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Perinatal Depression Among HIV-Infected Women in KwaZulu-Natal South Africa: Prenatal Depression Predicts Lower Rates of Exclusive Breastfeeding

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Abstract

Exclusive breastfeeding (EBF) provides infants with optimal nutrition, and together with appropriate antiretroviral therapy has also been shown to decrease mother-to-child transmission of HIV from 45 to less than 1 %. However, rates of EBF are particularly low in South Africa, where rates of HIV are some of the highest in the world. Although perinatal depression has been identified as a potential barrier to EBF, little is known about its impact on EBF among HIV-infected women. A cohort study was conducted as part of a pilot randomized controlled trial (RCT) examining the effect of an Information, Motivation and Behavioral skills-based intervention promoting EBF among South African women living with HIV in their third trimester (28–42 weeks) of pregnancy. At baseline and follow-up, participants were interviewed on depression symptoms (PHQ-9), and breastfeeding intentions and behavior. Multivariate logistic regressions were conducted to determine predictors of EBF at 6-weeks postpartum. A total of 68 women were enrolled and 58 women completed both baseline and follow-up assessments. Most (80.9 %) of the sample reported at least some symptoms of depression prenatally. Rates of depression were lower postpartum (47.1 %). In multivariate models, higher prenatal depression scores significantly predicted lower likelihood of EBF at 6-weeks postpartum after adjusting for demographics, condition, and intentions (AOR = 0.68, p < 0.05). Postpartum depression was not a significant predictor of EBF rates (AOR = 0.99, p = 0.96). These findings demonstrate the negative impact of prenatal depression on breastfeeding behavior. Future interventions focused on depression are warranted to identify those at risk for sub-optimal EBF. Improving maternal psychosocial well-being could be a new frontier to improving infant and young child feeding and reducing pre/postnatal transmission.

Resumen

La lactancia materna exclusiva (LME) proporciona los lactantes con una nutrición óptima, y junto con la terapia antirretroviral apropiada también se ha demostrado que disminuye la transmisión de madre a hijo del VIH de 45 % a menos del 1 %. Sin embargo, las tasas de lactancia materna exclusiva son particularmente bajos en África del Sur, donde las tasas de VIH son algunas de las más altas del mundo. Aunque la depresión perinatal ha sido identificado como una barrera potencial para LME, se sabe poco sobre su impacto en la LME entre las mujeres infectadas por el VIH. Un estudio de cohortes se llevó a cabo como parte de un piloto para examinar el efecto de una información, motivación y de comportamiento de intervención promover la lactancia materna exclusiva entre las mujeres sudafricanas que viven con el VIH en su tercer trimestre (28-42 semanas) del embarazo basado en habilidades. Al inicio del estudio y seguimiento, los participantes fueron entrevistados en los síntomas de depresión (PHQ-9), y la lactancia intenciones y el comportamiento. Se realizaron análisis de regresión logística multivariante para determinar predictores de la lactancia materna exclusiva a los seis semanas después del parto. Un total de 68 mujeres se inscribieron y 58 mujeres completaron dos bases de referencia y las evaluaciones de seguimiento. La mayoría (80.9 %) de la muestra informó de al menos algunos de los síntomas de la depresión prenatal. Las tasas de depresión postparto fueron más bajos (47,1 %). En los modelos multivariados, las puntuaciones de depresión prenatal superiores predijeron significativamente menor probabilidad de lactancia materna exclusiva a los seis semanas después del parto después de ajustar por la demografía, condiciones e intenciones (AOR = 0,68, p < 0,05). La depresión posparto no fue un predictor significativo de la prevalencia de LME (AOR = 0,99, p = 0,96). Estos resultados demuestran el impacto negativo de la depresión prenatal sobre el comportamiento de la lactancia materna. Las futuras intervenciones se centraron en la depresión están garantizados para identificar aquellos en riesgo de EBF subóptima. Mejorar el bienestar psicosocial materno podría ser una nueva frontera para mejorar la alimentación del lactante y del niño pequeño y la reducción de la transmisión de VIH pre /post-natal.

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References

  1. Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007;369(9567):1107–16. doi:10.1016/S0140-6736(07)60283-9.

