AIDS and Behavior

, Volume 21, Issue 6, pp 1691–1698 | Cite as

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

  • Emily L. Tuthill
  • Jennifer A. Pellowski
  • Sera L. Young
  • Lisa M. Butler
Original Paper


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.


Prenatal depression HIV Perinatal depression South Africa Breastfeeding Maternal and child health 


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.



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.

Compliance with Ethical Standards

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.

Informed Consent

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


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Emily L. Tuthill
    • 1
  • Jennifer A. Pellowski
    • 2
  • Sera L. Young
    • 3
  • Lisa M. Butler
    • 4
    • 5
  1. 1.UCSF School of NursingUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Psychiatry and Human BehaviorThe Warren Alpert Medical School of Brown UniversityProvidenceUSA
  3. 3.Department of AnthropologyInstitute for Policy Research Northwestern UniversityEvanstonUSA
  4. 4.Department of PediatricsHarvard Medical SchoolBostonUSA
  5. 5.Department of Medicine, Division of General PediatricsBoston Children’s HospitalBostonUSA

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