[email protected] Abstract. In this study, the occurrence rate of postpartum depression of breastfeeding mothers and relation between postpartum. Association between postpartum depression and the practice of exclusive breastfeeding in the first three months of lifeAssociação entre a depressão pós- parto. no significant relationship between postpartum depression and breastfeeding status [32, 39, 85–91].
The researchers also assessed the women's risk of depression during pregnancy and after giving birth. The researchers found that 65 percent of the women in the study planned to breastfeed for at least the first four weeks after giving birth. However, only 80 percent of those women actually started breastfeeding, and 56 percent breastfed for the entire four weeks. Just 43 percent breastfed exclusively for those first four weeks. Four weeks after giving birth, the women who were not breastfeeding despite wanting to during pregnancy had a fourfold increase in PPD risk compared with breastfeeding women.
Mothers who were not breastfeeding but who had never planned to had double the risk of the breastfeeding women. But according to Iacovou, what is new — and urgent from a public health perspective — is the finding that there is increased PPD risk among women who plan to breastfeed and then are not able to. Does breastfeeding reduce PPD risk? Several studies have suggested that breastfeeding could help protect women against PPD. Breastfeeding has been associated with getting more sleep — possibly because it is faster than preparing a bottle in the middle of the night — and having lower levels of stress hormones during anxiety-provoking situations, both of which could improve mood and reduce the risk of depressive symptoms.
Kathleen Kendall-Tackett, PhD, a clinical associate professor of pediatrics at Texas Tech University School of Medicine and international board certified lactation consultant, researches the connection between breastfeeding and PPD. She thinks that women who do not breastfeed could miss out on these stress and sleep benefits. Some research, including Kendall-Tackett's, suggests that women may have to breastfeed exclusively, not combine it with formula feeding, to gain these benefits.
Often postpartum psychosis leads to hospitalization and considerable functional impairment [ 26 ]. There is, however, some debate concerning the degree to which psychosis is related to the unipolar variation of postpartum depression [ 24 ].
Emerging evidence suggests that postpartum psychosis is more likely a variant of bipolar disorder [ 27 ]. Due to the potential devastating consequences of postpartum depression for the mother, the infant, and their family, it is necessary that research clearly delineate the potential risk and protective factors for postpartum depression.
Emerging research suggests that breastfeeding may offer protective benefits against postpartum depression [ 28 ]; however, the exact nature of the association between breastfeeding and postpartum depression remains unclear [ 29 ]. The purpose of this paper is to provide an overview of the association between breastfeeding and postpartum depression as it has been examined in the empirical literature. All original studies located through this search and reported in English examining the relationship between postpartum depression and breastfeeding were included.
Breastfeeding and Postpartum Depression Initially the relationship between breastfeeding and postpartum depression was conceptualized to be unidirectional, with postpartum depression resulting in lower rates of breastfeeding initiation and early cessation [ 30 ].
More recently however, reports indicate that the relationship may be bidirectional in nature, suggesting that while postpartum depression may reduce rates of breastfeeding, not engaging in breastfeeding may increase the risk of postpartum depression. Additionally, there is some evidence that breastfeeding may protect against postpartum depression or assist in a swifter recovery from symptoms [ 28 ]. The association between breastfeeding and postpartum depression has been studied by a number of investigators, but the direction of this relationship and the question of whether it is a direct relationship still eludes us.
Numerous studies on the topic of breastfeeding and postpartum depression have come to contrasting conclusions, likely a result of the interaction between the numerous and complex physiological, psychological, and sociocultural mechanisms potentially responsible for the relationship [ 31 ], as well as the use of varying methods for studying the association.
Specifically, a number of researchers have reported no relationship between breastfeeding and postpartum depression e.
In contrast, a number of more recent studies have revealed that women who formula feed have higher rates of depression than women who breastfeed e. Breastfeeding Intention and Initiation Intention to breastfeed refers to the perinatal decision to breastfeed an infant following childbirth, but the prenatal time frame may differ between studies depending on when this information was obtained i.
Breastfeeding initiation refers broadly to the act of breastfeeding. Unfortunately, breastfeeding initiation is operationalized differently between investigations and may include women who attempt to breastfeed but discontinue shortly thereafter, women who exclusively breastfeed for long periods, women who used expressed breast milk, and women who supplement their infant with formula in addition to breastfeeding.
These discrepancies can complicate our interpretation of the research. With that being said, a number of investigators have examined the relationship between breastfeeding intention or initiation and postpartum depression. Some researchers have found no association between prenatal depressive symptoms and intention to breastfeed [ 37 — 40 ]. In contrast, Insaf and colleagues [ 41 ] did find that women with prenatal depressive symptoms were less likely to intend to breastfeed, though this study did not follow the women through to childbirth to determine initiation rates.
