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Armstrong S, Fernando R. Chronic consequences of accidental dural puncture and postdural puncture headache in obstetric anaesthesia - sieving through the evidence. Curr Opin Anaesthesiol 2024; 37:533-540. [PMID: 39258349 DOI: 10.1097/aco.0000000000001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
PURPOSE OF REVIEW Accidental dural puncture (ADP) and postdural puncture headache (PDPH) are relatively common complications of neuraxial anaesthesia and analgesia in obstetrics. Both may result in acute and chronic morbidity. This review intends to discuss the chronic implications of ADP and PDPH and raise awareness of severe and potentially life-threatening conditions associated with them. RECENT FINDINGS ADP may be associated with a high rate of PDPH, prolonged hospitalization and increased readmissions. Studies have shown that PDPH may lead to chronic complications such as post-partum depression (PPD), post-traumatic stress disorder (PTSD), chronic headache, backache and reduced breastfeeding rates. There are many case reports indicating that major, severe, life-threatening neurologic complications may follow PDPH in obstetric patients including subdural haematoma and cerebral venous thrombosis. SUMMARY Many clinicians still believe that ADP and PDPH are benign and self-limiting conditions whereas there may be serious and devastating consequences of both. It is imperative that all women with ADP and PDPH are appropriately diagnosed and treated.
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Affiliation(s)
- Sarah Armstrong
- Frimley Health Foundation Trust, Surrey
- St George's University London Medical School, London
- Southampton University, Southampton, UK
| | - Roshan Fernando
- Department of Anesthesiology and Intensive Care Medicine, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
- University College London, London, UK
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2
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Hare MM, Barber A, Shaffer SA, Deligiannidis KM. Bidirectional associations between perinatal allopregnanolone and depression severity with postpartum gray matter volume in adult women. Acta Psychiatr Scand 2024. [PMID: 38923502 DOI: 10.1111/acps.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 04/30/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Perinatal depression (PND) is a debilitating condition affecting maternal well-being and child development. Allopregnanolone (ALLO) is important to perinatal neuroplasticity, however its relationship with depression severity and postpartum structural brain volume is unknown. METHOD We examined perinatal temporal dynamics and bidirectional associations between ALLO and depression severity and the association between these variables and postpartum gray matter volume, using a random intercept cross-lagged panel model. RESULTS We identified a unidirectional predictive relationship between PND severity and ALLO concentration, suggesting greater depression severity early in the perinatal period may contribute to subsequent changes in ALLO concentration (β = 0.26, p = 0.009), while variations in ALLO levels during the perinatal period influences the development and severity of depressive symptoms later in the postpartum period (β = 0.38, p = 0.007). Antepartum depression severity (Visit 2, β = 0.35, p = 0.004), ALLO concentration (Visit 2, β = 0.37, p = 0.001), and postpartum depression severity (Visit 3, β = 0.39, p = 0.031), each predicted the right anterior cingulate volume. Antepartum ALLO concentration (Visit 2, β = 0.29, p = 0.001) predicted left suborbital sulcus volume. Antepartum depression severity (Visit 1, β = 0.39, p = 0.006 and Visit 2, β = 0.48, p < 0.001) predicted the right straight gyrus volume. Postpartum depression severity (Visit 3, β = 0.36, p = 0.001) predicted left middle-posterior cingulate volume. CONCLUSION These results provide the first evidence of bidirectional associations between perinatal ALLO and depression severity with postpartum gray matter volume.
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Affiliation(s)
- Megan M Hare
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Anita Barber
- Department of Psychiatry, Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Scott A Shaffer
- The Mass Spectrometry Facility, UMass Chan Medical School, Shrewsbury, Massachusetts, USA
| | - Kristina M Deligiannidis
- Department of Psychiatry, Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Departments of Psychiatry, Molecular Medicine and Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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3
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Dennis CL, Singla DR, Brown HK, Savel K, Clark CT, Grigoriadis S, Vigod SN. Postpartum Depression: A Clinical Review of Impact and Current Treatment Solutions. Drugs 2024; 84:645-659. [PMID: 38811474 DOI: 10.1007/s40265-024-02038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a summary of postpartum depression, examining the etiology and consequences, pharmacological and psychological treatments, and potential mechanisms of change and current barriers to care. Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible. Key potential mechanisms underlying their effectiveness include treatment variables (e.g., dosage and therapeutic alliance) and patient behaviors (e.g., activation and avoidance and emotional regulation). Among pharmacological treatments, the selective serotonin reuptake inhibitor (SSRI) sertraline is generally the first-line antidepressant medication recommended to women in the postpartum period due to its minimal passage into breastmilk and the corresponding decades of safety data. Importantly, most antidepressant drugs are considered compatible with breastfeeding. Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available. Barriers to widespread access to treatment include those that are systematic (e.g., lack of specialist providers), provider-driven (e.g., lack of flexibility in treatment delivery), and patient-driven (e.g., stigma and lack of time for treatment engagement). We propose virtual care, task-sharing to non-specialist treatment providers, and collaborative care models as potential solutions to enhance the reach and scalability of effective treatments to address the growing burden of postpartum depression worldwide and its negative impact on families and society.
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Affiliation(s)
- Cindy-Lee Dennis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Rm 280, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Daisy R Singla
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Katarina Savel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Crystal T Clark
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
- Women's College Research Institute, Toronto, Canada
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Carvalho Hilje C, Bauer NH, Reis D, Kapp C, Ostermann T, Vöhler F, Längler A. The role of breastfeeding and formula feeding regarding depressive symptoms and an impaired mother child bonding. Sci Rep 2024; 14:11417. [PMID: 38763963 PMCID: PMC11102907 DOI: 10.1038/s41598-024-62168-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] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024] Open
Abstract
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.
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Affiliation(s)
- Clara Carvalho Hilje
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
- Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany
| | - Nicola H Bauer
- Institute of Midwifery Science, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Daniela Reis
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany.
- Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany.
| | - Claudia Kapp
- Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Franziska Vöhler
- Department of Obstetrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Alfred Längler
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
- Professorship for Integrative Pediatrics, Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany
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Vickers N, Matthews A, Paul G. Factors associated with informal human milk sharing among donors and recipients: A mixed-methods systematic review. PLoS One 2024; 19:e0299367. [PMID: 38457478 PMCID: PMC10923476 DOI: 10.1371/journal.pone.0299367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The multiple benefits associated with the provision of human milk exceed individual health outcomes, engendering substantial economic, societal and environmental domains. Human milk is the absolute, unparalleled source of nutrition for infants. Informal human milk sharing is a modernistic and rapidly progressing practice. No systematic review of the factors associated with this contemporary practice among donors and recipients of informal human milk sharing exists. AIM The aim of this review was to identify, evaluate, synthesize and integrate the evidence on the factors associated with informal human milk sharing among donors and recipients. METHODS A mixed methods systematic review was conducted according to the Joanna Briggs Institute methodological guidance utilizing a convergent integrated approach. The following databases were systematically searched: CINAHL, Scopus, Medline and Embase and Web of Science between inception to August 2023. A grey literature search was conducted using multiple techniques. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Twenty-four studies were included in this review. Ten integrated findings relating to the factors associated with informal human milk sharing among donors and recipients were identified. The four integrated findings pertaining to donors included: altruistic motivation and value, resistance to commercialization and overcoming inaccessibility, uniting digital and personal connectedness and lack of awareness and acceptance of informal human milk sharing in healthcare settings. The six integrated findings relating to recipients included: maternal or infant factors, superiority and advantageous impact of breastmilk, human milk bank influences, digital connections and transparency, healthcare professional facilitation of informal human milk sharing, and professional and logistical implications. CONCLUSION This review highlighted a multitude of factors that motivate, facilitate and impede the practice of informal human milk sharing. Future research is required to explore these factors further within broader geographical locations to enhance the generalizability and rigor of the body of knowledge. Further studies should consider the exploration of the experiences and psychological impact of informal human milk sharing on donors and recipients. The provision of human milk to all infants is an imperative public health endeavor and thus positioning this as a key benchmark for research and practice is crucial.
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Affiliation(s)
- Niamh Vickers
- School of Nursing, Psychotherapy and Community Health, Glasnevin Campus, Dublin City University, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | - Anne Matthews
- School of Nursing, Psychotherapy and Community Health, Glasnevin Campus, Dublin City University, Dublin, Ireland
| | - Gillian Paul
- School of Nursing, Psychotherapy and Community Health, Glasnevin Campus, Dublin City University, Dublin, Ireland
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Schwarze CE, von der Heiden S, Wallwiener S, Pauen S. The role of perinatal maternal symptoms of depression, anxiety and pregnancy-specific anxiety for infant's self-regulation: A prospective longitudinal study. J Affect Disord 2024; 346:144-153. [PMID: 37832733 DOI: 10.1016/j.jad.2023.10.035] [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] [Received: 03/20/2023] [Revised: 09/10/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Maternal symptoms of anxiety and depression are highly prevalent during pregnancy and postpartum and have the potential to impact fetal development and offspring behavior. However, research on the effects of fetal exposure to maternal subclinical affective symptoms on infant self-regulation is still lacking. Self-regulation provides a fundamental precondition for healthy development and overall life success whereas dysfunctional self-regulation can lead to behavioral problems, poor academic achievement, social rejection, and physical/mental disorders. During pregnancy and infancy, children largely depend upon their mothers in order to successfully regulate their internal states. Given the high prevalence of mothers suffering from anxiety and depressive symptoms during pregnancy and after childbirth, the aim of the present study is to explore how maternal affective symptoms change during the pre- and postnatal period, and how measures obtained in pregnancy and beyond impact self-regulation in infants, as indicated by crying-, sleeping-, and/or feeding problems. METHODS This prospective longitudinal study investigates the effects of maternal symptoms of depression, anxiety, and pregnancy-specific anxiety on infant's self-regulation in N = 225 mother-infant dyads. Maternal affective symptoms were examined at five prenatal and three postnatal time-points using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) and the Pregnancy Related Anxiety Questionnaire Revised (PRAQ-R2). Infant's self-regulation was assessed twice - at the age of three and six months - using the Crying Feeding Sleeping Scale (SFS). RESULTS Maternal pregnancy-specific anxiety was the most significant predictor for infant self-regulatory problems. It predicted crying-, sleeping, and feeding problems and explained up to 18 % of the variance. Even when controlling for maternal postpartum affective symptoms, pregnancy-specific anxiety remained a significant predictor for infant self-regulation problems. LIMITATIONS Rather homogenous sample (high socioeconomic status). Data based on maternal reports of infant behavior. CONCLUSIONS Our results suggest that fetal exposure to maternal affective symptoms - specifically pregnancy-related anxiety - plays a substantial role in the development of infant self-regulation problems, potentially mediated by epigenetic modifications. Importantly, even though maternal symptoms of depression and anxiety only reached subclinical levels, they were predictive for infant crying-, sleeping-, and feeding problems. Our findings underline the importance of early prevention and clearly tailored interventions during pregnancy and postpartum to prevent adverse outcome for mother, child and family.
