Compromised weight gain, milk intake, and feeding behavior in breastfed newborns of depressive mothers

Coding Dyadic Behavior in Caregiver-Child Interaction from a Clinical Psychology Perspective: How Should Multiple Instruments and Outcomes Be Dealt with?

The experiences children have in the interactions with their caregivers influence their developmental outcomes. To target caregiving and optimize intervention effects, the assessment of caregiver-child interactions is highly relevant for families affected by parental mental disorders. Behavioral observation is a widely used method for assessing family dynamics, and the literature offers a wide variety of instruments with which to code such data. However, a structured overview of behavioral observation instruments (BOIs) is lacking, and the multitude of types of dyadic behaviors (DBs) assessed within each BOI are complicating their application. We aim to provide an overview of the BOIs applied to families affected by mental disorders and suggest a DB taxonomy that may be used across BOIs. We first conducted a systemic literature search to identify the most frequently used BOIs and the DBs they capture in clinical psychology. Second, we asked 13 experts to sort DB terms based on perceived conceptual similarity and analyzed these results using multidimensional scaling. We found approximately 450 different terms for DBs, and we argue that DBs can be classified within two overarching dimensions, i.e., in terms of structure and in terms of reaction to a child's signals. These efforts can facilitate the coding and application of BOIs in clinical practice.

Breastfeeding, Antidepressants, and Depression in the Mercy Pregnancy and Emotional Well-Being Study

BACKGROUND:

Depression is consistently shown to predict lower rates of breastfeeding. In a handful of studies, breastfeeding has predicted lower depression symptoms. However, studies demonstrating the latter are limited in their measurement of both depression and breastfeeding and have not followed participants from pregnancy across the postpartum period.

RESEARCH AIM:

The primary aim of this study was to describe breastfeeding intentions and behaviors for the first 12 months postpartum among nonmedicated depressed, antidepressant-exposed, and control participants. The secondary aim was to examine group differences in the association between depressive symptoms and breastfeeding duration up to 12 months postpartum.

METHODS:

First-trimester women ( N = 212) were recruited into a prospective longitudinal study. Depressive disorders at baseline were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders, and depressive symptoms were measured at the first and second trimesters and 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. Breastfeeding duration, support from family and employers, and perceptions of participants' experience were measured.

RESULTS:

Depressed women and antidepressant-exposed women reported a trend toward lower rates of intention, initiation, and duration, but this did not reach statistical significance. There was a statistically significant difference on depressive symptoms for women taking antidepressants during pregnancy, compared with controls, when they continued to breastfeed for 12 months postpartum.

CONCLUSIONS:

This study did not find a strong association between depression or antidepressant use and intention to breastfeed, partner breastfeeding support, or initiation or duration of breastfeeding. However, for women who took antidepressants, there was evidence that breastfeeding for 12 months was associated with lower depressive symptoms.

The effectiveness of interventions using relaxation therapy to improve breastfeeding outcomes: A systematic review

Maternal psychological state is recognised to influence lactation success, largely by affecting milk ejection. Thus, increased psychological distress can disrupt milk flow and in the long‐term, affect milk synthesis. Conversely, it is possible that milk ejection could be improved by using relaxation therapy during breastfeeding. We performed a systematic review to evaluate the effectiveness of interventions using relaxation therapy to improve breastfeeding outcomes and to assess the consequent impact(s) on infant growth and behaviour. A literature search was performed using the PRISMA guidelines where we included intervention studies (including nonrandomised controlled studies) using relaxation therapy in breastfeeding mothers during the post‐natal period. Out of 147 identified records at the initial search, 5 studies were eligible, of which 3 were randomised controlled trials and 2 were nonrandomised or quasi‐experimental studies. These studies were conducted in Europe, America, and India and included 311 mother–infant pairs, of which 64 infants were full‐term and 247 were premature infants. Relaxation therapy was shown to increase milk yield in mothers of preterm infants in 2 randomised trials, however, the milk sampling protocol for these studies could be questioned. None of the studies investigated the consequent effects on infant outcomes. Overall, limited evidence was found on the effectiveness of relaxation therapy on breast milk composition and infant outcomes. Experimental studies with better standardisation of protocol and robust methodological design are needed to investigate the effectiveness of relaxation therapy on both breastfeeding and infant growth and behavioural outcomes.

Breastfeeding as a public health responsibility: a review of the evidence

BACKGROUND

Although intention to breastfeed in Western culture is high, many women stop breastfeeding before they are ready. From a physiological perspective, rates of primary milk insufficiency or contraindications to breastfeed should be low. However, numerous women encounter numerous barriers to breastfeeding, many of which occur at the social, cultural and political level and are therefore outside of maternal control. This review identifies and examines the impact of these barriers and considers how public health services should play a central role in creating a supportive breastfeeding environment.

METHODS

A narrative review to synthesise themes in the literature was conducted, using Web of Science, PubMed and Science Direct. Barriers to breastfeeding at the societal rather than individual level were identified (e.g. in relation to health services, policies and economic factors). Only English language papers were included.

RESULTS

Many barriers to breastfeeding exist at the societal rather than individual level. These influences are typically outside mothers' control. Five core themes were identified; the need for investment in (i) health services; (ii) population level health promotion; (iii) supporting maternal legal rights; (iv) protection of maternal wellbeing; and (v) reducing the reach of the breast milk substitute industry.

CONCLUSIONS

Although individual support is important, breastfeeding must be considered a public health issue that requires investment at a societal level. Focusing solely on solving individual issues will not lead to the cultural changes needed to normalise breastfeeding. Countries that have adopted a multicomponent public heath strategy to increase breastfeeding levels have had significant success. These strategies must be emulated more widely.

