Researchers at the University of North Carolina studied 2,586 women who had breastfed. A history of postpartum major depression score was reported by 223 of them. Women who had disliked breastfeeding in that first week after delivery were 42% more likely to experience postpartum depression at 2 months when compared with women who liked breastfeeding in that first week. Women who had severe breast pain with breastfeeding anytime from day 1 postpartum through the second week postpartum were about twice as likely to experience postpartum depression by 2 months postpartum as women with no breastfeeding breast pain. Women were less likely to continue breastfeeding once they had the onset of postpartum depression. Unfortunately, lactation education did not offer any helpful protective effect unless it had occurred while the woman and infant were still in the hospital, and even with those women who did receive some benefit, while in the hospital, it was only small and only for those with moderate to severe breast pain related to nursing.

Commentary: Major depression during pregnancy is common, affecting between 10% and 20% of pregnant women. Untreated maternal depression increases the risk of negative pregnancy outcomes. Some consider postpartum depression to be the most under-recognized, under-diagnosed, and under-treated obstetrical complication in America. Health care practitioners can reduce this problem by screening for depression in early postpartum, in pregnant women and in women planning for pregnancy. In addition, breastfeeding support should be commonplace and even more strategic in new mothers who are exhibiting symptoms of depression. Fortunately, there are numerous botanicals and nutraceuticals that can be used to enhance lactation, decrease breast pain during breastfeeding, and to treat depression in non-pregnant, pregnant and postpartum women.

Reference

Watkins S, Meltzer-Brody S, Zolnoun D, Stuebe A. Early breastfeeding experiences and postpartum depression. Obstet Gynecol. 2011; 118(2 Pt 1): 214-221.

During the three months before pregnancy or the first month of pregnancy, mothers of children with autism were less likely than those of typically developing children to report having taken prenatal vitamins. In addition, there were greater risks for autism observed in some of the metabolic genetic variants, in those mothers who did not take prenatal vitamins preconception and/or in the first month. In short, the use of prenatal vitamins, taken preconception, may reduce the risk of having children with autism, especially for genetically susceptible mothers and children.

Commentary: Attention is being increasingly given to the preconception time period and the health and nutritional status of the mother in particular. This is distinct from the use of vitamins/minerals/herbs to enhance fertility in men and women. I’m encouraged to see research in this area, and to see positive results, in something as simple and affordable as prenatal vitamins is especially reassuring, and in something as daunting as autism, with the incidence increasing and as yet with an unclear cause. According to “Autism Speaks”, a leading science and advocacy organization, it is estimated that 1 in 110 children in US are diagnosed with autism. Government statistics suggest the prevalence rate of autism is increasing 10 to 17 percent annually. We clearly need to become more aggressive in understanding the potential causes and influences on autism, and be assertive in any prevention strategies that can reduce the incidence.

Reference

Schmidt R, Hansen R, Hartiala J, et al. Prenatal Vitamins, One-carbon Metabolism Gene Variants, and Risk for Autism. Epidemiology; July 2011 – Volume 22 – Issue 4 – pp 476-485

In the last five years, some studies have suggested that high levels of unmetabolized folate may be associated with an increase in the risk for colorectal cancer. [ii]^{, [iii]}

In those individuals with premalignant colorectal lesions, excess folate, and in particular the thymidylate, a component of DNA that is synthesized from folate, could facilitate cell division of these premalignant lesions and lead to cancer. On the other hand, in those individuals without a premalignant lesion, folate may actually protect normal cells from becoming neoplastic. 3

Some evidence now exists for this “dual-modulator” effect of folate and colorectal neoplasia, whether dietary or supplemental. [iv],[v] This dual effect of folate, prevention vs. proliferative effect of premalignant lesions has been raised with prostate and breast cancer but recent studies have shown that appropriate folate intake does not significantly increase or decrease risks for breast[vi] and prostate cancer.[vii]

Adequate maternal intake of folic acid reduces the frequency of neural tube defects by up to 75%, and may also reduce the frequency of other birth defects such as ventricular septal defects, tetralogy of Fallot and transposition of the great vessels,[viii] urinary tract abnormalities [ix] and possibly even cleft lip and/or cleft palate.[x]

Currently, the average intake of folic acid from the diet of women of childbearing age is about 170mcg/day.[xi] A diet without folic acid fortified grains is typically 140 mcg/day. Clearly, too few women are achieving adequate serum folate levels through diet alone and do require supplementation. The RDA for folate in non-pregnant women is 400 mcg per day. [xii]The RDA for folate in pregnancy is 600 mcg per day[xiii] although the latest US Preventive Services Task Force recommendation is 400mcg-800 mcg per day for women of childbearing age.[xiv] The American College of Obstetricians and Gynecologists recommends that non pregnant women of childbearing aged consume 400 mcg/day. [xv] This variability reflects the uncertainty about the exact dose that is option for the prevention of neural tube defects. For women with a previous pregnancy resulting in a neural tube defect, 4,000 mcg is necessary to achieve these prevention benefits.15

While there is some concern about long term folic acid supplementation for a select number of individuals, the benefits for reproductive aged women, pre-pregnancy and pregnant, outweighs any concerns. A cautionary approach in terms of benefits and risks might be to meticulously track dietary intake to assure adequate levels, or to supplement with folic acid in combination with L-5-methyl-THF or L-5-methyl-THF alone.