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Affiliation(s)
- Cornelia E Schwarze
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany.
| | - Sina von der Heiden
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany
| | - Stephanie Wallwiener
- University Hospital Heidelberg, Department of Gynecology and Obstetrics, Heidelberg, Germany; University of Halle-Wittenberg, Department of Obstetrics and Prenatal Medicine, Halle, Germany
| | - Sabina Pauen
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany
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Klatzkow H, Gitomer S, St John-Larkin C, Scholes MA, Cooper E. Prevalence of Postpartum Depression in Mothers Presenting to a Pediatric Otolaryngology Clinic. Laryngoscope 2024; 134:973-976. [PMID: 37462331 DOI: 10.1002/lary.30901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To further understand specific risk factors for the development of postpartum depression (PPD) amongst mothers of infants with common otolaryngologic diagnoses. METHODS A prospective cohort study was performed to screen for PPD in mothers of infants presenting to the pediatric otolaryngology clinic. After obtaining consent for inclusion, subjects were administered the Edinburgh Postnatal Depression Scale, which was completed during the visit. The primary outcome measure was the rate of positive screening, with additional data obtained to include demographic and diagnostic information. RESULTS The overall rate for positive PPD screening in included subjects was 18.8%. An increased rate of positive PPD screening was demonstrated amongst the subgroups of frequent noisy breathing (25%) and lip tie (26.7%). CONCLUSION This study provides additional insight into risk factors for the development of PPD. This highlights the potential benefit of increased screening within the population of mothers presenting to the pediatric otolaryngologic clinic, which could improve long-term health outcomes for both mother and child. LEVEL OF EVIDENCE 3 Laryngoscope, 134:973-976, 2024.
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Affiliation(s)
- Hannah Klatzkow
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Sarah Gitomer
- Children's Hospital Colorado - Otolaryngology, Aurora, Colorado, U.S.A
| | | | - Melissa Anne Scholes
- University of Mississippi Medical Center - Otolaryngology, Jackson, Mississippi, U.S.A
| | - Emily Cooper
- University of Colorado - Anschutz Medical Campus, Aurora, Colorado, U.S.A
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Arshadi Bostanabad M, Hosseinzadeh M, Molazemi Z, Namdar Areshtanab H. Emotional intelligence and stress and their relationship with breastfeeding self-efficacy in mothers of premature infants. BMC Womens Health 2024; 24:15. [PMID: 38172831 PMCID: PMC10765695 DOI: 10.1186/s12905-023-02849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Premature infants need to be hospitalized in the neonatal intensive care unit (NICU) for long periods of time, which can increase anxiety and stress in their mothers. Additionally, the breastfeeding rate is lower among preterm infants. This study aimed to determine stress levels and emotional intelligence in mothers of preterm infants and their relationship with breastfeeding self-efficacy. METHODS This descriptive-correlational study was performed with a convenience sampling of 210 mothers of premature infants admitted to the neonatal intensive care unit in Tabriz, Iran in 2021. Data collection tools included socio-demographic checklist, perceived stress scale (PSS14), Dennis' breastfeeding self-efficacy scale, and the Schering emotional intelligence questionnaire. Data were analyzed using SPSS software version 16 via descriptive and inferential statistics (Pearson correlation and one-way ANOVA and modified general linear model). RESULTS Study findings demonstrated that most of the mothers had low stress (75.2%) and high breastfeeding self-efficacy (61.9%). The mean (SD) of emotional intelligence of the participants was 88.18 (16.60), ranging from 33 to 165. The results of the general linear model by modifying the demographic characteristics showed that the variables of emotional intelligence (B = 0.23, P = 0.03), stress (B=-0.56, P = 0.01), gestational age (B = 2.81, P < 0.001) and number of deliveries (B = 9.41, P < 0.001) were predictors of breastfeeding self-efficacy. CONCLUSION The findings showed that mothers of preterm infants had low emotional intelligence, and the majority of them had low perceived stress and high breastfeeding self-efficacy. Findings highlight the importance of addressing maternal stress and enhancing emotional intelligence to promote successful breastfeeding in mothers of preterm infants. Healthcare providers and managers are encouraged to offer support and educational programs to mothers of preterm infants, aiming to enhance their emotional intelligence. Further research and interventions focusing on these factors are warranted to improve the overall well-being of both mothers and infants in the neonatal intensive care unit.
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Affiliation(s)
- Mohammad Arshadi Bostanabad
- Department of Pediatric Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Hosseinzadeh
- Department of Community Health Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Molazemi
- Department of Mental Health and Psychiatric Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Namdar Areshtanab
- Department of Mental Health and Psychiatric Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
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Feldens CA, Heck ABDS, Rodrigues PH, Coelho EMRDB, Vítolo MR, Kramer PF. Ankyloglossia and Breastfeeding Duration: A Multicenter Birth Cohort Study. Breastfeed Med 2024; 19:17-25. [PMID: 38241126 DOI: 10.1089/bfm.2023.0182] [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: 01/21/2024]
Abstract
Background and Objective: The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil. Materials and Methods: This multicenter prospective cohort study involved the recruitment of mother-infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR). Results: The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1-8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79-1.23; p = 0.907). Conclusion: The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration. Clinical Trial Registration: Registered with clinicaltrials.gov (n° NCT03841123).
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Affiliation(s)
- Carlos Alberto Feldens
- Department of Pediatric Dentistry, School of Dentistry, Universidade Luterana do Brasil, Porto Alegre, Brazil
| | - Amanda Baptista da Silva Heck
- Department of Pediatric Dentistry, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Priscila Humbert Rodrigues
- Department of Pediatric Dentistry, School of Dentistry, Universidade Luterana do Brasil, Porto Alegre, Brazil
- Department of Pediatric Dentistry, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Elisa Maria Rosa de Barros Coelho
- Department of Pediatric Dentistry, School of Dentistry, Universidade Luterana do Brasil, Porto Alegre, Brazil
- Department of Pediatric Dentistry, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Márcia Regina Vítolo
- Graduate Program in Pediatrics, Child and Adolescent Health Care, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Paulo Floriani Kramer
- Department of Pediatric Dentistry, School of Dentistry, Universidade Luterana do Brasil, Porto Alegre, Brazil
- Department of Pediatric Dentistry, School of Dentistry, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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He Q, Cheng G, He S, Tian G, Xie X, Jiang N, Min X, Li C, Li R, Shi Y, Zhou T, Yan Y. Association between maternal postpartum depression and children's physical growth in early childhood: a birth cohort study. Front Pediatr 2023; 11:1135876. [PMID: 37565240 PMCID: PMC10410140 DOI: 10.3389/fped.2023.1135876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
Background Untreated maternal postpartum depression (PPD) has consequences for children's physical growth, but no published study has evaluated changes in this effect over time. Here we therefore aimed to evaluate the dynamic effects of PPD on the physical growth of children in a prospective birth cohort. Methods Between 2015 and 2019, 960 mother-child pairs in Changsha, China were followed up when the child was aged 1-48 months. Data were obtained through household surveys. The mothers' depressive symptoms were measured using the Edinburgh Postpartum Depression Scale (EPDS) at 1 month postpartum. Linear mixed models were used to examine the changes in the association of PPD and EPDS scores with physical growth in six different age groups of children between 1 and 48 months. Results A total of 604 mother-child pairs completed the follow-up, and 3.3% of mothers reported PPD. No associations were found between PPD and weight or height growth at any age. While EPDS scores were associated with weight gain (β = -0.014, 95% CI (-0.025, -0.002), P = 0.024) and height growth (β = -0.044, 95% CI (-0.084, -0.004), P = 0.030) rates at 1-3 months, no associations were found in older children. Limitations The number of mothers who reported PPD was relatively small, and the measurement of PPD was not continuously taken. Conclusions After adjustments for confounders, no dynamic association was found between PPD and children's weight and height growth. EPDS scores, in contrast, did negatively affect children's weight and height growth at age 1-3 months, but this effect was not long-lasting.
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Affiliation(s)
- Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Medical Record Management and Statistical Information Center, Xiangya Hospital, Central South University, Changsha, China
| | - Gang Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Simin He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaowei Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Ni Jiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xianying Min
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Rui Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Shi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tong Zhou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Shriyan P, Khetrapal S, van Schayck OCP, Babu GR. Maternal depressiveness and infant growth outcomes: Findings from the MAASTHI cohort study in India. J Psychosom Res 2023; 170:111378. [PMID: 37244068 PMCID: PMC7614640 DOI: 10.1016/j.jpsychores.2023.111378] [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] [Received: 09/25/2021] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The study aims to examine the association between depressiveness in mothers on infant obesity and stunting at one year of age. METHODS We enrolled 4829 pregnant women, followed them up at public health facilities in Bengaluru for one year after birth. We collected information on women's sociodemographic characteristics, obstetric history, depressive symptoms during pregnancy and delivery within 48 h. We took infant anthropometric measurements at birth and one year. We used chi-square tests, and calculated an unadjusted odds ratio using univariate logistic regression. We used multivariate logistic regression to examine the association between maternal depressiveness, childhood adiposity, and stunting. RESULTS We found that the prevalence of depressiveness was 31.8% in mothers who delivered in public health facilities in Bengaluru. Infants born to mothers with depressiveness at birth had 3.9 times higher odds of having larger waist circumference than infants born to mothers with no depressiveness (AOR: 3.96, 95% Confidence Interval: 1.24,12.58) and 1.9 times higher odds of having a larger sum of skinfold thickness (AOR: 1.99, 95% CI: 1.18,3.38). Additionally, we found that infants born to mothers with depressiveness at birth had 1.7 times higher odds of stunting than infants born to mothers with no depressiveness (AOR: 1.72; 95%CI: 1.22,2.43) after adjusting for confounders. CONCLUSION Our study highlights a high prevalence of depressiveness among mothers seeking antenatal care at a public hospital is associated with an increased risk of infant adiposity and stunting at one year. Further research is needed to understand the underlying mechanisms and identify effective interventions.
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Affiliation(s)
- Prafulla Shriyan
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, Karnataka 560023, India
| | | | - Onno C P van Schayck
- Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, the Netherlands
| | - Giridhara R Babu
- Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, Karnataka 560023, India; The Wellcome Trust/DBT India Alliance, New Delhi 110025, India.
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12
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Fricke HP, Hernandez LL. The Serotonergic System and Bone Metabolism During Pregnancy and Lactation and the Implications of SSRI Use on the Maternal-Offspring Dyad. J Mammary Gland Biol Neoplasia 2023; 28:7. [PMID: 37086330 PMCID: PMC10122632 DOI: 10.1007/s10911-023-09535-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
Lactation is a physiological adaptation of the class Mammalia and is a product of over 200 million years of evolution. During lactation, the mammary gland orchestrates bone metabolism via serotonin signaling in order to provide sufficient calcium for the offspring in milk. The role of serotonin in bone remodeling was first discovered over two decades ago, and the interplay between serotonin, lactation, and bone metabolism has been explored in the years following. It is estimated that postpartum depression affects 10-15% of the population, and selective serotonin reuptake inhibitors (SSRI) are often used as the first-line treatment. Studies conducted in humans, nonhuman primates, sheep, and rodents have provided evidence that there are consequences on both parent and offspring when serotonin signaling is disrupted during the peripartal period; however, the long-term consequences of disruption of serotonin signaling via SSRIs during the peripartal period on the maternal and offspring skeleton are not fully known. This review will focus on the relationship between the mammary gland, serotonin, and bone remodeling during the peripartal period and the skeletal consequences of the dysregulation of the serotonergic system in both human and animal studies.
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Affiliation(s)
- Hannah P Fricke
- Animal and Dairy Sciences Department, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura L Hernandez
- Animal and Dairy Sciences Department, University of Wisconsin-Madison, Madison, WI, USA.
