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Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010–2011 Pregnancy Risk Assessment Monitoring System

Maternal and Child Health Journal volume 21, pages 636–647 (2017)Cite this article

Abstract

Objective Evidence suggests that women with postpartum depression (PPD) are at risk for early breastfeeding cessation, but previous studies have been limited by small samples. The objective of this analysis is to estimate the association between PPD symptoms and breastfeeding using a national, stratified, random sample of U.S. mothers. Methods Data from the 2010–2011 Pregnancy Risk Assessment Monitoring System were analyzed for New York City and the 29 states for which data were available. Multivariable logistic regression was used to explore the association between a pre-pregnancy mental health visit and subsequent breastfeeding initiation as well as PPD and 3-month any and exclusive breastfeeding. To identify state-level variation, we created maps of prevalence and adjusted odds of breastfeeding by PPD and pre-pregnancy mental health status. Results Women reporting a pre-pregnancy mental health visit had 0.61 (95 % CI 0.56, 0.67) times the odds of initiating breastfeeding compared with women who reported no pre-pregnancy visit. At 3 months postpartum, women with PPD symptoms since birth had 0.79 (95 % CI 0.70, 0.88) times the odds of any breastfeeding and reduced odds of exclusive breastfeeding modified by race/ethnicity. We found variation in state-level PPD symptoms and pre-pregnancy mental health prevalence and adjusted odds of breastfeeding. Conclusions for Practice Our results highlight the importance of providing targeted breastfeeding support to women with PPD symptoms, because they are at risk of early breastfeeding cessation. Given the cross-sectional nature of these data, women with early breastfeeding cessation may also be at risk for PPD, requiring screening and treatment.

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References

  • Adedinsewo, D. A., Fleming, A. S., Steiner, M., Meaney, M. J., Girard, A. W., & MAVAN team. (2014). Maternal anxiety and breastfeeding: Findings from the MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) Study. Journal of Human Lactation, 30(1), 102–109. doi:10.1177/0890334413504244.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Press.

    Book  Google Scholar 

  • Campbell, S., Matestic, P., von Stauffenberg, C., Mohan, R., & Kirchner, T. (2007). Trajectories of maternal depressive symptoms, maternal sensitivity, and children’s functioning at school entry. Developmental Psychology, 43(5), 1202–1215. doi:10.1037/0012-1649.43.5.1202.

    Article  PubMed  Google Scholar 

  • Campbell, S., Morgan-Lopez, A., Cox, M., Mcloyd, V., & NICHD Early Childcare Research Network. (2009). A latent class analysis of maternal depressive symptoms over 12 years and offspring adjustment in adolescence. Journal of Abnormal Psychology, 118(3), 479–493. doi:10.1037/a0015923.A.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention (CDC). (2011). Nutrition, physical activity and obesity: Data, trends and maps. Retrieved from https://nccd.cdc.gov/NPAO_DTM/.

  • Chowdhury, R., Sinha, B., Sankar, M. J., Taneja, S., Bhandari, N., Rollins, N., et al. (2015). Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. Acta Paediatrica, 104, 96–113. doi:10.1111/apa.13102.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dennis, C., & McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123(4), e736–e751. doi:10.1542/peds.2008-1629.

    Article  PubMed  Google Scholar 

  • Dias, C. C., & Figueiredo, B. (2014). Breastfeeding and depression: A systematic review of the literature. Journal of Affective Disorders, 171c, 142–154. doi:10.1016/j.jad.2014.09.022.

    Google Scholar 

  • Essex, M. J., Klein, M. H., Miech, R., & Smider, N. A. (2001). Timing of initial exposure to maternal major depression and children’s mental health symptoms in kindergarten. British Journal of Psychiatry, 179, 151–156. doi:10.1192/bjp.179.2.151.

    Article  CAS  PubMed  Google Scholar 

  • Fairlie, T. G., Gillman, M. W., & Rich-Edwards, J. (2009). High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation. Journal of Women’s Health, 18(7), 945–953. doi:10.1089/jwh.2008.0998.

    Article  PubMed  PubMed Central  Google Scholar 

  • Feldens, C. A., Vitolo, M. R., Rauber, F., Cruz, L. N., & Hilgert, J. B. (2012). Risk factors for discontinuing breastfeeding in Southern Brazil: A survival analysis. Maternal and Child Health Journal, 16(6), 1257–1265. doi:10.1007/s10995-011-0885-7.

    Article  PubMed  Google Scholar 

  • Flores-Quijano, M. E., Cordova, A., Contreras-Ramirez, V., Farias-Hernandez, L., Cruz Tolentino, M., & Casanueva, E. (2008). Risk for postpartum depression, breastfeeding practices, and mammary gland permeability. Journal of Human Lactation, 24(1), 50–57. doi:10.1177/0890334407310587.

