Risk factors for cessation of breastfeeding prior to six months postpartum among a community sample of women in Calgary, Alberta

Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression

BACKGROUND

This prospective cohort study explored the effects of prenatal and postpartum depression on breastfeeding and the effect of breastfeeding on postpartum depression.

METHOD

The Edinburgh Postpartum Depression Scale (EPDS) was administered to 145 women at the first, second and third trimester, and at the neonatal period and 3 months postpartum. Self-report exclusive breastfeeding since birth was collected at birth and at 3, 6 and 12 months postpartum. Data analyses were performed using repeated-measures ANOVAs and logistic and multiple linear regressions.

RESULTS

Depression scores at the third trimester, but not at 3 months postpartum, were the best predictors of exclusive breastfeeding duration (β = -0.30, t = -2.08, p < 0.05). A significant decrease in depression scores was seen from childbirth to 3 months postpartum in women who maintained exclusive breastfeeding for ⩾3 months (F 1,65 = 3.73, p < 0.10, η p 2 = 0.05).

CONCLUSIONS

These findings suggest that screening for depression symptoms during pregnancy can help to identify women at risk for early cessation of exclusive breastfeeding, and that exclusive breastfeeding may help to reduce symptoms of depression from childbirth to 3 months postpartum.

Maternal anxiety and breastfeeding: findings from the MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) Study

BACKGROUND

Maternal anxiety and depression may impair maternal intention, motivation, and self-efficacy in multiple domains associated with child health including breastfeeding.

OBJECTIVE

We tested the hypothesis that mothers who experience substantial anxiety during pregnancy or the postpartum period are at increased risk for reduced initiation, exclusivity, and continuation of breastfeeding.

METHODS

We obtained data on 255 Canadian pregnant women from the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) study recruited between June 2004 and February 2009. We utilized data collected from 18 to 23 weeks gestation through 12 months postpartum. Multivariate logistic regression was used to assess whether scores on the Hamilton Anxiety Scale (HAM-A) and State-Trait Anxiety Inventory (STAI) were associated with initiation, exclusivity, and continuation of breastfeeding.

RESULTS

Prenatal anxiety was not associated with breastfeeding outcomes. In adjusted models, a single point increase in HAM-A scores at 3 months postpartum was associated with an 11% reduction in the odds of exclusive breastfeeding at 6 months (adjusted odds ratio [aOR] = 0.89; 95% CI, 0.80-0.99). A single point increase in STAI State and STAI Trait scores at 3 months postpartum was associated with a 4% (aOR = 0.96; 95% CI, 0.92-0.99) and 7% (aOR = 0.93; 95% CI, 0.86-1.00) reduction, respectively, in the odds of any breastfeeding at 12 months.

CONCLUSION

Our findings suggest a relationship between maternal anxiety and reduced exclusivity and continuation of breastfeeding. Maternal anxiety should be actively monitored and managed appropriately in the postpartum period to support optimal breastfeeding practices.

Relationship between intention to supplement with infant formula and breastfeeding duration

OBJECTIVES

According to Health Canada and the Canadian Paediatric Society, infants should be exclusively breastfed for the first six months with continued breastfeeding for two years and beyond. This study examined the relationship between a mother's intention to supplement with infant formula and the risk of discontinuing breastfeeding during the 12 months postpartum.

METHODS

Surveys were administered to a cohort of mothers at 6 weeks, 6 months and 12 months postpartum as part of York Region's Infant Feeding Survey. Those who initiated breastfeeding were included in the analysis (n=345). The relationship between a mother's prenatal intention to supplement with infant formula and breastfeeding duration was examined using Cox proportional hazards regression controlling for mother's age, prenatal education, immigration status, parity, household income, mother's ethnicity and education.

RESULTS

Nearly one third of mothers intended to supplement with infant formula. Of those mothers, 69% actually supplemented their baby with infant formula within 12 months postpartum. Intention to supplement was found to be associated with shorter breastfeeding duration (HR=2.64, 95% CI 1.83-3.81). First-time mothers experienced shorter breastfeeding duration compared to experienced mothers (HR=2.13, 95% CI 1.39-3.27). Mothers who identified as European experienced shorter breastfeeding duration compared to East, Southeast or South Asian mothers (HR=1.79, 95% CI 1.05-3.06).

