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Maternal mood symptoms in pregnancy and postpartum depression: association with exclusive breastfeeding in a population-based birth cohort

Abstract

Purpose

This study aimed to evaluate the association between mood symptoms during pregnancy and exclusive breastfeeding at 3 months, as well as the association between exclusive breastfeeding at 3 months and maternal depression at 12 months postpartum.

Methods

Data from the Pelotas 2004 Birth Cohort with 4231 live births were used. Maternal mood symptoms during pregnancy were assessed through the question "During pregnancy, did you have depression or nervous problems?" and depression symptomatology at 12 months postpartum was assessed with the Edinburg Postnatal Depression Scale (EPDS). Information on exclusive breastfeeding at 3 months was collected through a dietary recall questionnaire. Crude and adjusted relative risks (RR) with 95% confidence intervals (95% CI) were estimated by Poisson regression.

Results

Prevalence of mood symptoms during pregnancy was 25.1% (95% CI 23.8; 26.4%) and prevalence of EPDS ≥ 10 at 12 months after birth was 27.6% (95% CI 26.2; 29.0%). Prevalence of exclusive breastfeeding at 3 months was 26.5% (95% CI 25.2; 27.9%). In crude analyses, maternal mood symptoms during pregnancy were associated with non-exclusive breastfeeding at 3 months and non-exclusive breastfeeding at 3 months was associated with postpartum maternal depression at 12 months. In the adjusted analyses, both associations were lost after the inclusion of maternal education (RR 0.92; 95% CI 0.81–1.04 and RR 0.92; 95% CI 0.81–1.03, respectively).

Conclusion

In our study, the crude association between mood symptoms in pregnancy, exclusive breastfeeding at 3 months, and postpartum depression was due more to the low maternal education than to a true relationship between them.

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References

  1. Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 387(10017):475–490. https://doi.org/10.1016/S0140-6736(15)01024-7

    Article  PubMed  Google Scholar 

  2. WHO (2000) Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO Collaborative Study Team on the role of breastfeeding on the prevention of infant mortality. Lancet 355(9202):451–455

    Article  Google Scholar 

  3. Quigley MA, Kelly YJ, Sacker A (2007) Breastfeeding and hospitalization for diarrheal and respiratory infection in the United Kingdom Millennium Cohort Study. Pediatrics 119(4):e837–842. https://doi.org/10.1542/peds.2006-2256

    Article  PubMed  Google Scholar 

  4. Kramer MS, Kakuma R (2004) The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol 554:63–77

    Article  Google Scholar 

  5. Horta BL, Victora CG, World Health Organization (2013) Long-term effects of breastfeeding: a systematic review. World Health Organization, Geneva

    Google Scholar 

  6. Victora CG, Barros FC, Horta BL, Lima RC (2005) Breastfeeding and school achievement in Brazilian adolescents. Acta Paediatr 94(11):1656–1660. https://doi.org/10.1080/08035250500252658

    Article  PubMed  Google Scholar 

  7. Figueiredo B, Dias CC, Brandão S, Canário C, Nunes-Costa R (2013) Amamentação e depressão pós-parto: revisão do estado de arte. J Pediatr 89:332–338

    Article  Google Scholar 

  8. Committee on Obstetric Practice (2015) The American College of Obstetricians and Gynecologists Committee Opinion no. 630. screening for perinatal depression. Obstet Gynecol 125(5):1268–1271. https://doi.org/10.1097/01.AOG.0000465192.34779.dc

    Article  Google Scholar 

  9. O'Hara MW, McCabe JE (2013) Postpartum depression: current status and future directions. Annu Rev Clin Psychol 9:379–407. https://doi.org/10.1146/annurev-clinpsy-050212-185612

    Article  PubMed  Google Scholar 

  10. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106(5 Pt 1):1071–1083. https://doi.org/10.1097/01.AOG.0000183597.31630.db

    Article  PubMed  Google Scholar 

  11. Matijasevich A, Golding J, Smith GD, Santos IS, Barros AJD, Victora CG (2009) Differentials and income-related inequalities in maternal depression during the first two years after childbirth: birth cohort studies from Brazil and the UK. Clin Pract Epidemiol Ment Health 5:12–12. https://doi.org/10.1186/1745-0179-5-12

