Fish-Eating for Perinatal Depression: A Systematic Review and Meta-Analysis

OBJECTIVES: Perinatal depression is a major depressive episode during pregnancy, the postpartum period, or both. Previous studies have shown beneficial effects of ω-3 polyunsaturated fatty acids (PUFAs) and vitamin D supplementation on perinatal depression, but concerns have been raised in the public domain on the safety and efficacy of taking supplements during pregnancy. Fish is enriched with ω-3 PUFAs, vitamin D, phospholipids, and other vitamins and minerals. The association between fish consumption and perinatal depression was reported by multiple studies, but the results were inconsistent. Therefore, we aimed to systematically review the effectiveness of fish eating on perinatal depression. METHODS: We searched MEDLINE, Google Scholar and Web of Science up to April 1, 2021. We pooled the odds ratios (ORs) with 95% confidence intervals (CIs) from individual studies by using a random effect model. Meta-regression was employed to explore the potential source of heterogeneity. Risk of bias was assessed by using the Quality in Prognostic Studies tool. We registered our search protocol on PROSPERO (registration number: CRD42021248257). RESULTS: Data from 10 publications on 230,443 subjects were included. Among which, results from eight studies were pooled to achieve an overall effect of 0.84 (95% CI = 0.77, 0.92; Z = 3.70; P < 0.01). Subgroup analyses revealed that the effect of fish-eating is significant on both antenatal depression (OR = 0.83; 95% CI = 0.69, 0.98; Z = 2.15; P = 0.003) and postpartum depression (OR = 0.87; 95% CI = 0.79, 0.96; Z = 2.78; P = 0.005). The heterogeneity was moderate (I(2) = 58%, P = 0.02). After removing the potential source of heterogeneity, the result remained significant (OR = 0.83, 95% CI = 0.78, 0.88; Z = 6.73; P < 0.01). No evidence of publication bias was found. CONCLUSIONS: Fish-eating may reduce the risk of perinatal depression. In the countries or areas where fish intake is low, increasing fish intake among pregnant women may bring beneficial effects, especially for psychological distress, but the recommended fish intake amount needs to be determined by future studies. FUNDING SOURCES: This research was not funded.