Association between postpartum depression and the practice of exclusive breastfeeding in the first three months of life

Longitudinal assessment of sleep and fatigue according to baby feeding method in postpartum women: a prospective observational study

BACKGROUND

Poor subjective sleep quality, depressive symptoms and fatigue occur frequently in postpartum. However, the dynamics of their respective associations from prepartum throughout the maternity period in function of baby feeding method have not been fully elucidated.

METHODS

Prospective, longitudinal study using validated questionnaires probing for sleep quality, insomnia, fatigue and depressive symptoms at 35-37 weeks of gestation and at 2, 8 and 12 weeks postpartum in the obstetric departments of two Flemish hospitals. Somers'd ordinal correlation was used for correlations between the results of questionnaires (ratio variables) and the feeding method variable (an ordinal variable); T tests (normal data) or Mann Whitney (non normal data) tests for equality of means; ordinal regression ('Proportional odds model') to investigate the predictive value of parameters at one moment on the feeding method choice at a later moment; logistic regression to investigate the predictive value of parameters on later change of feeding method.

RESULTS

188 women indicating a choice for either bottle or breastfeeding in prepartum (27-35 weeks' gestation) were included. Higher fatigue assessed through the Fatigue Severity Scale within late pregnancy was moderately associated with primary bottle feeding choice. Fatigue decreased at early and late postpartum in bottle feeding (-0.38 ± 1.04; p = .110 and - 0.31 ± 1.01; p = .642 respectively), but remained unchanged from late pregnancy through early and late postpartum in breastfeeding (0.04 ± 1.21; p = .110 and - 0.27 ± 0.96; p = .642 respectively), resulting in similar fatigue in both feeding methods in early through late postpartum. There were no differences in sleep quality or insomnia symptoms at all time points. Presence of postpartum depressive symptoms were associated with early switching to bottle feeding (Somers' d correlation 0.11 (p = .021).

CONCLUSIONS

Fatigue and depressive symptoms are inversely associated with breastfeeding initiation or maintenance and influence feeding method dynamics.

Factors associated with exclusive breastfeeding by maternal HIV status: a population-based survey in Kenya

BACKGROUND

Exclusive breastfeeding (EBF) in the first six months remains low globally, despite known benefits of lower morbidity and mortality among breastfed infants. It is important to understand factors associated with breastfeeding to support optimal breastfeeding practices, particularly in settings with a high burden of HIV.

METHODS

We analyzed data from a population-level survey of mother-infant pairs attending 6-week or 9-month immunizations at 141 clinics across Kenya. Primary outcomes included maternal report of (1) EBF at 6-week visit, defined as currently feeding the infant breast milk only, (2) EBF for the first 6-months of life, defined as breastfeeding or feeding the infant breast milk only with no introduction of other liquids or solid foods until 6 months, and (3) continued breastfeeding with complementary feeding at 9-months. Correlates of breastfeeding practices were assessed using generalized Poisson regression models accounting for facility-level clustering.

RESULTS

Among 1662 mothers at 6-weeks, nearly all self-reported breastfeeding of whom 93% were EBF. Among 1180 mothers at 9-months, 99% had ever breastfed, 94% were currently breastfeeding and 73% reported 6-month EBF. At 6-weeks, younger age (< 25 years) (adjusted Prevalence Ratio (aPR) 0.96; 95% CI 0.93, 0.99), lower education (aPR 0.96; 95% CI 0.93, 0.99) and recent infant illness (aPR 0.97; 95% CI 0.94, 1.00) were associated with lower EBF prevalence while women living with HIV (WLWH) had higher EBF prevalence (aPR 1.06; 95% CI 1.02, 1.10) than women without HIV. 6-month EBF prevalence was 26% higher in WLWH (aPR 1.26; 95% CI 1.15, 1.35) than women without HIV, 14% lower in women reporting mild or above depressive symptoms (aPR 0.86; 95% CI 0.76, 0.99) than those with none or minimal depressive symptoms, and 15% lower in women with versus without history of intimate partner violence (aPR 0.85; 95% CI 0.74, 0.98). At 9-months, WLWH had a lower prevalence of continued breastfeeding with complementary feeding (aPR 0.73; 95% CI 0.64, 0.84) than women without HIV.

CONCLUSION

WLWH had higher EBF prevalence in the first 6-months, but lower prevalence of continued breastfeeding at 9-months. Strategies to support EBF and continued breastfeeding beyond 6-months postpartum, particularly among WLWH, are needed.

The role of breastfeeding and formula feeding regarding depressive symptoms and an impaired mother child bonding

Associations between depressive symptoms and breastfeeding are well documented. However, evidence is lacking for subdivisions of feeding styles, namely exclusive breastfeeding, exclusive formula feeding and a mixed feeding style (breastfeeding and formula feeding). In addition, studies examining associations between mother-child-bonding and breastfeeding have yielded mixed results. The aim of this study is to provide a more profound understanding of the different feeding styles and their associations with maternal mental health and mother-child-bonding. Data from 307 women were collected longitudinally in person (prenatally) and by telephone (3 months postnatally) using validated self-report measures, and analyzed using correlational analyses, unpaired group comparisons and regression analyses. Our results from a multinomial regression analysis revealed that impaired mother-child-bonding was positively associated with mixed feeding style (p = .003) and depressive symptoms prenatal were positively associated with exclusive formula feeding (p = .013). Further studies could investigate whether information about the underlying reasons we found for mixed feeding, such as insufficient weight gain of the child or the feeling that the child is unsatiated, could help prevent impaired mother-child-bonding. Overall, the results of this study have promising new implications for research and practice, regarding at-risk populations and implications for preventive measures regarding postpartum depression and an impaired mother-child-bonding.

Examination of risk factors for high Edinburgh postnatal depression scale scores: a retrospective study at a single university hospital in Japan

BACKGROUND

Perinatal mental health, such as postpartum depression, is an important issue that can threaten the lives of women and children. It is essential to understand the risk factors in advance and intervene before they can lead to postnatal depression. The risk factors of postpartum depression are reported to vary considerably in Japan. This study aimed to evaluate the risk factors for women with high Edinburgh Postnatal Depression Scale (EPDS) scores and to find women who may need our intervention to prevent postpartum depression.

METHODS

This was a retrospective observational study conducted at a single center. At the one-month check-up after birth, the EPDS test was performed in 1625 women who gave birth at our hospital from 2008 to 2016. We evaluated maternal, birth, neonatal and social factors and the breastfeeding status from medical records. Thereafter, we examined the factors that contributed to a high EPDS score.

RESULTS

There were 284 women in the high-score group with an EPDS of ≥ 9, and 1341 women in the low-score group with an EPDS score ≤ of 8. Maternal mental disorders and neonatal transport were significantly associated with high EPDS scores. Conversely, exclusive breastfeeding was significantly associated with the low-score EPDS group.

CONCLUSIONS

The principal factor for high EPDS scores was a mental disease. Based on this result, we suggest that early intervention in women at high risk for postpartum depression could prevent serious consequences such as abuse and suicide.

The Role of Maternal Depression Symptoms and Maternal Attachment in Predicting Exclusive Breastfeeding: A Multisite Prospective Study

Background: Previous research shows that 61% of children younger than 6 months in low- and middle-income countries (LMICs) are not exclusively breastfed. Although data on the role of pre- and postnatal depression on breastfeeding exclusivity is mixed, fetomaternal attachment might foster breastfeeding exclusivity. Thus, we tested the potential mediating role of fetomaternal attachment and postnatal depression in the relationship between maternal prenatal depression and exclusive breastfeeding. Materials and Methods: Data were collected as part of a prospective, cross-cultural project, Evidence for Better Lives Study, which enrolled 1208 expectant mothers, in their third trimester of pregnancy across eight sites, from LMICs. Of the whole sample, 1185 women (mean age = 28.32, standard deviation [SD] = 5.77) completed Computer-Aided Personal Interviews on prenatal depressive symptoms, fetomaternal attachment, and socioeconomic status. A total of 1054 women provided follow-up data at 3-6 months after birth, about postnatal depressive symptoms, exclusive breastfeeding, and infant health indicators. Path analysis was used to assess parallel mediation. Results: In the whole sample, the effect of prenatal depression on breastfeeding exclusivity was completely mediated by postnatal depression, whereas fetomaternal attachment did not mediate the relationship. The full mediation effect was replicated individually in Pakistan and Sri Lanka. Conclusions: The study results indicate that prenatal depression symptoms contributed to the development of depressive symptoms after birth, negatively affecting the probability of exclusive breastfeeding. Future research should explore this in early prevention interventions, increasing the chances of healthy child development in LMICs. Considering the mixed results around the sites, it is important to better understand the relationship between maternal depression, fetomaternal attachment and breastfeeding behavior in each site's socio-cultural context.