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13
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Zhu Y, Yin X, Qiu L, Sun N, An R, Gong Y. Association between breastfeeding and perinatal depressive symptoms: A 13-months cross-lagged analysis in China. Asian J Psychiatr 2023; 82:103474. [PMID: 36709612 DOI: 10.1016/j.ajp.2023.103474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Lei Qiu
- Department of Epidemiology, School of Public Health, Hainan Medical University, Xue Yuan Road 3, Haikou 571199, Hainan, PR China.
| | - Na Sun
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Rongrong An
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
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14
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Stipelman CH, Stoddard GJ, Bennion J, Young PC, Brown LL. Real-Time Breastfeeding Documentation: Timing of Breastfeeding Initiation and Outpatient Duration. Acad Pediatr 2023; 23:351-358. [PMID: 35863738 PMCID: PMC10516406 DOI: 10.1016/j.acap.2022.07.010] [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: 01/17/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current breastfeeding guidelines promote initiating breastfeeding ≤1 h after birth to establish long-term breastfeeding. Previous studies dichotomized initiation to ≤1 h versus subsequent hours combined. There are limited data evaluating the effect of initiation in each subsequent hour on breastfeeding duration. Our objective was to evaluate the association between breastfeeding initiated at ≤1 h versus the subsequent 23 hours after birth and outpatient breastfeeding duration. METHODS In this retrospective cohort study, we analyzed real-time, discretely documented electronic health record (EHR) breastfeeding data for 3315 infants born at a university center and followed to age ≥12 mo at 27 university primary care clinics. The primary outcome was breastfeeding duration. The exposure variable was hour of breastfeeding initiation within 24 h postnatally. Data were analyzed by univariable and multivariable linear regression separately for infants born by vaginal versus cesarean delivery. RESULTS In adjusted models, initiating breastfeeding during each hour from age >1 to ≤6 h and during ages >6 to ≤24 h was not associated with decreased breastfeeding duration versus initiating breastfeeding at ≤1 h after birth for infants born via vaginal or cesarean delivery. CONCLUSIONS Delaying breastfeeding initiation to >1 to ≤24 h after birth is not associated with decreased breastfeeding duration compared with initiating breastfeeding at ≤1 h after birth. Integration of breastfeeding measures into inpatient and outpatient EHR discrete data fields may clarify best practices that support long-term breastfeeding as a public health imperative.
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Affiliation(s)
- Carole H Stipelman
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City; Sugar House Health Center, Department of Pediatrics (CH Stipelman), University of Utah School of Medicine, Salt Lake City; University Information Technology (CH Stipelman and J Bennion), University of Utah, Salt Lake City.
| | - Gregory J Stoddard
- Department of Internal Medicine (GJ Stoddard), University of Utah School of Medicine, Salt Lake City
| | - Jeff Bennion
- University Information Technology (CH Stipelman and J Bennion), University of Utah, Salt Lake City
| | - Paul C Young
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City
| | - Laura L Brown
- University Pediatric Clinic, Department of Pediatrics (CH Stipelman, PC Young, and LL Brown), University of Utah School of Medicine, Salt Lake City
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15
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Machado Ramos KC, Konopka CK, Costa AG, Schunemann GZ, Ribeiro Rios LK, Barbieri Soder Â, Aguiar Ribeiro T. Risk factors associated with postpartum depression in a high-risk maternity clinic: a cross-sectional study. Minerva Obstet Gynecol 2023; 75:7-17. [PMID: 34180614 DOI: 10.23736/s2724-606x.21.04867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Kelly C Machado Ramos
- Unit of Gynecology and Obstetrics, Health Sciences Center, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Brazil.,Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Cristine K Konopka
- Unit of Gynecology and Obstetrics, Health Sciences Center, University Hospital of Santa Maria, Federal University of Santa Maria, Santa Maria, Brazil.,Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Arthur G Costa
- Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Lúcia K Ribeiro Rios
- Health Sciences Center, Faculty of Psychology, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Tiango Aguiar Ribeiro
- Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil - .,Department of Surgery, Health Sciences Center, University Hospital of Santa Maria, Faculty of Medicine, Federal University of Santa Maria, Santa Maria, Brazil
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16
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Weldu A, Belachew A, Yilma M. The relationship between postpartum depression and appropriate infant feeding practice in eastern zone of Tigray, Ethiopia: A comparative cross-sectional study. PLoS One 2023; 18:e0280141. [PMID: 36696424 PMCID: PMC9876352 DOI: 10.1371/journal.pone.0280141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 12/21/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Understanding the relationship between postpartum depression and infant feeding practice may help to reduce the indirect impact of postpartum depression on infant feeding practice. This will further have a positive impact on reducing infant morbidity and mortality attributed to improper feeding practices. Although studies in the country have assessed the prevalence of infant feeding practices, those assessing the association between postpartum depression and infant feeding practices are lacking. Therefore, this study aimed to compare appropriate infant feeding practices and their associated factors among postpartum depressed and non-depressed mothers in Eastern Tigray. METHODS A comparative cross-sectional study was conducted from March 2019 to April 2019. A multistage random sampling technique was used to select 171 mothers with postpartum depression and 342 mothers without postpartum depression. Data were collected using a structured questionnaire from the Monitoring and Evaluating for Breastfeeding Practices toolkit, then entered into Epi- info and exported into SPSS for further analysis. A binary logistic regression was applied to determine the association between postpartum depression and appropriate infant feeding practice. RESULTS The overall prevalence of appropriate infant feeding practice was 37.6% (95% CI: 33.5%-41.9%). The prevalence was higher among mothers without postpartum depression 42.7% (95% CI: 42.9%-53.2%) than among postpartum depressed mothers 27.5% (95% CI: 24.7%-32.5%). The odds of appropriate infant feeding practice among mothers with infant birth orders of three or above was 58% (AOR = 0.42; 95% CI: 0.26-0.97) less than those mothers with infant birth orders of three and below. Households with monthly income 1000-1999 ETB (AOR = 2.26; 95% CI: 1.01-5.08), 2000-2999 ETB (AOR = 1.96; 95% CI: 1.21-4.73) and 3000-3999 ETB (AOR = 5.13; 95% CI: 1.97-13.4) were more likely to practice appropriate infant feeding. CONCLUSION The overall prevalence of appropriate infant feeding practices in the study area was low. A significantly higher proportion of mothers without postpartum depression practice appropriate infant feeding compared to mothers with postpartum depression. In addition, households with higher monthly incomes and mothers with infant birth orders three or above were significant determinants of appropriate infant feeding practice. Therefore, strengthening the provisions of nutritional education, integrating maternal mental health with routine maternal health care services, providing economic support to mothers with low income, and health education for multiparous women is a critical interventions to improve appropriate infant feeding practice.
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Affiliation(s)
- Angesom Weldu
- Department of Epidemiology, School of Public Health, Mizan Tepi University, Tepi, Ethiopia
- * E-mail:
| | - Ayele Belachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mengistu Yilma
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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17
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Rudzik AEF, Robinson-Smith L, Tugwell F, Ball HL. Relationships between postpartum depression, sleep, and infant feeding in the early postpartum: An exploratory analysis. Front Psychiatry 2023; 14:1133386. [PMID: 37032920 PMCID: PMC10079948 DOI: 10.3389/fpsyt.2023.1133386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction The study objectives were to determine the relationships between postpartum depression and maternal and infant sleep parameters and to examine the impact of infant feeding method on infant and maternal sleep and postpartum depression symptomatology. Methods Participants were 61 new mothers aged 18 to 45 years old, and their full-term, normal birth-weight, singleton infants. Participants were recruited from a large teaching hospital in northeast England. Data collection took place in participants' homes. The study used a prospective longitudinal design, with data collected at six, 12 and 18 weeks postpartum. We collected data on total sleep time, longest sleep period, wake after sleep onset, and night waking for mothers and infants objectively from actigraphic records and subjectively from maternal sleep logs. Participants reported on sleep disturbances using the General Sleep Disturbances Scale, on maternal sleepiness, and on depression symptomatology using the Edinburgh Postnatal Depression Scale. Results Scores on the Edinburgh Postnatal Depression Scale and General Sleep Disturbances Scale were consistently correlated with each other (6 weeks r = 0.452, p < 0.01; 12 weeks r = 0.317, p < 0.05; 18 weeks r = 0.493, p < 0.01), and did not correlate with objective measures or subjective reports of maternal or infant sleep. Edinburgh Postnatal Depression Scale scores at six, 12 and 18 weeks were predicted by General Sleep Disturbances Scale, prior Edinburgh Postnatal Depression Scale score, or both, but not by sleep parameters. With regard to infant feeding method, EPDS score was not higher among exclusively breastfeeding than among exclusively formula-feeding participants at any time point (6 weeks t = 0.306, p = 0.762; 12 weeks t = 0.343, p = 0.733; 18 weeks t = 0.426; p = 0.673). Different pathways emerged to predict Edinburgh Postnatal Depression Scale score for exclusively breastfeeding and exclusively formula-feeding women. Discussion Postpartum depression may be associated with disturbed sleep due to negative perception of sleep among depressed women, rather than disrupted sleep causing postpartum depression. With regard to infant feeding method, exclusively breastfeeding women are not more likely to suffer from postpartum depression, and different pathways may predict development of postpartum depression symptoms in exclusively breastfeeding and exclusively formula feeding women.
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Affiliation(s)
- Alanna E. F. Rudzik
- Durham Infancy and Sleep Centre, Durham University, Durham, United Kingdom
- Department of Anthropology, Durham University, Durham, United Kingdom
- *Correspondence: Alanna E. F. Rudzik,
| | - Lyn Robinson-Smith
- Durham Infancy and Sleep Centre, Durham University, Durham, United Kingdom
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Francesca Tugwell
- Durham Infancy and Sleep Centre, Durham University, Durham, United Kingdom
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Helen L. Ball
- Durham Infancy and Sleep Centre, Durham University, Durham, United Kingdom
- Department of Anthropology, Durham University, Durham, United Kingdom
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18
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Canfield SM, Canada KE. Systematic Review of Online Interventions to Reduce Perinatal Mood and Anxiety Disorders in Underserved Populations. J Perinat Neonatal Nurs 2023; 37:14-26. [PMID: 36707743 DOI: 10.1097/jpn.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Online health interventions increase access to care, are acceptable to end users and effective for treating mental and physical health disorders. However, less is known about interventions to prevent and treat perinatal mood and anxiety disorders (PMADs). This review synthesizes existing research on PMAD prevention and treatment by exploring the treatment modalities and efficacy of online interventions and examining the inclusion of underserved populations in PMAD research. METHODS Using PRISMA guidelines, authors conducted a systematic review of peer-reviewed literature published between 2008 and 2018 on online interventions aimed to prevent or treat PMADs. The authors also assessed quality. Eligible articles included perinatal women participating in preventive studies or those aimed to reduce symptoms of PMADs and utilized a Web-based, Internet, or smartphone technology requiring an online component. This study excluded telephone-based interventions that required one-on-one conversations or individualized, text-based responses without a Web-based aspect. RESULTS The initial search yielded 511 articles, and the final analysis included 23 articles reporting on 22 interventions. Most studies used an experimental design. However, no study achieved an excellent or good quality rating. Psychoeducation and cognitive-behavioral therapies (CBTs) were most common. Several interventions using CBT strategies significantly decreased depression or anxiety. Four studies recruited and enrolled mainly people identifying as low-income or of a racial or ethnic minority group. Attrition was generally high across studies. DISCUSSION More research using rigorous study designs to test PMAD interventions across all perinatal times is needed. Future research needs to engage diverse populations purposefully.
