.
authors.forename: G
authors.initials: G
authors.lastname: Kac
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003863:Depression / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D015118:Eicosapentaenoic Acid / Q000031:analogs & derivatives / Q000097:blood; D015525:Fatty Acids, Omega-3 / Q000097:blood*; D005231:Fatty Acids, Unsaturated / Q000097:blood; D005260:Female; D006801:Humans; D011203:Poverty; D011247:Pregnancy; D011264:Pregnancy Trimesters; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
chemical_list: D015525:Fatty Acids, Omega-3; D005231:Fatty Acids, Unsaturated; C035276:eicosapentaenoic acid ethyl ester; D015118:Eicosapentaenoic Acid; C026219:docosapentaenoic acid
keywords: Depression; mental health; nutrition; pregnancy; prospective study