Postpartum depression and partner support during the period of lactation: Correlation research and its influencing factors

BACKGROUND

Postpartum depression (PPD) not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development. Partners who are in close contact with parturient women play a key role in communication and emotional support. This study explores the PPD support relationship with partners and its influencing factors, which is believed to establish psychological well-being and improve maternal partner support.

AIM

To explore the correlation between PPD and partner support during breastfeeding and its influencing factors.

METHODS

Convenience sampling was used to select lactating women (200 women) who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022. A cross-sectional survey was conducted on the basic information (general information questionnaire), depression level [edinburgh postnatal depression scale (EPDS)], and partner support score [dyadic coping inventory (DCI)] of the selected subjects. Pearson's correlation analysis was used to analyze the correlation between PPD and DCI in lactating women. Factors affecting PPD levels during lactation were analyzed using multiple linear regression.

RESULTS

The total average score of EPDS in 200 lactating women was (9.52 ± 1.53), and the total average score of DCI was (115.78 ± 14.90). Dividing the EPDS, the dimension scores were: emotional loss (1.91 ± 0.52), anxiety (3.84 ± 1.05), and depression (3.76 ± 0.96). Each dimension of the DCI was subdivided into: Pressure communication (26.79±6.71), mutual support (39.76 ± 9.63), negative support (24.97 ± 6.68), agent support (6.87 ± 1.92), and joint support (17.39 ± 4.19). Pearson's correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support, stress communication, mutual support, and co-support (P < 0.05). The total mean score of the EPDS and its dimensions were positively correlated with negative support (P < 0.05). Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony, newborn health, stress communication, mutual support, negative support, co-support, and the total score of partner support (P < 0.05).

CONCLUSION

PPD during breastfeeding was associated with marital harmony, newborn health, stress communication, mutual support, negative support, joint support, and the total DCI score.

Self-efficacy and breastfeeding outcomes in mothers of premature and term infants: a longitudinal study

PURPOSE

To analyze the breastfeeding self-efficacy in mothers of premature and full-term newborns, in the period of 180 days, and to know the social and obstetric factors that influence the practice of maintaining the exclusive breastfeeding in the period of exclusive recommendation.

METHODS

Cohort with 44 mothers admitted to a public maternity hospital between January and October 2018. The mothers were divided into two groups: Premature and Full-term Groups. The Breastfeeding Self-efficacy Scale was applied in the immediate postpartum period, in addition to a questionnaire elaborated by the authors to collect sociodemographic and obstetric variables. The follow-up was done on the 30th, 120th and 180th days of the newborn's life, by telephone. For the statistical analysis between the groups, the Statistical Package for the Social Sciences (SPSS) was used.

RESULTS

There was no difference in the self-efficacy score, nor in the obstetric and socioeconomic characteristics between the groups, except for family income (lower in the Premature Group - p = 0.031). The diet type was different on the 30th day after delivery (p = 0.023), with greater adherence to the exclusive breastfeeding in the Premature Group. No association was found between breastfeeding self-efficacy and exclusive breastfeeding practice in the 180-day period.

CONCLUSION

In this sample, the breastfeeding self-efficacy was not related to the exclusive breastfeeding practice in the period of 180 days, in both groups. The premature group showed lower family income and greater adherence to exclusive breastfeeding on the 30th day postpartum.

Postpartum Depression Is Associated with Maternal Sociodemographic and Anthropometric Characteristics, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence

Postpartum depression, with a prevalence ranging between 14% and 25% worldwide, has been considered an urgent health concern that negatively affects both mothers' and their infants' health. Postpartum depression may negatively affect maternal sociodemographic and anthropometric parameters and lifestyle factors. Nutrition has recently been identified as a crucial factor for the management and co-treatment of postpartum depression. This survey aims to determine the possible association of postpartum depression with mothers' socio-demographic and anthropometric characteristics, perinatal outcomes, breastfeeding practices, and Mediterranean diet (MD) adherence.

METHODS

This is a cross-sectional survey, which was performed on 3941 women during the postpartum period. Postpartum depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS). Anthropometric parameters and perinatal outcomes were retrieved from mothers' medical records. Sociodemographic data and breastfeeding practices were recorded by face-to-face interviews between enrolled mothers and trained personnel. Mediterranean diet adherence was assessed by MedDietScore. Both univariate and multivariate binary logistic regression were applied for analyzing our data.

RESULTS

Postpartum depression was significantly associated with lower educational level, Greek nationality, higher prevalence of multiparity and overweight/obesity postpartum, higher incidence of caesarean section and not breastfeeding, and lower levels of MD adherence. In multivariate analysis, postpartum depression was independently associated with mothers' educational level, postpartum BMI status, type of delivery, breastfeeding practices, and MD adherence after adjusting for multiple confounding factors.

CONCLUSIONS

This study has provided evidence that elevated MD compliance was related to a decreased risk of postpartum depression. Additionally, postpartum depression was associated with multiple sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Future well-designed, prospective studies with high-quality methodology should be performed to obtain conclusive results.

Factors associated with exclusive breastfeeding during postpartum in Lanzhou city, China: a cross-sectional study

Aim

Breastfeeding generates short-term and long-term benefits for both mother and child. Exclusive breastfeeding (EBF) is promoted in China for years, but its practice still lags far behind the international average, even among low- and middle- income countries. This study aimed to investigate factors associated with EBF during postpartum.

Methods

This study was conducted in a tertiary referral hospital in Gansu Province, Northwest China from October 2019 to April 2020. 3,738 postnatal women were finally included and each of them completed an elaborately designed questionnaire. Infant feeding patterns (EBF or not) and reasons for NEBF (non-exclusive breastfeeding) were collected. The feeding knowledge score was based on 17 questions in relation to breastfeeding. The total score ranges from 0 to 17. Higher score means better understanding about breastfeeding knowledge. Multivariate logistic regression models were used to determine associated factors of EBF during postpartum. A subgroup analysis was conducted to investigate the association between feeding knowledge score and exclusive breastfeeding.

Results

Six weeks after childbirth, 1891 mothers (50.6%) maintained EBF. Among the NEBF mothers, 57.01% (n = 1,053) of them stopped exclusive breastfeeding due to self-perceived lack of breast milk production. Factors associated with NEBF were higher maternal age, ethnic minorities and cesarean section. Protective factors of EBF included multipara, positive feeding attitude and high breastfeeding knowledge score. In subgroup analysis, we found the breastfeeding knowledge score had a significant impact on the mothers of Han nationality, underwent cesarean or natural delivery, both primiparous and multiparous, and those with positive attitude towards breastfeeding (p < 0.05).

Conclusion

We need a comprehensive and individualized framework of strategies to support children, mothers and their families. During puerperium, improving maternal knowledge of breastfeeding is beneficial to EBF practice. However, for ethnic minorities and those with less active breastfeeding attitudes, breastfeeding knowledge is of limited use, more researches are needed to explore the uncovered reasons, so that more personalized interventions could be developed for them.

Relationships among Postpartum Weight Retention, Stress, and Disinhibited Eating: A Scoping Review

Postpartum weight retention (PPWR) is a significant contributor to maternal cardiometabolic disease risk. The transition to motherhood is a stressful time period in which women report consuming food to cope, an eating behavior that is associated with PPWR. In this scoping review, we identified original research and review articles published since 2010 that examined relationships among PPWR, maternal stress, and disinhibited eating. In total, 16 articles met the inclusion criteria. Findings were inconsistent related to PPWR and stress. PPWR and disinhibited eating were not significantly correlated; however, disinhibition scores were higher during the postpartum period compared to prenatally. Stress and disinhibited eating were directly correlated in 4 studies. Our findings suggest these concepts, particularly disinhibited eating, have not been robustly examined during the postpartum period. Additionally, instruments used to measure maternal stress vary widely and should be further studied and refined.

