Maternal Depression and Child Development After Prenatal DHA Supplementation—Reply

In Reply: As Dr Suzuki suggests, some investigators have used different cutoffs on the EPDS to indicate postpartum depression, although the core validation studies indicate that a score above 12 has high sensitivity (68%-95%) and high specificity (78%-96%) against a clinical psychiatric diagnosis of depression.^1- 3 Nevertheless, applying increasing EPDS cutoff scores (10, 12, 14, 16, and 18) to the data from our DOMInO trial resulted in a progressive reduction in the estimated prevalence of postpartum depression, as expected (Table). However, the risk of postpartum depression in the DHA group compared with the control group is consistently around 10% to 15% lower, without reaching statistical significance, regardless of the cutoff used. In addition, the median EPDS scores of 5 at both 6 weeks and 6 months postpartum did not differ between the DHA and control groups. Collectively, these data provide a high degree of confidence that DHA supplementation during pregnancy does not significantly reduce the prevalence of postpartum depression in women without known risk factors for depression.