From womb to world—is it time to revisit our current guidelines for treatment of antenatal depression? Supporting the next generation to have the best start to life

Antenatal depression affects 15-21% of pregnant women globally, increasing the risk of pregnancy complications, postnatal depression and poor birth and infant outcomes. Psychotherapy is a recommended treatment, but access barriers like cost, time and stigma often prevent their use. For severe cases, antidepressants are advised; however, only 3% of pregnant women in New Zealand take antidepressants, with concerns about risks to their infant identified as a main reason for discontinuing medications. Poor nutrition during pregnancy, particularly ultra-processed foods, is associated with higher maternal depression and greater likelihood of mental health issues in the offspring. Increasing consumption of real whole foods improves outcomes for both mother and infant. As proof that the nutritional environment during pregnancy is inadequate, a randomised placebo-controlled trial in pregnancy for women with moderate depression is showcased to illustrate the importance of supplementing with vitamins and minerals (micronutrients) in recovery from antenatal depression. The additional micronutrients also mitigated the negative effects of depression on birth outcomes and improved early indicators of infant competencies, with more favourable birth and infant outcomes compared to antidepressants. The substantially enhanced birth outcomes emphasise the potential for significant healthcare savings. The breadth of data urges updates to the current guidelines from the Royal Australia and New Zealand College of Psychiatrists and the Royal Australia and New Zealand College of Obstetricians and Gynaecologists to include nutrition intervention as part of maternal care.