    Article  PubMed  PubMed Central  Google Scholar 

  12. Robinson G, Stewart D (2001) Postpartum disorders. In: Stotland N, Stewart D (eds) Psychological aspects of women's health care. American Psychiatric Press Inc, Washington, pp 117–139

    Google Scholar 

  13. Serati M, Redaelli M, Buoli M, Altamura AC (2016) Perinatal major depression biomarkers: a systematic review. J Affect Disord 193:391–404. https://doi.org/10.1016/j.jad.2016.01.027

    Article  PubMed  CAS  Google Scholar 

  14. Dias CC, Figueiredo B (2015) Breastfeeding and depression: a systematic review of the literature. J Affect Disord 171:142–154. https://doi.org/10.1016/j.jad.2014.09.022

    Article  PubMed  Google Scholar 

  15. Pope CJ, Mazmanian D (2016) Breastfeeding and postpartum depression: an overview and methodological recommendations for future research. Depress Res Treat 2016:4765310. https://doi.org/10.1155/2016/4765310

    Article  PubMed  PubMed Central  Google Scholar 

  16. Santos IS, Barros AJ, Matijasevich A, Domingues MR, Barros FC, Victora CG (2011) Cohort profile: the 2004 Pelotas (Brazil) birth cohort study. Int J Epidemiol 40(6):1461–1468. https://doi.org/10.1093/ije/dyq130

    Article  PubMed  Google Scholar 

  17. Santos IS, Barros AJ, Matijasevich A, Zanini R, Chrestani Cesar MA, Camargo-Figuera FA, Oliveira IO, Barros FC, Victora CG (1437a) Cohort profile update: 2004 Pelotas (Brazil) Birth Cohort Study. Body composition, mental health and genetic assessment at the 6 years follow-up. Int J Epidemiol 43(5):1437–1437a–f. https://doi.org/10.1093/ije/dyu144

    Article  PubMed  PubMed Central  Google Scholar 

  18. Matijasevich A, Murray J, Cooper PJ, Anselmi L, Barros AJ, Barros FC, Santos IS (2015) Trajectories of maternal depression and offspring psychopathology at 6 years: 2004 Pelotas Cohort Study. J Affect Disord 174:424–431. https://doi.org/10.1016/j.jad.2014.12.012

    Article  PubMed  PubMed Central  Google Scholar 

  19. WHO (2009) SESSION 2: the physiological basis of breastfeeding. In: Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. World Health Organization, Geneva, ISBN 978 92 4 159749 4. https://www.who.int/nutrition/publications/infantfeeding/9789241597494.pdf

  20. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786

    Article  CAS  Google Scholar 

  21. Santos IS, Matijasevich A, Tavares BF, Barros AJD, Botelho IP, Lapolli C, Magalhães PVdS, Barbosa APPN, Barros FC (2007) Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of mothers from the 2004 Pelotas Birth Cohort Study. Cad Saude Publica 23:2577–2588

    Article  Google Scholar 

  22. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML (2005) Births: final data for 2003. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics. Nat Vital Stat Syst 54(2):1–116

    Google Scholar 

  23. Dubowitz L, Ricciw D, Mercuri E (2005) The Dubowitz neurological examination of the full-term newborn. Ment Retard Dev Disabil Res Rev 11(1):52–60. https://doi.org/10.1002/mrdd.20048

    Article  PubMed  Google Scholar 

  24. Figueiredo B, Canario C, Field T (2014) Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychol Med 44(5):927–936. https://doi.org/10.1017/s0033291713001530

    Article  PubMed  CAS  Google Scholar 

  25. Ystrom E (2012) Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childbirth 12(1):36. https://doi.org/10.1186/1471-2393-12-36

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ystrom E, Niegel S, Klepp KI, Vollrath ME (2008) The impact of maternal negative affectivity and general self-efficacy on breastfeeding: the Norwegian Mother and Child Cohort Study. J Pediatr 152(1):68–72. https://doi.org/10.1016/j.jpeds.2007.06.005

    Article  PubMed  Google Scholar 

  27. Imsiragic AS, Begic D, Sarajlic I, Palavra IR, Orban M (2016) Predictors of exclusive breastfeeding 6–9 weeks after delivery: a Prospective Cohort Study. public mental health perspective. Psychiatr Danub 28(4):395–403

