Early breastfeeding is associated with low risk of postpartum depression in Taiwanese women

Risk and protective factors for postpartum depression among Polish women - a prospective study

This prospective study conducted at a single center in 2022 aims to identify risk and protective factors for postpartum depression (PPD) in Polish women and to assess the impact of pregnancy, delivery, the postpartum period, and psychosocial factors on PPD. After delivery and 4 weeks later, 311 women filled out two questionnaires of our design related to risk factors for PPD. Immune Power Personality Questionnaire, Walsh Family Resilience Questionnaire, and Edinburg Postnatal Depression Scale were also applied. The predictors of PPD identified at two time points included: use of antidepressants, previous depressive episodes, family history of depression, risk of preterm delivery, anxiety about child's health, and breastfeeding and sleep problems. Risk factors for PPD found only after delivery were: suicidal ideation before pregnancy, stressful life events, premature rupture of the membranes, and cesarean section. Inhalation analgesia during labor reduced the PPD frequency. At 4 weeks' postpartum, regular physical activity was also predictive of PPD, while breastfeeding, financial satisfaction, and sufficient sleep duration were protective factors. PPD after delivery was negatively correlated with capacity to confide, hardiness, assertiveness, self-complexity, and communication. PPD at 4 weeks postpartum decreased belief systems, organization patterns, and communication. Two proposed self-designed questionnaires can be useful for effectively screening PPD in the Polish population.

Influence of postpartum depression on maternal-infant bonding and breastfeeding practices among mothers in Abeokuta, Ogun state

BACKGROUND

Postpartum Depression (PPD) is a severe mental health condition that adversely affects mothers and their infants. The influence of PPD on maternal-infant bonding and breastfeeding practices has been scarcely reported in Nigeria. Therefore, we examined the prevalence of PPD, the associated factors, and the relationship with maternal-infant bonding and breastfeeding practices in Abeokuta, Nigeria.

METHOD

A descriptive cross-sectional survey was conducted among 600 mothers within the extended postpartum period (≤ 1 year) from three government-owned immunisation clinics at primary, secondary, and tertiary health facilities in Abeokuta, Ogun State. PPD was assessed using the Edinburgh postnatal depression Scale (EPDS ≥ 13), and maternal-infant bonding was evaluated using the Postpartum Bonding Questionnaire (PBQ ≥ 50). We also examined breastfeeding practices (i.e. the time to initiation by 30 min, exclusive breastfeeding for 6 months and early commencement of complementary feeding by 2 months). Data was analysed using chi-square and logistics regression models at a 5% significance level.

RESULTS

The prevalence of PPD was 21.8%, 95% CI (18.7-25.3). Factors associated with PPD were maternal age: 25-34 years [AOR = 0.52; 95% CI (0.29-0.90)]; ≥ 35 years [AOR = 0.44; 95% CI (0.20-0.96)], being married [AOR = 0.43; 95% CI (0.21-0.85)], perceived stress increased the odds of PPD: moderate stress level [AOR = 8.38; 95% CI (3.50-19.9)]; high-stress level [AOR = 47.8; 95% CI (8.65-263.7)] and self-reported history of emotional problems [AOR = 3.25; 95% CI (1.43-7.38)]. There was a significant direct association between PPD and poor maternal-infant bonding [AOR = 3.91; 95% CI (1.04-4.60)]. PPD reduces the odds of early breastfeeding initiation [AOR = 0.43; 95% CI (0.28-0.68)], but no association was found between PPD and exclusive breastfeeding [AOR = 1.07; 95% CI (0.07-1.67)].

CONCLUSION

The prevalence of PPD was high in our study population and associated with poor maternal-infant bonding and late breastfeeding initiation but not with exclusive breastfeeding. Promoting maternal mental health to foster stronger mother-infant relationships and better breastfeeding practices has become crucial.

Acute Onset or Worsening of Psychiatric Symptoms Following Breastfeeding Cessation: An Illustrative Case and Literature Review

BACKGROUND

Breastfeeding shares a complex, occasionally contradictory relationship with maternal mental health. Both positive and negative mood impacts have been noted in relation to breastfeeding initiation as well as cessation. Though popular magazines and online forums discuss the onset of psychiatric symptoms following weaning, there is limited medical literature detailing this relationship.

