title: Maternal psychosocial aspects in hypernatremic dehydration with high sodium concentrations in breast milk: a case-control study.
abstract: OBJECTIVE
  To investigate whether mothers, with no known biological reason to account for elevated breast milk sodium (BMS) and associated hypernatremic dehydration (HND) in their exclusively breastfed infants, have more adverse psychosocial characteristics compared with controls.
  
  
  METHODS
  Design is prospective case-control. Mothers of 21 term infants diagnosed as HND with associated high BMS and mothers of 43 healthy, exclusively breastfed term infants, with expected milk sodium levels, were compared on rates of socio-demographic and relationship variables, pregnancy wantedness and planning, maternal attitudes towards breastfeeding, postnatal maternal depression and anxiety. A semi-structured interview, State and Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale were used.
  
  
  RESULTS
  Reported maternal history of previous psychiatric morbidity (57.1% vs. 18.6%; P = 0.003), poor relationship with her own mother (36.8% vs. 9.6%; P = 0.026), not finding herself suitable to be a mother (28.6% vs. 4.6%; P = 0.012), unplanned pregnancy (52.4% vs. 20.9%; P = 0.020) and higher state anxiety scores (mean (SD) = 42.2 (11.1) vs. 35.5 (10.5); P = 0.038) in the post-partum period were significantly common in mothers with elevated BMS levels compared with the controls. Univariate analyses revealed that unplanned pregnancy and maternal perception of not being suitable to be mother constitute significant risks with odds ratios 4.2 and 8.2, respectively.
  
  
  CONCLUSIONS
  The present study displays that mothers, with no known biological reason to account for elevated BMS, have more adverse psychosocial characteristics compared with controls; emphasising the importance of psychosocial and emotional factors during lactation and offering implications for the establishment of successful lactation through providing additional psychosocial support to vulnerable mothers.
authors.affiliation: Dokuz Eylul University Medical Faculty, Department of Child Psychiatry, Izmir, Turkey. aylinozbektr@yahoo.com
authors.forename: Aylin
authors.initials: A
authors.lastname: Ozbek
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kumral
authors.forename: Taner
authors.initials: T
authors.lastname: Guvenir
authors.forename: Fatma Varol
authors.initials: FV
authors.lastname: Tas
authors.forename: Ozlem
authors.initials: O
authors.lastname: Gencer
authors.forename: Nuray
authors.initials: N
authors.lastname: Duman
authors.forename: Hasan
authors.initials: H
authors.lastname: Ozkan
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology / Q000523:psychology; D001942:Breast Feeding / Q000523:psychology*; D016022:Case-Control Studies; D003681:Dehydration / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000150:complications / Q000523:psychology*; D007223:Infant; D007231:Infant, Newborn; D007774:Lactation / Q000523:psychology; D008895:Milk, Human / Q000737:chemistry; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D011446:Prospective Studies; D011581:Psychological Tests; D012964:Sodium / Q000097:blood; D014421:Turkey
chemical_list: D012964:Sodium