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Affiliation(s)
- Shannon M Canfield
- Family and Community Medicine (Dr Canfield), Center for Health Policy (Dr Canfield), and School of Social Work (Dr Canada), University of Missouri-Columbia
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19
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Zou H, Sun M, Liu Y, Xi Y, Xiang C, Yong C, Liang J, Huo J, Lin Q, Deng J. Relationship between Dietary Inflammatory Index and Postpartum Depression in Exclusively Breastfeeding Women. Nutrients 2022; 14:nu14235006. [PMID: 36501036 PMCID: PMC9738724 DOI: 10.3390/nu14235006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
(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.
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Affiliation(s)
- Hanshuang Zou
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Minghui Sun
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
- Jining First People’s Hospital, Jining 272000, China
| | - Yan Liu
- Department of Child Care, Changsha Maternal and Child Health Care Hospital, 416 Chengnan East RD of Yuhua District, Changsha 410007, China
| | - Yue Xi
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510275, China
| | - Caihong Xiang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Cuiting Yong
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Jiajing Liang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Jiaqi Huo
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
- Correspondence: (Q.L.); (J.D.); Tel.: +86-138-7482-0173 (Q.L.); +86-135-4864-3020 (J.D.)
| | - Jing Deng
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd, Changsha 410078, China
- Correspondence: (Q.L.); (J.D.); Tel.: +86-138-7482-0173 (Q.L.); +86-135-4864-3020 (J.D.)
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20
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Chen J, Lai X, Zhou L, Retnakaran R, Wen SW, Krewski D, Huang L, Li M, Xie RH. Association between exclusive breastfeeding and postpartum post-traumatic stress disorder. Int Breastfeed J 2022; 17:78. [PMID: 36419193 PMCID: PMC9685859 DOI: 10.1186/s13006-022-00519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Research on the association between breastfeeding and postpartum post-traumatic stress disorder (PTSD) is sparse. This study aimed to examine the association between exclusive breastfeeding up to 42 days after childbirth and postpartum PTSD. METHODS An epidemiologic study was conducted in a tertiary hospital in China between October 2019 and October 2020. Eligible mothers were recruited at 3 days after childbirth and assessed using the Post-Traumatic Stress Disorder Checklist - Civilian version (PCL-C) for PTSD at 42 days postpartum. The independent association between exclusive breastfeeding up to 42 days after childbirth and postpartum PTSD was estimated using log-binomial regression models, after adjusting for potential confounders. RESULTS Ninety-two of 759 (12.1%) mothers developed postpartum PTSD within 42 days after childbirth. Compared with partially breastfeeding mothers, exclusively breastfeeding mothers had lower risks of postpartum PTSD (relative risk [RR] 0.28; 95% confidence interval [CI] 0.13, 0.59), re-experience (RR 0.48; 95% CI 0.30, 0.76), avoidance (RR 0.55; 95% CI 0.32, 0.97), and hyperarousal (RR 0.52; 95% CI 0.34, 0.78). After adjustment for family support, parity, mode of delivery, perceived birth trauma, early contact / suckling, and rooming-in, associations between exclusive breastfeeding and postpartum PTSD remained significant: the overall PTSD adjusted relative risk [aRR] was 0.31; (95% CI 0.15, 0.66), with a re-experience aRR of 0.48; (95% CI 0.30, 0.77) and hyperarousal aRR of 0.56; (95% CI 0.37, 0.85). CONCLUSION Exclusive breastfeeding up to 42 days after childbirth was associated with reduced risk of postpartum PTSD. While the potential for reverse causation cannot be ruled out, strategies to improve rates of exclusive breastfeeding through teaching, counselling, and support may benefit mothers and their infants by reducing the risk of postpartum PTSD.
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Affiliation(s)
- Jingfen Chen
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaolu Lai
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Lepeng Zhou
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Ravi Retnakaran
- grid.416166.20000 0004 0473 9881Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario Canada ,grid.250674.20000 0004 0626 6184Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Division of Endocrinology, University of Toronto, Toronto, Ontario Canada
| | - Shi Wu Wen
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Daniel Krewski
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario Canada ,Risk Science International, Ottawa, Ontario Canada
| | - Liping Huang
- grid.284723.80000 0000 8877 7471Department of Obstetrics and Gynecology, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Meng Li
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.284723.80000 0000 8877 7471Department of Obstetrics, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Ri-hua Xie
- grid.284723.80000 0000 8877 7471Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China ,grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China ,grid.28046.380000 0001 2182 2255The Telfer School of Management, University of Ottawa, Ottawa, Ontario Canada
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21
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Zimmerman E, Gachigi KK, Rodgers RF, Watkins DJ, Woodbury M, Cordero JF, Alshawabkeh A, Meeker JD, Huerta-Montañez G, Pabon ZR, Hines M, Velez-Vega CM, Camargo CA, Zhu Y, Nozadi SS, Comstock SS, Hockett C, Tarwater PM. Association between Quality of Maternal Prenatal Food Source and Preparation and Breastfeeding Duration in the Environmental Influences on Child Health Outcome (ECHO) Program. Nutrients 2022; 14:4922. [PMID: 36432608 PMCID: PMC9695213 DOI: 10.3390/nu14224922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/22/2022] Open
Abstract
This study examined the relationship between maternal food source and preparation during pregnancy and the duration of breastfeeding among 751 mother-child dyads in the United States. The data collected from the Environmental influences on Child Health Outcomes (ECHO) Program included twelve cohorts of mothers (age ≥ 18) who delivered infant(s). Three categories of maternal food source and preparation including, High, Moderate, or Low Food Source Quality were derived from the mother report. The mean duration of breastfeeding differed strongly across the three categories. The High Food Source Quality group breastfed an average of 41 weeks, while shorter durations were observed for the Moderate (26 weeks) and Low (16 weeks) Food Source Quality groups. Cox proportional hazards models were used to estimate the relative hazard of time to breastfeeding cessation for each participant characteristic. The full model adjusted for clustering/cohort effect for all participant characteristics, while the final model adjusted for the subset of characteristics identified from variable reduction modeling. The hazard of breastfeeding cessation for those in the High Food Source Quality group was 24% less than the Moderate group (RH = 0.76; 95% CI, 0.63-0.92). Pregnant women in the High Food Source Quality group breastfed longer than the Moderate and Low groups. We encourage more detailed studies in the future to examine this relationship longitudinally.
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Grants
- UG3 OD035509 NIH HHS
- UG3 OD035517 NIH HHS
- UH3 OD023282 NIH HHS
- U2COD023375, U24OD023382, U24OD023319, UH3OD023251, UH3OD023313, UH3OD023328 , UH3OD023289, UH3OD023285, UH3OD023271, UH3OD023253, UH3OD023279, UH3OD023332, UH3OD023305, and UH3OD023286, UH3OD023282, UH3OD023244, UH3OD023275, UH3OD023268, UH3OD023272, U NIH HHS
- UG3 OD023282 NIH HHS
- P30 ES017885 NIEHS NIH HHS
- UH3OD023337, UH3OD023271 NIH HHS
- UH3 OD023251 NIH HHS
- UH3 OD023279 NIH HHS
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Affiliation(s)
- Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, 228C Forsyth Building, 360 Huntington Ave, Boston, MA 02115, USA
| | - Kennedy K. Gachigi
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Rachel F. Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA 02115, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, 34090 Montpellier, France
| | - Deborah J. Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Megan Woodbury
- Department of Communication Sciences and Disorders, Northeastern University, 228C Forsyth Building, 360 Huntington Ave, Boston, MA 02115, USA
| | - José F. Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA 30602, USA
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA 02115, USA
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Gredia Huerta-Montañez
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA 02115, USA
| | - Zaira Rosario Pabon
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA 02115, USA
| | - Morgan Hines
- Department of Communication Sciences and Disorders, Northeastern University, 228C Forsyth Building, 360 Huntington Ave, Boston, MA 02115, USA
| | - Carmen M. Velez-Vega
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA 02115, USA
- Department of Social Sciences, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - Sara S. Nozadi
- Health Sciences Center, College of Pharmacy, University of New Mexico, Albuquerque, NM 87131, USA
| | - Sarah S. Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA
| | - Christine Hockett
- Avera Research Institute, Sioux Falls, SD 57108, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57105, USA
| | - Patrick M. Tarwater
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX 77843, USA
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22
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Abstract
Breastfeeding inequities by race are a persistent public health problem in the United States. Inequities in occupation and working conditions likely contribute to relatively less breastfeeding among Black compared to White mothers, yet little research has addressed these interrelationships. Here, we offer a critical review of the literature and a conceptual framework to guide future research about work and racial inequities in breastfeeding. There is a strong public health case for promoting breastfeeding equity for mothers across race groups and occupation types. Existing theory suggests that employment opportunities and working conditions are a likely pathway that connects structural racism to Black-White breastfeeding inequities, in addition to other known factors. We propose a new conceptual model for studying the interrelationships among work, race, and breastfeeding outcomes.
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Affiliation(s)
- Margaret Whitley
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Ashley Banks
- Social Ecology, University of California Irvine, Irvine, CA, USA
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23
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Effect of transcutaneous auricular vagus nerve stimulation on major depressive disorder with peripartum onset: A multicenter, open-label, controlled proof-of-concept clinical trial (DELOS-1). J Affect Disord 2022; 316:34-41. [PMID: 35932937 DOI: 10.1016/j.jad.2022.07.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postpartum depression has a high prevalence in the United States (~13 %) and often goes undertreated/untreated. We conducted a multicenter, open-label, proof-of-concept trial to assess the Nēsos wearable, non-invasive, transcutaneous auricular vagus nerve stimulation (taVNS) system for the treatment of major depressive disorder with peripartum onset (PPD). METHODS Women (n = 25), ages 18 to 45, within 9 months postpartum, and diagnosed with PPD were enrolled at 3 sites. The study included 6 weeks open-label therapy and 2 weeks observation. Efficacy outcomes included change from baseline (CFB) in Hamilton Rating Scale for Depression (HAMD17) total scores, HAM-D17 response and remission, and patient and clinician global impression of change (PGIC, CGIC) scores. Analysis included descriptive statistics and mixed-effects models for repeated measures. RESULTS The most common AEs (≥5 %) were discomfort (n = 5), headache (n = 3), and dizziness (n = 2); all resolved without intervention. No serious AEs or deaths occurred. Baseline mean HAM-D17 score was 18.4. Week 6 least squares (LS) mean CFB in HAM-D17 score was -9.7; 74 % achieved response and 61 % achieved remission. At week 6, at least some improvement was reported by 21 of 22 (95 %) clinicians on CGIC and 22 of 23 (96 %) participants on PGIC. LIMITATIONS This was a single-arm, open-label study, and enrollment was limited to participants with mild-to-moderate peripartum depression. CONCLUSION Results from this proof-of-concept study suggest that the Nēsos taVNS system is well tolerated and may be an effective non-invasive, non-pharmacological treatment for major depressive disorder with peripartum onset. Further evaluation in larger sham-controlled studies is needed. CLINICALTRIALS govNCT03972995.