Disrespect and abuse during childbirth and postpartum depression: a scoping review

This study aims to map, within the scientific literature, the relationship between disrespect and abuse during childbirth and the occurrence of postpartum depression. This is a scoping review designed in accordance with the recommendations of the Joanna Briggs Institute. The search was performed in Embase, LILACS, MEDLINE, PsycINFO, Web of Science, and in the CAPES Portal of Theses and Dissertations. We included studies that investigated the relationship between disrespect and abuse during childbirth with postpartum depression, considering cases diagnosed by physicians and by self-reports via validated scales, without restrictions regarding the year of publication and language. A total of 3,399 publications were identified and, after removing the duplicates and reading the title, abstracts, and the full-texts, seven articles were selected to integrate this review. Studies were published from 2017 onward, in four countries. Women who had experienced disrespect and abuse during childbirth were more likely to experience symptoms of postpartum depression. A standard terminology is necessary for disrespectful and abusive care during childbirth, as well as the elaboration of a measurement instrument that is universally accepted.

Association between breastfeeding and perinatal depressive symptoms: A 13-months cross-lagged analysis in China

Breastfeeding is associated with perinatal depressive symptoms, the directionality of this relationship, however, remains unclear. Therefore, the present study aimed to evaluate the longitudinal relationship between breastfeeding and perinatal depressive symptoms. A longitudinal study was conducted from September 2018 to August 2020 in two cities of China. Depressive symptoms and breastfeeding behaviors were investigated during the third trimester and at 1, 3, 6, and 12 months postpartum. A total of 856 women participated in the present study. The cross-lagged model revealed that after adjustments were made for covariates, depressive symptoms at 3 and 6 months postpartum predicted breastfeeding at 6 and 12 months postpartum, respectively. Additionally, prenatal and 1-month postpartum depressive symptoms were not found to predict breastfeeding. Nor was found that breastfeeding, in turn, predicted depressive symptoms. These results indicated that women who experienced depressive symptoms at 3 months postpartum were more likely to discontinue breastfeeding. The first 3-months postpartum period seems to be the optimal time to identify and treat depressive symptoms to maintain and increase breastfeeding rates. Early intervention of perinatal depressive symptoms is warranted.

Maternal perinatal depression and child neurocognitive development: A relationship still to be clarified

Pregnancy frequently is associated with emotional conditions such as anxiety and depression. Perinatal depression has an incidence of around 12%. Only recently researcher put the attention on the effects of pre- and postpartum psychopathology on infant neurocognitive development. Neurobiology studies indicate that perinatal maternal depression can significantly affect the structure and function of children's prefrontal cortex and modulate the development of cognitive abilities from intrauterine life. On the topic, the scientific literature appears ambiguous, reporting mixed results. Some studies have found no significant differences in developmental outcomes between prenatal and postpartum exposure to maternal depression, others have suggested a greater burden of depression in pregnancy than in postpartum, and still others have emphasized the role of chronicity of symptoms rather than the period of onset. Few studies have examined the effects of different developmental trajectories of maternal depression on children's neurocognitive outcomes. The assessment of maternal health has for years been limited to postpartum depression often neglecting the timing of onset, the intensity of symptoms and their chronicity. These aspects have received less attention than they deserve, especially in relation to the effects on children's neurocognitive development. The aim of this Perspective was to highlight inconsistencies and gaps that need to be filled in the approach to the study of this problem. Given the wide heterogeneity of data in the current literature, further studies are needed to clarify these interactions. This Perspective provides an overview of current progress, future directions, and a presentation of the authors' views on the topic.

Risk factors associated with postpartum depression in a high-risk maternity clinic: a cross-sectional study

BACKGROUND

The aim of this study was to evaluate obstetric, epidemiological and social factors related to postpartum depression (PPD) and investigate possible risk factors related to this disorder, in puerperal women who had their childbirth and were referred to the High-Risk Outpatient Clinic.

METHODS

A cross-sectional study from August-December/2019 was carried out. One hundred seventy-one puerperal women were analyzed by filling out an epidemiological questionnaire and the Edinburgh Postpartum Depression Scale (EPDS) Form. Scores ≥10 were considered positive. Research on risk factors for postpartum depression was carried out.

RESULTS

29.8% of mothers had a score related with PPD. Breastfeeding without complication is protective against PPD (P=0.002 and χ²=12.533). In contrast, not having a planned pregnancy (P=0.0175, χ²=5.717), having depression at any stage of life (P=0.013, χ²=6.237), depression during pregnancy (P≤0.0001, χ²=46.201) or having a family history of depression (P=0.001, χ²=10.527), are factors associated with the development of PPD. Moreover, just having depression during pregnancy was found to be a significant risk factor for the occurrence of PPD, increasing the risk of developing this pathology by 12 times (OR=12.891).

CONCLUSIONS

Depression during pregnancy is an important risk factor for the development of PPD. This can easily be detected using the Edinburgh Postpartum Depression Scale and treated in a timely manner.

Relationship between Dietary Inflammatory Index and Postpartum Depression in Exclusively Breastfeeding Women

(1) Background: Research has shown that chronic inflammation can increase the risk of depression. The dietary inflammatory index (DII) is a novel measure of dietary inflammation, which has been used to investigate the relationship between diet and mental disorders in adults. However, little research has been conducted to establish an association between dietary inflammation (as measured by DII) and postpartum depression (PPD) in exclusively breastfeeding women. (2) Methods: In this cross-sectional study, 293 women who were exclusively breastfeeding for 6 months or less were enrolled. The DII scores were evaluated using semi-quantitative Food Frequency Questionnaires (FFQ), and the Edinburgh Postpartum Depression Scale (EPDS) was used to measure depression levels of breastfeeding mothers during the six months following delivery. The participants were classified by tertiles, and the possibility of DII being associated with PPD was assessed by binary regression analysis. (3) Results: The average DII score was 2.32 ± 1.08, which ranged from -1.66 to 4.19. The rate of depression was 60.1%. Adjusted for potential risk factors such as age, educational level, occupational level, number of babies, number of caregivers, social support level, and sleep quality, the results showed that the lowest DII score was associated with a lower risk of PPD than the highest score (OR tertile Q₁ vs. 3 = 0.47, 95% CI: 0.24, 0.93, p = 0.030). (4) Conclusions: In exclusive breastfeeding women, the inflammatory potential of dietary intake seems to be related to depression. Interventions to improve diet quality might consider including a dietary component that aims to lower chronic systemic inflammation to prevent PPD. However, the relationship between DII and PPD among Chinese women remains to be demonstrated in a larger population.

A subpopulation of oxytocin neurons initiate expression of CRF receptor 1 (CRFR1) in females post parturition

Oxytocin (OT) is essential for successful reproduction, particularly during parturition and lactation. During the postpartum period, OT also influences maternal behavior to promote bonding between mothers and their newborns, and increases stress resilience. However, the mechanism by which stress influences OT neuron activity and OT release has remained unclear. Here, we provide evidence that a subpopulation of OT neurons initiate expression of the receptor for the stress neuropeptide Corticotropin Releasing Factor (CRF), CRFR1, in reproductive females. OT neuron expression of CRFR1 begins at the first parturition and increases during the postpartum period until weaning. The percentage of OT neurons that express CRFR1 increases with successive breeding cycles until it reaches a plateau of 20-25% of OT neurons. OT neuron expression of CRFR1 in reproductive females is maintained after they are no longer actively breeding. CRFR1 expression leads to activation of OT neurons when animals are stressed. We propose a model in which direct CRF signaling to OT neurons selectively in reproductive females potentiates OT release to promote stress resilience in mothers.

Association between breastfeeding and postpartum depression: A meta-analysis

BACKGROUND

The association of breastfeeding (BF) for postpartum depression (PPD) remains controversial. Currently there are no specific guidelines on the role of BF in the management of PPD.

OBJECTIVES

To determine the association between BF and PPD.

METHODS

We searched PubMed, Cochrane Library, and EMBASE up to December 2021 for relevant articles associated between PPD and BF. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with a random-effects model.

RESULTS

A total of 8 studies with 18,570 participants were included. BF was associated with a 14% lower risk of PPD (OR 0.86, 95% CI 0.77-0.94, I² = 51.78%). For a single BF episode, BF duration of >1 month was associated a 37% lower risk (OR 0.63, 95% CI 0.47-0.79, I² = 34.98%, P = 0.19), and BF for <1 month was associated with a 6% lower risk (OR 0.94, 95% CI 0.89-0.99, I² = 0.00%, P = 0.61). Exclusive breastfeeding (EBF) compared with never breastfeeding (NBF) was associated with a 53% lower risk for PPD (OR 0.47, 95% CI 0.27-0.66, I² = 0.00%, P = 0.98). And EBF compared with partial breastfeeding (PBF) was associated with an 8% lower risk for PPD (OR 0.92, 95% CI 0.86-0.98, I² = 13.86%, P = 0.31). The subgroups we studied may be a source of heterogeneity.

