Maternal Nutrition and Mental Health

The old adage “you are what you eat” still holds true. Good nutrition is essential for brain growth and development in particular, and for good physical and mental health in general. And yet poor nutrition is extremely common. The impact of a poor diet is magnified in pregnancy-when a woman’s nutritional needs increase and the fetus depletes maternal reserves.

“We know the level of nutrition a mother needs to meet her own basic requirements and those of her unborn infant through the course of a pregnancy,” says the University of Alberta’s Dr. Catherine Field. “But very little has been done to define nutrition in terms of functional outcomes; for example, how nutrition affects the mental health of the mother or the neurological development of the child. That’s what our team is exploring.”

Dr. Field is one of the leaders, with Dr. Bonnie Kaplan and Dr. Deborah Dewey, of the team officially called “The Impact of Maternal Nutrient Status During Pregnancy on Maternal Mental Health and Child Development”. The team has paraphrased this for the sake of convenience, and refers to itself as the Alberta Pregnancy Outcomes and Nutrition (APRON) team.
Why look at the mental health of mothers? Because it matters. Maternal depression, for instance, is strongly associated with poor physical, emotional, and behavioural development in newborns. Depression can also influence the mother-child interaction, including how a mother feeds her baby. Children of depressed mothers have reduced muscle tone and lower activity levels, along with increased behavioural problems. They also score lower on developmental tests.

Why look at the neurological development of children? Because it matters too. Many neurodevelopmental disorders appear to be increasing. These include attention-deficit hyperactivity disorder (ADHD), learning disorders such as reading disabilities, and autism spectrum disorders. These disorders can significantly affect children’s performance in school, as well as their physical and mental health and that of their families.

For the APRON team, the link is nutrition. “There’s been an explosion of research around the world on nutrition and brain function,” says APRON team co-leader Dr. Bonnie Kaplan from the University of Calgary. “And it’s not just research-people are being treated successfully with various nutritional interventions. This needs to be explored further. We need to understand the relationship between nutritional inadequacy and depression in women before and after birth. We need to look at maternal nutrition and the brain development of children. We have an incredible opportunity to do this in Alberta.”

The APRON team is composed of 16 researchers from the University of Calgary, the University of Alberta, and the University of Tilburg in the Netherlands. The team includes such health professionals as dietitians, psychologists, and physicians, as well as young people who are training in these areas. “With direct links to the health professionals of today and tomorrow, we have the opportunity to translate new understanding about maternal nutrition into action that improves maternal and infant health,” says Dr. Kaplan.

Insights into mood disorders in mothers and the health of their babies will come from a study involving 10,000 pregnant women in Calgary and Edmonton (5,000 from each city). The work involves complete assessments of maternal mood and maternal nutrition, as well as of the neurodevelopment of the child from infancy to age three. Nutrition will be evaluated from reports of what individuals eat, and also from measurements of the levels of various nutrients in their blood.

“The information we collect will be a rich database not only for our team but for future researchers,” Dr. Field points out.

The team will ask questions in three main areas: women’s mental health, birth, and child development.

“In [the area of] women’s mental health, we’ve known for a long time that many women struggle with depression after birth,” notes Dr. Kaplan. “The latest research shows that some women experience altered mood during pregnancy-and not just women with a history of depression. So we will be looking at maternal mood throughout pregnancy and after childbirth. There are hints in the literature that nutritional insufficiency contributes [negatively] to maternal mood. We hope that we’ll be able to understand more about this connection.”

The second area centres around birth and birth outcomes: labour, Apgar assessments of the health of newborns, their birthweight, any congenital anomalies, and their neurodevelopmental function. The team will also collect blood from the umbilical cord and a small swab from inside the mouth of each infant for future genetic analysis.

The third area is the neurological and cognitive development of children. Is there a relationship between nutrients taken in by the mother during pregnancy and the development of disorders such as ADHD, autism, or learning disabilities in the child? In this part of the team’s work, led by the University of Calgary’s Dr. Deborah Dewey, mothers will periodically report on their children’s physical and mental development. Members of the team will do a complete assessment of mental ability and motor skills of a random subset of children when those children are three years old. A key goal is to find predictors of neurological development in the child from the nutrient intake of the mother.

For example, we already know that folic acid, a B vitamin, reduces the risk of certain serious birth defects called neural tube defects, which affect the brain and spinal cord. One of these, spina bifida, is the second most common birth defect in Canada. In this disorder, an abnormality of the spinal column results in varying types and degrees of handicap, including bending of the spine, paralysis, learning disabilities, and mental retardation.

Because of the importance of folic acid in preventing neural tube defects, flour, pasta, and cornmeal products are fortified with the nutrient. When fortification programs began in the late 1990s, food manufacturers added a lot more folic acid than required because little was known about its shelf life. But now that they have had more experience with fortification, manufacturers have reduced the amount of folic acid added to food.

“Some researchers are concerned that we’re going to see a resurgence in neural tube defects,” says Dr. Field. “There is a simple solution-just add more. But we don’t know what impact this will have on mothers and infants, as too much folic acid may increase the risk of cancer. We really need to know whether the current recommendation is appropriate.

“This is the kind of issue that our team will be able to get a handle on. And there’s much more to find out. We’ve known for years about straightforward relationships like vitamin C and scurvy. But when we’re into complex brain development and neural function, it’s unlikely that only a single factor is involved. We will be measuring the intake of vitamins, minerals, and omega-3 fatty acids, and whether those levels are sufficient. The potential to improve health is amazing. We’re eager to get going.”


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