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24
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Chen TL, Chien LY. Feeding self-efficacy and feeding outcome expectancy mediate the association between maternal depressive symptoms and responsive feeding. Acta Psychol (Amst) 2022; 230:103755. [DOI: 10.1016/j.actpsy.2022.103755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/01/2022] Open
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25
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Choi KW, Denckla CA, Hoffman N, Budree S, Goddard L, Zar HJ, Stern M, Stein DJ. Influence of Maternal Childhood Trauma on Perinatal Depression, Observed Mother-Infant Interactions, and Child Growth. Matern Child Health J 2022; 26:1649-1656. [PMID: 35508679 PMCID: PMC9826718 DOI: 10.1007/s10995-022-03417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Mothers who have experienced childhood trauma may be at increased risk for disruptions in caregiving behavior, with potential consequences for early child development. However, assessments of caregiving behavior tend to be self-reported, which may bias results, and have been limited in lower-resource settings. METHODS In an overall sample of 256 South African mothers followed across the perinatal period, this longitudinal study used structural equation modeling to test pathways of association between maternal childhood trauma and depressive symptoms on observed mother-infant interactions at 3.5 months and subsequent child growth outcomes at 1 year. RESULTS On average, mothers with childhood trauma histories tended to show lower rated overall interactions with their infants (B = - 0.16, p = .013), which in turn was associated with reduced child growth at 1 year (B = 0.17, p = .046). When this model was adjusted for maternal age and relative socioeconomic status (SES), maternal SES strongly explained child growth (B = 0.31, p < .001) such that the direct effect of mother-infant interactions was no longer significant. DISCUSSION For child growth in a lower-resource setting, quality of mother-infant interactions could be a relevant predictor but more strongly explained by maternal SES factors, suggesting a need for broader approaches that not only improve dyadic relationships but also address maternal ecological resources.
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Affiliation(s)
- Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Christy A. Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Nadia Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital J2, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Shrish Budree
- Unit on Child and Adolescent Health, South African Medical Research Council, Cape Town, South Africa,Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Liz Goddard
- Unit on Child and Adolescent Health, South African Medical Research Council, Cape Town, South Africa,Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Heather J. Zar
- Unit on Child and Adolescent Health, South African Medical Research Council, Cape Town, South Africa,Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - Micky Stern
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital J2, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital J2, Anzio Road, Observatory, Cape Town 7925, South Africa,Research Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Cape Town, South Africa
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26
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Breastfeeding: The Basics, the History, and Barriers in the Modern Day. Obstet Gynecol Surv 2022; 77:423-432. [DOI: 10.1097/ogx.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Nanishi K, Okawa S, Hongo H, Shibanuma A, Abe SK, Tabuchi T. Influence of the COVID-19 pandemic on breastfeeding support for healthy mothers and the association between compliance with WHO recommendations for breastfeeding support and exclusive breastfeeding in Japan. PeerJ 2022; 10:e13347. [PMID: 35611173 PMCID: PMC9124456 DOI: 10.7717/peerj.13347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/06/2022] [Indexed: 01/13/2023] Open
Abstract
Background Professional breastfeeding support contributes to maternal and child health. However, the influence of the current coronavirus disease 2019 (COVID-19) pandemic on breastfeeding support has not been carefully examined. Therefore, we assessed maternal breastfeeding intention and professional breastfeeding support before and during the pandemic. We further examined the association of compliance with World Health Organization (WHO) recommendations for professional breastfeeding support with exclusive breastfeeding during the pandemic. Methods This cross-sectional, internet-based, questionnaire study analyzed data from 484 healthy women with live singleton births between 15 October 2019 and 25 October 2020 in Japan. A delivery before 5 March 2020 was classified as a before-pandemic delivery (n = 135), and a delivery after 6 March 2020 was a during-pandemic delivery (n = 349). Among the ten breastfeeding support steps recommended by the WHO, we assessed the five steps that are measurable by maternal self-report and would likely exhibit variability. Receipt of a free formula sample or invitation to a free sample campaign by the time of survey was also asked. Infant feeding status at the time of the survey was measured among women with infants younger than 5 months, which was a subgroup of mothers who delivered during the pandemic. Mothers were asked what was given to infants during the 24 h before the survey and when nothing other than breast milk was given, the status was classified as exclusive breastfeeding. Results While 82.2% of women with a delivery before the pandemic intended to breastfeed, the rate was 75.6% during the pandemic (p = 0.120). The average number of breastfeeding support steps received was 3.24 before the pandemic but it was 3.01 during the pandemic (p = 0.069). In particular, rooming-in was less frequent (39.3% before vs. 27.8% during the pandemic, p = 0.014). Among mothers with infants younger than 5 months who had a delivery during the pandemic (n = 189), only 37.0% (n = 70) reported exclusively breastfeeding during the 24 h before completing the survey. Multiple logistic regression analysis indicated that receiving support for all five steps was positively associated with exclusive breastfeeding during the 24 h before the survey (adjusted odds ratio 4.51; 95% CI [1.50-13.61]). Receipt of a free formula sample or invitation to a free sample campaign was negatively associated with exclusive breastfeeding (adjusted odds ratio 0.43; 95% CI [0.19-0.98]). Other factors related to non-exclusive breastfeeding were older maternal age, lower education level, primiparity, and no breastfeeding intention. Conclusions The pandemic weakened breastfeeding support for healthy women in Japan; however, support practice that adhered to WHO recommendations appeared to be effective during the pandemic.
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Affiliation(s)
- Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sumiyo Okawa
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroko Hongo
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sarah K. Abe
- Division of Prevention, National Cancer Center, Institute for Cancer Control, Chuo-ku, Tokyo, Japan
| | - Takahiro Tabuchi
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, Osaka City, Osaka, Japan
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28
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Bilal AM, Fransson E, Bränn E, Eriksson A, Zhong M, Gidén K, Elofsson U, Axfors C, Skalkidou A, Papadopoulos FC. Predicting perinatal health outcomes using smartphone-based digital phenotyping and machine learning in a prospective Swedish cohort (Mom2B): study protocol. BMJ Open 2022; 12:e059033. [PMID: 35477874 PMCID: PMC9047888 DOI: 10.1136/bmjopen-2021-059033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Perinatal complications, such as perinatal depression and preterm birth, are major causes of morbidity and mortality for the mother and the child. Prediction of high risk can allow for early delivery of existing interventions for prevention. This ongoing study aims to use digital phenotyping data from the Mom2B smartphone application to develop models to predict women at high risk for mental and somatic complications. METHODS AND ANALYSIS All Swedish-speaking women over 18 years, who are either pregnant or within 3 months postpartum are eligible to participate by downloading the Mom2B smartphone app. We aim to recruit at least 5000 participants with completed outcome measures. Throughout the pregnancy and within the first year postpartum, both active and passive data are collected via the app in an effort to establish a participant's digital phenotype. Active data collection consists of surveys related to participant background information, mental and physical health, lifestyle, and social circumstances, as well as voice recordings. Participants' general smartphone activity, geographical movement patterns, social media activity and cognitive patterns can be estimated through passive data collection from smartphone sensors and activity logs. The outcomes will be measured using surveys, such as the Edinburgh Postnatal Depression Scale, and through linkage to national registers, from where information on registered clinical diagnoses and received care, including prescribed medication, can be obtained. Advanced machine learning and deep learning techniques will be applied to these multimodal data in order to develop accurate algorithms for the prediction of perinatal depression and preterm birth. In this way, earlier intervention may be possible. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Swedish Ethical Review Authority (dnr: 2019/01170, with amendments), and the project fully fulfils the General Data Protection Regulation (GDPR) requirements. All participants provide consent to participate and can withdraw their participation at any time. Results from this project will be disseminated in international peer-reviewed journals and presented in relevant conferences.
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Affiliation(s)
- Ayesha M Bilal
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Centre for Women's Mental Health during the Reproductive Lifespan (Womher), Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Centre for Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - Emma Bränn
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Allison Eriksson
- Centre for Women's Mental Health during the Reproductive Lifespan (Womher), Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mengyu Zhong
- Centre for Women's Mental Health during the Reproductive Lifespan (Womher), Uppsala University, Uppsala, Sweden
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Karin Gidén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ulf Elofsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cathrine Axfors
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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29
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Exclusive Breastfeeding Duration and Perceptions of Infant Sleep: The Mediating Role of Postpartum Anxiety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084494. [PMID: 35457362 PMCID: PMC9029530 DOI: 10.3390/ijerph19084494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 01/27/2023]
Abstract
(1) Background: Existing literature has identified associations between exclusive breastfeeding, maternal mental health, and infant sleep. This study aims to examine these relationships simultaneously and consider the mediating role of postpartum anxiety. (2) Methods: Participants completed validated measures of postpartum anxiety, infant sleep, and reported exclusive breastfeeding duration. Postpartum mothers with infants between six and twelve months (n = 470) were recruited to a cross-sectional online survey containing a battery of psychological measures. (3) Results: Correlation analyses examined the relationships between the predictor (exclusive breastfeeding duration), outcome (perceptions of infant sleep), and mediator (postpartum anxiety). Exclusive breastfeeding duration was significantly associated with postpartum anxiety (p < 0.05), postpartum anxiety was significantly associated with perceptions of infant sleep (p < 0.001), and exclusive breastfeeding duration was significantly associated with perceptions of infant sleep (p < 0.001). A simple mediation model was conducted, showing a significant total (B = −0.029 (0.010), p < 0.05), direct (B = −0.035 (0.009), p < 0.001), and indirect effect (B = 0.007, SE = 0.003, 95% CI = 0.000 to 0.014) of exclusive breastfeeding duration on perceptions of infant sleep via postpartum anxiety. (4) Conclusions: Associations were identified between exclusive breastfeeding duration, postpartum anxiety, and perceptions of infant sleep. The mediation model suggests postpartum anxiety may be an underlying mechanism which reduces exclusive breastfeeding duration and negatively affects maternal perceptions of infant sleep quality.
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30
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Alimi R, Azmoude E, Moradi M, Zamani M. The Association of Breastfeeding with a Reduced Risk of Postpartum Depression: A Systematic Review and Meta-Analysis. Breastfeed Med 2022; 17:290-296. [PMID: 34964664 DOI: 10.1089/bfm.2021.0183] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Rasoul Alimi
- Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Elham Azmoude
- Department of Midwifery, School of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Maryam Moradi
- Department of Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Zamani
- Department of Midwifery, School of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
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31
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Krohn H, Guintivano J, Frische R, Steed J, Rackers H, Meltzer-Brody S. App-Based Ecological Momentary Assessment to Enhance Clinical Care for Postpartum Depression: Pilot Acceptability Study. JMIR Form Res 2022; 6:e28081. [PMID: 35319483 PMCID: PMC8987954 DOI: 10.2196/28081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 01/23/2023] Open
Abstract
Background Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective This study aims to investigate the clinical utility, predictive ability, and acceptability of using ecological momentary assessment to collect daily mood, sleep, and activity data through the use of an Apple Watch and mobile app among women with postpartum depression. Methods This was a pilot study consisting of 3 in-person research visits over the course of a 6-week enrollment period. Questionnaires to assess depression, anxiety, and maternal functioning were periodically collected, along with daily self-reported symptoms and passively collected physiological data via an Apple Watch. Feedback was collected from study participants and the study clinician to determine the utility and acceptability of daily tracking. Logistic regression was used to determine whether mood scores in the 2 weeks before a visit predicted scores at follow-up. Compliance with daily assessments was also measured. Results Of the 26 women enrolled, 23 (88%) completed the 6-week study period. On average, the participants completed 67% (34.4/51.5 days) of all active daily assessments and 74% (38/51.5 days) of all passive measures. Furthermore, all 23 participants completed the 3 required visits with the research team. Predictive correlations were found between self-reported mood and Edinburgh Postnatal Depression Scale score at follow-up, self-reported anxiety and EDPS, and sleep quality and Edinburgh Postnatal Depression Scale. Conclusions Using ecological momentary assessment to track daily symptoms of postpartum depression using a wearable device was largely endorsed as acceptable and clinically useful by participants and the study clinician and could be an innovative solution to increase care access during the COVID-19 pandemic.