    Article  PubMed  Google Scholar 

  2. Kuhn L, Skinkala M, Kankasa C, et al. High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission. PLoS One. 2007;2(12):e1363.

    Article  PubMed  PubMed Central  Google Scholar 

  3. UNICEF. Achieving an AIDS-free Generation. 2013. http://www.unicef.org/aids/files/VisionPaper_Interactive_ENG.pdf. Accessed 26 Jan 2016.

  4. American Academy of Pediatrics. Breastfeeding Initiatives. http://www2.aap.org/breastfeeding/. Accessed 26 Jan 2016.

  5. Centres for Disease Control and Prevention. The Surgeon General’s Call to Action to Support Breastfeeding. 2012. http://www.cdc.gov/breastfeeding/promotion/calltoaction.htm. Accessed 26 Jan 2016.

  6. UNICEF. 2015. http://www.unicef.org/nutrition/index_24824.html. Accessed 26 Jan 2016.

  7. Babita NK, Singh M, Malik J, Kalhan M. Breastfeeding reduces breast cancer risk: a case-control study in north India. Int J Prev Med. 2014;5(6):791–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Kwan M, Bernard P, Kroenke C, Factor R, Habel L, Weltzien E, Castillo A, Gunderson E, Maxfield K, Stijleman I, Langholz B, Quesenberry C, Kushi L, Sweeney C, Caan B. Breastfeeding, PAM50 tumor subtype, and breast cancer prognosis and survival. J Natl Cancer Inst. 2015;4(28):107.

    Google Scholar 

  9. Chowdhury R, Sinha B, Sankar MJ, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104:96–113. doi:10.1111/apa.13102.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Department of Health South Africa. Demographic and health survey 2003. Pretoria: Department of Health; 2007.

    Google Scholar 

  11. Tomlinson M, Cooper P, Stein A, Swartz L, Molteno C. Post-partum depression and infant growth in a South African peri-urban settlement. Child Care Health Dev. 2006;32:81–6.

    Article  CAS  PubMed  Google Scholar 

  12. CDC. Mental health among women of reproductive age. http://www.cdc.gov/reproductivehealth/depression/pdfs/mental_health_women_repo_age.pdf. Accessed 26 Jan 2016.

  13. Antelman G, Kaaya S, Wei R, Mbwambo J, Msamanga G, Fawzi W. Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania. J Acquir Immune Defic Syndr. 2007;44:470–7.

    Article  PubMed  Google Scholar 

  14. Kaaya S, Garcia ME, Li N, et al. Association of maternal depression and infant nutritional status among women living with HIV in Tanzania. Matern Child Health. 2014;. doi:10.1111/mcn.12154.

    Google Scholar 

  15. Rochat TJ, Tomlinson M, Barnighausen T, Newell ML, Stein A. The prevalence and clinical presentation of antenatal depression in rural South Africa. J Affect Disord. 2011;135:362–73. doi:10.1016/j.jad.2011.08.011.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Basu S, Chwastiak LA, Bruce RD. Clinical management of depression and anxiety in HIV-infected adults. AIDS. 2005;19(18):2057–67.

    Article  PubMed  Google Scholar 

  17. Lusskin S, Pundiak TM, Habib SM. Perinatal depression: hiding in plain sight. Can. J Psychiatry. 2007;52(8):479–88.

    Article  PubMed  Google Scholar 

  18. Aaron E, Bonacquisti A, Geller PA, Polansky M. Perinatal depression and anxiety in women with and without human immunodeficiency virus infection. Women’s Health Issues. 2015;25(5):579–85.

    Article  PubMed  Google Scholar 

  19. Kapetanovic S, Dass-Brailsford P, Nora D, Talisman N. Mental health of HIV-seropositive women during pregnancy and postpartum period: a comprehensive literature review. AIDS Behav. 2014;18(6):1152–73.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sidebottom A, Hellerstedt W, Harrison P, Hennrikus D. An examination of prenatal and postpartum depressive symptoms among women served by urban community health centers. Arch Womens Ment Health. 2014;17:27–40.