CONCLUSIONS

Continued breastfeeding is not only beneficial for the infant, but it also has important benefits for the mother. The analysis indicates that a mother's prenatal intent to supplement may be associated with shorter breastfeeding duration. Further research is required to confirm these findings and to address the underlying assumptions and limitations.

Breastfeeding difficulties and exclusivity among late preterm and term infants: results from the all our babies study

OBJECTIVE

To compare breastfeeding difficulties attributable to the baby and mother/milk and exclusive breastfeeding between a group of late preterm (LP) infants and term infants.

METHODS

We utilized data from a prospective community-based cohort (n=2977) in Calgary, Alberta, and performed bivariate and multivariable analyses to identify demographic, obstetric, maternal and infant health indicators that were independently associated with term status and breastfeeding outcomes.

RESULTS

Multivariable analyses found that LP status was an independent risk factor for breastfeeding difficulties attributable to the baby (OR 1.72, 95% CI 1.24-2.38), but not for difficulties due to mother/milk (defined as not producing enough milk or having flat or inverted nipples). Among women who were breastfeeding at hospital discharge, mothers of LP infants were less likely to report exclusive breastfeeding at 4 months (OR 0.67, 95% CI 0.46-0.97), after controlling for household income level, mode of delivery and postpartum maternal physical health.

CONCLUSIONS

Mothers of LP infants need increased support to establish successful breastfeeding outcomes and to ensure that these infants receive the full benefits of breast milk.

Breastfeeding and postpartum depression: state of the art review

OBJECTIVE

To review the literature on the association between breastfeeding and postpartum depression.

SOURCES

A review of literature found on MEDLINE/PubMed database.

SUMMARY OF FINDINGS

The literature consistently shows that breastfeeding provides a wide range of benefits for both the child and the mother. The psychological benefits for the mother are still in need of further research. Some studies point out that pregnancy depression is one of the factors that may contribute to breastfeeding failure. Others studies also suggest an association between breastfeeding and postpartum depression; the direction of this association is still unclear. Breastfeeding can promote hormonal processes that protect mothers against postpartum depression by attenuating cortisol response to stress. It can also reduce the risk of postpartum depression, by helping the regulation of sleep and wake patterns for mother and child, improving mother's self-efficacy and her emotional involvement with the child, reducing the child's temperamental difficulties, and promoting a better interaction between mother and child.

CONCLUSIONS

Studies demonstrate that breastfeeding can protect mothers from postpartum depression, and are starting to clarify which biological and psychological processes may explain this protection. However, there are still equivocal results in the literature that may be explained by the methodological limitations presented by some studies.

Rates and determinants of exclusive breastfeeding in first 6 months among women in Nova Scotia: a population-based cohort study

BACKGROUND

Despite compelling evidence that exclusive breastfeeding for the first 6 months of life provides important health benefits to both mothers and their infants, most mothers do not follow this practice. We conducted a study to identify predictors of early cessation of exclusive breastfeeding (before 6 months after delivery).

METHODS

For this population-based longitudinal cohort study, we linked data from a perinatal database and a public health database for infants born between 2006 and 2009 in 2 regions in the province of Nova Scotia, Canada. The cohort was followed from the mother's first prenatal visit until her infant was 6 months old. Hazard ratios (HRs) for early cessation of exclusive breastfeeding were determined through Cox proportional hazards regression modelling.

RESULTS

Overall, 64.1% (2907/4533) of the mothers in the cohort initiated breastfeeding. Only 10.4% (413/3957) exclusively breastfed for the recommended 6 months. The largest drop in exclusive breastfeeding occurred within the first 6 weeks after birth. Among the mothers who initiated breastfeeding, significant predictors of early cessation of exclusive breastfeeding identified by multivariable modelling included less than high school education (HR 1.66, 95% confidence interval [CI] 1.35-2.04), lowest neighbourhood income quintile (HR 1.35, 95% CI 1.13-1.60), single motherhood (HR 1.24, 95% CI 1.10-1.41), prepregnancy obesity (HR 1.43, 95% CI 1.23-1.65), smoking throughout pregnancy (HR 1.39, 95% CI 1.21-1.60), no early breast contact by the infant (< 1 hour after birth) (HR 1.44, 95% CI 1.29-1.62) and no intention to breastfeed (HR 1.78, 95% CI 1.44-2.16).