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Affiliation(s)
- Holly Krohn
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rachel Frische
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jamie Steed
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hannah Rackers
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Suzuki T, Nojiri K, Higurashi S, Tsujimori Y, Toba Y, Nomura K. Relationship between Child Care Exhaustion and Breastfeeding Type at Two and Six Months in a Cohort of 1210 Japanese Mothers. Nutrients 2022; 14:1138. [PMID: 35334795 PMCID: PMC8955404 DOI: 10.3390/nu14061138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 02/05/2023] Open
Abstract
This study investigated whether parenting stress is associated with breastfeeding type (exclusive or partial). Between 2014 and 2019, we recruited 1210 healthy mothers (mean age, 31.2 years; 65%, multiparity) from 73 obstetric institutions across all prefectures of Japan. Among these, 1120 mothers at two months and 1035 mothers at six months were investigated for parenting stress and breastfeeding type: exclusive versus otherwise (partial). Parenting stress was measured by a validated Japanese scale consisting of childcare exhaustion, worry about child's development, and no partner support. Exclusive breastfeeding prevalence was 75% at two and 78% at six months. The total scores for childcare exhaustion and worry about child development were statistically higher in the partial breastfeeding group than in the exclusive breastfeeding group at two months but not at six months. A logistic regression model demonstrated that childcare exhaustion was significantly associated with an increased risk of having partial breastfeeding at two months after adjusting for the maternal Body Mass Index, parity, and baby's current weight. However, the association was no longer significant at six months. The present study suggests that intervention for parenting stress at two months postpartum may promote prolonged exclusive breastfeeding.
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Affiliation(s)
- Tomoya Suzuki
- School of Medicine, Akita University, 1-1-1 Hondo, Akita 010-8543, Japan;
| | - Keisuke Nojiri
- Research and Development Department, Bean Stalk Snow Co., Ltd., Saitama 350-1165, Japan; (K.N.); (S.H.); (Y.T.); (Y.T.)
| | - Satoshi Higurashi
- Research and Development Department, Bean Stalk Snow Co., Ltd., Saitama 350-1165, Japan; (K.N.); (S.H.); (Y.T.); (Y.T.)
| | - Yuta Tsujimori
- Research and Development Department, Bean Stalk Snow Co., Ltd., Saitama 350-1165, Japan; (K.N.); (S.H.); (Y.T.); (Y.T.)
| | - Yasuhiro Toba
- Research and Development Department, Bean Stalk Snow Co., Ltd., Saitama 350-1165, Japan; (K.N.); (S.H.); (Y.T.); (Y.T.)
| | - Kyoko Nomura
- Department of Environment Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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The association between intravenous iron for antenatal anemia and postnatal depression: a retrospective cohort study. Arch Gynecol Obstet 2022; 306:1477-1484. [PMID: 35129661 DOI: 10.1007/s00404-022-06417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/21/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Determine if intravenous iron for antenatal anemia is associated with reduced incidence of postnatal depression (PND) within 12 months. METHODS This retrospective cohort study included adult women with antenatal anemia (hemoglobin value of < 11.0 g/dL within 3 months before delivery). PND was defined as Edinburgh Postnatal Depression Scale (EPDS) or Patient Health Questionnaire-9 (PHQ-9) ≥ 10. Data on intravenous iron, lowest hemoglobin concentration, EPDS and PHQ-9 scores, insurance status, history of anxiety, depression, chronic pain, and substance use, obstetric complications, labor analgesia, and mode of delivery were obtained. Standardized mean difference (SMD) was estimated and multivariable logistic regression models were constructed with adjustment for potential confounders with absolute SMD of ≥ 0.1. RESULTS Data from 3988 women were analyzed. The 368 (9.2%) women who received intravenous iron therapy had lower antenatal hemoglobin levels, were more likely to be African American or single/widowed women, and more commonly had Medicaid coverage, repeat cesarean delivery, and history of depression compared to those who did not receive intravenous iron therapy. Unadjusted analysis showed women who received intravenous iron had higher incidence of PND (18.5%) than those who did not (13.4%) (p = 0.008). Multivariable analysis showed no significant association between intravenous iron and PND incidence (aOR 1.21, 95%CI 0.89-1.63, p = 0.232), although history of depression (aOR 2.42, 95%CI 1.91-3.08, p < 0.001), higher gravidity (aOR 1.09, 95%CI 1.02-1.17, p = 0.016), and Medicaid insurance (aOR 1.44, 95%CI 1.16-1.80, p = 0.001) were independently associated with PND. CONCLUSION Intravenous iron for antenatal anemia was not associated with significant change in the incidence of PND.
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Effect of perinatal depression on birth and infant health outcomes: a systematic review and meta-analysis of observational studies from Africa. Arch Public Health 2022; 80:34. [PMID: 35057865 PMCID: PMC8772173 DOI: 10.1186/s13690-022-00792-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 01/07/2022] [Indexed: 01/10/2023] Open
Abstract
Background Antenatal depression is associated with intrauterine growth retardation, preterm birth, and low birth weight. Infants born to mothers with postnatal depression also may suffer from malnutrition and other health problems. Even though there are few single studies conducted so far, a systematic review of these studies is highly important to highlight the effect of antenatal and perinatal depression on adverse birth and infant health outcomes in Africa. Methods We used the Preferred Report Items for Systematic Review and Meta-analysis (PRISMA) when conducting this study. Databases like CINAHL (EBSCO), MEDLINE (via Ovid and PubMed), PsycINFO, Emcare, Psychiatry Online, and Scopus were searched. In addition, Google Scholar and references from a list of eligible studies were explored. We included good quality observational studies based on Newcastle Ottawa Scale which are published in the English language between 2007 and 2018. Heterogeneity and publication bias were assessed. Meta-analysis with a random effect model was employed to determine the pooled effect sizes with a 95% confidence interval. The review protocol is registered in PROSPERO (CRD42018106714). Result We found three studies (1511 participants) and 11 studies (22,254 participants) conducted on the effect of antenatal depression on birth outcomes and perinatal depression on adverse infant health outcomes, respectively. The overall risk of having adverse birth outcomes was 2.26 (95% CI: 1.43, 3.58) times higher among pregnant mothers with depression. The risk of preterm birth and low birth weight was 1.77 (95% CI: 1.03, 3.04) and 2.98 (95% CI: 1.60, 5.55) respectively. Similarly, the risk of having adverse infant health outcomes namely malnutrition and febrile illness was 1.61 (95% CI: 1.34, 1.95) times higher among mothers who had perinatal depression. Conclusions We have found a significant association between antenatal depression and adverse birth outcomes, low birth weight and preterm birth. Similarly, a significant effect of perinatal depression on adverse infant health outcomes namely, malnutrition, and febrile illnesses was observed. The findings highlight that it is time to integrate mental health services with routine maternal health care services to improve birth outcomes and reduce infant morbidity. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00792-8.
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Kaufman Y, Carlini SV, Deligiannidis KM. Advances in pharmacotherapy for postpartum depression: a structured review of standard-of-care antidepressants and novel neuroactive steroid antidepressants. Ther Adv Psychopharmacol 2022; 12:20451253211065859. [PMID: 35111296 PMCID: PMC8801644 DOI: 10.1177/20451253211065859] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Postpartum depression is one of the most common morbidities of childbearing, yet it is underdiagnosed and undertreated with negative consequences for mother and offspring. Despite the widespread use of standard-of-care antidepressants as the mainstay of treatment for postpartum depression, there is limited evidence on their safety and efficacy due to their slow onset of action and suboptimal outcomes. The emergence of gamma-aminobutyric acidergic neuroactive steroids may offer faster response and remission times and improved patient outcomes. This article reviews the evidence base for the efficacy of standard-of-care antidepressants, hormonal therapeutics including progestins and estradiol, and gamma-aminobutyric acidergic neuroactive steroids in the treatment of postpartum depression, as well as the safety of infant exposure to these agents during lactation.
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Affiliation(s)
- Yardana Kaufman
- Perinatal Psychiatry Center, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Sara V Carlini
- Perinatal Psychiatry Center, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Kristina M Deligiannidis
- Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY, USA
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Postpartum depression in Irish mothers and associations with infant feeding practices. Proc Nutr Soc 2022. [DOI: 10.1017/s0029665122000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Incollingo Rodriguez AC, Nagpal TS. The WOMBS Framework: A review and new theoretical model for investigating pregnancy-related weight stigma and its intergenerational implications. Obes Rev 2021; 22:e13322. [PMID: 34288364 DOI: 10.1111/obr.13322] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
As the growing weight stigma literature has developed, one critically relevant and vulnerable population has received little consideration-pregnant and postpartum women. Because weight fluctuations are inherent to this life phase, and rates of prepregnancy overweight and obesity are already high, this gap is problematic. More recently, however, there has been a rising interest in pregnancy-related weight stigma and its consequences. This paper therefore sought to (a) review the emerging research on pregnancy-related weight stigma phenomenology and (b) integrate this existing evidence to present a novel theoretical framework for studying pregnancy-related weight stigma. The Weight gain, Obesity, Maternal-child Biobehavioral pathways, and Stigma (WOMBS) Framework proposes psychophysiological mechanisms linking pregnancy-related weight stigmatization to increased risk of weight gain and, in turn, downstream childhood obesity risk. This WOMBS Framework highlights pregnant and postpartum women as a theoretically unique at-risk population for whom this social stigma engages maternal physiology and transfers obesity risk to the child via social and physiological mechanisms. The WOMBS Framework provides a novel and useful tool to guide the emerging pregnancy-related weight stigma research and, ultimately, support stigma-reduction efforts in this critical context.
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Affiliation(s)
- Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Department of Social Science & Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Taniya S Nagpal
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
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Analysis of gene expression from human breastmilk cells: A comparison between low and high producers, and the influence of anxiety and depression on milk production, gene expression and bacterial production. Heliyon 2021; 7:e08335. [PMID: 34825075 PMCID: PMC8605299 DOI: 10.1016/j.heliyon.2021.e08335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/05/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background Breastmilk is considered the gold standard of infant nutrition. Many mothers have difficulty with breastfeeding and over 50% of women stop due to perceived low production. Aims and methods Our study compared gene expression in 8 samples of low and high producers of milk. All subjects were administered GAD-7 and PHQ-9 questionnaires. Low-producers were all found to have more depression and anxiety compared to high-producers. Results We did not find significant differences between gene expression between low and high milk producers. Only 5 of 8 samples contained a significant number of human cells. We did find differences in the amount of various bacterial populations. Conclusion Our results indicate that gene expression in breastmilk is complicated by collection methods. We recommend that even though some women produced less than 600 ml of milk over a 24-hour period of time, due to the nature of the bacteria found in milk they try to breastfeed as much as they can for the health benefits of their infants. the rich bacterial diversity in all patients including the low producers strongly suggests that even women producing lesser quantities of milk confer their children numerous benefits by breastfeeding them.