CONCLUSIONS

Our results show an association between PPD and risk for BF. To confirm the conclusion, more studies with large sample sizes are required.

Effectiveness of Internet-based psychological interventions for treating perinatal depression: A systematic review and meta-analysis

BACKGROUND

Perinatal depression can result in short- and long-term adverse effects for women and their children if untreated. Psychological interventions, the preferred treatment for most women with perinatal depression, can also be provided online.

AIMS

This study aimed to provide a comprehensive and systematic review of Internet-based psychological interventions and to evaluate their effectiveness in the treatment of perinatal depression.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic literature search was conducted of six databases, including CINAHL, PubMed, Embase, Web of Science, the Cochrane Library and PsycINFO. Depression and anxiety, which were the primary and secondary results of this search, were presented as standardised mean differences (SMD) and 95% confidence intervals (CIs). This review was conducted according to the PRISMA checklist.

RESULTS

Thirteen studies involving 2158 perinatal women were included. Content, method, duration and frequency of Internet-based psychological interventions were varied. Participants indicated a high rate of satisfaction with these interventions; participants' dropout rates ranged from 2.6% to 60.8%. Meta-analysis demonstrated that Internet-based psychological interventions improved perinatal depression (SMD = -0.72, CI = [-1.02, -0.42], p < .01) and anxiety symptoms (SMD = -0.52, CI = [-0.73, -0.30], p < .01), with heterogeneity of 86% and 59%, respectively.

CONCLUSIONS

Internet-based psychological interventions are considered as convenient and effective alternative treatment for perinatal depression and anxiety. In the future, additional studies are needed to investigate the long-term effects of these interventions on the mental health of perinatal women and the effects on the growth and development of infants while controlling for the dropout rate.

RELEVANCE TO CLINICAL PRACTICE

Internet-based psychological interventions are innovative approaches to improving perinatal depressive symptoms that can leverage mental health resources and improve accessibility while promoting multidisciplinary integration. The approach, content, frequency and duration of intervention should be considered comprehensively to achieve the objectives of the intervention while maintaining compliance of women with perinatal depression.

Relationship between perceived obstetric violence and the risk of postpartum depression: An observational study

OBJECTIVE

To determine the relationship between perceived obstetric violence and the risk of postpartum depression (PPD).

DESIGN

A cross-sectional observational study SETTING: During 2019 in Spain PARTICIPANTS: 782 women who had given birth in the preceding 12 months in Spain.

MEASUREMENTS

Online questionnaires were distributed to the women via their midwives and women's associations. The questionnaire included sociodemographic and clinical variables, and questions regarding the mothers' perception of obstetric violence globally and in its different forms: verbal, physical and psycho-affective. The response rate was 93.65%. Crude and adjusted odds ratios (OR and aOR, respectively) were estimated using binary logistic regression. Risk of PPD was estimated by the Edinburgh Postnatal Depression Scale (EPDS).

FINDINGS

The mean EPDS score was 8.34 points (standard deviation: 3.80), with 25.4% (199) at risk of PPD (≥ 10 points). Risk factors for PPD included, multiparity (aOR: 1.62, 95% CI:1.10-2.39), newborn NICU admission (aOR: 1.93, 95% CI: 1.06-3.51), experiencing verbal obstetric violence (aOR: 2.02, 95% CI: 1.35-3.02), and psycho-affective obstetric violence (aOR: 2.65, 95% CI: 1.79-3.93). The perception of support during pregnancy, birth, and the puerperium was found to be a protective factor: aOR 0.15 (95% CI: 0.04-0.54) for women who perceived enough support and aOR 0.13 (95% CI: 0.0-0.45) for women who received much support KEY CONCLUSIONS: One in four women are at risk of PPD. Multiparous women, those whose newborn required NICU admission, those who lacked partner support, and those who experienced verbal or psycho-affective obstetric violence had a higher prevalence of PPD risk.

FUNDING

The authors declare that this study was conducted without funding.

Postpartum depression and associated risk factors during the COVID-19 pandemic

Objective

To describe postpartum depression and associated risk factors among postpartum patients in the United States (US) between February and July 2020. This study used a cross-sectional descriptive design to collect survey data from a convenience sample of postpartum patients who lived in the US and delivered a live infant after the US declared COVID-19 a public health emergency.

Results

Our sample included 670 postpartum patients who completed an online survey inclusive of the Edinburgh Postnatal Depression Scale (EPDS) and selected demographic items (e.g. NICU admission status, infant gestational age, infant feeding method). In our sample, 1 in 3 participants screened positive for postpartum depression and 1 in 5 had major depressive symptoms. Participants who fed their infants formula had 92% greater odds of screening positive for postpartum depression and were 73% more likely to screen positive for major depressive symptoms compared to those who breastfed or bottle-fed with their own human milk. Participants with infants admitted to a NICU had 74% greater odds of screening positive. Each 1 week increase in weeks postpartum increased the odds of screening positive by 4%. Participants who worried about themselves and their infants contracting COVID-19 had 71% greater odds of screening positive.

A randomised controlled trial evaluating the effect of a brief motivational intervention to promote breastfeeding in postpartum depression

Postpartum depression (PPD) is the most frequent psychiatric complication during the postnatal period. According to existing evidence, an association exists between the development of PPD and the maintenance of breastfeeding. A brief motivational intervention (bMI), based on the motivational interview, seems effective in promoting breastfeeding. The objective of this study was to analyse the impact of a bMI aiming to promote breastfeeding on the development of PPD and explore the mediating/moderating roles of breastfeeding and breastfeeding self-efficacy in the effect of the intervention on developing PPD. Eighty-eight women who gave birth by vaginal delivery and started breastfeeding during the immediate postpartum period were randomly assigned to the intervention group (bMI) or control group (breastfeeding education). Randomisation by minimisation was carried out. The breastfeeding duration was longer in the intervention group (11.06 (± 2.94) weeks vs 9.02 (± 4.44), p = 0.013). The bMI was associated with a lower score on the Edinburgh Postnatal Depression Scale, with a regression β coefficient of - 2.12 (95% CI - 3.82; - 0.41). A part of this effect was mediated by the effect of the intervention on the duration of breastfeeding (mediation/moderation index β = - 0.57 (95% CI - 1.30; - 0.04)). These findings suggest that a bMI aiming to promote breastfeeding has a positive impact preventing PPD mainly due to its effectiveness in increasing the duration of breastfeeding.

Sintomas de depressão pós-parto e sua associação com as características socieconômicas e de apoio social

Resumo Objetivo verificar a prevalência de sintomas de depressão pós-parto em puérperas atendidas em uma maternidade pública e sua associação com características socioeconômicas e de apoio social. Método estudo epidemiológico, analítico, do tipo transversal, em uma maternidade pública conduzido de agosto a outubro de 2017. A amostra de 330 puérperas foi entrevistada por meio da aplicação de um formulário, para mensuração da presença de sintomas de depressão pós-parto. Foi utilizada a escala de depressão pós-natal de Edimburgo. Já para mensuração do apoio social, foi utilizado o instrumento Medical Outcomes Study. A medida de associação adotada foi a razão de prevalência (RP) com intervalos de confiança de 95% (IC95%), e aplicada a regressão de Poisson ajustada. Resultados a prevalência de sintomas de DPP foi de 29,7%. A idade entre 14 e 24 anos (PR:1,60; 95%CI: 1,10–2,34), ter até 8 anos de escolaridade (RP:1,39; IC95%:1,01–2,14) e o baixo nível de suporte social afetivo (RP:1,52; IC95%:1,07–2,14) e emocional (RP:2,12; IC95%:1,41-3,19) estiveram associados à maior prevalência de sintomas de DPP. Conclusão e implicações para a prática nesse contexto, os profissionais de saúde podem possuir um papel essencial no qual podem desenvolver, em conjunto, um plano de cuidados de acordo com as necessidades da mulher em período gravídico-puerperal.

Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy

INTRODUCTION

Perinatal depression (PD) is a cluster of clinical depressive symptoms occurring globally during pregnancy or after childbirth, with a prevalence of 11.9%. Risk factors for PD among pregnant women may include personality traits of neuroticism, low personal resilience, higher anxiety, avoidance in close relationships, as well as dysfunctional coping strategies.

