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Jack A, Mullin C, Brown E, Burtner M, Standish KR, Fields A, Rosen-Carole C, Hartman S. Academy of Breastfeeding Medicine Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Period (Revised 2024). Breastfeed Med 2024; 19:575-587. [PMID: 39186728 DOI: 10.1089/bfm.2024.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Background: The Academy of Breastfeeding Medicine revised the 2015 version of this clinical protocol to review the evidence and provide recommendations related to breastfeeding promotion in the prenatal period. Key Information: Promoting and normalizing breastfeeding in the prenatal period can improve breastfeeding outcomes including initiation and duration of breastfeeding. Ideally, prenatal interventions should be a part of a comprehensive longitudinal breastfeeding support program. Recommendations: Clinicians or other health workers should discuss breastfeeding at each prenatal visit. Counseling topics should include the health benefits of breastfeeding versus not breastfeeding, the basics of breastfeeding (e.g., physiology, positioning), what to expect of hospital-based and immediate postpartum breastfeeding support (i.e., Baby-Friendly Ten Steps), and the risks of unnecessary supplementation. Medical, anatomical, and other risk factors for breastfeeding challenges should be identified, and targeted anticipatory guidance should be given. Prenatal counseling should include distribution of structured breastfeeding education at low literacy levels and in the parent's preferred language. Counseling should be culturally sensitive and patient-centered, including family members when appropriate. Prenatal support may integrate various health workers (e.g., medical doctors, midwives, community health workers, lactation consultants, among others) and include various modalities including telecommunication. Enhancing breastfeeding education for prenatal care providers is also imperative. Additional themes related to implementation of recommendations for specific populations are also reviewed.
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Affiliation(s)
- Anna Jack
- Department of Family Medicine, East Ridge Family Medicine, Department of Pediatrics, Division of Breastfeeding and Lactation Medicine, University of Rochester, Rochester, New York, USA
| | - Caroline Mullin
- Department of Family Medicine, Chobanian & Avedisian School of Medicine, Boston Medical Center and East Boston Neighborhood Health Center, Boston University, Boston, Massachusetts, USA
| | - Elizabeth Brown
- Department of Family Medicine, Highland Family Medicine, University of Rochester, Rochester, New York, USA
| | - Michele Burtner
- Department of Pediatrics, Division of Breastfeeding and Lactation Medicine, Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Katherine R Standish
- Department of Family Medicine, Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts, USA
| | - Alecia Fields
- Women's Care of Lake Cumberland, Cumberland Family Medical Center, Somerset, Kentucky, USA
| | - Casey Rosen-Carole
- Department of Pediatrics, Division of Breastfeeding and Lactation Medicine, Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Scott Hartman
- Department of Family Medicine, North Ponds Family Medicine and Maternity Care, Department of Pediatrics, Division of Breastfeeding and Lactation Medicine, University of Rochester, Rochester, New York, USA
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Holstad Y, Johansson B, Lindqvist M, Westergren A, Poromaa IS, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Wikström AK, Bay A. Breastfeeding in primiparous women with congenital heart disease - a register study. Int Breastfeed J 2024; 19:19. [PMID: 38509505 PMCID: PMC10956229 DOI: 10.1186/s13006-024-00627-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The number of pregnant women with congenital heart disease (CHD) is rising, and the disease poses increased risks of cardiovascular and obstetric complications during pregnancy, potentially impacting breastfeeding success. This study aimed to investigate breastfeeding in primiparous women with CHD compared to primiparous women without CHD, and to examine potential hindering factors for breastfeeding in women with CHD. METHODS The data were gathered between 2014 and 2019 and obtained by merging the Swedish Congenital Heart Disease Register (SWEDCON) with the Swedish Pregnancy Register. Primiparous women ≥ 18 years of age with CHD (n = 578) were matched by age and municipality to 3049 women without CHD, giving birth after 22 gestational weeks. Multivariable logistic regression analysis was used to identify factors associated with non-breastfeeding in women with CHD. RESULTS Fewer women with CHD breastfed than women without CHD two days (94% vs. 97%, p = 0.001) and four weeks after birth (84% vs. 89%, p = 0.006). When all women were analysed, having CHD was associated with non-breastfeeding at both two days and four weeks after birth. For women with CHD, body mass index (BMI) ≥ 30 (OR 3.1; 95% CI 1.4, 7.3), preterm birth (OR 6.4; 95% CI 2.1, 19.0), self-reported history of psychiatric illness (OR 2.4; 95% CI 1.2, 5.1), small for gestational age (OR 4.2; 95% CI 1.4, 12.2), and New York Heart Association Stages of Heart Failure class II - III (OR 6.0; 95% CI 1.4, 26.7) were associated with non-breastfeeding two days after birth. Four weeks after birth, factors associated with non-breastfeeding were BMI ≥ 30 (OR 4.3; 95% CI 2.1, 9.0), self-reported history of psychiatric illness (OR 2.2; 95% CI 1.2, 4.2), and preterm birth (OR 8.9; 95% CI 2.8, 27.9). CONCLUSIONS The study shows that most women with CHD breastfeed, however, at a slightly lower proportion compared to women without CHD. In addition, factors related to the heart disease were not associated with non-breastfeeding four weeks after birth. Since preterm birth, BMI ≥ 30, and psychiatric illness are associated with non-breastfeeding, healthcare professionals should provide greater support to women with CHD having these conditions.
