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Are Unmet Breastfeeding Expectations Associated With Maternal Depressive Symptoms?

      Abstract

      Objective

      Most US women intend and initiate breastfeeding, yet many do not breastfeed as long as desired. Not meeting one's own prenatal expectations is a plausible mechanism for the previously observed association between lack of breastfeeding and postpartum depression (PPD). This study explored whether meeting prenatal expectations for exclusive breastfeeding was associated with PPD symptoms.

      Methods

      The 2005 Infant Feeding Practices Study II (IFPSII) followed US mothers, primarily white women with higher education and income, from midpregnancy to 1 year postpartum. Depressive symptoms were defined as Edinburgh Postnatal Depression Scale (EPDS) of 10 or higher, measured at 2 months postpartum. Logistic regression analysis evaluated the odds of maternal depressive symptoms as a function of meeting prenatal expectations for exclusive breastfeeding, accounting for breastfeeding behavior, demographics, and postnatal experiences.

      Results

      Among IFPSII participants, 1501 intended exclusive breastfeeding and completed the EPDS. At 2 months, 589 (39.2%) had met prenatal expectations for exclusive breastfeeding. EPDS was 10 or higher for 346 participants (23.1%). Adjusted odds of depressive symptoms were lower among women meeting prenatal exclusive breastfeeding expectations versus those who were not (odds ratio 0.71, 95% confidence interval 0.52–0.96). In subgroup analysis, there was no association between met expectations and depressive symptoms among women with lower incomes (<200% federal poverty level) or those intending mixed breast and formula feeding.

      Conclusions

      Among middle- and higher-income women who intended exclusive breastfeeding, those meeting prenatal breastfeeding expectations reported fewer PPD symptoms at 2 months postpartum. Clinician understanding and support of maternal expectations may improve maternal mental health.

      Keywords

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      References

        • Earls M.F.
        • Committee on Psychosocial Aspects of Child and Family Health American Academy of Pediatrics
        Incorporating recognition and management of perinatal and postpartum depression into pediatric practice.
        Pediatrics. 2010; 126: 1032-1039
        • Beck C.T.
        The effects of postpartum depression on child development: a meta-analysis.
        Arch Psychiatr Nurs. 1998; 12: 12-20
        • Ip S.
        • Chung M.
        • Raman G.
        • et al.
        Breastfeeding and maternal and infant health outcomes in developed countries.
        Evid Rep Technol Assess (Full Rep). 2007; 153: 1-186
        • Grigoriadis S.
        • Vonderporten E.H.
        • Mamisashvili L.
        • et al.
        The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis.
        J Clin Psychiatry. 2013; 74: e321-e341
        • Dennis C.
        • McQueen K.
        Does maternal postpartum depressive symptomatology influence infant feeding outcomes?.
        Acta Paediatr. 2007; 96: 590-594
        • Taveras E.M.
        • Capra A.M.
        • Braveman P.A.
        • et al.
        Clinician support and psychosocial risk factors associated with breastfeeding discontinuation.
        Pediatrics. 2003; 112: 108-115
        • Hahn-Holbrook J.
        • Haselton M.G.
        • Schetter C.D.
        • et al.
        Does breastfeeding offer protection against maternal depressive symptomatology?.
        Arch Womens Ment Health. 2013; 5: 411-422
        • Anderson A.K.
        • Damio G.
        • Chapman D.J.
        • et al.
        Differential response to an exclusive breastfeeding peer counseling intervention: the role of ethnicity.
        J Hum Lact. 2007; 23: 16-23
        • Bonuck K.A.
        • Freeman K.
        • Trombley M.
        Country of origin and race/ethnicity: impact on breastfeeding intentions.
        J Hum Lact. 2005; 21: 320-326
      1. Centers for Disease Control and Prevention.
        Breastfeeding Report Card. 2014;
      2. US Department of Health and Human Services. The Surgeon General's Call to Action to Support Breastfeeding. 2011.