METHODS

We describe the case of a patient who developed psychiatric symptoms shortly after weaning, including acute-onset insomnia and worsening anxiety. A literature review of psychiatric symptom development following breastfeeding cessation was conducted using the search engines PubMed, PsycINFO (EBSCOhost), and Embase. Search terms included controlled vocabulary, keywords (within title and abstract fields), synonyms, and related concepts for: postpartum period, postpartum depression, postpartum anxiety, breastfeeding cessation, breastfeeding weaning, lactation, dysphoric milk ejection reflex, and insomnia. Relevant case reports were reviewed and compared to this case. Information including the patient's age, psychiatric symptoms, past psychiatric history, medical work-up, treatment, and outcome was extracted from each article.

RESULTS

Nine patients who developed psychiatric symptoms following breastfeeding cessation were identified in six case reports. Three patients experienced recurrent symptoms in multiple pregnancies. This led to documentation of 13 discrete post-weaning syndromes. All cases involved either first-time parents, those new to breastfeeding, or those experiencing symptoms during multiple weaning periods. Table 1 synthesizes data from article review. As with our case, 11 clinical cases describe sleep changes (primarily insomnia) and 4 discuss anxiety symptoms. Treatment varied based upon symptoms experienced, with no consistently effective treatments identified across cases.

CONCLUSIONS

This case of unspecified insomnia and anxiety disorders following abrupt weaning adds to the limited literature in the field and suggests that physiologic and psychologic factors associated with breastfeeding cessation may play a role in the development or worsening of postpartum mood disorders. Intensive psychiatric treatment resulted in resolution of the patient's symptoms. The relationship between weaning and psychiatric disorders is evident in the lay press but is underrepresented in medical literature. Additional research is needed to better understand this relationship so that physicians can counsel, diagnose, and treat patients more effectively.

"A systematic review of risk factors of postpartum depression. Evidence from Asian culture "

OBJECTIVES

One of the largest health concerns, postpartum depression (PPD), has detrimental effects on new mothers, their child, and their family. Investigating under-researched risk factors for postpartum depression in Asian women is the goal of this review of the literature.

METHODS

The literature was searched using a number of electronic research databases. This review included studies that meet the following requirements: (a) they evaluated risk variables; (b) they were conducted in Asian countries using quantitative or qualitative methods; and (c) they were published in English in peer-reviewed journals between 2007 and 2023. A total of 90 studies from 14 different countries were reviewed, compiled, and synthesized.

RESULTS

In Asian countries, where rates ranged from 0.82 % to 93 %, South Korea and Japan had the lowest and highest rates of postpartum depression, respectively. The risk factors for postpartum depression were divided into five main categories: biological/physical (e.g., ABO blood group, oxytocin level), psychological (e.g., antenatal depression, body dissatisfaction, child care stress), obstetric/pediatric (e.g., loss of baby, abortions, pain), socio-demographic (e.g., low social support, poverty, loss of autonomy), and cultural (e.g., gender preference).

CONCLUSION

This phenomenon is prevalent in Asian cultures as it is in European Countries. The repercussions of untreated postpartum depression can lead to long-term psychological and developmental issues in children and strain the familial bonds essential for a nurturing environment. Moreover, understanding the specific risk factors faced by Asian women can pave the way for culturally sensitive interventions and support systems designed to address and mitigate these challenges effectively.

A systematic review of the benefits of breastfeeding against postpartum depression in low-middle-income countries

BACKGROUND

The positive impact of breastfeeding against postpartum depression has been increasingly reported. However, no studies have systematically and critically examined current evidence on breastfeeding practices' influences on postpartum depression in LMICs.

AIM

To review the influence of breastfeeding on postpartum depression in LMICs.