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Nisa F, Damayanti N, Suhariadi F, Anggasari Y, Dewi FE, Arini D, Rahman FS. Breastfeeding based on Breastfeeding Self-efficacy and Social Support in Wonokromo Surabaya. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A mother, who has low self-confidence in her ability to provide exclusive breastfeeding, supported by culture and myth, think when a baby cries it means that the baby is hungry and breast milk only is not enough. Therefore, a lot of mothers decided to give banana, porridge, honey, and other additional foods. This research aimed to determine the relationship between breastfeeding self-efficacy and social support with breastfeeding in Wonokromo, Surabaya.
This research was conducted through analytical design using cross-sectional approach. The research samples involved were 112 mothers who had baby aged 6-12 months old. Among them, 106 mothers were chosen as research respondents using simple random sampling technique. The independent variable of this research was breastfeeding self-efficacy and social support, while the dependent variable was breastfeeding. Data were collected using a questionnaire, and then analyzed through Chi-Square test using SPSS program with the level of significance determined was α = 0.05.
The results showed that most of the respondents had poor breastfeeding self-efficacy (77.4%) and low social support (51.9%), as well as did not exclusively breastfeed (66.9%). Based on the Chi-square test, the value obtained was ρ - 0.00 < α - 0.05, so H0 rejected, indicating that there was a relationship between breastfeeding self-efficacy and breastfeeding. Another value obtained was ρ - 0.00 < α - 0.05 so H0 rejected, which also means that there was a relationship between social support and breastfeeding.
This outcome concluded that the better the breastfeeding self-efficacy and higher social support, the higher level of breastfeeding without additional food. Therefore, we suggested that health workers and the community will be able to motivate mothers and provide social support in terms of providing breast milk to babies without additional food.
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Lenells M, Andersson E, Gustafsson A, Wells M, Dennis CL, Wilson E. Breastfeeding interventions for preventing postpartum depression. Hippokratia 2021. [DOI: 10.1002/14651858.cd014833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Mikaela Lenells
- Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Ewa Andersson
- Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Anna Gustafsson
- Clinical Science, Intervention and Technology, Division of Paediatrics; Karolinska Institutet; Stokholm Sweden
- Department of Neonatology; Karolinska University Hospital; Stockholm Sweden
| | - Michael Wells
- Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto Canada
| | - Emilija Wilson
- Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
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Radwan H, Fakhry R, Metheny N, Baniissa W, Faris MAIE, Obaid RS, Al Marzooqi S, Al Ghazal H, ElHalik M, Dennis CL. Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study. Int Breastfeed J 2021; 16:79. [PMID: 34641934 PMCID: PMC8507212 DOI: 10.1186/s13006-021-00428-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors. METHODS Using a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes. RESULTS Almost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum. CONCLUSION This study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.
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Affiliation(s)
- Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - Randa Fakhry
- Department of Nursing, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nick Metheny
- School of Nursing and Health Studies, University of Miami, Miami, USA
| | - Wegdan Baniissa
- Department of Nursing, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Moez Al Islam E Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Reyad Shaker Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Suad Al Marzooqi
- Department of Psychology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hessa Al Ghazal
- Sharjah Child-Friendly Office, Sharjah, United Arab Emirates
| | - Mahmoud ElHalik
- Department of Neonatology, Latifa Women and Children Hospital, Dubai, United Arab Emirates
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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Stelson EA, Kulkacek L, Frasso R, Hall M, Guevara JP. Perspectives on Breastfeeding from Mothers with Postpartum Depression Symptoms: A Qualitative Assessment of Antecedents, Barriers, Facilitators, and Intervention Suggestions. Breastfeed Med 2021; 16:790-798. [PMID: 34010030 PMCID: PMC8817733 DOI: 10.1089/bfm.2020.0251] [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] [Indexed: 11/13/2022]
Abstract
Background: Postpartum depression (PPD) is one of the most common birthing complications, and studies negatively associate PPD with breastfeeding initiation and continuation. However, little is known about either the breastfeeding experience of mothers with PPD or what resources mothers need for sustained breastfeeding from their perspectives. This study aimed to identify the antecedents, barriers, and facilitators to breastfeeding for mothers with PPD, understand the relationship between self-efficacy and emergent themes, and generate suggestions to inform supportive interventions. Materials and Methods: Birth mothers who screened positive for PPD and reported breastfeeding were recruited to participate in semistructured interviews. Interviews were transcribed verbatim, and inter-coder discrepancies from double coding were resolved through consensus. Thematic analysis was facilitated using immersion-crystallization methods. Results: Participants identified five antecedent themes that encourage initiation (professional support, infant health, mother's health, cost-effectiveness, and faith), four facilitator themes for sustained breastfeeding (infant connection, decreased stress, personal attributes, and logistical strategies), and seven barrier themes (physical pain, infant nutrition, negative feelings, latching difficulties, medical conditions, public breastfeeding, and sleep). Participants' suggestions fell into three primary themes: supportive services, managing expectations, and respecting self-determination. Conclusion: Antecedent and facilitator themes did not overlap, indicating that factors encouraging breastfeeding initiation differ from sustaining factors. Participant suggestions, barriers, and facilitators did not largely differ from mothers without PPD in other qualitative studies. Therefore, interventions should tailor support to specific breastfeeding phase and may not need to be markedly different for mothers with PPD, in addition to depression management.
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Affiliation(s)
- Elisabeth A. Stelson
- Department of Social and Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Laura Kulkacek
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Moriah Hall
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James P. Guevara
- Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Dagla M, Dagla C, Mrvoljak-Theodoropoulou I, Kontiza E, Tsolaridou E, Antoniou E. The Association of Breastfeeding Difficulties at the 6 th week Postpartum with Maternal Psychological Well-being and Other Perinatal Factors: a Greek Retrospective Longitudinal Study. Mater Sociomed 2021; 33:109-113. [PMID: 34483738 PMCID: PMC8385733 DOI: 10.5455/msm.2021.33.109-113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The difficulties a woman faces with breastfeeding are among the factors that can lead to its early cessation. Objective: The aim of this study was to investigate whether the presence of maternal breastfeeding difficulties at the 6th week postpartum is associated either with maternal psychological well-being and the presence of a mental health disorder in the perinatal period or with other perinatal factors. Methods: This study was conducted at a primary mental health facility in Athens (Greece), the “Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders)”. It is a retrospective longitudinal study, examining a sample of 622 women who used the Day Center’s services from January 2015 to May 2018. Statistical analyses included the Spearman rank correlation coefficients and multiple univariate analyses of variance. Results: Increased scores on psychometric tools (EPDS, PHQ-9) during pregnancy or postpartum are associated with increased maternal breastfeeding difficulties at the 6th week postpartum. Other factors such as an unplanned conception (p=.016), maternal dissatisfaction with labor (p=.038) and formula feeding in the hospital (p<.001) or at the end of the 1st month postpartum (p<.001) are associated with the occurrence of breastfeeding difficulties. Also, the mothers who experienced lactation mastitis (p=.009), had sleep difficulties (p=.013), woke up fatigued (p<.001) during the first 6 weeks postpartum, and the mothers whose infants experienced colic (p=.009) were more likely to complain about breastfeeding difficulties at the 6th week postpartum. Conclusion: This study demonstrates a relationship between increased scores on maternal psychometric tools in the perinatal period and other perinatal factors with increased breastfeeding difficulties at the 6th weeks postpartum.
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Affiliation(s)
- Maria Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization "FAINARETI", Athens, Greece.,Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Calliope Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization "FAINARETI", Athens, Greece
| | - Irina Mrvoljak-Theodoropoulou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization "FAINARETI", Athens, Greece
| | - Eleni Kontiza
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization "FAINARETI", Athens, Greece
| | - Eleni Tsolaridou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization "FAINARETI", Athens, Greece.,Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Evangelia Antoniou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization "FAINARETI", Athens, Greece.,Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
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Dagla M, Dagla C, Mrvoljak-Theodoropoulou I, Sotiropoulou D, Kavakou AT, Kontiza E, Antoniou E. Do Maternal Stress and Depressive Symptoms in Perinatal Period Predict the Lactation Mastitis Occurrence? A Retrospective Longitudinal Study in Greek Women. Diagnostics (Basel) 2021; 11:diagnostics11091524. [PMID: 34573866 PMCID: PMC8469520 DOI: 10.3390/diagnostics11091524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The aim of this study is to investigate whether symptoms of anxiety and depression disorders in women during the perinatal period predict the occurrence of lactation mastitis. Methods: This is a retrospective longitudinal study of 622 Greek women who were monitored from pregnancy until the first year postpartum (during the period January 2015–May 2018). The Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal Anxiety Screening Scale (PASS) were administered at four time points: (a) 24th–28th gestation week, (b) 34th–38th gestation week, (c) 6 weeks postpartum, and (d) 12 months postpartum. Multivariate binary logistic regression analyses were performed. Results: Results showed that (a) increased EPDS (p < 0.02) and PASS (p < 0.05) scores during the last period before birth, (b) increased EPDS score at 6 weeks postpartum (p < 0.02), (c) PMS symptoms (p < 0.03), (d) traumatic life events during the last year (p < 0.03), and (e) the existence of a history of psychotherapy (before pregnancy) (p = 0.050) appear to be the psycho-emotional factors that can predict the possible occurrence of lactation mastitis in a breastfeeding mother. Conclusions: The association between women’s poor mental health and the occurrence of a physical health problem, such as lactation mastitis, is recognized. This study highlights the important role of early and timely detection of perinatal mental health disorders.
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Affiliation(s)
- Maria Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (C.D.); (I.M.-T.); (D.S.); (A.-T.K.); (E.K.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
- Correspondence: ; Tel.: +30-210-932-4415
| | - Calliope Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (C.D.); (I.M.-T.); (D.S.); (A.-T.K.); (E.K.); (E.A.)
| | - Irina Mrvoljak-Theodoropoulou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (C.D.); (I.M.-T.); (D.S.); (A.-T.K.); (E.K.); (E.A.)
| | - Dimitra Sotiropoulou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (C.D.); (I.M.-T.); (D.S.); (A.-T.K.); (E.K.); (E.A.)
| | - Aikaterini-Taxiarchoula Kavakou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (C.D.); (I.M.-T.); (D.S.); (A.-T.K.); (E.K.); (E.A.)
| | - Eleni Kontiza
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (C.D.); (I.M.-T.); (D.S.); (A.-T.K.); (E.K.); (E.A.)
| | - Evangelia Antoniou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (C.D.); (I.M.-T.); (D.S.); (A.-T.K.); (E.K.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
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Irish AM, White JS, Modrek S, Hamad R. Paid Family Leave and Mental Health in the U.S.: A Quasi-Experimental Study of State Policies. Am J Prev Med 2021; 61:182-191. [PMID: 34294424 DOI: 10.1016/j.amepre.2021.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Several U.S. states have implemented paid family leave policies for new parents. Few studies have evaluated the impacts of U.S. paid family leave policies on families' health. This study tests the hypothesis that paid family leave policies in California and New Jersey improved parent and child mental health. METHODS Using national data from the 1997-2016 waves of the National Health Interview Survey, the study assessed changes in parental psychological distress (measured using the Kessler 6 score, n=28,638) and child behavioral problems (measured using the Mental Health Indicator score, n=15,987) using difference-in-differences analysis, a quasi-experimental method that compared outcomes before and after the implementation of paid family leave policies in California and New Jersey while accounting for secular trends in states without paid family leave policies. Secondary analyses were conducted to assess differential responses among prespecified subgroups. Data analysis was conducted in 2018-2021. RESULTS Exposure to paid family leave policies was associated with decreased psychological distress among parents (-0.49, 95% CI= -0.77, -0.21). There was no association between the paid family leave policies and children's behavioral problems (-0.06, 95% CI= -0.13, 0.012). Associations varied by demographic and socioeconomic characteristics, with some subgroups experiencing benefits, whereas others were negatively impacted. CONCLUSIONS Study findings suggest that state paid family leave policies improved mental health among parents, with mixed findings among children, including positive, negative, or no changes in mental health, depending on the subgroup. Future work should clarify how more recent state policies, some of which provide more generous benefits and job protections for low-income parents, influence health among affected families.
