Summaries of our recent research publications - written for everyone
Many women experience postpartum psychiatric problems. But, we don’t fully understand what causes these problems, or why some new mothers have them while others don’t. Environmental factors (e.g. stress) affect our postpartum mental health. Research suggests that our genes and nutrient levels may also play a role.
One gene - called MTHFR – helps our bodies regulate levels of folate. Some people have a change to this gene which we call the MTHFR C677T variant. Studies have shown that this change may be linked to lower levels of folate. Folate is a vitamin we get from food and supplements (like multivitamins or prenatal vitamins, in the form of folic acid). Low folate may increase a person's risk for mental health disorders like depression and psychosis. Folate is important in our bodies at all times, but we need more during pregnancy. So, we studied whether women with the MTHFR C677T variant had higher risk for postpartum psychiatric symptoms due to differences in folate levels.
We looked to see if pregnant/postpartum women had 0, 1 or 2 copies of the MTHFR C677T variant. (0 copies is the “typical” MTHFR gene. We each have 2 copies of every gene). We used surveys and interviews to measure symptoms of depression, psychosis, and mania. We also measured folate levels in the blood during pregnancy and up to 3 times postpartum.
We found that for women with 0 or 1 copy of the MTHFR C667T variant, those with higher folate had slightly less symptoms of mania. For women with 2 copies, folate levels (being higher or lower) did not influence their symptoms of mania. We also looked at symptoms of depression and psychosis. Folate levels did not influence these symptoms for any of the women (regardless of MTHFR) in the study.
What does this mean for me?
To be honest, not much! Taking a folic acid supplement is already recommended during pre-conception and pregnancy. This is important for all women - no matter how many copies of the MTHFR C677T variant you have. It is also possible for any woman to develop postpartum mania (or depression or psychosis). For example, if you have higher levels of folate it does not mean you won’t experience postpartum mania. This is true even if you have 0 or 1 copy of the variant.
This information will help scientists better understand what causes postpartum psychiatric problems. One day, this will show us how we can best protect postpartum mental health. But right now, knowing if you have 0, 1 or 2 copies of the MTHFR C677T variant doesn’t change anything. Recommendations for your diet and mental health care remain the same.
So, continue to follow the standard guidelines for pregnancy care. Please talk to you doctor if you have any questions about your current mental health care.
Folate is important during pregnancy, but a history of mental illness is associated with lower folate. We measured folate levels in pregnant women with a history of depression or bipolar disorder, and found that only 12.5% had optimal folate levels. No one had a folate deficiency, but more research is needed to understand the implications.
We measured how often women with a history of depression experienced mood symptoms during pregnancy and in the postpartum. About 1/4 of women experienced depression and about 1/3 experienced mania or hypomania - suggesting that perhaps women with a history of depression should be screened for mania/hypomania in the postpartum, in addition to depression.
Similar to study 2 above, we measured how often women with a history of depression experienced symptoms of psychosis (such as delusions or hallucinations) during pregnancy and in the postpartum. About ¼ of women in our group experienced symptoms of psychosis which was higher than expected, indicating the need for more research.
In this study, we interviewed 16 women about why they chose to participate in the main study. Some factors that influenced women’s decisions included wanting to give back, getting access to more resources, and having convenient study procedures. This information can guide future perinatal mental health research to create a safe space for women to participate.
We tested whether women who had a short amount of time between their pregnancies had lower folate levels or smaller birth weights compared to women with more time between their pregnancies. There was no difference between the groups, perhaps because women often continued taking folate supplements between pregnancies.