    PubMed  Google Scholar 

  28. Woolhouse H, James J, Gartland D, McDonald E, Brown SJ (2016) Maternal depressive symptoms at three months postpartum and breastfeeding rates at six months postpartum: Implications for primary care in a prospective cohort study of primiparous women in Australia. Women Birth 29(4):381–387. https://doi.org/10.1016/j.wombi.2016.05.008

    Article  PubMed  Google Scholar 

  29. Kehler HL, Chaput KH, Tough SC (2009) Risk factors for cessation of breastfeeding prior to six months postpartum among a community sample of women in Calgary, Alberta. Can J Public Health 100(5):376–380

    Article  Google Scholar 

  30. McCarter-Spaulding D, Horowitz JA (2007) How does postpartum depression affect breastfeeding? MCN Am J Matern Child Nurs 32(1):10–17

    Article  Google Scholar 

  31. Hahn-Holbrook J, Haselton MG, Dunkel Schetter C, Glynn LM (2013) Does breastfeeding offer protection against maternal depressive symptomatology? A prospective study from pregnancy to 2 years after birth. Arch Womens Ment Health 16(5):411–422. https://doi.org/10.1007/s00737-013-0348-9

    Article  PubMed  Google Scholar 

  32. Biaggi A, Conroy S, Pawlby S, Pariante CM (2016) Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord 191:62–77. https://doi.org/10.1016/j.jad.2015.11.014

    Article  PubMed  PubMed Central  Google Scholar 

  33. Field T (2017) Prenatal depression risk factors, developmental effects and interventions: a review. J Pregnancy Child Health. https://doi.org/10.4172/2376-127x.1000301

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ladin K (2008) Risk of late-life depression across 10 European Union countries: deconstructing the education effect. J Aging Health 20(6):653–670. https://doi.org/10.1177/0898264308321002

    Article  PubMed  Google Scholar 

  35. Santana GS, Giugliani ERJ, Vieira TO, Vieira GO (2018) Factors associated with breastfeeding maintenance for 12 months or more: a systematic review. J Pediatr 94(2):104–122. https://doi.org/10.1016/j.jped.2017.06.013

    Article  Google Scholar 

  36. Santos IS, Barros FC, Horta BL, Menezes AMB, Bassani D, Tovo-Rodrigues L, Lima NP, Victora CG, The Pelotas Cohorts Study Group (2018) Breastfeeding exclusivity and duration: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015. Int J Epidemiol 489:i72–i79 (in press)

    Google Scholar 

  37. Feinstein JS (1993) The relationship between socioeconomic status and health: a review of the literature. Milbank Q 71(2):279–322

    Article  CAS  Google Scholar 

  38. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14. https://doi.org/10.1016/j.ajog.2009.09.007

    Article  PubMed  PubMed Central  Google Scholar 

  39. Theme Filha MM, Ayers S, da Gama SG, Leal Mdo C (2016) Factors associated with postpartum depressive symptomatology in Brazil: The Birth in Brazil National Research Study, 2011/2012. J Affect Disord 194:159–167. https://doi.org/10.1016/j.jad.2016.01.020

    Article  PubMed  Google Scholar 

  40. Hatton DC, Harrison-Hohner J, Coste S, Dorato V, Curet LB, McCarron DA (2005) Symptoms of postpartum depression and breastfeeding. J Hum Lact 21(4):444–449. https://doi.org/10.1177/0890334405280947(quiz 450–444)

    Article  PubMed  Google Scholar 

  41. Dennis CL, McQueen K (2007) Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatr 96(4):590–594. https://doi.org/10.1111/j.1651-2227.2007.00184.x

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was funded by Wellcome Trust, Conselho Nacional de Pesquisa (CNPq, Brazil), Research Support Foundation of the State of Rio Grande do Sul (FAPERGS), the Brazilian Ministry of Health (MS), Children’s Pastorate, and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

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Correspondence to Simone Farías-Antúnez.

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Farías-Antúnez, S., Santos, I.S., Matijasevich, A. et al. Maternal mood symptoms in pregnancy and postpartum depression: association with exclusive breastfeeding in a population-based birth cohort. Soc Psychiatry Psychiatr Epidemiol 55, 635–643 (2020). https://doi.org/10.1007/s00127-019-01827-2

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  • DOI: https://doi.org/10.1007/s00127-019-01827-2

Keywords

  • Maternal depression
  • Postpartum depression
  • Breastfeeding
  • Cohort study