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Maternal psychological distress and child weight at 24 months: investigating indirect effects through breastfeeding in the All Our Families cohort

Abstract

Objective

Maternal psychological distress in pregnancy has been associated with both breastfeeding duration and child weight at 24 months; however, the potential that breastfeeding duration partially mediates the risk of maternal mental health problems during pregnancy on child weight classification has not been examined. The current study investigated this proposed relationship.

Methods

Data was taken from the All Our Families (AOF) cohort, an ongoing prospective pregnancy cohort located in Calgary, Canada. Psychological distress, defined as clinically significant symptoms of anxiety and depression, was assessed via self-report and measured between 34 and 36 weeks of gestation. Breastfeeding duration was assessed in the postpartum by self-report. Child overweight classification was defined as a weight-for-length/height z-score at or above the 97th percentile as per World Health Organization’s child growth guidelines.

Results

In this sample of 1582 mother−child pairs, there was no direct relationship between psychological distress and child overweight status. Both anxiety (B = − 5.40, p = 0.001) and depression (B = − 6.54, p = 0.008) were associated with decreased weeks breastfeeding. Breastfeeding duration mediated the association between maternal prenatal psychological distress and child overweight status at 24 months, for both anxiety (B(SE) = 0.10(0.05), CI 0.03–0.21) and depression (B(SE) = 0.11(0.07), CI 0.01–0.27). Covariates included maternal age, education, ethnicity, income, pre-pregnancy BMI, gestational weight gain, and infant birth weight.

Conclusions

The results of this longitudinal cohort analysis support an indirect relationship between maternal psychological distress in pregnancy and the childhood overweight/obesity at 24 months old, mediated through breastfeeding duration.

Résumé

Objectif

La détresse psychologique maternelle pendant la grossesse a été associée à l’allaitement et au poids de l’enfant à 24 mois; cependant, la possibilité que la durée de l’allaitement puisse être un médiateur de la relation entre la santé mentale maternelle pendant la grossesse et la classification du poids de l’enfant n’a pas encore été examinée. La présente étude a examiné cette relation proposée.

Méthodes

Les données proviennent de l’étude All Our Families (AOF), une cohorte de grossesse prospective en cours à Calgary, au Canada. La détresse psychologique, définie comme la présence de symptômes d’anxiété et de dépression significatifs sur le plan clinique, a été évaluée à l’aide de questionnaires entre la 34ème et la 36ème semaines de gestation. La durée de l’allaitement a été mesurée pendant le postpartum en s’appuyant sur l’auto-déclaration des mères. La classification du surpoids chez l’enfant a été définie comme un rapport poids-pour-la-longueur/score z pour la hauteur qui est égal ou supérieur au 97e centile, selon les recommandations sur la croissance de l’enfant de l’Organisation mondiale de la Santé.

Résultats

Parmi les 1582 dyades mère−enfant inclus dans l’étude, il n’y avait pas de relation directe entre la détresse psychologique maternelle et le surpoids chez l’enfant. L’anxiété (B = − 5,40, p = 0,001) et la dépression (B = − 6,54, p = 0,008) maternelle étaient associés à une diminution du nombre de semaines d’allaitement. La durée de l’allaitement maternel avait un effet médiateur sur l’association entre la détresse psychologique maternelle prénatale et le surpoids de l’enfant à 24 mois, pour l’anxiété (B(SE) = 0,10(0,05), IC 0,03 – 0,21) et la dépression (B(SE) = 0,11(0,07), IC 0,01 – 0,27). Les covariables comprenaient l’âge maternel, l’éducation, l’origine ethnique, le revenu, l’IMC avant la grossesse, le gain de poids gestationnel et le poids de l’enfant à la naissance.

Conclusions

Les résultats de cette étude longitudinale soutiennent une relation indirecte entre la détresse psychologique maternelle pendant la grossesse et le surpoids/l’obésité de l’enfant à 24 mois, médiée par la durée de l’allaitement.

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Acknowledgements

Special thanks to the participant mothers and children of the AOF cohort, as well as all the investigators, research assistants, administrators, and volunteers who helped bring such a large-scale project to life. Thank you to Meredith Brockway, who was consulted on breastfeeding information in Calgary, and to Anna L. MacKinnon for providing the French language translation of the abstract.

Funding

The All Our Babies (AOB) study was funded by Alberta Innovates Health Solutions Interdisciplinary Team grant #200700595, Calgary, Alberta, Canada. Matthew Shay was supported by grants from the Alberta Children’s Hospital Research Initiative, Talisman Energy Fund for Healthy Living and Injury Prevention Studentship Support, and internal awards through the University of Calgary.

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Correspondence to Matthew Shay.

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Ethical approval was provided by Research Ethics Board Certification #REB16-0345 through University of Calgary.

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Shay, M., Tomfohr-Madsen, L. & Tough, S. Maternal psychological distress and child weight at 24 months: investigating indirect effects through breastfeeding in the All Our Families cohort. Can J Public Health 111, 543–554 (2020). https://doi.org/10.17269/s41997-020-00312-7

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Keywords

  • Breastfeeding
  • Pregnancy
  • Depression
  • Anxiety
  • Child weight

Mots-clés

  • Allaitement
  • Grossesse
  • Dépression
  • Anxiété
  • Poids de l’enfant