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Affiliation(s)
- Ylva Holstad
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Maria Lindqvist
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | | | | | | | - Mikael Dellborg
- Department of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
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Miller EB, Whipps MDM, Bogen DL, Morris PA, Mendelsohn AL, Shaw DS, Gross RS. Collateral benefits from a school-readiness intervention on breastfeeding: A cross-domain impact evaluation. MATERNAL & CHILD NUTRITION 2022; 19:e13446. [PMID: 36218286 PMCID: PMC9749611 DOI: 10.1111/mcn.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
This study evaluated the collateral, or unanticipated, impacts of Smart Beginnings (SB), a two-site, tiered intervention designed to promote responsive parenting and school readiness, on breastfeeding intensity in a low-income sample. Impact analyses for the SB intervention were conducted using an intent-to-treat design leveraging a two-arm random assignment structure. Mothers assigned to the SB intervention group were more than three times more likely to give breastmilk as the only milk source at infant age 6 months than mothers assigned to the control group at one site, an effect not evident at the other study site. As development and growth are the two most salient domains of child health, understanding how interventions impact subsequent parenting practices across both domains is critical to address long-term economic and racial/ethnic disparities. Implications of the findings are discussed for improving the efficacy of interventions based on paediatric primary care.
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Affiliation(s)
- Elizabeth B. Miller
- Department of Population HealthNYU Grossman School of MedicineNew YorkNew YorkUSA
| | | | - Debra L. Bogen
- Department of PediatricsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Pamela A. Morris
- Department of Applied PsychologyNew York UniversityNew YorkNew YorkUSA
| | - Alan L. Mendelsohn
- Department of PediatricsNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Daniel S. Shaw
- Department of PsychologyUniversity of Pittsburgh, PittsburghPennsylvaniaUSA
| | - Rachel S. Gross
- Department of PediatricsNYU Grossman School of MedicineNew YorkNew YorkUSA
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Jordan S, Bromley R, Damase-Michel C, Given J, Komninou S, Loane M, Marfell N, Dolk H. Breastfeeding, pregnancy, medicines, neurodevelopment, and population databases: the information desert. Int Breastfeed J 2022; 17:55. [PMID: 35915474 PMCID: PMC9343220 DOI: 10.1186/s13006-022-00494-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background The pharmacoepidemiology of the long-term benefits and harms of medicines in pregnancy and breastfeeding has received little attention. The impact of maternal medicines on children is increasingly recognised as a source of avoidable harm. The focus of attention has expanded from congenital anomalies to include less visible, but equally important, outcomes, including cognition, neurodevelopmental disorders, educational performance, and childhood ill-health. Breastfeeding, whether as a source of medicine exposure, a mitigator of adverse effects or as an outcome, has been all but ignored in pharmacoepidemiology and pharmacovigilance: a significant ‘blind spot’. Whole-population data on breastfeeding: why we need them Optimal child development and maternal health necessitate breastfeeding, yet little information exists to guide families regarding the safety of medicine use during lactation. Breastfeeding initiation or success may be altered by medicine use, and breastfeeding may obscure the true relationship between medicine exposure during pregnancy and developmental outcomes. Absent or poorly standardised recording of breastfeeding in most population databases hampers analysis and understanding of the complex relationships between medicine, pregnancy, breastfeeding and infant and maternal health. The purpose of this paper is to present the arguments for breastfeeding to be included alongside medicine use and neurodevelopmental outcomes in whole-population database investigations of the harms and benefits of medicines during pregnancy, the puerperium and postnatal period. We review: 1) the current situation, 2) how these complexities might be accommodated in pharmacoepidemiological models, using antidepressants and antiepileptics as examples; 3) the challenges in obtaining comprehensive data. Conclusions The scarcity of whole-population data and the complexities of the inter-relationships between breastfeeding, medicines, co-exposures and infant outcomes are significant barriers to full characterisation of the benefits and harms of medicines during pregnancy and breastfeeding. This makes it difficult to answer the questions: ‘is it safe to breastfeed whilst taking this medicine’, and ‘will this medicine interfere with breastfeeding and/ or infants’ development’?
