The effect of vitamin D and calcium supplementation on inflammatory biomarkers, estradiol levels and severity of symptoms in women with postpartum depression: a randomized double-blind clinical trial

ABSTRACT

Objectives: Postpartum depression (PPD) is a major depressive disorder. Vitamin D deficiency may play a role in PPD pathogenesis. This study was designed to determine the effect of vitamin D and calcium supplementation on the severity of symptoms and some related inflammatory biomarkers in women with PPD.

Materials and Methods: Eighty-one women with a PPD score >12 participated in this study. A total of 27 patients were randomly assigned into three groups (1:1:1 ratio) to receive either 50,000 IU vitamin D3 fortnightly + 500 mg calcium carbonate daily; or 50,000 IU vitamin D3 fortnightly + placebo of calcium carbonate daily, or placebo of vitamin D3 fortnightly + placebo of calcium carbonate daily (placebo group) for 8 weeks. At the baseline and end of the study, the severity score of PPD, levels of 25-hydroxy vitamin D, calcium, tumor necrosis factor-alpha (TNFα), interleukin 6 (IL6) and estradiol were measured.

Results: The PPD score had more reduction in the vitamin D + calcium and vitamin D + calcium placebo groups than that of the placebo group (−1.7 ± 3.44, −4.16 ± 5.90 and 0.25 ± 2.81, respectively; p = 0.008). The effect of vitamin D on the PPD score was larger when vitamin D was given alone than given together with calcium (p = 0.042 and p = 0.004, respectively). No significant differences in estradiol, IL6 and TNFα were observed between the three groups.

Discussion: Vitamin D may be effective in improving the clinical symptoms of PPD; however, the mechanism of the effect might not entirely operate through inflammatory and/or hormonal changes.

GRAPHICAL ABSTRACT

KEYWORDS:

• Vitamin D
• depression
• postpartum
• inflammatory mediators
• estradiol
• high sensitive C-reactive protein
• tumor necrosis factor-alpha
• interleukin 6

Acknowledgements

The authors are very grateful to Dr. Hadi Safavi (Copper Queen Community Hospital, Sierra Vista, Arizona, U.S.A.) for editing of the manuscript for English and greatly appreciated mothers who participated in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Author Contributions

All persons who met authorship criteria are listed as authors. S Amini and S Jafarirad contributed significantly to the work’s conception, participated in the writing and critical revision of the manuscript in a manner sufficient to establish the ownership of the intellectual content. R Amani contributed significantly to the work’s conception. B Cheraghian analyzed and interpreted data. M Sayyah and AA Hemmati involved in the design of work. All authors approved the final version of the manuscript to be published.

Ethics approval

The study protocol was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences, in accordance with the Declaration of Helsinki (IR.AJUMS.REC.1396.59, date: March 10, 2017). Written informed consent was given by all the participants before their inclusion in the study. Furthermore, the study design was registered in Iranian Registry of Clinical Trials (www.irct.ir) with this ID: IRCT2016091416123N9.

Additional information

Funding

This work was a part of Ph.D. thesis of Shirin Amini, (Ph.D. candidate of Nutrition) and was financially supported by the Vice-Chancellor for Research Affairs of Ahvaz Jundishapur University of Medical Sciences (grant number: NRC-9601), and approved by the Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences.

Notes on contributors

Shirin Amini

Dr Shirin Amini got Ph.D. in Nutrition and works in Shoushtar Faculty of Medical Sciences.

Reza Amani

Reza Amani is a Nutritionist and worked in Ahvaz Jundishapur University of Medical Sciences. He changed his university in 2016 and now he works in Isfahan University of Medical Sciences.

Sima Jafarirad

Dr Sima Jafarirad is a nutritionist and an associate professor in Ahvaz Jundishapur University of Medical Sciences.

Bahman Cheraghian

Dr Bahman Cheraghian is an epidemiologist and he is one of the main investigators of Hoveizeh Cohort Study (a part of Persian cohort study).

Mehdi Sayyah

Dr Mehdi Sayyah is an psychiatrist and works in Education Development Center, Ahvaz Jundishapur University of Medical Sciences.

Ali Asghar Hemmati

Ali-Asghar Hemmati is a pharmacologist and head of Pharmaceutical Technology Incubator of Ahvaz Jundishapur University of Medical Sciences.