METHODS

We searched original research in English published over the last ten years (2012 - 2022) within 8 databases: EBSCOhost, EMBASE, Pubmed, Sage Journals, Science Direct, APA PsycArticles, Taylor & Francis, Google Scholar, and citation tracking. The risk of bias assessment used The Newcastle Ottawa Scale and The Modified Jadad Scale. We followed the PRISMA statement after the protocol had been registered on the PROSPERO. The review included 21 of 11015 articles.

RESULTS

Of 21 articles, 16 examined breastfeeding practices, 2 each investigated breastfeeding self-efficacy and breastfeeding education, and 1 each assessed breastfeeding attitude and breastfeeding support. 3 randomized control trials and 5 cohorts revealed that breastfeeding decreased the EPDS scores. However, 4 cross-sectional studies indicated that breastfeeding is nonsignificantly associated with postpartum depression.

CONCLUSION

This review indicated that breastfeeding may alleviate or prevent postpartum depression. Our findings indicated that integrating breastfeeding-related programs and policies into postpartum depression prevention may benefit public health.

REGISTRATION

PROSPERO (CRD42022315143).

Breastfeeding Self-efficacy is Inversely Associated with Postpartum Depression: Findings from a Tertiary Hospital in Saudi Arabia

Background

High breastfeeding self-efficacy is linked with lower rates of postpartum depression. No study from Saudi Arabia has previously assessed the relation between breastfeeding self-efficacy and postpartum depression.

Objective

To determine the correlation between breastfeeding self-efficacy and postpartum depression in a cohort from Saudi Arabia.

Materials and Methods

This cross-sectional study included mothers who had given birth between February to June 2022 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and were between 2 weeks and 3 months postpartum. Data were collected using a self-administered questionnaire comprising the following three sections: sociodemographic characteristics, Edinburgh Postpartum Depression Scale (EPDS), and Breastfeeding Self Efficacy Scale-Short Form (BSES-SF).

Results

A total of 257 participants completed the questionnaire, with most aged 25-34 years (59.1%). The prevalence of postpartum depression was 25.3%, and it was significantly associated with lack of support from the husband and family during pregnancy (for both, P < 0.001), history of violence (P < 0.001), family history of depression (P = 0.045), complications during pregnancy (P = 0.004), and multiple pregnancies (P = 0.004). The mean score on the BSES-SF was 47.4, and participants who scored above the mean had significantly lower rates of postpartum depression (P = 0.003). In addition, an inverse relation was noted between BSES-SF and postpartum depression scores (r = -0.297): when the scores of BSES-SF increased, the scores of postpartum depression decreased.

Conclusion

The rate of postpartum depression was high in Jeddah, Saudi Arabia; nonetheless, positive breastfeeding self-efficacy was found to be correlated with lower rates of postpartum depression. These findings indicate the need for careful screening of patients at risk of postpartum depression and for providing breastfeeding support/knowledge, both in the antenatal and postpartum periods.

The prevalence and risk factors of postpartum depression among women during the early postpartum period: a retrospective secondary data analysis

OBJECTIVE

Postpartum depression (PPD) is common and detrimental affecting both maternal health and child development. The purpose of this study was to determine the prevalence and factors of PPD screened immediately after delivery.

MATERIALS AND METHODS

A retrospective study design using secondary data analysis is applied. Four years of data, containing linkable maternal, neonate and PPD screen records between 2014 and 2018, was retrieved and combined from the electronic medical systems of MacKay Memorial Hospital in Taiwan. For each woman, the PPD screen record contained self-reported depressive symptoms assessed by the Edinburgh Postnatal Depression Scale (EPDS) within 48-72 h after delivery. A set of factors pertaining to maternal, pregnancy and obstetric, neonatal and breastfeeding were selected from the combined data set.

RESULTS

In total, 10.2% (1244 of 12,198) of women reported with the symptoms of PPD (EPDS ≥10). Through logistic regression analysis, eight predictors of PPD were identified. Specifically, PPD was shown to be associated with educational level of high school or lower (odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.27-1.93), marital status of unmarried (OR = 1.52, 95% CI 1.18-1.99), unemployed (OR = 1.26, 95% CI 1.11-1.42), Cesarean section (OR = 1.7, 95% CI 1.5-1.93), unplanned pregnancy (OR = 1.38, 95% CI = 1.22-1.57), gestational age at 24-36 weeks (OR = 1.3, 95% CI 1.08-1.56), non-intention of breastfeeding (OR = 1.7, 95% CI 1.18-2.45) and Apgar at 5 min < 7 (OR = 2.18, 95% CI 1.11-4.29).