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Affiliation(s)
- Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK.
| | - Rebecca Bromley
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Christine Damase-Michel
- Faculté de Médecine, Center for Epidemiology and Research in POPulation Health (CERPOP), Université Toulouse III, CHU Toulouse INSERM, Pharmacologie Médicale, Toulouse, France
| | - Joanne Given
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
| | - Sophia Komninou
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Maria Loane
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
| | - Naomi Marfell
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK
| | - Helen Dolk
- Faculty Life & Health Sciences, University of Ulster, Co Antrim, Newtownabbey, N Ireland, UK
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Screening for Postpartum Depression in a Neonatal Intensive Care Unit. Adv Neonatal Care 2022; 22:E102-E110. [PMID: 34966058 DOI: 10.1097/anc.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is a common mental health condition that affects approximately 13% of postpartum women in the United States. However, the prevalence in the neonatal intensive care unit (NICU) has been shown to be higher. Routine screening for maternal PPD is recommended at infant primary care well-child visits up to 6 months of age. The absence of a routine PPD screening program in a level IV NICU created a large gap in screening in an at-risk population. PURPOSE To develop and implement a screening program in the NICU to increase the identification of maternal PPD symptoms and to develop both a referral algorithm for NICU staff to follow and a referral resource packet to be given to mothers with positive PPD screenings. METHODS Mothers with infants in the NICU were screened for PPD using the Edinburgh Postnatal Depression Scale (EPDS). Bedside nurses administered the screening tool and used a referral algorithm to determine appropriate follow-up. EPDS scores of 10 or more were considered positive and indicated a need for referral. RESULTS The overall EPDS screening compliance was 66% with a positive rate of 26%. Nurses followed the referral algorithm appropriately 100% of the time. It was confirmed that 93% of the mothers with positive EPDS screenings sought help from a mental health provider. IMPLICATIONS FOR PRACTICE AND RESEARCH Routine maternal PPD screening should be implemented in all NICU settings. Postpartum mental health issues should not be the sole responsibility of obstetricians, mental health providers, or maternal primary care providers.
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Bradshaw H, Riddle JN, Salimgaraev R, Zhaunova L, Payne JL. Risk factors associated with postpartum depressive symptoms: A multinational study. J Affect Disord 2022; 301:345-351. [PMID: 34979186 DOI: 10.1016/j.jad.2021.12.121] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/03/2021] [Accepted: 12/30/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the association between maternal age, parity, gestational number (singleton vs twin), newborn gender and self-reported postpartum depressive symptoms (PDS) in a large multinational sample using survey data from a digital telephone application. METHODS Women using the Flo app answered a survey (available in 10 languages) from January 2018 to April 2020. A survey question asking about emotional state was used to determine the presence of PDS. Chi-squared statistics were used to compare groups. A weighted mean prevalence was calculated based upon the socioeconomic status and reproductive population of each country in 2020. RESULTS Over a million women from 138 countries participated. Of all respondents, 9.4% endorsed PDS. The weighted mean prevalence of PDS was 11%. We found that PDS decreased with advancing age. First-time mothers reported higher rates of PDS. Twin births were associated with a higher symptom burden than singleton births and mothers of twins in the oldest age group reported the greatest burden. We did not find a clinically significant difference in rates of PDS between mothers of singleton girls and boys. CONCLUSIONS To our knowledge, this study is the first to examine risk factors for postpartum symptoms using the same survey across a large international population. These results can further research and clinical aims to identify and treat maternal depression more effectively. LIMITATIONS Data was aggregated, thereby limiting analysis of individual associations. The survey was self-report and not diagnostic for postpartum depression. Generalizability of risks of postpartum depression should be approached with caution.