    Article  PubMed  Google Scholar 

  • Gaynes, B. N., Gavin, N., Meltzer-Brody, S., Lohr, K. N., Swinson, T., Gartlehner, G., et al. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evidence report/technology assessment (Summary), 119, 1–8.

    Google Scholar 

  • Gross, K. H., Wells, C. S., Radigan-Garcia, A., & Dietz, P. M. (2002). Correlates of self-reports of being very depressed in the months after delivery: Results from the Pregnancy Risk Assessment Monitoring System. Maternal and Child Health Journal, 6(4), 247–253.

    Article  PubMed  Google Scholar 

  • Gunderson, E. P., Quesenberry, C. P., Ning, X., Jacobs, D. R., Gross, M., Goff, D. C., et al. (2015). Lactation duration and midlife atherosclerosis. Obstetrics and Gynecology, 126(2), 381–390. doi:10.1097/AOG.0000000000000919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hatton, D. C., Harrison-Hohner, J., Coste, S., Dorato, V., Curet, L. B., & Mccarron, D. A. (2004). Symptoms of postpartum depression and breastfeeding. Journal of Human Lactation, 21(4), 444–449. doi:10.1177/0890334405280947.

    Article  Google Scholar 

  • Horta, B. L., de Mola, C. L., & Victora, C. G. (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure, and type-2 diabetes: systematic review and meta-analysis. Acta Paediatrica, 104, 30–37. doi:10.1111/apa.13133.

    Article  CAS  PubMed  Google Scholar 

  • Howell, E. A., Mora, P. A., Horowitz, C. R., & Leventhal, H. (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105(6), 1442–1450. doi:10.1097/01.aog.0000164050.34126.37.

    Article  PubMed  PubMed Central  Google Scholar 

  • Imbula, E., Okitundu, L., & Mampunza, M. (2012). Postpartum depression in Kinshasa (DR Congo): Prevalence and risk factors. Médecine et Santé Tropicales, 22(4), 379–384.

    Google Scholar 

  • Insaf, T. Z., Fortner, R. T., Pekow, P., Dole, N., Markenson, G., & Chasan-Taber, L. (2011). Prenatal stress, anxiety, and depressive symptoms as predictors of intention to breastfeed among Hispanic women. Journal of Women’s Health, 20(8), 1183–1192. doi:10.1089/jwh.2010.2276.

    Article  PubMed  Google Scholar 

  • Ip, S., Chung, M., Raman, G., Trikalinos, T. A., & Lau, J. (2009). A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 4(Suppl 1), S17–S30. doi:10.1089/bfm.2009.0050.

    Google Scholar 

  • Kotelchuck, M. (1994). An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. American Journal of Public Health, 84(9), 1414–1420. doi:10.2105/AJPH.84.9.1414.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lindahl, V., Pearson, J. L., & Colpe, L. (2005). Prevalence of suicidality during pregnancy and the postpartum. Archives of Women’s Mental Health, 8(2), 77–87. doi:10.1007/s00737-005-0080-1.

    Article  CAS  PubMed  Google Scholar 

  • Liu, C. H., Giallo, R., Doan, S. N., Seidman, L. J., & Tronick, E. (2016). Racial and ethnic differences in prenatal life stress and postpartum depression symptoms. Archives of Psychiatric Nursing, 30(1), 7–12. doi:10.1016/j.apnu.2015.11.002.

    Article  CAS  PubMed  Google Scholar 

  • McCoy, S. J. B., Beal, J. M., Saunders, B., Hill, E. N., Payton, M. E., & Watson, G. H. (2008). Risk factors for postpartum depression: A retrospective investigation. The Journal of Reproductive Medicine, 53(3), 166–170.

    PubMed  Google Scholar 

  • McLearn, K., Minkovitz, C., Strobino, D., Marks, E., & Hou, W. (2006). Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices, 160(3), 279–284. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=mwic&NEWS=N&AN=2006032531.

  • O’Hara, M. W., Stuart, S., Watson, D., Dietz, P. M., Farr, S. L., & D’Angelo, D. (2012). Brief scales to detect postpartum depression and anxiety symptoms. Journal of Women’s Health, 21(12), 1237–1243. doi:10.1089/jwh.2012.3612.

    Article  PubMed  Google Scholar 

  • Paul, I. M., Downs, D. S., Schaefer, E. W., Beiler, J. S., & Weisman, C. S. (2013). Postpartum anxiety and maternal-infant health outcomes. Pediatrics, 131(4), e1218–e1224. doi:10.1542/peds.2012-2147.

    Article  PubMed  Google Scholar 

  • Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. (2015). Heterogeneity of postpartum depression: A latent class analysis. The Lancet Psychiatry, 2(1), 59–67. doi:10.1016/S2215-0366(14)00055-8.

    Article  Google Scholar 

  • Sankar, M. J., Sinha, B., Chowdhury, R., Bhandari, N., Taneja, S., Martines, J., et al. (2015). Optimal breastfeeding practices and infant and child mortality—A systematic review and meta-analysis. Acta Paediatrica,. doi:10.1111/apa.13147.