    Article  PubMed  Google Scholar 

  21. Gregory EF, Butz AM, Ghazarian SR, Gross SM, Johnson SB. Are unmet breastfeeding expectations associated with maternal depressive symptoms. Acad Pediatr. 2015;15(3):319–25.

    Article  PubMed  Google Scholar 

  22. Schwarze C, Hellhammer D, Stroehle V, Lieb K, Mobascher A. Lack of breastfeeding: A potential risk factor in the multifactorial genesis of borderline personality disorder and impaired maternal bonding. J Pers Disord. 2014;29(5):610–26.

    Article  PubMed  Google Scholar 

  23. Diego M, Field T, Hernandez-Reif M, Schanberg S, Kuhn C, Gonalez-Quintero V. Prenatal depression restricts fetal growth. Early Hum Dev. 2009;85(1):65–70.

    Article  PubMed  Google Scholar 

  24. Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013;74(4):321–41.

    Article  Google Scholar 

  25. Weobong B, Asbroek AH, Soremekun A, et al. Assocation of antenatal depression with adverse consequences for the mother and newborn in rural Ghana: findings from the DON population-based cohort study. PLoS One. 2014;9(12):1–16.

    Article  Google Scholar 

  26. Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med. 2001;63(5):830–4.

    Article  CAS  PubMed  Google Scholar 

  27. Dubber S, Reck C, Muller M, Gawlik S. Postpartum bonding: the role of perinatal depression, anxiety and maternal-fetal bonding during pregnancy. Arch Womens Mental Health. 2015;18(2):187–95.

    Article  CAS  Google Scholar 

  28. Muzic M, Borovska S. Perinatal depression: implications for child mental health. Mental Health Fam Med. 2010;7(4):239–47.

    Google Scholar 

  29. Sheth SS, Coleman J, Cannon T, et al. Association between depression and nonadherence to antiretroviral therapy in pregnant women with perinatally acquired HIV. AIDS Care. 2015;27(3):350–4.

    Article  PubMed  Google Scholar 

  30. Nachega JB, Morroni C, Zuniga JM, Sherer R, Beyrer C, Solomon S, Schechter M, Rockstroh J. HIV-related stigma, isolation, discrimination, and serostatus disclosure: a global survey of 2035 HIV-infected adults. J Int Assoc Phys AIDS Care. 2012;11(3):172–8.

    Article  Google Scholar 

  31. Dias CC, Figueiredo B. Breastfeeding and depression: A systematic review of the literature. J Affective Disorders. 2015;171:142–54.

    Article  Google Scholar 

  32. Sowa N, Cholera R, Pence BW, Gaynes BN. Perinatal depression in HIV-infected African women: a systematic review. J Clin Psychiatry. 2015;76(10):1385–96.

    Article  PubMed  Google Scholar 

  33. WHO. Guidelines on HIV and infant feeding. 2010. http://whqlibdoc.who.int/publications/2010/9789241599535_eng.pdf. Accessed 26 Jan 2016.

  34. Stringer EM, Meltzer-Brody S, Kasaro M, et al. Depression, pregnancy, and HIV: the case to strengthen mental health services for pregnant and post-partum women in sub-Saharan Africa. Lancet Psychiatry. 2014;1(2):159–62.

    Article  PubMed  Google Scholar 

  35. UNICEF/WHO/World Bank/UN. Levels and trends in child mortality. 2014. http://www.unicef.org/media/files/Levels_and_Trends_in_Child_Mortality_2014.pdf. Accessed 24 Feb 2016.

  36. Fisher JD, Fisher WA. Changing AIDS risk behavior. Psychol Bull. 1992;111:455–74.

    Article  CAS  PubMed  Google Scholar 

  37. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Zhong Q, Gelaye B, Rondon M, et al. Comparative performance of patient health questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression. J Affect Disord. 2014;162(20):1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Xiong N, Fritzsche K, Wei J, et al. Validation of patient health questionnaire (PHQ) for major depression in Chinese outpatients with multiple somatic symptoms: a multicenter cross-sectional study. J Affect Disord. 2015;174:636–43. doi:10.1016/j.jad2014.12.042.