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Affiliation(s)
- Helen Bradshaw
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Women's Mood Disorders Center, 550 North Broadway, Suite 305, Baltimore, MD 21025, USA
| | - Julia N Riddle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Women's Mood Disorders Center, 550 North Broadway, Suite 305, Baltimore, MD 21025, USA
| | - Rodion Salimgaraev
- Flo Health, Inc. 1013 Centre Road, Suite 403-B, Wilmington, DE, 19805, USA
| | - Liudmila Zhaunova
- Flo Health, Inc. 1013 Centre Road, Suite 403-B, Wilmington, DE, 19805, USA
| | - Jennifer L Payne
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Women's Mood Disorders Center, 550 North Broadway, Suite 305, Baltimore, MD 21025, USA; Department of Psychiatry and Neurobehavioral Sciences, Reproductive Pschiatry Research Program, PO Box 800548, Charlottesville, VA 22908.
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Kim S, Park M, Ahn S. The Impact of Antepartum Depression and Postpartum Depression on Exclusive Breastfeeding: A Systematic Review and Meta-Analysis. Clin Nurs Res 2021; 31:866-880. [PMID: 34719979 DOI: 10.1177/10547738211053507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to systematically review the impact of antepartum depression on exclusive breastfeeding. A total of 15 studies were included in the review and 12 studies were used for the meta-analysis. The mean values of antepartum depression indicated that women who breastfed exclusively between 3 and 6 months had less antepartum depression symptoms (Mean Difference = -0.55, 95% CI = -0.76 to -0.35). The analysis also showed that the existence of antepartum depression was negatively related to continuing exclusive breastfeeding for longer than 3 months postpartum as well as for 8 weeks postpartum (OR = 0.48, 95% CI = 0.26-0.88 and OR = 0.83, 95% CI = 0.75-0.91, respectively). The cumulative evidence is conclusive that antepartum depressive symptoms are negatively associated with exclusive breastfeeding, particularly between 3 and 6 months postpartum. This review supports the necessity of screening and follow-up for depression throughout the perinatal period to promote exclusive breastfeeding for 6 months.
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Affiliation(s)
- Sehee Kim
- Chungnam National University, Daejeon, Republic of Korea
| | - Mihyeon Park
- Chungnam National University, Daejeon, Republic of Korea
| | - Sukhee Ahn
- Chungnam National University, Daejeon, Republic of Korea
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Woldetensay YK, Belachew T, Ghosh S, Kantelhardt EJ, Biesalski HK, Scherbaum V. The effect of maternal depressive symptoms on infant feeding practices in rural Ethiopia: community based birth cohort study. Int Breastfeed J 2021; 16:27. [PMID: 33743775 PMCID: PMC7980325 DOI: 10.1186/s13006-021-00375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Maternal depression and other psychosocial factors have been shown to have adverse consequences on infant feeding practices. This study explored the longitudinal relationship of maternal depressive symptoms and other selected psychosocial factors with infant feeding practices (IFPs) in rural Ethiopia using summary IFP index. METHODS This study uses existing data from the ENGINE birth cohort study, conducted from March 2014 to March 2016 in three districts in the southwest of Ethiopia. A total of 4680 pregnant women were recruited and data were collected once during pregnancy (twice for those in the first trimester), at birth, and then every 3 months until the child was 12 months old. A standardized questionnaire was used to collect data on IFPs, maternal depressive symptoms, household food insecurity, intimate partner violence (IPV), maternal social support, active social participation, and other sociodemographic variables. A composite measure of IFP index was computed using 14 WHO recommended infant and young child feeding (IYCF) practice indicators. High IFP index indicated best practice. Prenatal and postnatal maternal depressive symptoms were assessed using the patient health questionnaire (PHQ-9). Linear multilevel mixed effects model was fitted to assess longitudinal relationship of IFPs with maternal depression and other psychosocial factors. RESULTS Reports of higher postnatal depressive symptoms (ß = - 1.03, P = 0.001) and IPV (ß = - 0.21, P = 0.001) were associated with lower scores on the IFP index. Whereas, reports of better maternal social support (ß = 0.11, P = 0.002) and active social participation (ß = 0.55, P < 0.001) were associated with higher scores on the IFP index. Contrary to expectations, moderate household food insecurity (ß = 0.84, P = 0.003), severe household food insecurity (ß = 1.03, P = 0.01) and infant morbidity episodes (ß = 0.63, P = 0.013) were associated with higher scores on the IFP index. CONCLUSIONS Overall, a multitude of factors are related to IFPs and hence coordinated, multi-sectoral and multi-stakeholder interventions including maternal depressive symptoms screening and management are needed to improve infant feeding practices.