        • Easthall C.
        • Song F.
        • Bhattacharya D.
        A meta-analysis of cognitive-based behaviour change techniques as interventions to improve medication adherence.
        BMJ Open. 2013; 3: 1-17
        • Hazard R.G.
        Goal achievement model for low back pain.
        Spine (Phila Pa 1976). 2013; 38: 1431-1435
        • Knittle K.P.
        • De Gucht V.
        • Hurkmans E.J.
        • et al.
        Effect of self-efficacy and physical activity goal achievement on arthritis pain and quality of life in patients with rheumatoid arthritis.
        Arthritis Care Res (Hoboken). 2011; 63: 1613-1619
        • Moberly N.J.
        • Watkins E.R.
        Negative affect and ruminative self-focus during everyday goal pursuit.
        Cogn Emot. 2010; 24: 729-739
        • Perrine C.G.
        • Scanlon K.S.
        • Li R.
        • et al.
        Baby-friendly hospital practices and meeting exclusive breastfeeding intention.
        Pediatrics. 2012; 130: 54-60
        • Declercq E.
        • Labbok M.H.
        • Sakala C.
        • et al.
        Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed.
        Am J Public Health. 2009; 99: 929-935
        • Odom E.C.
        • Li R.
        • Scanlon K.S.
        • et al.
        Reasons for earlier than desired cessation of breastfeeding.
        Pediatrics. 2013; 131: e726-e732
        • Fishbein M.
        The role of theory in HIV prevention.
        AIDS Care. 2000; 12: 273-278
        • Fein S.B.
        • Labiner-Wolfe J.
        • Shealy K.R.
        • et al.
        Infant feeding practices study II: study methods.
        Pediatrics. 2008; 122: S28-S35
        • Beck C.T.
        Predictors of postpartum depression: an update.
        Nurs Res. 2001; 50: 275-285
        • Holmes A.V.
        Establishing successful breastfeeding in the newborn period.
        Pediatr Clin North Am. 2013; 60: 147-168
        • Watkins S.
        • Meltzer-Brody S.
        • Zolnoun D.
        • et al.
        Early breastfeeding experiences and postpartum depression.
        Obstet Gynecol. 2011; 118: 214-221
        • Cox J.L.
        • Holden J.M.
        • Sagovsky R.
        Detection of postnatal depression. development of the 10-item Edinburgh postnatal depression scale.
        Br J Psychiatry. 1987; 150: 782-786
        • Beck C.T.
        • Gable R.K.
        Comparative analysis of the performance of the postpartum depression screening scale with two other depression instruments.
        Nurs Res. 2001; 50: 242-250
        • US Department of Health and Human Services
        The 2007 HHS poverty guidelines.
        Fed Reg. 2007; 72: 3147
        • StataCorp
        Stata statistical software: release 12.
        StataCorp, College Station, Tex2011
        • Stuebe A.M.
        • Grewen K.
        • Meltzer-Brody S.
        Association between maternal mood and oxytocin response to breastfeeding.
        J Womens Health (Larchmt). 2013; 22: 352-361
        • Lefkowitz D.S.
        • Baxt C.
        • Evans J.R.
        Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU).
        J Clin Psychol Med Settings. 2010; 17: 230-237
        • Witt A.M.
        • Smith S.
        • Mason M.J.
        • et al.
        Integrating routine lactation consultant support into a pediatric practice.
        Breastfeed Med. 2012; 7: 38-42
        • Gross S.M.
        • Resnik A.K.
        • Nanda J.P.
        • et al.
        Early postpartum: a critical period in setting the path for breastfeeding success.
        Breastfeed Med. 2011; 6: 407-412
        • Schmied V.
        • Beake S.
        • Sheehan A.
        • et al.
        Women's perceptions and experiences of breastfeeding support: a metasynthesis.
        Birth. 2011; 38: 49-60
        • Liu C.H.
        • Tronick E.
        Rates and predictors of postpartum depression by race and ethnicity: results from the 2004 to 2007 New York City PRAMS survey (Pregnancy Risk Assessment Monitoring System).
        Matern Child Health J. 2013; 17: 1599-1610
        • Insaf T.Z.
        • Fortner R.T.
        • Pekow P.
        • et al.
        Prenatal stress, anxiety, and depressive symptoms as predictors of intention to breastfeed among hispanic women.
        J Womens Health (Larchmt). 2011; 20: 1183-1192