Similarly, Fairlie and colleagues [ 42 ] also found that prenatal depressive symptoms were associated with a reduced intention to breastfeed reported in the second trimester. However, follow-up in the postpartum period revealed that depressive symptoms during pregnancy were not associated with the actual initiation of breastfeeding, indicating that some of the women who initially reported that they did not intend to breastfeed changed their minds and attempted to breastfeed.
Furthermore, Pippins and colleagues [ 43 ] found, in their longitudinal study following a large sample of pregnant women, that women with prenatal depressive symptoms were not less likely to initiate breastfeeding. Thus, it appears that women's prenatal intention to breastfeed may fluctuate, perhaps due to breastfeeding encouragement or education in the third trimester. The potential relationship between breastfeeding intention and initiation and postpartum depression was further explored by Borra et al.
In this large longitudinal study the investigators found that, in women who were not depressed before delivery, the risk of postpartum depression was decreased if they had intended to breastfeed and initiated breastfeeding. In contrast, women were at an increased risk for postpartum depression if they had not intended to breastfeed and initiated breastfeeding.
Interestingly, Davey and colleagues [ 45 ] found that failure to breastfeed when attempted is associated with postpartum depressive symptoms. Also, women who never established breastfeeding were reported to have a 2. Breastfeeding and Maternal Mood A number of studies report that women who are not breastfeeding are more likely to have higher levels of depressive symptoms than women who are breastfeeding [ 3547 — 61 ].
Interestingly, one study found that depression severity was not related to breastfeeding status in a group of women diagnosed with postpartum depression [ 65 ]. Thus, while breastfeeding may be associated with depressive symptoms, it may not influence the severity of the symptoms.
Although postpartum depression has been identified as a risk factor for early breastfeeding cessation [ 56 ], early negative breastfeeding experiences may be a risk factor for postpartum depression [ 66 ].
Further, it has also been suggested that breastfeeding may offer protective benefits against postpartum depression [ 28 ].
Breastfeeding and Postpartum Depression — Seleni Institute
One study to report on the protective benefits of breastfeeding found that lower levels of depressive symptoms in the prenatal but not postnatal period predicted exclusive breastfeeding. Furthermore, breastfeeding duration was associated with a significant decrease in depressive symptom scores from childbirth to 3 months postpartum for women who initiated breastfeeding. These investigators also found that women who did not initiate breastfeeding did not experience changes in depressive symptoms over the first three postpartum months.
After considering the findings collectively, the investigators postulated that breastfeeding alleviates depressive symptomology over time [ 28 ]. Additionally, results from a study by Mezzacappa and Katkin [ 67 ] lend further support to the premise that breastfeeding offers ameliorating effects on postpartum depressive mood symptoms.
The relationship between postpartum depression and breastfeeding.
These investigators looked at the acute effects of breastfeeding on maternal mood and found that breastfeeding mothers experienced a decrease in negative mood from prefeeding to postfeeding. Moreover, bottle-feeding mothers experienced a decrease in positive mood from prefeeding to postfeeding.
Thus, breastfeeding may offer both acute and long-term ameliorating effects on postpartum depression; however, further research is required to substantiate these initial findings. Breastfeeding Duration Breastfeeding duration has been found to be inversely related to postpartum depressive symptoms. A relationship has been found to persist even after controlling for socioeconomic status, age, and education level [ 68 ], as well as for past history of depression, increased life stress, and psychoactive medication use [ 64 ].
In particular, a number of studies have reported an association between postpartum depressive symptoms and early weaning [ 3069 — 75 ].My journey continues! Choosing between Breastfeeding and Postpartum Depression medicine
In fact, McLearn et al. A number of studies note that postpartum depressive symptoms preceded breastfeeding cessation [ 6876 ]. In a large prospective study of postpartum women, Taveras and colleagues [ 77 ] found that having higher depressive symptoms at two weeks postpartum was associated with discontinuation of breastfeeding at 12 weeks postpartum.
Dennis and McQueen [ 36 ] reported similar findings. Specifically, depressive symptomology in the early postpartum period predicted early cessation of breastfeeding at eight weeks postpartum.
The relationship between postpartum depression and breastfeeding.
Also, in a smaller prospective study, Galler et al. Interestingly, these investigators did not find an association between depressive symptoms at six months postpartum and breastfeeding practices at the same time point. More recently, Dennis and McQueen [ 36 ] found that after controlling for baseline depressive symptoms there was no relationship between infant feeding outcome feeding method used, satisfaction with method, breastfeeding difficulties, and breastfeeding self-efficacy at one week postpartum and the development of postpartum depressive symptoms measured one and two months postpartum.