INTERPRETATION

We found that most predictors of early cessation of breastfeeding were intertwined with social determinants of health. However, we identified potentially modifiable risk factors. Providing opportunities for early breast contact by the infant and continued efforts in smoking cessation and obesity reduction may contribute to a longer duration of exclusive breastfeeding.

The relationship between postpartum depression and breastfeeding

INTRODUCTION

The purpose was to investigate the possible correlation or predictive relationship between breastfeeding and Postpartum Depression (PPD).

METHOD

We conducted a prospective study in which 137 Arab women were assessed during pregnancy and postpartum. Current breastfeeding was correlated with postpartum outcomes (EPDS and MINI), employment, and use of formula at 2 and 4 months postpartum, as well as with other variables.

RESULTS

Women who were breastfeeding at 2 and 4 months had lower scores on EPDS (p < 0.0037 andp < 0.0001, respectively) and were less likely to be diagnosed with PPD at 4 months (p < 0.0025). Higher scores on EPDS and diagnosis of PPD at 2 months were predictive of lower rates of breastfeeding at 4 months (p < 0.0001 and p < 0.005, respectively). Women who were employed and using formula at 2 months were less likely to breastfeed at 4 months (p < 0.0001). Breastfeeding women at 2 months had lower scores on EPDS (p < 0.003) and were less likely to be diagnosed with PPD (p <0.05) at 4 months.

DISCUSSION

The results indicate that women who breastfeed their infants reduced their risk of developing PPD, with effects being maintained over the first 4 months postpartum. PPD may also decrease the rate of breastfeeding, suggesting a reciprocal relationship between these variables.

Predictors of breastfeeding exclusivity among migrant and Canadian-born women: results from a multi-centre study

The objective of this study was to examine and compare predictors of breastfeeding exclusivity among migrant and Canadian-born women. As part of a longitudinal study, a sample of 1184 mothers were recruited from 12 hospitals in Canada and completed questionnaires at 1 and 16 weeks post-partum that included diverse questions from the following domains: demographic, social, migration, obstetrical, breastfeeding and maternal mood. After bivariate analysis, multivariate logistic regression analysis was completed to examine and compare predictors of exclusive breastfeeding at 16 weeks post-partum. Among migrant women, factors predictive of breastfeeding exclusivity included non-refugee immigrant or asylum-seeking status, residence in Toronto or Vancouver, maternal age of ≥35 years, feels most comfortable in the country of origin or nowhere and higher Gender-related Development Index of the country of origin. Factors predictive of not exclusively breastfeeding included maternal age of <20 years, not planning to exclusively breastfeed, not making the decision to breastfeed before pregnancy and not exclusively breastfeeding at 1 week post-partum. Among Canadian-born women, factors predictive of a lower likelihood of breastfeeding exclusivity included not living with father of infant, infant neonatal intensive care unit admission, planned duration of exclusive breastfeeding for <6 months, not exclusively breastfeeding at 1 week post-partum and Edinburgh Postnatal Depression Scale score of ≥10. The only similar risk factor predicting a lower likelihood of breastfeeding exclusivity between migrant and Canadian-born women was not exclusively breastfeeding at 1 week post-partum; all other risk factors were dissimilar, suggesting that these groups might benefit from different strategies to optimise breastfeeding outcomes.

Development of eating behavior: biology and context

Eating is necessary for survival, gives great pleasure, and can be perturbed leading to undernutrition, overnutrition, and eating disorders. The development of feeding in humans relies on complex interplay between homeostatic mechanisms; neural reward systems; and child motor, sensory, and socioemotional capability. Furthermore, parenting, social influences, and the food environment influence the development of eating behavior. The rapid expansion of new knowledge in this field, from basic science to clinical and community-based research, is expected to lead to urgently needed research in support of effective, evidence-based prevention and treatment strategies for undernutrition, overnutrition, and eating disorders in early childhood. Using a biopsychosocial approach, this review covers current knowledge of the development of eating behavior from the brain to the individual child, taking into account important contextual influences.

