EBP Abstract
Appraised by:
Nichole Fields SN, Sabrina Elmi SN, Cabbrina Plainfeather SN, & Fawzia Hassan SN
(NDSU Nursing at Sanford Health, Bismarck, ND)
Clinical Question:
Does the consumption of omega-3 fatty acids during pregnancy reduce postpartum depression
symptoms?
Articles:
Freeman, M. P., Davis, M., Sinha, P., Wisner, K. L., Hibbeln, J. R., & Gelehberg, A. J. (2008).
Omega-3 fatty acids and supportive psychotherapy for perinatal depression: A
randomized placebo-controlled study. Journal of Affective Disorders, 110(1-2), 142-148.
http://dx.doi.org/10.1016/j.jad.2007.12.228
Judge, M. P., Beck, C. T., Durham, H., McKelvey, M. M., & Lammi-Keefe, C. J. (2014). Pilot
trial evaluating maternal docosahexaenoic acid consumption during pregnancy:
Decreased postpartum depressive symptomatology. International Journal of Nursing
Sciences, 339-345.
Markhus, M. W., Skotheim, S., Graff, I. E., Froyland, L., Braarud, H. C., Stormark, K. M., &
Malde, M. K. (2013). Low omega-3 index in pregnancy is a possible biological risk
factor for postpartum depression. Plos One, 1-15.
http://dx.doi.org/10.1371/journal.pone.0067617
Reese, A. M., Austin, M. P., Owwn, C., & Parker, G. (2009). Omega-3 deficiency associated
with perinatal depression: Case control study. Psychiatry Research, 166(2-3), 254-259.
http://dx.doi.org/10.1016/j.psychres.2007.12.011
Synthesis of Evidence:
A study conducted by Judge, Beck, Durham, McKelvey &Lammi-Keefe (2014) was to
determine if maternal DHA (a type of Omega-3 fatty acid) supplementation is efficacious in
reducing symptoms of postpartum depression. The research was a double-blind, randomized,
control trial, and did not conclude until six months postpartum. The sample used during this
investigation were forty-two maternal-infant dyads between the ages of eight-teen and thirty-five
years of age, whom had not given birth in the previous two years, and did report a significant
medical history. The participants were randomly and blindly placed in either the placebo group,
or intervention group. In order to measure DHA levels maternal venous blood samples were
drawn for analysis. Postpartum symptoms were measured using the postpartum depressive
symptomatology (PDSS) scale. When the study concluded it was found that postpartum
depression symptoms were significantly lower than the placebo group.
Markhus et al., (2013) conducted a prospective cohort study on 72 pregnant women in their
24th week of gestation, in their communities located outside of Bergen, Norway between
November 2009 and June 2011. The purpose of this study was to discover if there is a direct
correlation between seafood consumption, mental health and infant development therefore
participants consumed seafood, as well as supplements to increase their Omega-3 blood levels.
Fasting blood analysis and online questionnaires (which were scored using Edinburgh Postnatal
Depression Scale) were used to screen participant’s fatty acid levels and postpartum depression;
each individual was tested and screened at 28 weeks gestation, and three, six, and twelve weeks
postpartum. This study concluded that a low omega-3 index late in pregnancy was associated
with higher depression score three months postpartum (Markhus et al., 2013).
Freeman et al (2008), conducted a experimental study following 51 women, between the ages of
18-45, with major depressive disorder, over an 8 week period. The women were randomized into
groups that were administered supplemental omega-3 fatty acids, or given a placebo; in addition,
psychotherapy was provided to the participants. Symptoms were assessed using the Hamilton
Rating Scale for Depression and Edinburgh Postnatal Depression Scale biweekly (Freeman et al.,
2008). When the study concluded it was found that there was no relationship between major
depressive disorder and omega-3 fatty acid intake.
Rees, Austin, Owen, & Parker (2007), recruited 16 depressed and 22 non-depressed women
during their third trimester of pregnancy. Blood analysis was used to test the fatty acid level of
each group (depressed and non-depressed). Study results quantified women with lower omega-3
levels as being six times more likely to be depressed antenatally, compared to women who had
had higher omega-3 levels Rees, Austin, Owen, & Parker (2007).
Three of the four studies agreed with the usage of omega-3 fatty acids during pregnancy to treat
the symptoms of postpartum depression. The preponderance of the three studies indicates that
fatty acids can be used as a non-pharmacological treatment for postpartum depression, or at least
an adjuvant to current treatments.
Bottom Line (findings):
Omega-3 fatty acids may reduce or prevent depressive symptoms during late pregnancy or the
postpartum period. This non-pharmacological treatment is affordable, and can easily be added to
the diet, or taken in supplemental form, it is also financially attainable, and limits fetal
teratogenic exposure.
Implications for Nursing Practice:
Nurses should assess the intake of omega 3 fatty acids in pregnant women and recommend
women eat foods high in omega 3 fatty acids.