Postpartum Anxiety and Infant-Feeding Outcomes

There is increasing evidence for the effect of postpartum anxiety (PPA) on maternal and infant health outcomes. Despite evidence linking suboptimal infant-feeding outcomes with other indices of maternal mental health, the relationship between PPA and infant feeding has not yet been reviewed. A systematic review with narrative synthesis was conducted to examine the relationship between PPA and infant-feeding outcomes. Electronic searches were performed using specific keywords (eg, "postnatal anxiet*"; "breastfeed*"). A hand search of selected journals and reference lists of included articles was then conducted. All studies were considered that provided information related to PPA and infant-feeding outcomes. One hundred and two studies were identified, of which 33 were eligible. Two authors independently extracted data including study design, participants, and results. Results indicated that women with symptoms of PPA are less likely to breastfeed exclusively and more likely to terminate breastfeeding earlier. Some evidence also suggests that those experiencing PPA are less likely to initiate breastfeeding and more likely to supplement with formula in the hospital. In those who do breastfeed, PPA reduces self-efficacy, increases breastfeeding difficulties, and may negatively affect breastfeeding behaviors and breast milk composition. Heterogeneous outcomes and methodological limitations somewhat limit the comparability of findings. However, in combination with a review linking depression with similar negative infant-feeding sequelae, the findings provide evidence for the effect of negative postpartum mood on breastfeeding. Additional support for breastfeeding mothers with PPA is warranted.

Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties

AIMS

To examine the relationship between specific reasons for stopping breastfeeding and depressive symptoms in the postnatal period.

BACKGROUND

Difficulty breastfeeding has been connected to postnatal depression although it is unclear whether difficulty breastfeeding precedes or succeeds a diagnosis. However, the concept of 'breastfeeding difficulty' is wide and includes biological, psychological and social factors.

DESIGN

A cross-sectional self-report survey.

METHODS

Data were collected between December 2012 and February 2013. 217 women with an infant aged 0-6 months who had started breastfeeding at birth but had stopped before 6 months old completed a questionnaire examining breastfeeding duration and reasons for stopping breastfeeding. They further completed a copy of the Edinburgh Postnatal Depression Scale.

RESULTS

A short breastfeeding duration and multiple reasons for stopping breastfeeding were associated with higher depression score. However, in a regression analysis only the specific reasons of stopping breastfeeding for physical difficulty and pain remained predictive of depression score.

CONCLUSIONS

Understanding women's specific reasons for stopping breastfeeding rather than breastfeeding duration is critical in understanding women's breastfeeding experience and providing women with emotional support. Issues with pain and physical breastfeeding were most indicative of postnatal depression in comparison to psychosocial reasons highlighting the importance of spending time with new mothers to help them with issues such as latch.

A pilot randomised controlled trial to evaluate the feasibility and acceptability of the Baby Triple P Positive Parenting Programme in mothers with postnatal depression

Few interventions for Postnatal Depression (PND) have focused on parenting difficulties; the aim of this research was to investigate the feasibility and evaluate a parenting intervention (Baby Triple P) in women with PND. This was a pilot randomised controlled trial (RCT) to evaluate and determine the feasibility of the newly developed Baby Triple P compared with treatment as usual (TAU) in women with PND. In all, 27 female participants aged from 18 to 45 years (mean age = 28.4 years, standard deviation (SD) = 6.1), with a primary diagnosis of major depression and an infant under 12 months (mean age = 6.2 months, SD = 3.2 months), were recruited from primary care trusts in Greater Manchester, United Kingdom. Participants were randomly allocated to receive either eight Baby Triple P sessions in addition to TAU or TAU only. Outcomes were assessed at post-treatment (Time 2) and 3 months post-treatment (Time 3). Self-report outcomes were as follows: Beck Depression Inventory, Oxford Happiness Inventory, What Being the Parent of a New Baby is Like, Postpartum Bonding Questionnaire and the Brief Parenting Beliefs Scale-baby version. An assessor-rated observational measure of mother-infant interaction, the CARE Index and measure of intervention acceptability were also completed. Significant improvements from Time 1 to Time 2 and Time 1 to Time 3 were observed across both groups. Although women allocated to Baby Triple P showed more favourable improvements, the between-group differences were not significant. However, the intervention was highly acceptable to women with PND. A large-scale RCT is indicated.

Prevalence and risk factors for postpartum depressive symptoms among women enrolled in WIC

The objectives of this study were to determine the prevalence and correlates of postpartum depressive symptoms (PDS) among women with a recent live birth and specifically among women participating in and eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pregnancy Risk Assessment and Monitoring System data from 22 states in 2006-2008 (n = 75,234) were used to estimate the prevalence of PDS using a two-question screener. Associations between PDS and respondent demographics, risk factors and behaviors, and WIC program eligibility and participation were assessed using logistic regression. Overall prevalence of PDS was 13.8 %:19.8 % among WIC participants, 16.3 % among non-participants eligible for WIC, and 6.8 % of women not eligible for the program. PDS prevalence was higher among younger, less educated, and poorer women, as well as those engaging in risky behaviors during pregnancy (smoking and binge drinking), and those with an unintended pregnancy and who experienced intimate partner violence during pregnancy. Controlling for these factors, the odds of PDS were no different between WIC participants and women eligible but not participating in the program (aOR 1.08, 95 % CI 0.97-1.22), but WIC enrollees were significantly more likely than ineligible women to report PDS (aOR 1.65, 95 % CI 1.39-1.95). WIC serves more than 1 million pregnant women each year, one-fifth of whom may experience PDS. WIC has a unique opportunity to screen and provide referrals to new mothers receiving postpartum WIC benefits.