Maternal prepregnancy body mass index and initiation and duration of breastfeeding: a review of the literature

BACKGROUND

Previous studies have found an association between maternal obesity and overweight and breastfeeding (BF) difficulties, including delayed lactogenesis and shorter duration of BF. Biological, psychological, and mechanical causes have been linked with poor BF outcomes. Other review articles on this topic have included studies that measured maternal body mass index (BMI) in the postpartum period instead of prenatally, presenting difficulties in teasing out the role of gestational weight gain and prepregnancy BMI on BF success. My objective was to evaluate the relationship between maternal prepregnancy BMI, including comorbidities associated with overweight and obesity such as diabetes mellitus, and BF initiation and duration.

METHODS

Four PubMed searches were conducted, retrieving 13 articles.

RESULTS

Of the 12 studies reviewed that assessed the association between prepregnancy maternal BMI category and BF initiation, 9 found an association between maternal overweight or obesity and delayed lactogenesis or failure to initiate BF. One study found increased risk for not initiating BF only in Hispanic women, and 1 found the association only among women with medical comorbidities in addition to obesity. Of the 13 studies retrieved that assessed the association between BMI category and BF duration, 10 found an association between higher BMI categories and shorter duration of BF. Ten of the 13 studies reviewed adjusted for multiple confounders, including maternal smoking status, parity, type of delivery, and infant birthweight. The studies that found an association between BMI category and reduced duration did so in some cases only for certain ethnic/racial groups or BMI categories or if other comorbidities were present in addition to overweight/obesity.

CONCLUSIONS

Higher BMI levels can adversely impact BF initiation and duration. Further studies need to be conducted to better understand the role of race/ethnicity, gestational weight gain, and such comorbidities as diabetes in increasing risk for reduced BF initiation and duration in overweight and obese women.

Unique perspectives of women and their partners using the Prenatal Psychosocial Profile Scale

AIM

This paper is a report of a study to examine the underlying factors of the Prenatal Psychosocial Profile as a composite measure of stress, support from partner, support from others and self-esteem; and compares factor structures between pregnant women and men.

BACKGROUND

In order to promote positive pregnancy outcomes, addressing unique differences in psychosocial factors between women and men is important. There is very little information or data directly collected from both groups.

METHODS

As part of a larger smoking cessation study during pregnancy, a sample of 66 low-income couples (n =132) living in rural Missouri--the Midwestern region of the United States of America--was selected between 2006 and 2008. Principal component analysis was used to evaluate the factor structure of the composite measure.

RESULTS

Similarities and unique differences in the Prenatal Psychosocial Profile subscales between the two groups were found. For the stress subscale, 'problems related to family', 'the current pregnancy' and 'feeling generally overloaded' loaded as financial stressors for men but as emotional stressors for women. For the partner support subscale, women perceived they were receiving more tangible support from their partners whereas men perceived receiving more emotional support. The support from others subscale was similar for both partners. The self-worth factor explained more of the variance in self-esteem among pregnant women, while the self-criticism factor explained more of the variance among men.

CONCLUSION

Assessment of psychosocial well-being in both women and men during pregnancy, especially careful assessment of stressors of pregnancy should be part of nursing practice.

Preventing postpartum depression

Major depression is a frequent complication of the postpartum period. Untreated postpartum depression increases the risk of maternal suicide and can impair parenting capability with resultant adverse effects on offspring development. A number of factors influence a woman's vulnerability to postpartum depressive episodes. This article summarizes processes for assessing these risk factors and implementing primary preventive interventions, and summarizes methods of early detection to promote secondary and tertiary prevention.

Overcoming barriers to breastfeeding continuation and exclusivity

PURPOSE OF REVIEW

To review recent research that delineates predictors of breastfeeding duration and exclusivity.

RECENT FINDINGS

Many mothers find it difficult to meet personal goals and follow expert recommendations for continued and exclusive breastfeeding despite increased rates of initiation. Recent studies have revealed varied sociodemographic, biomedical, and psychosocial determinants of breastfeeding duration and exclusivity.

SUMMARY

In order to help mothers meet personal goals and expert recommendations for breastfeeding, pediatricians should educate themselves regarding predictors of and barriers to successful breastfeeding. Once these predictors and barriers have been identified, targeted anticipatory guidance can be provided to help mothers achieve breastfeeding success.