    Article  PubMed  Google Scholar 

  40. Tuthill EL, Butler LM, McGrath JM, et al. Cross-cultural adaptation of instruments assessing breastfeeding determinants: a multi-step approach. Int Breastfeed J. 2014;9(1):16. doi:10.1186/1746-4358-9-16.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yusuff AS, Tang L, Binns CW, Lee AH. Breastfeeding and postnatal depression: a prospective cohort study in Sabah, Malaysia. J Hum Lact. 2015;. doi:10.1177/0890334415620788.

    PubMed  Google Scholar 

  42. Machado MC, Assis KF, Oliveira FC, et al. Determinants of the exclusive breastfeeding abandonment: psychosocial factors. Rev Saude Publ. 2014;48(6):985–94.

    Article  Google Scholar 

  43. Pope C, Mazmanian D, Bedard M, Sharma V. Breastfeeding and postpartum depression: assessing the influence of breastfeeding intention and other risk factors. J Affect Disord. 2016;19(200):45–50.

    Article  Google Scholar 

  44. Lau Y, Wong D, Chan K. The utility of screening for perinatal depression in the second trimester among Chinese: a three-wave prospective longitudinal study. Arch Women’s Health. 2010;13:153–64.

    Article  Google Scholar 

  45. Rahman A, Creed F. Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: prospective study from Rawalpindi, Pakistan. J Affect Disord. 2007;100:115–21.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Bascom EM, Napolitano MA. Breastfeeding duration and primary reasons for breastfeeding cessation among women with postpartum depressive symptoms. J Hum Lact. 2015;32(2):282–91. doi:10.1177/0890334415619908.

    Article  PubMed  Google Scholar 

  47. Dennis CL, Brown S. Psychosocial interventions fro the treatment of perinatal depression. Best Pract Res Clin Obstet Gynaecol. 2014;28:97–111.

    Article  PubMed  Google Scholar 

  48. Tharner A, Luijk M, Raat H, Ijzendoorn M, Bakermanse-Kranenburg M, Moll H, Jaddoe V, Hofman A, Verhulst F, Tiemeier H. Breastfeeding and its relation to maternal sensitivity and infant attachment. J Dev. Behav Pediatr. 2012;33:396–404.

    Article  PubMed  Google Scholar 

  49. Kingston K, Austin MP, Hegadoren K, et al. Study protocol for a randomized, controlled, superiority trial comparing the clinical and cost-effectiveness of integrated online mental health assessment-referral-care in pregnancy to usual prenatal care on prenatal and postnatal mental health and infant health and development: the Integrated Maternal Psychosocial Assessment to Care Trial (IMPACT). Trials. 2014;15:72–92.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

ELT was supported by Grant Number T32NR007081 from the National Institute of Nursing Research and F31MH099990 from National Institute of Mental Health. SLY was supported by Grant Number K01 MH098902 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. UCSF School of Nursing, University of California San Francisco, 2 Koret Way, Box 0608, San Francisco, CA, 94143-0608, USA

    Emily L. Tuthill

  2. Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Jennifer A. Pellowski

  3. Department of Anthropology, Institute for Policy Research Northwestern University, Evanston, IL, USA

    Sera L. Young

  4. Department of Pediatrics, Harvard Medical School, Boston, USA

    Lisa M. Butler

  5. Department of Medicine, Division of General Pediatrics, Boston Children’s Hospital, Boston, USA

    Lisa M. Butler

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  1. Emily L. Tuthill
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Correspondence to Emily L. Tuthill.

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Conflicts of Interest

Drs. Tuthill, Pellowski, Young and Butler declare no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical Considerations

The University of Connecticut Institutional Review Board and the Human Sciences Research Council Ethics Review Board approved the study protocol.

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Informed consent was obtained for all individual participants included in the study.

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Tuthill, E.L., Pellowski, J.A., Young, S.L. et al. Perinatal Depression Among HIV-Infected Women in KwaZulu-Natal South Africa: Prenatal Depression Predicts Lower Rates of Exclusive Breastfeeding. AIDS Behav 21, 1691–1698 (2017). https://doi.org/10.1007/s10461-016-1557-9

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  • DOI: https://doi.org/10.1007/s10461-016-1557-9

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