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Affiliation(s)
- Yitbarek Kidane Woldetensay
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Tefera Belachew
- Department of Population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Shibani Ghosh
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, USA
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Faculty of Medicine, Martin-Luther University, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther University, Halle, Germany
| | - Hans Konrad Biesalski
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutrition Science (140a), University of Hohenheim, Stuttgart, Germany
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Luo W, Lim PH, Wert SL, Gacek SA, Chen H, Redei EE. Hypothalamic Gene Expression and Postpartum Behavior in a Genetic Rat Model of Depression. Front Behav Neurosci 2020; 14:589967. [PMID: 33192370 PMCID: PMC7649805 DOI: 10.3389/fnbeh.2020.589967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023] Open
Abstract
Postpartum depression is a complex illness that often occurs in genetically predisposed individuals. Closely related inbred rat strains are a great resource to identify novel causative genes and mechanisms underlying complex traits such as postpartum behavior. We report differences in these behaviors between the inbred depression model, Wistar Kyoto (WKY) More Immobile (WMI), and the isogenic control Wistar Kyoto Less Immobile (WLI) dams. WMI dams showed significantly lower litter survival rate and frequency of arched back and blanket nursing, but increased pup-directed licking, grooming, and retrieval during postpartum days (PPD) 1-10, compared to control WLIs. This increased pup-directed behavior and the frequency of self-directed behaviors segregated during selective breeding of the progenitor strain of WKY, which is also a depression model. These behaviors are manifested in the WMIs in contrast to those of WLIs. Furthermore, habitual differences in the self-directed behavior between light and dark cycles present in WLIs were missing in WMI dams. Hypothalamic transcript levels of the circadian rhythm-related gene Lysine Demethylase 5A (Kdm5a), period 2 (Per2), and the maternal behavior-related oxytocin receptor (Oxtr), vasopressin (Avp), and vasopressin receptor 1a (Avpr1a) were significantly greater in the post-weaning WMI dams at PPD 24 compared to those of WLIs, and also to those of WMI dams whose litter died before PPD 5. Expression correlation amongst genes differed in WLI and WMI dams and between the two time-points postpartum, suggesting genetic and litter-survival differences between these strains affect transcript levels. These data demonstrate that the genetically close, but behaviorally disparate WMI and WLI strains would be suitable for investigating the underlying genetic basis of postpartum behavior.