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Affiliation(s)
- Amanda M Irish
- UCSF Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Justin S White
- UCSF Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; UCSF Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - Sepideh Modrek
- Health Equity Institute, San Francisco State University, San Francisco, California
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; Department of Family and Community Medicine, University of California San Francisco, San Francisco, California.
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47
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Bibi S, Shah M, Malik MO, Goosens KA. T3 is linked to stress-associated reduction of prolactin in lactating women. J Neuroendocrinol 2021; 33:e13003. [PMID: 34241933 DOI: 10.1111/jne.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/01/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
The relationship between stress responses and lactation is bidirectional. Breastfeeding confers many benefits to maternal health, including attenuated hypothalamic-pituitary-adrenal axis responsiveness to stress. However, increased stress burden can impair lactation. The mechanisms that underlie these relationships are poorly understood. The present study aimed to compare breastfeeding habits, as well as subjective and objective measures of stress, in employed and non-employed lactating women and assess the relationships between these measures and prolactin (PRL), thyroid hormones (thyroid-stimulating hormone, triiodothyronine [T3] and thyroxine), vasopressin and cortisol levels. A dexamethasone suppression test was also administered to determine the sensitivity of the hypothalamic-pituitary-adrenal axis to negative-feedback. We report that lactating employed women had lower breastfeeding rates and lower PRL than lactating non-employed women. They also had a significantly higher stress burden, indicated by elevations in blood pressure and evening cortisol, relative to lactating non-employed women. In regression analyses that controlled for feeding modality and breastfeeding duration, we found these factors differentially affected PRL in the two groups and there were significant differences in PRL across groups that were not accounted for by these factors. A mediation regression analysis suggested that group differences in PRL were best explained by differences in T3 and income levels, rather than breastfeeding duration or other variables. Our data fit a speculative model in which elevated maternal stress increases cortisol, which suppresses T3, leading to decreased PRL. The decreases in PRL are associated with higher rates of bottlefeeding, which may further contribute to decreased PRL.
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Affiliation(s)
- Safia Bibi
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Muhammad Omar Malik
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ki Ann Goosens
- Department of Psychiatry and Center for Affective Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Fry HL, Levin O, Kholina K, Bianco JL, Gallant J, Chan K, Whitfield KC. Infant feeding experiences and concerns among caregivers early in the COVID-19 State of Emergency in Nova Scotia, Canada. MATERNAL & CHILD NUTRITION 2021; 17:e13154. [PMID: 33619906 PMCID: PMC7995067 DOI: 10.1111/mcn.13154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/24/2020] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
The global emergency caused by the novel coronavirus (COVID-19) pandemic has impacted access to goods and services such as health care and social supports, but the impact on infant feeding remains unclear. Thus, the objective of this study was to explore how caregivers of infants under 6 months of age perceived changes to infant feeding and other food and health-related matters during the COVID-19 State of Emergency in Nova Scotia, Canada. Four weeks after the State of Emergency began, between 17 April and 15 May 2020, caregivers completed this online survey, including the Perceived Stress Scale. Participants (n = 335) were 99% female and mostly White (87%). Over half (60%) were breastfeeding, and 71% had a household income over CAD$60,000. Most participants (77%) received governmental parental benefits before the emergency, and 59% experienced no COVID-19-related economic changes. Over three quarters of participants (77%) scored moderate levels of perceived stress. Common themes of concern included social isolation, COVID-19 infection (both caregiver and infant), and a lack of access to goods, namely, human milk substitutes ('infant formula'), and services, including health care, lactation support, and social supports. Most COVID-19-related information was sought from the internet and social media, so for broad reach, future evidence-based information should be shared via online platforms. Although participants were experiencing moderate self-perceived stress and shared numerous concerns, very few COVID-19-related changes to infant feeding were reported, and there were few differences by socio-economic status, likely due to a strong economic safety net in this Canadian setting.
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Affiliation(s)
- Hillary L. Fry
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Olga Levin
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Ksenia Kholina
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Jolene L. Bianco
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Jelisa Gallant
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Kathleen Chan
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Kyly C. Whitfield
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
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Richard SA, McCormick BJJ, Murray‐Kolb LE, Patil CL, Chandyo RK, Mahopo C, Maciel BL, Bose A, Mahfuz M, Ambikapathi R, Olortegui MP, Caulfield LE. Characteristics associated with the transition to partial breastfeeding prior to 6 months of age: Data from seven sites in a birth cohort study. MATERNAL & CHILD NUTRITION 2021; 17:e13166. [PMID: 33660928 PMCID: PMC8189203 DOI: 10.1111/mcn.13166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors associated with the timing of an early transition to partial breastfeeding across seven sites of a birth cohort study in which twice weekly information on infant feeding practices was collected. Infant (size, sex, illness and temperament), maternal (age, education, parity and depressive symptoms), breastfeeding initiation practices (time of initiation, colostrum and pre-lacteal feeding) and household factors (food security, crowding, assets, income and resources) were considered. Three consecutive caregiver reports of feeding animal milks and/or solids (over a 10-day period) were characterized as a transition to partial breastfeeding, and Cox proportional hazard models with time (in days) to partial breastfeeding were used to evaluate associations with both fixed and time-varying characteristics. Overall, 1470 infants were included in this analysis. Median age of transition to partial breastfeeding ranged from 59 days (South Africa and Tanzania) to 178 days (Bangladesh). Overall, higher weight-for-length z-scores were associated with later transitions to partial breastfeeding, as were food insecurity, and infant cough in the past 30 days. Maternal depressive symptoms (evaluated amongst 1227 infants from six sites) were associated with an earlier transition to partial breastfeeding. Relative thinness or heaviness within each site was related to breastfeeding transitions, as opposed to absolute z-scores. Further research is needed to understand relationships between local perceptions of infant body size and decisions about breastfeeding.
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Affiliation(s)
- Stephanie A. Richard
- Fogarty International CenterNational Institutes of HealthBethesdaMarylandUSA
- Infectious Disease Clinical Research ProgramHenry M Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Benjamin J. J. McCormick
- Fogarty International CenterNational Institutes of HealthBethesdaMarylandUSA
- Science Fish LimitedInschUK
| | - Laura E. Murray‐Kolb
- Department of Nutritional SciencesThe Pennsylvania State UniversityState CollegePAUSA
| | - Crystal L. Patil
- Department of Human Development and Nursing ScienceUniversity of IllinoisChicagoIllinoisUSA
| | | | - Cloupas Mahopo
- Department of NutritionUniversity of VendaThohoyandouSouth Africa
| | - Bruna L. Maciel
- Department of NutritionFederal University of Rio Grande do NorteNatalBrazil
| | - Anuradha Bose
- Division of Gastrointestinal SciencesChristian Medical CollegeVelloreIndia
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Divisionicddr,bDhakaBangladesh
| | - Ramya Ambikapathi
- Fogarty International CenterNational Institutes of HealthBethesdaMarylandUSA
- Department of Public HealthPurdue UniversityWest LafayetteIndianaUSA
| | | | - Laura E. Caulfield
- The Department of International HealthThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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50
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Sakalidis VS, Rea A, Perrella SL, McEachran J, Collis G, Miraudo J, Prosser SA, Gibson LY, Silva D, Geddes DT. Wellbeing of Breastfeeding Women in Australia and New Zealand during the COVID-19 Pandemic: A Cross-Sectional Study. Nutrients 2021; 13:1831. [PMID: 34072039 PMCID: PMC8230305 DOI: 10.3390/nu13061831] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 01/17/2023] Open
Abstract
During the COVID-19 pandemic, breastfeeding women have experienced restricted access to support, placing them at increased risk of mental health concerns and limited breastfeeding assistance. This study investigated the effect of the pandemic on feeding choices and maternal wellbeing amongst breastfeeding mothers living in Australian and New Zealand. We conducted a cross-sectional online survey that examined feeding methods, maternal mental wellbeing, worries, challenges, and positive experiences during the pandemic. Most women were exclusively breastfeeding (82%). Partial breastfeeding was associated with perceived low milk supply and longer pregnancy duration during the pandemic. Reduced mental health and wellbeing was associated with lower levels of family functioning, increased perceived stress, and perinatal anxiety. Longer pregnancy duration during the pandemic was associated with lower mental health wellbeing scores, while higher perceived stress scores were reported for regions with higher COVID-19 infection rates and women with perceived low milk supply. Women reported that the pandemic resulted in less pressure and more time for family bonding, while worries about the pandemic, family health, and parenting challenges were also cited. Mental health concerns of breastfeeding women appear to be exacerbated by COVID-19, highlighting a critical need for access to mental health and broader family support during the pandemic.
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Affiliation(s)
- Vanessa S. Sakalidis
- Swiss Tropical and Public Health Institute, 4051 Basel, Switzerland;
- University of Basel, 4001 Basel, Switzerland
| | - Alethea Rea
- Mathematics and Statistics, Murdoch University, Perth, WA 6150, Australia;
| | - Sharon L. Perrella
- School of Molecular Sciences, University of Western Australia, Perth, WA 6009, Australia; (S.L.P.); (J.M.); (S.A.P.)
- One For Women, Mt Lawley, WA 6050, Australia; (G.C.); (J.M.)
| | - Jacki McEachran
- School of Molecular Sciences, University of Western Australia, Perth, WA 6009, Australia; (S.L.P.); (J.M.); (S.A.P.)
| | - Grace Collis
- One For Women, Mt Lawley, WA 6050, Australia; (G.C.); (J.M.)
| | | | - Stuart A. Prosser
- School of Molecular Sciences, University of Western Australia, Perth, WA 6009, Australia; (S.L.P.); (J.M.); (S.A.P.)
- One For Women, Mt Lawley, WA 6050, Australia; (G.C.); (J.M.)
| | - Lisa Y. Gibson
- Telethon Kids Institute, Perth, WA 6009, Australia; (L.Y.G.); (D.S.)
- The University of Western Australia, Perth, WA 6009, Australia
- School of Health and Medical Sciences, Edith Cowan University, Perth, WA 6027, Australia
| | - Desiree Silva
- Telethon Kids Institute, Perth, WA 6009, Australia; (L.Y.G.); (D.S.)
- Health and Medical Sciences, The University of Western Australia, Perth, WA 6009, Australia
- Joondalup Health Campus, Perth, WA 6027, Australia
| | - Donna T. Geddes
- School of Molecular Sciences, University of Western Australia, Perth, WA 6009, Australia; (S.L.P.); (J.M.); (S.A.P.)
- Telethon Kids Institute, Perth, WA 6009, Australia; (L.Y.G.); (D.S.)
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