METHODS

We report on descriptive findings of a screening/prevention program aimed to detect depressive symptoms and associated risk factors in a large sample of women (N = 1,664) accessing the gynecological departments of the Regione Puglia (South of Italy) from July to November 2020. Pregnant women were assessed in their third trimester of pregnancy (T0), after childbirth (T1), and those at risk for PD within 1 year from delivery (T2-T4); The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time as well as other standardized measures for neuroticism, resilience, coping strategies, and quality of life.

RESULTS

Of 1,664, n = 1,541 were tested at T1, and 131 scored ≥ 12 at EPDS (14.6 ± 2.95), showing a higher risk for PD. They were followed over time at 1, 6, and 12 months after childbirth (T2-T4), and 15 of them scored ≥ 12 (EPDS) at T4. Women with a higher risk of PD also reported higher levels of neuroticism, lower levels of personal resilience, more anxiety and avoidance in close relationships, higher employment of dysfunctional coping strategies (e.g., denial, self-blame, etc.), and lower quality of life (0.0008 < all p < 0.0001).

CONCLUSION

This study confirmed the benefit of screening programs for the early detection of PD among pregnant women. We may suggest a set of risk factors to be considered in the clinical assessment of PD risk as well as the promotion of similar programs to improve depressive outcomes and pathways to care for PD on the basis of a more accurate assessment and referral.

Predictors of postpartum depression among Chinese mothers and fathers in the early postnatal period: A cross-sectional study

OBJECTIVE

Postpartum depression is a serious mental health problem in early parenthood. The prevalence of postpartum depression is currently increasing. However, no studies have yet examined and compared maternal and paternal psychological health during the early postpartum period. The objectives of this study were therefore to explore the prevalence of postpartum depression and identify its predictors among Chinese mothers and fathers in the early postpartum period.

DESIGN

A cross-sectional study was conducted from September 24, 2020 to April 7, 2021 in Guangzhou, China.

SETTING

A regional teaching hospital in Guangzhou, China, with approximately 3000 births per year.

PARTICIPANTS

Four hundred and fifty-four married couples in the 2, 3 days postpartum period following a singleton, full-term birth.

MEASUREMENTS AND FINDINGS

Participants completed the Edinburgh Postnatal Depression Scale, Parenting Satisfaction Subscale and Parenting Efficacy Subscale, Social Support Rating Scale, and the demographic and obstetric datasheet. The prevalence of depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 13) was 13.0% and 7.5% in mothers and fathers, respectively, in the early postpartum period. The predictors of maternal depression were maternal parenting satisfaction, paternal depression, maternal social support and maternal relationship with mother-in-law (adjusted R²= 0.34, F = 58.40, df = [4, 449], P < 0.001). While the predictors of paternal depression were paternal parenting satisfaction and self-efficacy, maternal depression and whether the pregnancy was planned (adjusted R²= 0.28, F = 44.85, df = [4, 449], P < 0.001).

KEY CONCLUSIONS

Maternal and paternal depression were positively correlated and were predictive factors for one another.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should screen both mothers and fathers for depression in the early postpartum period and provide targeted support during time in hospital following birth. In addition, the focus of future interventions should be on both parents rather than just mothers.

Development of a breastfeeding duration risk nomogram for use in postpartum Chinese women

Previous studies have investigated influencing factors of early discontinuation of breastfeeding, but few studies have developed an easy-to-use tool to identify risk of breastfeeding cessation at 6 months after birth. This research team aimed to develop and validate an exclusive breastfeeding duration risk nomogram in Chinese mothers. A longitudinal cohort survey was conducted. Data were collected from 394 postpartum women in three hospitals in Hubei Province, China from December 2017 to December 2018. The LASSO regression model was used to screen for optimized factors in an exclusive breastfeeding duration model. Multivariable logistic regression was applied to construct a prediction model. Discrimination and calibration were assessed using a C-index and calibration curve, and internal validity was established using bootstrapping validation. Factors integrated in the prediction risk nomogram were monthly household income (odds ratio [OR] = 1.31, 95% confidence interval [CI]: [0.95, 1.80]), experiences of breastfeeding (OR = 1.23, 95% CI: [0.92, 1.63]), attitude (OR = 1.72, 95% CI: [0.94, 3.16]), self-efficacy (OR = 2.45, 95% CI: [1.40, 4.29]), perceived insufficient milk supply (OR = 0.12, 95% CI: [0.06, 0.25]) and postpartum depression (OR = 0.06, 95% CI: [0.02, 0.17]). The model displayed good discrimination with a C-index of 0.87 (95% CI: [0.84, 0.91]) and good calibration. The C-index interval validation was confirmed to be 0.86. This study resulted in the development of a novel nomogram with good accuracy to aid healthcare professionals in assessing the probability of a mother discontinuing exclusive breastfeeding at the breast before 6 months.

Partner influences, breastfeeding, and body image and eating concerns: An expanded biopsychosocial model

BACKGROUND

Recent research among postpartum women has considered body image and eating attitudes as well as exclusive breastfeeding within common theoretical models. However, these efforts have so far neglected to include partner-related constructs, which constitutes an important gap. Thus, the aim of this study was to examine an integrated model of body image and eating concerns, and exclusive breastfeeding among mothers of infants six months and younger, that included partner appearance influences as well as general postpartum support.

METHODS

A sample of new mothers (N = 156), aged 20-47 years, mean = 32.7 (SD = 4.7) years, reported on postpartum partner support and appearance pressures, thin-ideal internalization and body dissatisfaction, symptoms of disordered eating, depression, breastfeeding self-efficacy and exclusive breastfeeding. Path analyses were conducted to test the hypothetical model.

RESULTS

Findings revealed that the final model was a good fit to these data. Postpartum partner support was associated with lower depression and higher breastfeeding self-efficacy, through which it was related to higher reports of exclusive breastfeeding and lower eating disorder symptoms. In addition, partner appearance pressures and thin-ideal internalization were associated with higher body dissatisfaction, and thin-ideal internalization was also related to lower breastfeeding self-efficacy.

CONCLUSIONS

Partner influences may be important to account for in models of body image and eating concerns among postpartum women, and exclusive breastfeeding, and further research on ways in which they can support mothers of young infants is warranted.

The Rate and Risk Factors of Postpartum Depression in Vietnam From 2010 to 2020: A Literature Review

Background: Postpartum depression (PPD) is commonly seen in women after birth and can lead to adverse effects on both the health of mothers and child(ren) development. In Vietnam, there have been a number of studies examining the rate and risk factors of PPD, but none has provided a systematic review.

Aim: This current literature review aims to summarize and synthesize the current state of knowledge of studies conducted in Vietnam to provide a comprehensive understanding of the PPD phenomena during the last 10 years.

Data Sources: A literature search was conducted relying on the most common online databases—MEDLINE/PubMed, ScienceDirect, and Google Scholar, which included articles if they (i) examined prevalence or risk factors of PPD; (ii) were conducted among Vietnamese participants using either quantitative, qualitative, or mixed-method, and (iii) were published from 2010 to 2020. After the filtering process, 18 articles were eligible to be reviewed.

Results: Research studies in Vietnam on PPD are conducted among women at and after 1-month delivery. The rate of PPD reported in Vietnam among mothers at postnatal time points from 1 to 12 months ranged from 8.2 to 48.1%. Risk factors can be clustered into three groups: personal factors, family factors, and environmental factors.

Recommendation: Further research studies should focus on examining PPD at an earlier stage within the first month after birth. The investigation of risk factors in a comprehensive manner for Vietnamese mothers would also be recommended.

Randomized Clinical Trial of a Prenatal Breastfeeding and Mental Health Mixed Management Intervention

BACKGROUND

The continuity of maternal depressive symptoms throughout the perinatal period and breastfeeding problems have adverse influences on breastfeeding.

RESEARCH AIM

To compare the feeding patterns and breastfeeding experiences, maternal health and mental health, and breastfeeding self-efficacy between women with depressive symptoms who participated in a prenatal individualized mixed management intervention and those who received usual care.

METHODS

Chinese primigravida (N = 182) with an Edinburgh Postnatal Depression Scale score ≥ 9 in late pregnancy (≥ 28 weeks and < 35 weeks) were randomly assigned to the intervention group (n = 84) or the control group (n = 84). Intervention group participants received four sessions of individualized mixed management combining psycho-education and breastfeeding education. Breastfeeding self-efficacy, feeding patterns, maternal depression, and health status were evaluated in both groups.