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Affiliation(s)
- Wendy Luo
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL, United States
| | - Patrick H Lim
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL, United States
| | - Stephanie L Wert
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL, United States
| | - Stephanie A Gacek
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL, United States
| | - Hao Chen
- Department of Pharmacology, Addiction Science, and Toxicology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Eva E Redei
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL, United States
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Kornstein SG, Joseph AC, Graves WC, Wallenborn JT. Prenatal Depression Severity and Postpartum Care Utilization in a Medicaid Population. WOMEN'S HEALTH REPORTS 2020; 1:468-473. [PMID: 33786513 PMCID: PMC7784765 DOI: 10.1089/whr.2020.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/25/2022]
Abstract
Background: Postpartum visits are a necessary continuum of medical care for women who are diagnosed with depression during pregnancy. However, postpartum care utilization is typically lower in populations who face adverse events and it is unclear to what extent having depression during pregnancy may compromise postpartum visit follow-up. Our study examined the association between severity of prenatal depression and postpartum care utilization among women on Medicaid. Materials and Methods: Data from a university-based, nonprofit managed care organization (2008–2012) were analyzed (N = 846). Prenatal depression severity and postpartum care utilization were determined using the International Classification of Diseases, Ninth Revision (ICD-9) codes, from medical claims records. Bivariate and multivariable logistic regression was conducted. Odds ratios and 95% confidence intervals (CIs) were calculated. Results: The majority (64.2%) of women received a mild/moderate prenatal depression diagnosis and 52.5% of the total sample attended their postpartum care visit. After adjusting for confounders, we found decreased odds of postpartum care utilization among women with less severe diagnoses. Women with a mild/moderate prenatal depression diagnosis were 12% less likely to attend the postpartum care visit compared with women with a severe prenatal depression diagnosis (adjusted odds ratio = 0.88, 95% CI = 0.65–1.19). However, this finding was not statistically significant. Conclusions: Our study did not yield evidence of a statistically significant relationship between prenatal depression severity and postpartum visit attendance among a sample of Medicaid beneficiaries. Additional research is needed to assess the association between prenatal depression severity and postpartum care use to enhance continuity of services for Medicaid-insured women into the postpartum period.
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Affiliation(s)
- Susan G Kornstein
- Department of Psychiatry, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anny-Claude Joseph
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Whitney C Graves
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jordyn T Wallenborn
- Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Pratt BA, Longo J, Gordon SC, Jones NA. Perceptions of Breastfeeding for Women with Perinatal Depression: A Descriptive Phenomenological Study. Issues Ment Health Nurs 2020; 41:637-644. [PMID: 32243211 DOI: 10.1080/01612840.2019.1691690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Women with perinatal depression have an increased risk for breastfeeding cessation, yet few studies have explored their lived experience. In this qualitative study, semistructured interviews were conducted with a purposeful sample of women (N = 10) who self-reported perinatal depression. Using Giorgi's descriptive phenomenological method of data analysis, five components were found to embody their lived experience of breastfeeding: (a) choosing selflessness, (b) harboring inadequacy, (c) deliberate persevering, (d) discerning meaning, and (e) cherishing intimacy. Findings contribute to understanding the experience of breastfeeding for this population and could provide guidance to improve lactation management and perinatal mental health education for nurses.
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Affiliation(s)
- Beth A Pratt
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Joy Longo
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Shirley C Gordon
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Nancy Aaron Jones
- Department of Psychology, Florida Atlantic University, Boca Raton, Florida, USA
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12
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Radoff K, Forman R. Lactation Education for Resident Obstetricians: Promoting Breastfeeding Advocates for the Future. J Midwifery Womens Health 2019; 64:754-762. [PMID: 31608544 DOI: 10.1111/jmwh.13037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022]
Abstract
Obstetrics and gynecology residency training programs are historically lacking in breastfeeding education and advocacy. Healthy People 2020 supports interventions that promote breastfeeding as a primary care strategy with significant health benefits to the newborn and woman. Midwives are well poised to engage obstetrics and gynecology residents in lactation education. A few educational interventions have been described in the literature to increase knowledge, confidence, and behavior related to lactation among residents. This article describes a breastfeeding education curriculum developed by midwifery faculty at Boston University School of Medicine. The project included 3 lectures and a simulation center workshop covering topics including lactogenesis, prenatal, intrapartum, and postpartum interventions that promote or limit lactation, hands-on latch assistance, hand expression, use of breast pumps and storage of human milk, and common disorders of lactation. Postintervention evaluations demonstrated improvements in knowledge and confidence. Providing breastfeeding education to resident physicians may be an intervention to promote patient breastfeeding education and support and close the gap of disparities in breastfeeding rates.
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Affiliation(s)
- Kari Radoff
- Boston University School of Medicine, Boston, Massachusetts
| | - Rosha Forman
- Boston University School of Medicine, Boston, Massachusetts
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