Risk of Postpartum Depression – Breastfeeding
A new study published in the Maternal and Child Health Journal suggests a link between not breastfeeding and postpartum depression (PPD) that seems to depend on whether or not a woman planned to breastfeed in the first place, and as well as her mental health during pregnancy. The research is based on data from a survey of around 14,000 children born in the Bristol area of England in the early 1990s.
Most new moms experience postpartum “baby blues” after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues usually begin within the first 2 to 3 days after delivery and may last for up to two weeks.
But some new moms experience a more severe, long-lasting form of depression known as postpartum depression. Postpartum depression may be mistaken for baby blues at first — but the symptoms are more intense and last longer. Symptoms usually develop within the first few weeks after giving birth. But they may begin earlier – during pregnancy – or later – up to a year after birth. Typically, a diagnosis of postpartum depression is considered after signs and symptoms persist for at least two weeks. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns.
Postpartum depression, also known as postnatal depression, develops in nearly 13 % of women typically within the first 3 months after giving birth. The condition is much more serious than the ‘baby blues’ and may have long-term effects on mothers’ mental health, and/or on the cognitive, social and physical development of their children.
The effect of breastfeeding on the risk of PPD is not well understood. Several studies have demonstrated an association between longer breastfeeding durations and a lower prevalence of PPD. However, other studies have suggested the opposite, namely that breastfeeding mothers are at increased risk of PPD; or found no association. Thus, the extent to which breastfeeding influences mental health, as opposed to mental health driving the incidence and duration of breastfeeding, has not been clear.
Cristina Borra, Maria Iacovou and Almudena Sevilla, the authors of the Maternal and Child Health study examined the hypothesis that the relationship between breastfeeding and maternal mental health is mediated by the mother’s intention to breastfeed.
The investigators found that the effect of breastfeeding on maternal mood differed by both maternal mental health during pregnancy; and whether mothers intended to breastfeed. This study is perhaps the first one to document this result.
The major finding of this study is that the majority of mothers who did not show symptoms of depression before birth, breastfeeding decreased the risk of PPD among mothers who had intended to breastfeed, but increased the risk of PPD among mothers who had not intended to breastfeed.
Of note, the authors also found that the beneficial effects of breastfeeding were strongest at 8 weeks after birth, and that the association was weaker at 8 months and onwards. This observation is in line with the findings of the only other longitudinal research in this area, which significant effects at 6 weeks but not at 12 weeks postpartum. Thus these results are important, because of the established relationship between depression, even in the very early postpartum period, and the maternal-infant bonding.
In summary, the effect of breastfeeding on maternal depression symptoms was found to be highly heterogeneous and, crucially, mediated by breastfeeding intentions during pregnancy.
The authors of this study found that breastfeeding decreased the risk of PPD among mothers who were not depressed during pregnancy, had intended to breastfeed and did so. The highest risk for PPD was found among women who had planned to breastfeed, but had not initiated breastfeeding.
These findings have implications for the way in which new mothers are supported; they suggest that the provision of expert breastfeeding support may, in addition to increasing breastfeeding rates and durations, have the additional benefit of improving mental health outcomes among new mothers.
Source: Maternal and Child Health Journal, August 2014, doi 10.1007/s10995-014-1591-z
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