CONCLUSION

Low educational level, unmarried, unemployed, Caesarean section, unplanned pregnancy, preterm delivery, not breastfeeding and low Apgar at 5 min are predictors for postpartum women to develop PPD. These predictors are easily recognized in the clinical environment for patient guidance, support and referral as early as possible to ensure the health and well-being of the mothers and the neonates.

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.

Mental Health Benefits of Breastfeeding: A Literature Review

Pregnancy is typically viewed as a time of emotional well-being for prospective mothers, but for some, this period can negatively impact mental health. However, the relationship between postpartum mental health and breastfeeding is not clearly understood. Considering that many health authorities recommend breastfeeding, clearly defining this relationship is important. This review aims to illustrate the effects that breastfeeding has on the mental health of postpartum mothers. An extensive computerized search was performed through databases of PubMed, CINAHL, and Medline. All studies conducted to determine the effects of breastfeeding on mental health were screened and included in this review. Search terms related to breastfeeding, postpartum, and mental health were used. This review on breastfeeding and postpartum depression (PPD) begins by discussing the correlation between lactation and the maternal stress response. Another component discussed is the duration of breastfeeding and its importance in limiting PPD symptoms. The review then shifts to focus more on the psychological aspects of breastfeeding, notably on changes to the sleep-wake cycle and mother-infant interactions. The final part of the review emphasizes the danger that early breastfeeding cessation imposes on a mother’s mental health, portraying how prenatal and early-onset postpartum depression may lead to early breastfeeding cessation. This composite collection of studies clarifies the importance of breastfeeding in reducing the incidence and severity of maternal postpartum depression.

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.

The Association of Breastfeeding with a Reduced Risk of Postpartum Depression: A Systematic Review and Meta-Analysis

Background: Previous research has noted an association between breastfeeding and a reduced risk of postpartum depression (PPD). This article provides a systematic review and meta-analysis on the possible association of the type and degree of breastfeeding and PPD. Methods: A systematic literature search in English was conducted by using PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Library Databases from their start dates until January 2021. Outcome estimates were pooled by odds ratios (ORs) or standardized mean differences. Result: Women who did not exclusively breastfeed had 89% higher odds of PPD (OR = 1.89, 95% confidence interval [CI]: 1.50-2.39). Included studies used different cutoff points for the diagnosis of PPD. Therefore, PPD in nonexclusive breastfeeding mothers was more in studies using the cutoff point 9/10 (OR 1.97, 95% CI 1.46-2.64) as symptoms of depression than those using the cutoff point 12 (OR 1.78, 95% CI 1.21-2.61). Some studies reported PPD based on means and the others reported it based on OR. Accordingly, nonexclusive breastfeeding mothers had higher odds of PPD in studies calculating the effect size based on means (OR 1.62, 95% CI 1.19-2.19) and OR (OR 2.36, 95% CI 1.65-3.39) than in other studies. Conclusion: This review showed that exclusive breastfeeding is associated with a reduced risk for PPD.

Becoming a Mother in the Shadow of COVID-19: A Grounded Theory Study

The current study aimed to explore the experiences and coping methods of primiparous (i.e., first-time) mothers during the coronavirus disease 2019 (COVID-19) pandemic. In-depth individual interviews were conducted with 17 primiparous mothers. Data were analyzed using Glaser's grounded theory analysis. A core theme emerged-Psychologically Worn Out Due to the Challenges of Becoming a Mother and Fear of Something Happening to the Baby-and was related to the following subthemes: postpartum mental health, maternal adjustment, maternal attachment, baby care, and coping methods. The study revealed that the COVID-19 pandemic negatively affects all aspects of motherhood in postpartum primiparous mothers. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Intranasal Oxytocin Restores Maternal Behavior and Oxytocin Neuronal Activity in the Supraoptic Nucleus in Rat Dams with Cesarean Delivery

