title: The impact of maternal diet fortification with lipid-based nutrient supplements on postpartum depression in rural Malawi: a randomised-controlled trial.
abstract: Perinatal depression is highly prevalent in low-and-middle-income countries and has been linked to poor child health. Suboptimal maternal nutrition may be a risk factor for perinatal depression. In this randomised-controlled trial conducted in rural Malawi, we set out to test the hypothesis that women taking a fatty acid-rich lipid-based nutrient supplement (LNS) would have fewer depressive symptoms postpartum than those taking iron-folate (IFA) or multiple-micronutrient (MMN) capsules. Women were recruited from antenatal clinics and randomised to receive LNS or MMN during pregnancy and for 6 months postpartum, or IFA during pregnancy only. Maternal depressive symptoms were measured using validated translations of the Self Reporting Questionnaire (SRQ) and Edinburgh Postnatal Depression Scale (EPDS), antenatally (SRQ only) and at 6 months postpartum (SRQ and EPDS). Analysis was by modified intention to treat. One thousand three hundred and ninety one women were randomised (LNS = 462, MMN = 466, IFA = 463). The groups were similar across a range of baseline variables. At 6 months postpartum, 1078 (77.5%) had SRQ completed; mean (SD) scores were LNS 1.76(2.73), MMN 1.92(2.75), IFA 1.71(2.66), P = 0.541. One thousand and fifty seven (76.0%) had EPDS completed; mean (SD) scores were LNS 5.77(5.53), MMN 5.43(4.97), IFA 5.52(5.18), P = 0.676. There were no statistically significant differences between the groups on SRQ or EPDS scores (continuous or dichotomised) in unadjusted or adjusted models. In conclusion, fortification of maternal diet with LNS compared with MMN or IFA did not reduce postnatal depressive symptoms in this study.
authors.affiliation: Manchester Mental Health and Social Care NHS Trust, Manchester, UK and Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Stewart
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Finland and Department of Pediatrics, Tampere University Hospital, Finland.
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.affiliation: Department of Community Health, College of Medicine, University of Malawi, Malawi.
authors.forename: Eric
authors.initials: E
authors.lastname: Umar
authors.affiliation: Department of Nutrition, University of California, Davis, USA.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Ashorn
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: Francis
authors.initials: F
authors.lastname: Creed
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, UK.
authors.forename: Atif
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Biostatistics Unit, Institute of Population Health, University of Manchester, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: Department of Nutrition, University of California, Davis, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Prado
authors.affiliation: Department of Community Health, College of Medicine, University of Malawi, Malawi.
authors.forename: Ken
authors.initials: K
authors.lastname: Maleta
mesh_terms: D000328:Adult; D015992:Body Mass Index; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000517:prevention & control*; D004032:Diet; D004041:Dietary Fats / Q000008:administration & dosage*; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D005527:Food, Fortified; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage; D008295:Malawi / Q000453:epidemiology; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage; D011247:Pregnancy; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004041:Dietary Fats; D019266:Iron, Dietary; D018977:Micronutrients; D005492:Folic Acid
keywords: controlled trial; low income countries; maternal mental health; nutritional interventions; polyunsaturated fatty acids; pregnancy and nutrition; randomised