[i] Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998.

[ii] Mason J, Dickstein A, Jacques P, et al. A temporal association between folic acid fortification and an increase in colorectal cancer rates myay be illuminating important biological principles : a hypothesis. Cancer Epidemiol Biomarkers Prev 2007;16(7):1325-1329

[iii] Sanjoaquin M, Allen N, Couto E, et al. Folate intake and colorectal cancer risk : a meta-analytical approach. Int J Cancer. 2005;113(5):825-828.

[iv] Mathers J. Folate intake and bowel cancer risk. Genes Nutr 2009;4(3)::173-178.

[v] Hubner R, Houlston R. Folate and colorectal cancer prevention. Br J Cancer. 2009;100(2):233-239.

[vi] Kim Y. Does a high folate intake increase rhe risk of breast cancer? Nutr Rev. 2006;64(10 pt 1):468-475

[vii] Figueiredo J, Grau M, Haile R, et al. Folic acid and risk of prostate cancer: results from a randomized clinical trial. J Natl Cancer Inst. 2009;101(6):432-435.

[viii] Botto L, Mulinare J, Erickson J. Do multivitamin or folic acid supplements reduce the risk for congenital heart defects? Evidence and gaps. Am J Med Genet. 2003;121A(2):95-101.

[ix] Czeizel A. Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation. Am J Med Genet. 1996;62(2):179-183.

[x] Badovinac R, Werler M, Williams P, et al. Folic acid-containing supplement consumption during pregnancy and risk for oral clefts: a meta-analysis. Birth Defects Res A Clin Mol Teratol. 2007;79(1):8-15.

[xi] US Food and Drug Administration. Food standards: amendment of standards of identity for enriched grain products to require addition of folic acid. Final rule. 212 CFR Parts 136, 137, 139. Fed Regist. 1996;61(44):8781-8797

[xii] Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington DC: National Academy Press; 1998.

[xiii] Simpson J, Bailey L, Pietrzik K, Shane B, Holzgreve . Micronutrients and women of reproductive potential: required dietary intake and consdquences of dietary deficiency or escess. Part !-Folate, Vitamin B12, Vitamin B6. J Matern Fetal Neonatal Med 2010.

[xiv] US Preventive Services Task Force. Folic acid for the prevention of neural tube defects: US preventive services task force recommendation statement. Ann Intern Med 2009;150(9):626-631

[xv] Cheschier N. ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin. Neural tube defects. November 44, July 2003. Int J Gynecol Obstet 2003;83(1):123-133.

This randomized, double-blind trial of children was conducted in women who received probiotic milk or placebo from 36 weeks of pregnancy to 3 months postpartum during breastfeeding. Women were given 250 mL of probiotic low fat fermented milk or 250 mL placebo skimmed fermented milk per day. The probiotic milk contained Lactobacillus rhamnosus GG (LGG), Bifidobacterium animalis (Bb-12) and Lactobacillus acidophilus (La-5) equaling 50 billion colony-forming unites of LGG and Bb-12 and 5 billion of La-5 per day. The study milk was given for 4 months. The children were to be breastfed during this time period. Children with an itchy rash for more than 4 weeks were evaluated for atopic dermatitis (eczema).

The incidence of eczema among the children at two years of age, of the mothers who drank the probiotic milk was significantly reduced. In addition the severity of the eczema was reduced in those who did acquire eczema and the primary preventive effect was most evident in children who did not have a family history of eczema or asthma.

Commentary: Overall, this and other research is convincing that probiotics reduce the incidence of eczema. The overall benefit of probiotics in this study is clear to those infants and children who do not have strong family histories of eczema and less clear to those children who are at high risk. For those infants… other strategies for mother during pregnancy and while breast feeding, as well as the first few years of the child’s life, include significant attention to dosing of omega-3 fatty acids from fish oils.

Reference

Dotterud C, Storro O, Johnsen R, Oien T. Probiotics in pregnant women to prevent allergic disease: a randomized, double-blind trial. British Journal of Dermatology 2010;163:616-623.

This study was a single-blind controlled randomized clinical trial in women up to 20 weeks of pregnancy in Iran. 32 women received ginger and 35 received placebo. One ginger (250 mg) or placebo capsule four times per day was given over the course of four days. A four page questionnaire was used for each woman, one page per day for the four days. Women were also asked to record nausea intensity twice a day. At the end of four days, a researcher completed the questionnaire based on the woman’s responses.

Nausea intensity improved in 84% of those who used the ginger and in 56% of the women in the control group. The incidence of vomiting in the control group was 9% decreased and 50% decreased in the ginger group.

Commentary: At least four previous published studies have shown success in the use of ginger for nausea and vomiting of pregnancy. Doses of 1,000 mg – 1,500 mg per day have been used previously. The current study showed not only a positive effect, but women were satisfied with that effect and no complications were observed during the treatment period.

References

Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea and vomiting. J Alternative and Complementary Medicine 2009;15(3):243-246