Maternal psychosocial aspects in hypernatremic dehydration with high sodium concentrations in breast milk: a case-control study.
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.
Ozbek
Aylin
A
Dokuz Eylul University Medical Faculty, Department of Child Psychiatry, Izmir, Turkey. aylinozbektr@yahoo.com
Kumral
Abdullah
A
Guvenir
Taner
T
Tas
Fatma Varol
FV
Gencer
Ozlem
O
Duman
Nuray
N
Ozkan
Hasan
H
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
D012964:Sodium