RESULTS

Significant differences were noted between the groups in breastfeeding self-efficacy at 42 days postpartum (p < .05) and feeding patterns at 3 months and 6 months postpartum (p < .05). Repeated measures analysis of variance showed significant differences in the EPDS scores between groups at three postpartum time points (p < .05). The intervention group had significantly lower postpartum depression as diagnosed by the MINI (p < .05).

CONCLUSIONS

A prenatal individualized mixed management intervention holds promise as an effective prevention and health promotion program addressing breastfeeding outcomes and maternal mental health.This RCT was registered (ChiCTR-IOR-17013761) with Chinese Clinical Trial Registry, http://www.chictr.org.cn/enIndex.aspx on 12/7/2017.

"It Is a Very Emotional Topic for Me"-Managing Breastfeeding Problems among German Mothers: A Qualitative Approach

Breastfeeding is associated with positive health outcomes for both child and mother. Nevertheless, some women experience breastfeeding problems which commonly lead to early cessation, or not starting breastfeeding at all. Our aim was to explore how women that have difficulties in breastfeeding perceive their situation and how they actively manage it. We conducted semi-structured interviews with 15 mothers living in Germany who had experienced breastfeeding problems. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Breastfeeding problems occurred due to different reasons and had a huge impact, as evidenced in the four main themes of the findings: individual situation, managing the situation, perceived consequences for relations, feelings, and potential future pregnancies, and perceived health consequences for the mother. They frequently experienced negative emotions, including psychological distress and mental health problems, with perceived negative consequences for the mother-infant-bonding. Trying to actively manage the situation and availability of social support seemed to have a relieving effect, whereas confrontation and lack of understanding worsened the situation. Breastfeeding problems and the inability to breastfeed can have a great influence on maternal well-being. These can affect different aspects of a mother's life, including the attachment to the child. Providing support for actively managing the situation and supporting the exchange of experience between mothers who perceive breastfeeding problems may help mothers to better deal with their situation. Our findings may help health professionals to understand what these mothers feel and how they can support these women in a sensitive way.

Hypernatremic Dehydration Risk Factors in Newborns: Prospective Case-Controlled Study

BACKGROUND

The prevalence of hypernatremic dehydration (HND) has increased in recent years most likely due to insufficient intake of breast milk as the most important factor. This study aimed to investigate risk factors of HND.

METHODS

In this study, 47 neonates whom were diagnosed to have HND were included in the study group and 96 healty neonates whom were included in the control group. While demographic data of the patients were recorded, mothers were asked to fill out the sociodemographic/ psychosocial data form, Edinburgh Postpartum Depression Scale(EPDS) and STAI I and II State and Trait Anxiety Scale. Breast milk sodium concentrations were studied from mothers of all infants. The relationship between the development of neonatal HND and risk factors affecting this condition were evaluated.

RESULTS

Being the first-born baby of the family was found to be a significant risk factor for HND. Breast milk sodium concentration was 25.8±7.9 mmol/L in the HND group which was significantly higher than the control group. Median depression score was similar in both groups and there was no statistical difference in terms of groups. The anxiety score was higher in the control group compared to the study group. There was no difference in terms of other sociodemographic / psychosocial data of mothers.

CONCLUSION

Primiparity or insufficient breastfeeding may result in elevated breast milk sodium levels and related neonatal HND. Breastfeeding support should principally target primiparous women to improve breastfeeding outcomes like as especially HND.

Father involvement, maternal depression and child nutritional outcomes in Soweto, South Africa

Father involvement in South Africa is low, despite evidence that it can improve maternal and child health and wellbeing. Within a larger randomised controlled trial, we assessed whether father involvement during and after pregnancy increased birth weight and exclusive breastfeeding through improved maternal mental health. At 6-week postnatal, mothers completed questionnaires on birth, feeding practices, social support, father involvement and postnatal depression. Father involvement during pregnancy was measured by their attendance at antenatal care and the study intervention, whereas postnatal involvement was measured by attendance at antenatal care and type of paternal support provided. Structural equation modelling was used to identify associations between father involvement, maternal depression, low birth weight and exclusive breastfeeding. Among the 212 mother-baby pairs, father involvement was very low with only 43%, 33% and 1% of partners attending early ultrasound, antenatal care and the birth of the child, respectively. Twenty-nine percent of the mothers showed signs of depression during pregnancy, compared with 7% after birth. Eighteen percent of the infants were born low birth weight, and 57% of mothers reported exclusively breastfeeding at 6 weeks. Father involvement was directly associated with postnatal depression, but it did not directly or indirectly impact exclusive breastfeeding or low birth weight. We conclude that postnatal father involvement can improve postnatal maternal depression and that men would benefit from specific guidance on how they can support mothers during and after pregnancy.

Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support

Background

Early termination of exclusive breastfeeding (EBF) and postpartum depression (PPD) are both recognized as global health problems. Recent literature reviews demonstrate a notable link between PPD and breastfeeding outcomes, however, the underlying mechanisms linking the two remain unclear.

Objectives

The aim of the study is to: 1) explore the comparative risk for PPD among new mothers who terminated EBF before the 6-month mark, compared to those who did not; and 2) test whether maternal stress and social support operate to mediate and/or moderate the relationship between EBF and PPD.

Methods

Between October 2015 and January 2016, a cross-sectional study was carried out among 426 new mothers of Bangladesh who were six months postpartum.

Results

Based on the multivariate logistic regression model, non-exclusively breastfeeding mothers were 7.58-fold more likely to experience PPD (95% CI [3.94, 14.59]) than exclusively breastfeeding mothers. Additionally, maternal stress and social support not only partially mediate the relationship between EBF and PPD but also substantially moderate this relationship. Specifically, the odds of PPD are significantly higher among mothers who had early EBF interruption in conjunction with increased stress levels and limited social support.

Conclusions

Current evidence suggests that concurrent screening for EBF difficulties and maternal stress are important red flags that might hint at complications even before mother’s screen positive for PPD. Support and care from family members can provide assistance in overcoming this issue.

Human Milk Microbiota and Oligosaccharides: A Glimpse into Benefits, Diversity, and Correlations

Human milk represents a cornerstone for growth and development of infants, with extensive array of benefits. In addition to exceptionally nutritive and bioactive components, human milk encompasses a complex community of signature bacteria that helps establish infant gut microbiota, contributes to maturation of infant immune system, and competitively interferes with pathogens. Among bioactive constituents of milk, human milk oligosaccharides (HMOs) are particularly significant. These are non-digestible carbohydrates forming the third largest solid component in human milk. Valuable effects of HMOs include shaping intestinal microbiota, imparting antimicrobial effects, developing intestinal barrier, and modulating immune response. Moreover, recent investigations suggest correlations between HMOs and milk microbiota, with complex links possibly existing with environmental factors, genetics, geographical location, and other factors. In this review, and from a physiological and health implications perspective, milk benefits for newborns and mothers are highlighted. From a microbiological perspective, a focused insight into milk microbiota, including origins, diversity, benefits, and effect of maternal diet is presented. From a metabolic perspective, biochemical, physiological, and genetic significance of HMOs, and their probable relations to milk microbiota, are addressed. Ongoing research into mechanistic processes through which the rich biological assets of milk promote development, shaping of microbiota, and immunity is tackled.

The Relationship of Breastfeeding Patterns in the Neonatal Intensive Care Unit to Maternal Symptoms of Anxiety and Depression

Background: The studies related to psychiatric disorders have demonstrated high frequency of maternal stress, anxiety, and postpartum depression in mothers who have infants in neonatal intensive care unit (NICU). It is well known that maternal anxiety and depression adversely affect breastfeeding. The research aims to examine the association between the anxiety and depressive symptom severity of NICU mothers and feeding type (exclusively breastfed [EBF] or mixed fed [MF]) of their infants within first week of life in NICU. Methods: Data were collected from 93 mothers and 105 infants in a single-center, prospective, cross-sectional, descriptive study. The state-trait anxiety and depressive symptom severity of NICU mothers were evaluated using the Spielberger State-Trait Anxiety Inventory (STAI, including Spielberger State-Trait Anxiety Inventory-State [STAI-S], Spielberger State-Trait Anxiety Inventory-Trait [STAI-T]), and Edinburgh Postnatal Depression Scale (EPDS). Results: Breastfeeding exclusivity in NICU infants was significantly related to gestational age, birth weight, prenatal steroid, and assisted reproductive technology (ART; p = 0.022, 0.041, 0.028, 0.017, respectively). The comparison of STAI-S, STAI-T, and EPDS scores of NICU mothers between EBF and MF groups revealed that STAI-T score was significantly high in EBF group than that in the MF group (p = 0.019). Logistic regression analyses showed that a 1-unit increase in STAI-T score in NICU mothers was significantly associated with a 5.7% increase in the odds of breastfeeding exclusivity within first week in postpartum period (p = 0.033; odds ratio = 1.057, 95% confidence interval = 1.004-1.113). Conclusions: Contrary to estimates, clinically significant state and trait anxiety symptoms and depressive symptoms of NICU mothers do not affect breastfeeding exclusivity negatively within first week of life in NICU. Preterm infants under 32 gestational weeks and infants born with ART have a tendency to being EBF.

Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015

INTRODUCTION

Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children.

METHODS

Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl.

RESULTS

Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother-child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3-30.2) and 6.9% (95% CI: 6.1-7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85-1.30). The sample did not have moderate or severe malnutrition.

CONCLUSIONS

There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.

An evaluation of a prenatal individualised mixed management intervention addressing breastfeeding outcomes and postpartum depression: A ramdomised controlled trial

AIMS AND OBJECTIVES

To determine the effects of an individualised mixed management combined lactation education and psychoeducation intervention on breastfeeding outcomes and postpartum depression (PPD) at 3 and 42 days postpartum.

BACKGROUND

Pregnant women with antenatal depression are prone to postpartum depression and failure in breastfeeding.

DESIGN

Eligible women participated in a randomised single-blind controlled trial. Results are reported as per the CONSORT 2010 statement.

METHODS

Participants were recruited from December 2017-August 2018 at a major teaching hospital located in Shanghai. Primiparous women (n = 182) with an Edinburgh Postnatal Depression Scale score ≥9 were randomly enrolled in the intervention group (n = 91) or the control group (n = 91). The intervention group participated in a 4-session face-to-face mixed management intervention targeting perinatal depression and breastfeeding. The control group received usual care. Breastfeeding and psychological outcomes were measured during the third trimester (≥28 weeks and <35 weeks), and at 3 and 42 days postpartum.

RESULTS

There were statistically significant differences in rates of overall and exclusive breastfeeding, initial breastfeeding experience, breastfeeding behaviour and self-efficacy between the two groups at 3 and 42 days postpartum (p < .05). Intention-to-treat linear mixed model analysis showed that EPDS scores were statistically significantly different between groups over time (F = 20.42, p < .001). Intervention group were more satisfied with their husbands' care and care received during the first month postpartum (p < .05).

CONCLUSIONS

The results demonstrate the effectiveness and feasibility of delivering an individualised mixed management intervention combining lactation guidance with psychological support during pregnancy.

RELEVANCE TO CLINICAL PRACTICE

This study supports the need to identify pregnant women at risk of perinatal depression and indicates that the prenatal individualised mixed management intervention has the potential to reduce PPD and help achieve better breastfeeding outcomes.

Psychological distress and mother-child relationship: influence of life context on a population sample (BRISA) through the use of directed acyclic graphs (DAG)

This study aimed to investigate the association between maternal psychological distress and impairment in mother-child relationship in a sample from a Northeast capital city in Brazil with a low Human Development Index, using directed acyclic graphs (DAG). A total of 3,215 women were evaluated for the presence of psychological distress through the Self Reporting Questionnaire instrument and for the mother-child relationship by the first factor of Postpartum Bonding Questionnaire, considered the most appropriate in the literature. Demographic and socioeconomic variables were used to construct a theoretical model and, after this, multivariate logistic regression was performed using variables suggested by Directed Acyclic Graphs (DAG). Psychological distress was present in 22.7% of the women and 12.6% of them presented impaired mother-child relationships. After adjustment, the variable 'maternal mental distress' remained associated with impaired mother-child relationship (RR=3.03), and among the explanatory variables only 'primary school level' (RR=1.48) was associated as a risk factor to this outcome. The results indicated that, in this population, women with psychological distress and lower schooling are more likely to present impaired mother-child relationships.

Association between maternal satisfaction with breastfeeding and postpartum depression symptoms

Background

Due to the multiple health benefits of breastfeeding, it is essential to identify factors that may negatively interfere with this healthy practice. Among such factors are postpartum depression (PPD) and maternal satisfaction with breastfeeding. The objective of this study was to evaluate the association between maternal satisfaction with breastfeeding and symptoms of PPD in the first month after childbirth.

Methods

This cross-sectional study nested in a cohort study was conducted in Porto Alegre, Brazil, with 287 puerperal women selected at two maternity hospitals, one public and one private. Women were interviewed at their homes the week after the infant completed 30 days of life. A structured questionnaire was applied, as well as instruments to evaluate maternal satisfaction with breastfeeding (Maternal Breastfeeding Evaluation Scale) and to screen for PPD (Edinburgh Postnatal Depression Scale). The association between higher satisfaction with breastfeeding (outcome) and negative PPD screening test was assessed using Poisson regression with robust variance, adjusting for specific covariables. Adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated.

Results

The prevalence of increased satisfaction with breastfeeding (defined as women with scores above the median) was 47% higher among women who screened negative for PPD when compared to those with a positive result (aPR 1.47; 95%CI 1.01–2.16). This result was adjusted for maternal age and skin color, cohabitation with the infant’s father, planned pregnancy, type of delivery, exclusive breastfeeding, and occurrence of breastfeeding problems.

Conclusions

The findings of this study showed an association between higher maternal satisfaction with breastfeeding and absence of PPD symptoms, reinforcing the importance of caring for the mental health of pregnant and puerperal women and paying attention to their satisfaction with breastfeeding.

Retrospective Comparison of the Safety and Effectiveness of Dexmedetomidine Versus Standard of Care Before and During Cesarean Delivery in a Maternity Unit in Zhengzhou, China

Background

The objective of the present study was to test the hypothesis that intravenous dexmedetomidine is safe and effective when administered to women before and during cesarean section.

Material/Methods

The analysis included 392 women who received spinal anesthesia and no analgesia prior to undergoing elective cesarean delivery. Of them, 115 women received dexmedetomidine before anesthesia and during delivery (DX cohort), 109 received normal saline before anesthesia and during delivery and dexmedetomidine after delivery (SC cohort), and 168 received normal saline only before anesthesia and during delivery (CN cohort). Data about the women’s consumption of sufentanil and ondansetron during hospitalization, onset of lactation, and hospital stays were retrospectively collected and analyzed.

Results

Most of the women in the study were primiparous (362/392). The women in the DX cohort received less sufentanil during their hospital stays than those in either of the other 2 cohorts (SC comparison: 151.45±11.15 μg vs. 175.12±25.15 μg, P<0.0001, q=8.776; CN comparison: 151.45±11.15 μg vs. 185.42±37.45 μg, P<0.0001, q=13.911). Also, the women in the DX cohort received less ondansetron before discharge and had shorter times to first lactation and hospital stays than those in the SC and CN cohorts.

Conclusions

Administering dexmedetomidine before spinal anesthesia appears to be safe and effective for women undergoing elective cesarean delivery.

Impact of Intraoperative Infusion and Postoperative PCIA of Dexmedetomidine on Early Breastfeeding After Elective Cesarean Section: A Randomized Double-Blind Controlled Trial

Objective

Few studies have investigated the effects of dexmedetomidine (DEX) on breastfeeding after cesarean delivery. A randomized double-blind controlled trial was conducted to investigate whether the administration of DEX, immediately after delivery and for patient-controlled intravenous analgesia (PCIA), can be beneficial for breastfeeding.

Patients and Methods

One hundred sixty parturients scheduled for elective cesarean section under spinal anesthesia were randomly allocated to the DEX group (a loading dose of DEX was pumped at 0.5 μg/kg within 10 min, followed by a further infusion of DEX at 0.5 μg/kg/h until the end of the surgery and PCIA for 2 days with DEX plus sufentanil) or the standard care group (infusion saline intraoperatively, and PCIA for 2 days with sufentanil). The number of days required to switch to exclusive breastfeeding within six weeks of delivery, the time to first lactation and breast milk volume on day 1 and day 2 after delivery were recorded. Recovery quality, comfort, anxiety, depression, postoperative analgesia, and adverse reactions of parturients were also assessed.