However, the women in this study who reported high levels of postpartum depressive symptoms were significantly more likely to discontinue breastfeeding. These women were also more likely to report being unsatisfied with their infant-feeding method, experience breastfeeding difficulties, and report lower breastfeeding self-efficacy. Taken together, these findings suggested that over time depressive symptoms may influence breastfeeding outcomes to a point of discontinuation.
Breastfeeding Dose-Response Effect A dose-response effect of breastfeeding on postpartum depression has been proposed.
In a large study of women evaluated between 8 and 12 weeks postpartum, Thome et al. Relatedly, Ystrom [ 80 ] found that, at six months postpartum, both partially breastfeeding and exclusively bottle-feeding were significantly related to higher levels of depressive symptoms in postpartum women compared to those who exclusively breastfed.
Furthermore, bottle-feeding was related to postpartum depression to a greater degree than partial breastfeeding. Also, when the investigator adjusted for baseline prenatal anxiety and depression measured at 30 weeks of gestation the relationship persisted, indicating that breastfeeding may reduce depressive symptoms or depressive symptoms may result in breastfeeding titration.
One other study compared exclusive breastfeeding to exclusive bottle-feeding [ 81 ]. These investigators found an inverse association between postpartum depression and exclusive breastfeeding continuation.
Also, it has been found that as early as one week postpartum levels of depressive symptoms are inversely related to exclusive breastfeeding [ 82 ]. Moreover, Kendall-Tackett et al. These investigators reported a relationship between exclusive breastfeeding and fewer reported sleep difficulties and depressive symptoms compared to women who partially breastfed or bottle-fed their infant.
Unfortunately these results are based on analyses of cross-sectional data, making the direction of the relationship in each case unclear. Reciprocal Relational Findings In light of conflicting reports that postpartum depression leads to early breastfeeding cessation e. Specifically, it has been proposed that postpartum depression can lead to early breastfeeding cessation but breastfeeding continuation may also reduce levels of postpartum depressive symptoms [ 28 ].
For example, results of a study by Hamdan and Tamim [ 31 ] support the reciprocal relationship hypothesis. These investigators found that women who were breastfeeding at two months postpartum had a lower risk of postpartum depression at four months postpartum. On the other hand, women who had postpartum depression at two months postpartum were less likely to be breastfeeding at four months postpartum. Also, Hahn-Holbrook et al.
These researchers also found that more frequent breastfeeding at three months postpartum was associated with greater subsequent declines in depressive symptom levels up to two years postpartum.
No Association or Nonsignificant Trends A number of studies have reported no significant relationship between postpartum depression and breastfeeding status [ 323985 — 91 ]. However, two of these studies did report finding a nonsignificant trend suggestive of an inverse association [ 8689 ]. In any case, most of these findings were incidental; the primary purpose of those investigations was not to evaluate the association between breastfeeding and postpartum depression.
However, recent data analyzed in our lab also failed to find support for a relationship between breastfeeding intention and initiation when controlling for other risk factors for postpartum depression. Conflicting Research Findings A majority of studies do report some association between breastfeeding and postpartum depression; however the direction of the relationship is unclear and some of the findings conflict with one another.
For all these reasons, greater compassion, understanding, and support are crucial to break through the barriers of these stigmas. Early intervention and treatment is crucial to improve the outcome of the entire family unit.
Screening for PPD is crucial for identifying risk factors as early as possible. Ideally, screening would begin during pregnancy and occur during regular intervals during the postpartum period.
It is the hope that in the future every hospital and birth center will have a screening protocol in place. The Edinburgh Postnatal Depression Scale EPDS 1 is an example of a widely used screening tool that is adaptable in many languages and is easy to administer and score. Please note that the EPDS is a screening tool only - it does not assess the severity of the symptoms, nor is it a diagnostic tool. Follow up with the clinician is necessary to make an accurate diagnosis.
Also, if the mother answers anything other than a zero on question number 10 harm-related questionan immediate referral for further assessment and intervention is mandated. The good news is that effective treatment for postpartum depression is available. Treatment includes individual counseling, support groups face to face or onlineone-to-one peer support, medication, or a combination of these.
Individual counseling provides a trusting, supportive atmosphere where the mother can open up about her experience, focus on her strengths, and work on solutions to improve coping skills. Support groups are very powerful in that the mother can identify with others experiencing similar circumstances. This is a powerful affirmation that she is not alone. Several online support groups are available, making it a cost effective option and allowing the mother to participate from home.
One-to-one peer support involves individuals, such as postpartum doulas, parent mentors, or other volunteers, communicating with the mother on a regular basis. Finally, medication may also be a very helpful option in reducing depression and anxiety symptoms, thus increasing coping skills.
However, many mothers are hesitant to consider medication for fear of stigma or how it will affect them or their babies. The decision to take medication is a personal one, and the risks and benefits of medication for the mother and her baby need to be carefully considered.
The mother will need to be referred to a physician for further information and a medication evaluation.