The Association between Positive Antenatal Depression Screening and Breastfeeding Initiation and Continuation

Abstract

Objective This study was aimed to determine the association between antenatal depression and breastfeeding initiation and continuation at 6 weeks postpartum.

Study Design This retrospective cohort study included all live-born deliveries after 24weeks' gestation at a single tertiary care institution between 2009 and 2014 with a documented antenatal depression screen using the Patient Health Questionnaire-9 (PHQ-9). During the study period, it was recommended that routine screening occur during both the first and third trimesters. A positive screen was defined as a PHQ-9 score ≥ 10. Breastfeeding initiation and continuation until 6 weeks' postpartum were compared between women with and without a positive screen using bivariable analyses. Stepwise backward elimination regressions were used to identify whether a positive screen was independently associated with breastfeeding rates after controlling for confounders.

Results Among the 2,871 women meeting inclusion criteria, 302 (10.5%) were screened positive for antenatal depression. After adjusting for confounders, there were no differences in breastfeeding initiation (adjusted odds ratio [aOR] = 0.78, 95% confidence interval [CI]: 0.52–1.16), but women with a positive antenatal depression screen were significantly less likely to continue breastfeeding at 6 weeks' postpartum (aOR= 0.67, 95% CI: 0.48–0.96).

Conclusion A positive antenatal depression, screened in the first or third trimester, is a significant risk factor for early breastfeeding cessation.

Keywords

breastfeeding - antenatal depression - postpartum depression - disparity

Publication History

Received: 11 March 2019

Accepted: 15 July 2019

Article published online:
03 September 2019

• References

• 1 Ip S, Chung M, Raman G. et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep) 2007; 153 (153) 1-186
• 2 Chien PF, Howie PW. Breast milk and the risk of opportunistic infection in infancy in industrialized and non-industrialized settings. Adv Nutr Res 2001; 10: 69-104
• 3 Oddy WH. The impact of breastmilk on infant and child health. Breastfeed Rev 2002; 10 (03) 5-18
• 4 Hanson LA. Session 1: feeding and infant development breast-feeding and immune function. Proc Nutr Soc 2007; 66 (03) 384-396
• 5 Arenz S, Rückerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity--a systematic review. Int J Obes Relat Metab Disord 2004; 28 (10) 1247-1256
• 6 Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. Am J Clin Nutr 2006; 84 (05) 1043-1054
• 7 Schwarz EB, Nothnagle M. The maternal health benefits of breastfeeding. Am Fam Physician 2015; 91 (09) 603-604
• 8 Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010; 125 (05) e1048-e1056
• 9 Gartner LM, Morton J, Lawrence RA. et al; American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005; 115 (02) 496-506
• 10 Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG committee opinion no. 361: breastfeeding: maternal and infant aspects. ObstetGynecol 2007; 109 (2, Pt. 1): 479-480
• 11 Bibbins-Domingo K, Grossman DC, Curry SJ. et al; US Preventive Services Task Force. Primary care interventions to support breastfeeding: us preventive services task force recommendation statement. JAMA 2016; 316 (16) 1688-1693
• 12 Centers for Disease Control and Prevention. Rates of any and exclusive breastfeeding by socio-demographics among children born in 2015. Accessed November 29, 2018 at: https://www.cdc.gov/breastfeeding/data/nis_data/rates-any-exclusive-bf-socio-dem-2015.htm
• 13 Li R, Rock VJ, Grummer-Strawn L. Changes in public attitudes toward breastfeeding in the United States, 1999-2003. J Am Diet Assoc 2007; 107 (01) 122-127
• 14 Jarlenski M, McManus J, Diener-West M, Schwarz EB, Yeung E, Bennett WL. Association between support from a health professional and breastfeeding knowledge and practices among obese women: evidence from the Infant Practices Study II. Womens Health Issues 2014; 24 (06) 641-648
• 15 Hedberg IC. Barriers to breastfeeding in the WIC population. MCN Am J Matern Child Nurs 2013; 38 (04) 244-249
• 16 Mulready-Ward C, Hackett M. Perception and attitudes: breastfeeding in public in New York City. J Hum Lact 2014; 30 (02) 195-200
• 17 Nguyen TT, Hawkins SS. Current state of US breastfeeding laws. Matern Child Nutr 2013; 9 (03) 350-358
• 18 Guendelman S, Kosa JL, Pearl M, Graham S, Goodman J, Kharrazi M. Juggling work and breastfeeding: effects of maternity leave and occupational characteristics. Pediatrics 2009; 123 (01) e38-e46
• 19 Guttman N, Zimmerman DR. Low-income mothers' views on breastfeeding. SocSci Med 2000; 50 (10) 1457-1473
• 20 Jones KM, Power ML, Queenan JT, Schulkin J. Racial and ethnic disparities in breastfeeding. Breastfeed Med 2015; 10 (04) 186-196
• 21 Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. J Affect Disord 2015; 171: 142-154
• 22 Wisner KL, Sit DK, McShea MC. et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013; 70 (05) 490-498
• 23 Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psych Ann 2002; 32 (09) 509-521
• 24 Mozingo JN, Davis MW, Droppleman PG, Merideth A. “It wasn't working. ”Women's experiences with short-term breastfeeding. MCN Am J Matern Child Nurs 2000; 25 (03) 120-126