Julia J Rucklidge, University of Canterbury; Elena Moltchanova, University of Canterbury; Roger Mulder, University of Otago, and Siobhan A Campbell, University of Canterbury

Antenatal depression affects 15% to 21% of pregnant women worldwide. It can influence birth outcomes and children’s development, as well as increase the risk of post-natal depression.

Current treatments like therapy can be inaccessible and antidepressants can carry risks for developing infants.

Over the past two decades, research has highlighted that poor nutrition is a contributing risk factor to mental health challenges. Most pregnant women in New Zealand aren’t adhering to nutritional guidelines, according to a longitudinal study. Only 3% met the recommendations for all food groups.

Another cohort study carried out in Brazil shows that ultra-processed foods (UPF) accounted for at least 30% of daily dietary energy during pregnancy, displacing healthier options.

UPFs are chemically manufactured and contain additives to improve shelf life, as well as added sugar and salt. Importantly, they are low in essential micronutrients (vitamins and minerals).

The consumption of these foods is concerning because a nutrient-poor diet during pregnancy has been linked to poorer mental health outcomes in children. This includes depression, anxiety, hyperactivity, and inattention.

Increasing nutrients in maternal diets and reducing consumption of UPFs could improve the mental health of the mother and the next generation. Good nutrition can have lifelong benefits for the offspring.

However, there are multiple factors that mean diet change alone may not in itself be sufficient to address mental health challenges. Supplementing with additional nutrients may also be important to address nutritional needs during pregnancy.

Micronutrients as treatment for depression

Our earlier research suggests micronutrient supplements for depression have benefits outside pregnancy.

But until now there have been no published randomised controlled trials specifically designed to assess the efficacy and safety of broad-spectrum micronutrients on antenatal depression and overall functioning.

The NUTRIMUM trial, which ran between 2017 and 2022, recruited 88 women in their second trimester of pregnancy who reported moderate depressive symptoms. They were randomly allocated to receive either 12 capsules (four pills, three times a day) of a broad-spectrum micronutrient supplement or an active placebo containing iodine and riboflavin for a 12-week period.

Micronutrient doses were generally between the recommended dietary allowance and the tolerable upper level.

Based on clinician ratings, micronutrients significantly improved overall psychological functioning compared to the placebo. The findings took into account all noted changes based on self-assessment and clinician observations. This includes sleep, mood regulation, coping, anxiety and side effects.

Both groups reported similar reductions in symptoms of depression. More than three quarters of participants were in remission at the end of the trial. But 69% of participants in the micronutrient group rated themselves as “much” or “very much” improved, compared to 39% in the placebo group.

Participants taking the micronutrients also experienced significantly greater improvements in sleep and overall day-to-day functioning, compared to participants taking the placebo. There were no group differences on measures of stress, anxiety and quality of life.

Importantly, there were no group differences in reported side effects, and reports of suicidal thoughts dropped over the course of the study for both groups. Blood tests confirmed increased vitamin levels (vitamin C, D, B12) and fewer deficiencies in the micronutrient group.

Micronutrients were particularly helpful for women with chronic mental health challenges and those who had taken psychiatric medications in the past. Those with milder symptoms improved with or without the micronutrients, suggesting general care and monitoring might suffice for some women.

The benefits of micronutrients were comparable to psychotherapy but with less contact. There are no randomised controlled trials of antidepressant medication to compare these results.

Retention in the study was good (81%) and compliance excellent (90%).

Beyond maternal mental health

We followed the infants of mothers enrolled in the NUTRIMUM trial (who were therefore exposed to micronutrients during pregnancy) for 12 months, alongside infants from the general population of Aotearoa New Zealand.

This second group of infants from the general population contained a smaller sub-group who were exposed to antidepressant medication for the treatment of antenatal depression.

We assessed the neuro-behavioural development of each infant within the first four weeks of life, and temperament up to one year after birth.

These observational follow-ups showed positive effects of micronutrients on the infants’ ability to regulate their behaviour. These results were on par with or better than typical pregnancies, and better than treatments with antidepressants.

Infants exposed to micronutrients during pregnancy were significantly better at attending to external stimuli. They were also better able to block out external stimuli during sleep. They showed fewer signs of stress and had better muscle tone compared to infants not exposed to micronutrients.

They also displayed greater ability to interact with their environment. They were better at regulating their emotional state and had fewer abnormal muscle reflexes than infants exposed to antidepressant medication in pregnancy.

Reassuringly, micronutrients had no negative impact on infant temperament.

These findings highlight the potential of micronutrients as a safe and effective alternative to traditional medication treatments for antenatal depression.

The prenatal environment sets the foundation for a child’s future. Further investigation into the benefits of micronutrient supplementation would gives us more confidence in their use for other perinatal (from the start of pregnancy to a year after birth) mental health issues. This could provide future generations with a better start to life.

