Nutritional Status and Mental Health During Pregnancy and Postpartum: a Cohort Study in Rio de Janeiro, Brazil
Condition: Pregnancy
Study type: Observational

Summary: 
      There is increasing evidence that psychosocial factors may affect health by means of
      biological effects and changes in behavioral health. Observational studies suggest an
      association between low levels of one long chain n-3 fatty acids, DHA (docosahexaenoic acid),
      after pregnancy and the occurrence of postpartum depression (PPD). This is an observational
      cohort with 4 waves of follow-up and a nested clinical trial with pregnant women residing in
      the city of Rio de Janeiro. The general objective is to describe the magnitude and identify
      factors associated to common mental disorders (CMD) during pregnancy and postpartum giving
      emphasis to maternal nutritional status.

      Main specific objectives:

        1. To evaluate the effect of CMD in the pattern of occurrence of selected maternal and
           child outcomes (inadequacy of gestational weight gain, postpartum weight retention, low
           birthweight, small for gestational weight and prematurity), considering the effect of
           other determinant factors, and

        2. To evaluate the effectiveness of daily omega-3 doses (fish oil) in preventing PPD.
    

Detailed description: 
      The protocol predicts CMD mapping and monitoring of nutritional status throughout pregnancy
      and once in postpartum. Women are interviewed in four time points:

        1. First trimester: 8th and 13th (baseline),

        2. Second trimester: 22nd-24th gestational weeks,

        3. Third trimester: 34th-36th gestational weeks,

        4. Postpartum: 30-45 days

      The following information will be gathered:

        1. Common mental disorders (CMD): MINI International Neuropsychiatric Interview, symptoms
           of depression (Edinburgh scale - EPDS), anxiety (Trait Anxiety Inventory - TAI)

        2. Dietary intake (food frequency questionnaire)

        3. Anthropometric measure (stature and body weight) and physical activity

        4. Biochemicals: fasting glucose, lipid profile (total cholesterol, HDL-c, LDL-c), serum
           fatty acid composition, inflammatory markers (C-reactive protein, interleukin-6),
           hormones (adiponectin, insulin, leptin).

      All women are followed throughout pregnancy constituting the observational cohort. In the
      second trimester, those women identified as being in risk for PPD [past history of depression
      (DSM-IV) or presenting a score of depression (Edinburgh scale) >= 9 at the baseline
      interview] are invited to participate in the clinical trial. These women will be randomly
      allocated in two groups:

      Intervention 1: Fish oil: [1,8 g/dia n-3 (1,08 g EPA e 0,72 g DHA)+ vit E (0,2 mg/g)
      Intervention 2: Placebo comparator: soybean oil + 1% fish oil + vit E (0,2 mg/g)

      The supplementation occurs from the 22nd-24th week of pregnancy for 16 weeks.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Pregnant women attending a health care center in the city of Rio de Janeiro, Brazil
      
Biospecimen description: 
      Fatty acids C-reactive protein Interleukin-6
    
Keywords: Nutritional status; Mental Health; Omega-3; Pregnancy; Postpartum depression