Results

Compared with the standard care group, parturients in the DEX group could be converted to exclusive breastfeeding earlier (11 [14] vs 8 [10] days, log-rank P=0.025), the first lactation time was sooner (28.38 [13.82] vs 33.79 [14.85] hrs, P=0.024), and the amount of breast milk on the second day after delivery increased (P=0.012). There was no difference between the two groups in postpartum uterine contraction pain, but postpartum rest and movement VAS scores and recovery quality score in the DEX group were better than those in the standard care group (all P<0.05). Moreover, the hospital anxiety and depression scale and anxiety subscale score on the second day after delivery and the comfort score on the third day after delivery in the DEX group were significantly better than those in the standard care group (5 [5] vs 6 [8], 2 [2] vs 3 [3], 83.58 [6.75] vs 80.48 [6.58]; P=0.013, P=0.005, P=0.006, respectively). The incidence of adverse events, such as bradycardia, vomiting, hypersomnia, hypertension and hypotension, was not significantly different between the DEX and standard care groups (6.9% vs 2.7%, 5.6% vs 13.7%, 4.2% vs 0%, 5.6% vs 2.7%, 11.1% vs 8.2%; P=0.275, P=0.158, P=0.366, P=0.681, P=0.556, respectively), except more parturients experienced nausea in the standard care group than in the DEX group (28.8% vs 11.1%, P=0.012). Furthermore, there was no difference in Neonatal Behavioral Neurological Assessment scores on the first and second days after delivery between the DEX and standard care groups (38 [3] vs 37 [2], 38.5 [2] vs 38 [2]; P=0.173, P=0.312, respectively).

Conclusion

The application of DEX in the perioperative period of cesarean section was not only conducive to the early conversion of infant feeding to exclusive breastfeeding but could also improve the recovery quality and comfort of the parturient, optimize analgesia, shorten the time to first lactation, and increase lactation.

Clinical Trials Registration

NCT03805945.

Postpartum stress and infant outcome: A review of current literature

Postpartum stress has been shown to have an association with infant growth, nutrition, bonding, temperament and ultimately childhood mental wellbeing. When persistent, recurring or chronic, it can negatively impact infant outcome, including the subscales of mental wellbeing such as growth, development, feeding, attachment and sleep. This study aims to define the physical and functional effect of postpartum stress on measures of infant mental wellbeing. A systematic review of English language articles published between 1995 and 2019 on PubMed, Medline and Psych base databases was carried out. Search terms used included postpartum, stress, infant, growth, development, nutrition, attachment and sleep. Both qualitative and quantitative studies were reviewed with eligibility criteria. Inclusion criteria of human studies, mothers diagnosed with depressive and anxiety symptoms postpartum with infant correlates were used. All animal studies and studies with women already on medication were excluded. A total of 74 articles were reviewed and summarized into postpartum stress associations with infant growth, development, nutrition, sleep and maternal fetal attachment. Postpartum stress is negatively associated with poor developmental trajectories and linear growth deficits, causing stunting in growth; poor language and cognitive development; poor gross and fine motor movement, and infant sleep. An inverse relationship exists with breast feeding and postpartum depression. More importantly, breastfeeding efficacy is important for sustaining positive infant feeding outcome. Increased maternal age during postpartum depression has been linked, as a contributing factor, to decreased maternal fetal attachment/bonding. A ripple effect exists from the association between postpartum stress and poor infant sleep. There is strong evidence that correlates PPS to infant outcome, mediated through many external factors. More research needs to be conducted to delineate and potentially mitigate the impact of modifiable factors. Not all articles in the literature were reviewed.

HIV infection, hunger, breastfeeding self-efficacy, and depressive symptoms are associated with exclusive breastfeeding to six months among women in western Kenya: a longitudinal observational study

BACKGROUND

Exclusive breastfeeding for the first six months of life is recommended for all infants. However, breastfeeding rates remain suboptimal; around 37% of infants are exclusively breastfed for the first six months globally. In Nyanza region, western Kenya, numerous challenges to breastfeeding have been identified, including food insecurity, hunger, depressive symptoms, and HIV infection. Yet, evidence to inform our understanding of how these problems influence women's breastfeeding behaviors across time is lacking. We therefore sought to examine these factors and how they interact to affect the initiation and duration of exclusive breastfeeding in this region. We hypothesized that women experiencing greater food insecurity, hunger, and/or depressive symptoms would be less likely to maintain exclusive breastfeeding for six months than women who were food secure or not depressed. We also hypothesized that women living with HIV would be more likely to maintain exclusive breastfeeding to six months compared to HIV-uninfected women.

METHODS

Women in Pith Moromo, a longitudinal cohort study in western Kenya, were surveyed at two antenatal and three postpartum timepoints (n = 275). Data were collected on breastfeeding behavior and self-efficacy, maternal food insecurity and hunger, maternal psychosocial health, and HIV status. Cox proportional hazards models were used to identify predictors of early exclusive breastfeeding cessation.

RESULTS

The majority of women (52.3%) exclusively breastfed for the first six months. In the final multivariable Cox proportional hazards model, living with HIV was associated with a 64% decrease in the rate of early exclusive breastfeeding cessation. Additionally, the rate of early exclusive breastfeeding cessation increased by 100 and 98% for those experiencing probable depression or hunger, respectively. Although there was no main effect of breastfeeding self-efficacy, the interaction between breastfeeding self-efficacy and hunger was significant, such that the rate of early exclusive breastfeeding cessation was predicted to decrease by 2% for every point increase in breastfeeding self-efficacy score (range: 0-56).

CONCLUSIONS

This study contributes to previous work demonstrating that women living with HIV more consistently exclusively breastfeed and suggests that rates of exclusive breastfeeding could be increased through targeted support that promotes maternal mental health and breastfeeding self-efficacy, while reducing maternal hunger.

TRIAL REGISTRATION

Study registration NCT02974972.

"Breast milk is important": what do nursing mothers in Fortaleza think about breastfeeding?

Abstract Objectives: to analyze the meaning of breastfeeding for nursing mothers, users of the public health network in Fortaleza city, Ceará. Methods: a cross-sectional study was carried out with nursing mothers from nine health units. The data were collected through the application of a socioeconomic and health questionnaire and the Word Free Association Test, using "breastfeeding" as an induced stimulus. The terms referred to in the Word Free Association Test were grouped into categories and analyzed by the EVOC 2000 ®software, which showed the results in a fourcell table, where the categories were distributed according to the level of meaning to the mothers. Results: the sample consisted of 279 nursing mothers. More than 60% of these women referred in receiving guidance on breastfeeding in prenatal, puerperal and childcare consultations, and 68% of them reported having no difficulties in breastfeeding. The most significant categories identified by the Word Free Association Test were: Milk, Important, Health, and Love. Conclusions: for the nursing mothers, breastfeeding is an important practice, represented by the breast milk itself, which is permeated by positive meanings. Knowing these meanings helps to understand the factors associated to early weaning, making it possible to reconstruct care directed to this public.

Prevalence of postpartum depressive symptoms in a multiethnic population and the role of ethnicity and integration

BACKGROUND

Postpartum depression (PPD) may have adverse effects on both mother and child. The aims were to determine the prevalence of postpartum depressive symptoms, PPDS, identify associations with ethnicity and with the level of social integration.

METHOD

Population-based, prospective cohort study of 643 pregnant women (58% ethnic minorities) attending primary antenatal care in Oslo. Questionnaires regarding demographics and health issues were collected through interviews. PPDS was defined as a sum score ≥ 10 by the Edinburgh Postnatal Depression Scale, used as the main outcome in logistic regression analyses, first with ethnicity, second with level of integration as main explanatory factors.

RESULTS

The prevalence of PPDS was higher in ethnic minorities 12.7% (95% CI: 9.31-16.09) than in Western Europeans 4.8% (2.26-7.34). Adverse life events, lack of social support and depressive symptoms during the index pregnancy were other significant risk factors. Western European with PPDS were more likely to have had depressive symptoms also during pregnancy than women from ethnic minorities (72.2% versus 33.3%, p = 0.041). When replacing ethnicity with integration, a low level of integration was independently associated with PPDS (2.1 (1.11-3.95)).

LIMITATIONS

Cases with PPDS were limited. Heterogeneity in the ethnic groups is a concern.

CONCLUSION

Both point prevalence and new onset of PPDS was higher among ethnic minorities than among Western Europeans. Low level of integration was associated with PPDS. Our findings suggest that clinicians should be aware of the increased risk of new cases of PPDS among ethnic minorities compared to Western European women and offer evidence-based care accordingly.