We would like to acknowledge the contribution of Dr Hayley Bradley to this research project.

Julia J Rucklidge, Professor of Psychology, University of Canterbury; Elena Moltchanova, Professor of Statistics, University of Canterbury; Roger Mulder, Professor of Psychiatry, University of Otago, and Siobhan A Campbell, Intern Psychologist, Researcher – Te Puna Toiora (Mental Health and Nutrition Research Lab), University of Canterbury

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What do you imagine a good night’s sleep to be?

Often when people come into our sleep clinic seeking treatment, they share ideas about healthy sleep.

Many think when their head hits the pillow, they should fall into a deep and restorative sleep, and emerge after about eight hours feeling refreshed. They’re in good company – many Australians hold the same belief.

In reality, healthy sleep is cyclic across the night, as you move in and out of the different stages of sleep, often waking up several times. Some people remember one or more of these awakenings, others do not. Let’s consider what a healthy night’s sleep looks like.

Sleep cycles are a roller-coaster

As an adult, our sleep moves through different cycles and brief awakenings during the night. Sleep cycles last roughly 90 minutes each.

We typically start the night with lighter sleep, before moving into deeper sleep stages, and rising again into rapid eye movement (REM) sleep – the stage of sleep often linked to vivid dreaming.

If sleeping well, we get most of our deep sleep in the first half of the night, with REM sleep more common in the second half of the night.

Adults usually move through five or six sleep cycles in a night, and it is entirely normal to wake up briefly at the end of each one. That means we might be waking up five times during the night. This can increase with older age and still be healthy. If you’re not remembering these awakenings that’s OK – they can be quite brief.

What does getting a ‘good’ sleep actually mean?

You’ll often hear that adults need between seven and nine hours of sleep per night. But good sleep is about more than the number of hours – it’s also about the quality.

For most people, sleeping well means being able to fall asleep soon after getting into bed (within around 30 minutes), sleeping without waking up for long periods, and waking feeling rested and ready for the day.

You shouldn’t be feeling excessively sleepy during the day, especially if you’re regularly getting at least seven hours of refreshing sleep a night (this is a rough rule of thumb).

But are you noticing you’re feeling physically tired, needing to nap regularly and still not feeling refreshed? It may be worthwhile touching base with your general practitioner, as there a range of possible reasons.

Common issues

Sleep disorders are common. Up to 25% of adults have insomnia, a sleep disorder where it may be hard to fall or stay asleep, or you may wake earlier in the morning than you’d like.

Rates of common sleep disorders such as insomnia and sleep apnoea – where your breathing can partially or completely stop many times during the night – also increase with age, affecting 20% of early adults and 40% of people in middle age. There are effective treatments, so asking for help is important.

Beyond sleep disorders, our sleep can also be disrupted by chronic health conditions – such as pain – and by certain medications.

There can also be other reasons we’re not sleeping well. Some of us are woken by children, pets or traffic noise during the night. These “forced awakenings” mean we may find it harder to get up in the morning, take longer to leave bed and feel less satisfied with our sleep. For some people, night awakenings may have no clear cause.

A good way to tell if these awakenings are a problem for you is by thinking about how they affect you. When they cause feelings of frustration or worry, or are impacting how we feel and function during the day, it might be a sign to seek some help.

We also may struggle to get up in the morning. This could be for a range of reasons, including not sleeping long enough, going to bed or waking up at irregular times – or even your own internal clock, which can influence the time your body prefers to sleep.

If you’re regularly struggling to get up for work or family needs, it can be an indication you may need to seek help. Some of these factors can be explored with a sleep psychologist if they are causing concern.

Can my smart watch help?

It is important to remember sleep-tracking devices can vary in accuracy for looking at the different sleep stages. While they can give a rough estimate, they are not a perfect measure.

In-laboratory polysomnography, or PSG, is the best standard measure to examine your sleep stages. A PSG examines breathing, oxygen saturation, brain waves and heart rate during sleep.

Rather than closely examining nightly data (including sleep stages) from a sleep tracker, it may be more helpful to look at the patterns of your sleep (bed and wake times) over time.

Understanding your sleep patterns may help identify and adjust behaviours that negatively impact your sleep, such as your bedtime routine and sleeping environment.

And if you find viewing your sleep data is making you feel worried about your sleep, this may not be useful for you. Most importantly, if you are concerned it is important to discuss it with your GP who can refer you to the appropriate specialist sleep health provider.

Amy Reynolds, Associate Professor in Clinical Sleep Health, Flinders University; Claire Dunbar, Research Associate, Sleep Health, Flinders University; Gorica Micic, Postdoctoral Research Fellow, Clinical Psychologist, Flinders University; Hannah Scott, Research Fellow in Sleep Health, Flinders University, and Nicole Lovato, Associate Professor, Adelaide Institute for Sleep Health, Flinders University

This article is republished from The Conversation under a Creative Commons license. Read the original article.