    PubMed Central  Google Scholar 

  • Stuebe, A., Schwarz, E. B., Grewen, K., Rich-Edwards, J. W., Michels, K. B., Foster, E. M., et al. (2011). Duration of lactation and incidence of maternal hypertension: A longitudinal cohort study. American Journal of Epidemiology, 174(10), 1147–1158. doi:10.1093/aje/kwr227.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thome, M., Alder, E. M., & Ramel, A. (2006). A population-based study of exclusive breastfeeding in Icelandic women: Is there a relationship with depressive symptoms and parenting stress? International Journal of Nursing Studies, 43(1), 11–20. doi:10.1016/j.ijnurstu.2004.10.009.

    Article  PubMed  Google Scholar 

  • Yonkers, K. A., Ramin, S. M., Rush, A. J., Navarrete, C. A., Carmody, T., March, D., et al. (2001). Onset and persistence of postpartum depression in an inner-city maternal health clinic system. American Journal of Psychiatry, 158(11), 1856–1863.

    Article  CAS  PubMed  Google Scholar 

  • Zayas, L. H., Cunningham, M., McKee, M. D., & Jankowski, K. R. (2002). Depression and negative life events among pregnant African-American and Hispanic women. Womens Health Issues, 12(1), 16–22.

    Article  PubMed  Google Scholar 

  • Zubaran, C., & Foresti, K. (2013). The correlation between breastfeeding self-efficacy and maternal postpartum depression in southern Brazil. Sexual and Reproductive Healthcare, 4(1), 9–15. doi:10.1016/j.srhc.2012.12.001.

    Article  PubMed  Google Scholar 

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Acknowledgments

The study was funded in part by a predoctoral training grant from the National Institute of Child Health and Human Development (5T32HD052468-08). This paper uses data collected by the Centers for Disease Control and Prevention’s surveillance project, the Pregnancy Risk Assessment Monitoring System (PRAMS). The authors would like to acknowledge the PRAMS Working Group: Alabama—Qun Zheng, MS Alaska—Kathy Perham-Hester, MS, MPH Arkansas—Mary McGehee, PhD Colorado—Alyson Shupe, PhD Connecticut—Jennifer Morin, MPH Delaware—George Yocher, MS Florida—Kelsi E. Williams Georgia—Chinelo Ogbuanu, MD, MPH, PhD Hawaii—Jane Awakuni Illinois—Theresa Sandidge, MA Iowa—Sarah Mauch, MPH Louisiana—Amy Zapata, MPH Maine—Tom Patenaude, MPH Maryland—Diana Cheng, MD Massachusetts—Emily Lu, MPH Michigan—Patricia McKane Minnesota—Judy Punyko, PhD, MPH Mississippi—Brenda Hughes, MPPA Missouri—Venkata Garikapaty, MSc, MS, PhD, MPH Montana—JoAnn Dotson Nebraska—Brenda CoufalI New Hampshire—David J. Laflamme, PhD, MPH New Jersey—Ingrid M. Morton, MS New Mexico—Eirian Coronado, MPH New York State—Anne Radigan-Garcia New York City—Candace Mulready-Ward, MPH North Carolina—Kathleen Jones-Vessey, MS North Dakota—Sandra Anseth Ohio—Connie Geidenberger PhD Oklahoma—Alicia Lincoln, MSW, MSPH Oregon—Kenneth Rosenberg, MD, MPH Pennsylvania—Tony Norwood Rhode Island—Sam Viner-Brown, PhD South Carolina—Mike Smith, MSPH Texas—Tanya Guthrie, PhD Tennessee—Ramona Lainhart, PhD Utah—Laurie Baksh, MPH Vermont—Peggy Brozicevic Virginia—Christopher Hill, MPH, CPH Washington—Linda Lohdefinck West Virginia—Melissa Baker, MA Wisconsin—Katherine Kvale, PhD Wyoming—Amy Spieker, MPH CDC PRAMS Team, Applied Sciences Branch, Division of Reproductive Health.

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Authors and Affiliations

  1. Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7445, Chapel Hill, NC, 27599, USA

    Kathryn Wouk & Alison M. Stuebe

  2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Alison M. Stuebe

  3. Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Samantha Meltzer-Brody

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  1. Kathryn Wouk
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  2. Alison M. Stuebe
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  3. Samantha Meltzer-Brody
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Correspondence to Kathryn Wouk.

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Wouk, K., Stuebe, A.M. & Meltzer-Brody, S. Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010–2011 Pregnancy Risk Assessment Monitoring System. Matern Child Health J 21, 636–647 (2017). https://doi.org/10.1007/s10995-016-2150-6

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  • DOI: https://doi.org/10.1007/s10995-016-2150-6

Keywords

  • Perinatal depression
  • PRAMS
  • Breastfeeding
  • Maps