title: Maternal depressive symptoms at three months postpartum and breastfeeding rates at six months postpartum: Implications for primary care in a prospective cohort study of primiparous women in Australia.
abstract: BACKGROUND
  The World Health Organisation recommends exclusive breastfeeding to six months postpartum, but most women in developed countries do not breastfeed this long. Prior studies exploring the relationship between breastfeeding duration and maternal depression show ambiguous findings.
  
  
  OBJECTIVE
  To explore associations between maternal depressive symptoms at three months postpartum, and breastfeeding status over the first six months postpartum.
  
  
  METHODS
  Prospective pregnancy cohort study of nulliparous women. 1507 women were recruited from six public hospitals in early pregnancy, completing baseline data in early pregnancy (mean gestation 15 weeks). Follow-up questionnaires were completed at three and six months postpartum. Women reported how many months they breastfed for (breastfeeding refers to 'any' breastfeeding, including expressed breastmilk). Depressive symptoms were measured at three months postpartum with the Edinburgh Postnatal Depression Scale (scores ≥13 indicated probable major depression).
  
  
  RESULTS
  Of the almost 95% of women who initiated breastfeeding, 76% were still breastfeeding at three months postpartum, and by six months postpartum this dropped to 61%. Women who reported depressive symptoms at three months had significantly lower rates of breastfeeding at six months postpartum compared to women without depressive symptoms (49% vs. 61%; adjusted OR=0.55, 95% CI 0.34-0.90). Maternal social characteristics associated with not breastfeeding at six months postpartum were: young maternal age; lower education; and smoking in pregnancy.
  
  
  CONCLUSIONS
  Women's decisions around infant-feeding are influenced by a range of psycho-social factors, and early postnatal depressive symptoms appear to be a significant part of this picture, as either a cause or consequence of decisions to cease breastfeeding.
authors.affiliation: Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia. Electronic address: hannah.woolhouse@mcri.edu.au.
authors.forename: Hannah
authors.initials: H
authors.lastname: Woolhouse
authors.affiliation: Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: James
authors.affiliation: Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Gartland
authors.affiliation: Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia.
authors.forename: Ellie
authors.initials: E
authors.lastname: McDonald
authors.affiliation: Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Brown
mesh_terms: D000328:Adult; D001315:Australia; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D015897:Comorbidity; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010298:Parity; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011320:Primary Health Care; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Breastfeeding; Lactation support; Maternal depression; Postnatal support; Primary care