Overview
This study aims to evaluate the effects of a methyl-donor-rich diet during the postpartum period on maternal depression, breastfeeding success, and infant weight.
Postpartum women will first complete a three-day dietary record to assess their intake of selected nutrients involved in one-carbon metabolism, including folate, choline, betaine, methionine, vitamin B6, and vitamin B12. Women whose intake of at least one of these nutrients is below two-thirds of the applicable reference intake and who meet the other eligibility criteria will be eligible to participate.
Eligible participants will be randomly assigned to one of two groups. The intervention group will receive an individualized methyl-donor-rich dietary program and nutrition education for two months. The control group will receive standard postpartum care and routine dietary advice.
The study will compare the groups in terms of maternal depressive symptoms, breastfeeding success, and infant weight. Dietary intake will also be assessed.
Description
Postpartum depression is an important public health concern that can affect maternal well-being, breastfeeding, infant care, and early mother-infant bonding. Nutrition is a potentially modifiable factor that may influence maternal mental health during the postpartum period. Folate, vitamin B6, vitamin B12, choline, betaine, and methionine are involved in one-carbon metabolism and may contribute to biological processes relevant to maternal health.
However, studies evaluating the effects of methyl-donor-rich nutrition during the postpartum period on maternal depression and breastfeeding outcomes remain limited. This randomized controlled trial aims to address this gap by evaluating the effects of a methyl-donor-rich dietary intervention on maternal postpartum depression, breastfeeding success, and infant weight.
The study will be conducted at Orhaneli Merkez Aile Sağlığı Merkezi in Bursa, Türkiye. The planned sample size is 100 postpartum women, with 50 participants allocated to the intervention group and 50 to the control group. The sample size was determined using a power analysis with a significance level of 0.05, statistical power of 80%, and an assumed effect size of Cohen's d = 0.60. The minimum required sample size was calculated as 44 participants per group and increased to 50 per group to account for potential losses to follow-up.
Before randomization, participants' dietary intake will be assessed using a three-day dietary record. Daily intakes of folate, choline, betaine, methionine, vitamin B6, and vitamin B12 will be evaluated in relation to the applicable reference intake values. Women whose intake of at least one of these nutrients is below two-thirds of the applicable reference intake and who meet the other eligibility criteria will be eligible for randomization.
Eligible participants will be randomly assigned in a 1:1 ratio to the intervention group or the control group. The intervention group will receive an individualized methyl-donor-rich dietary program and nutrition education for two months. The intervention will focus on increasing the intake of foods rich in the selected nutrients through dietary modification, without the use of supplements. Kitchen scales will be provided to support portion-size education.
The control group will receive standard postpartum care and routine dietary advice.
Maternal postpartum depression will be assessed using the Edinburgh Postnatal Depression Scale (EPDS). Breastfeeding success will be evaluated using the LATCH breastfeeding assessment tool, and infant weight will be assessed according to the study protocol.
The study hypothesizes that mothers receiving the methyl-donor-rich dietary intervention will have lower postpartum depression scores, higher breastfeeding success scores, and more favorable infant weight outcomes than mothers in the control group.
Eligibility
Inclusion Criteria:
- Women aged 18-40 years.
- Women presenting within the first 15 days after delivery.
- Mothers who had a term delivery (≥37 completed weeks of gestation).
- Mothers who are breastfeeding and whose infants are exclusively breastfed.
- No diagnosed psychiatric disorder or related medication use.
- No use of dietary supplements, including omega-3 supplements.
- No special diet program.
- No history of gestational diabetes, type 1 or type 2 diabetes, or insulin resistance.
- No malabsorption-related disorders, such as celiac disease or Crohn's disease.
- At least one assessed methyl donor nutrient intake below two-thirds of the applicable recommended intake, based on a 3-day dietary record.
- Willingness to participate voluntarily.
Exclusion Criteria:
- Development of serious postpartum complications, such as postpartum hemorrhage or sepsis.
- A maternal or infant health condition requiring prolonged hospitalization.
- Introduction of complementary foods to the infant during the study.
- Maternal smoking or alcohol use.
- Failure to adhere to the dietary intervention.
- Failure to attend follow-up assessments or voluntary withdrawal from the study.