Oxytocin (OT) is a key factor for maternal behavior. However, neurochemical regulation of OT neurons, the major source of OT, remains incompletely understood. Here we report the effect of intranasally-applied OT (IAO) on OT neuronal activity in the supraoptic nucleus (SON) and on maternal behavior in a rat model of cesarean delivery (CD) at day 4-5 (stage I) and day 8-9 (stage II) following delivery. We found that at stage I, CD dams exhibited significantly longer latency of pup retrieval, lower number of anogenital licks and smaller acinar area of the mammary glands. In the SON, the number of OT neurons expressing phosphorylated extracellular signal-regulated protein kinase 1/2 (pERK 1/2) decreased significantly. IAO reversed the depressive-like maternal behavior and involution-like change in the mammary glands, and restored the number of pERK1/2-positive OT neurons in CD dams. At stage II, CD did not significantly influence the latency of retrieval and pERK1/2 expression in the SON. However, CD still reduced the number of anogenital licks during suckling, which was reversed by IAO. Notably, IAO but not hypodermic OT application in CD dams significantly increased litter's body weight gains. In brain slices, CD but not CD plus IAO significantly depolarized membrane potential and increased spike duration in OT neurons. In vasopressin neurons, CD, but not CD plus IAO, significantly depolarized membrane potential and increased the firing rate. Thus, decreased OT neuronal activity and increased vasopressin neuronal activity impair maternal behavior in CD dams, which can be prevented by IAO .

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.

Early detection of mental illness for women suffering high-risk pregnancies: an explorative study on self-perceived burden during pregnancy and early postpartum depressive symptoms among Chinese women hospitalized with threatened preterm labour

BACKGROUND

The mental health of pregnant women, particularly those with elevated risks, has been an issue of global concern. Thus far, few studies have addressed the mental health of pregnant women with threatened preterm labour (TPL). This study investigated the prevalence of self-perceived burden (SPB) among Chinese women hospitalized due to TPL during pregnancy and early postpartum depressive disorders, exploring the effect of SPB and other potential risk factors on the early signs of postpartum depressive disorders.

METHODS

A self-reported survey was conducted in the obstetrics department of Anhui Provincial Hospital, China. Women hospitalized with TPL were approached 1 week after delivery. One hundred fifty women were recruited from January 2017 to December 2017. The Self-Perceived Burden Scale (SPBS) and Edinburgh Postnatal Depression Scale (EPDS) were the main measures. Descriptive statistics, Spearman correlations, and a multiple logistic regression were employed for data analysis.

RESULTS

SPB and early postpartum depressive disorders were commonly experienced by Chinese women hospitalized with TPL, and SPB was positively and significantly correlated with depressive symptoms. A multiple logistic regression analysis revealed that for the women hospitalized with TPL during pregnancy, the emotional aspect of SPB (OR = 1.42, 95% CI = 1.11-1.83, p = 0.006), age (OR = 1.14, 95% CI = 1.02-1.27, p = 0.023), occupation (OR = 3.48, 95% CI = 1.18-10.20, p = 0.023), the history of scarred uterus (OR = 7.96, 95% CI = 1.49-42.48, p = 0.015), the delivery mode of the present birth (OR = 6.19, 95% CI = 1.72-22.30, p = 0.005), and family support during pregnancy (OR = 0.60, 95% CI = 0.45-0.82, p = 0.001) were significant factors predicting early postpartum depressive symptoms.

CONCLUSION

This study indicates that SPB and early postpartum depressive disorders are prevalent mental issues among Chinese women hospitalized with TPL, and that SPB, especially perceived emotional burden, is a strong predictor of early postpartum depressive disorders. Our study suggests the necessity of paying attention to mental health issues, e.g. SPB and postpartum depressive symptoms among hospitalized women with TPL, and providing appropriate interventions at the prenatal stage to prevent adverse consequences.