Effects Of Folic Acid Supplementation And Dietary Patterns During Pregnancy On The Postpartum Depression

ObjectiveTo investigate effects of the duration of folic acid supplementation and the dietary pattern during pregnancy on PPD,and to analyze the relationship between serum folic acid,Hcy and plasma SAM concentrations at second-trimster and PPD,in order to provide a scientific basis for the prevention of PPD.MethodBetween July 2015 and July 2017,women were recruited from the Heping District Women’s and Children’s Health and Family Planning Service Center and Shuangjie Health Service Center of Beichen District in Tianjin for medical check-ups at second-trimesterand the first post-natal check.The general health questionnaire was used to investigate basic information of participants and folic acid supplements during pregnancy.The FFQ was used to investigate the dietary intake of pregnant women in the third trimester.The depression was evaluated by SDS.Blood samples from pregnant women in the second trimester were collected for laboratory testing.The measured indicators include:serum folic acid,Hcy and plasma SAM.The mean,ratio and M(P₂₅,P₇₅)were used to describe data characteristic,and independent-sample t test,chi-squared test and two independent samples rank sum test were used to assess differences between different groups.Analysis of the relationship between folic acid supplementation,dietary patterns and PPD using binary logistic regression analysis and propensity score matching.The generalized linear mixed model was used to analyze the interaction between the duration of folic acid supplementation and the dietary pattern and the main effects of both.Result1.A total of 1663 pregnant women were recruited,and the prevalence of PPD was37.7%（n=627）.After using 1:1 PSM,the prevalence of PPD in the folic acid>6m group was less than≤6 m during pregnancy,and the difference wasstatistically significant（P<0.05）.Binary logistic regression analysis showed thatfolic acid>6 m during pregnancy was a protective factor for PPD（OR:0.76,95%CI:0.59-0.97,P=0.030）.2.Factorial analysis was used to extract four major dietary patterns from eighteenfood groups.Model 1 was high factor loadings of potato,vegetables,beans,fungi,aquatic products and seaweedr;mode 2 was high factor loadings of instantfood,pickles,desserts,animal offal and cereals was higher;the mode 3 was highfactor loadings of poultry,meat and eggs;mode 4 was high factor loadings ofyogurt,milk,nuts,and fruit.After using binary logistic regression analysis tocorrect the remaining dietary patterns,sociological factors and obstetric factors,the prevalence of PPD in the highest tertile was lower in model4 than in thelowest tertile（OR:0.72,95%CI:0.53-0.98,P=0.020）,which implied that model4 was preventing dietary pattern of PPD.No effective relationship wasestablished between other dietary patterns and PPD（P>0.05）.The results ofgeneralized linear model analysis showed that there was no interaction betweenthe duration of folic acid supplementation and dietary patterns during pregnancy（P>0.05）.3.The results of binary logistic regression analysis showed that high serum Hcylevel was a risk factor for PPD（OR:1.09,95%CI:1.01-1.17,P<0.05）.Therewas no statistical correlation between serum folate and plasma SAM levels andPPD（P>0.05）.ConclusionProlonged folic acid supplementation during pregnancy（>6 m）was associated with a decreased risk of of PPD.Long-term（>6 m）folic acid supplementation during pregnancy is a protective factor for PPD.Pregnant women adopting a dietary patterns based on yogurt,milk,nuts and fruits during pregnancy helps to reduce the risk of PPD.There is a positive correlation between serum Hcy level and PPD;thus,high serum Hcy level is a risk factor for PPD.The duration of folic acid supplementation during pregnancy and the dietary pattern were an independent effect on the occurrence of PPD,and there is no interaction between the both.