title: Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010-2011 Pregnancy Risk Assessment Monitoring System.
abstract: Objective Evidence suggests that women with postpartum depression (PPD) are at risk for early breastfeeding cessation, but previous studies have been limited by small samples. The objective of this analysis is to estimate the association between PPD symptoms and breastfeeding using a national, stratified, random sample of U.S. mothers. Methods Data from the 2010-2011 Pregnancy Risk Assessment Monitoring System were analyzed for New York City and the 29 states for which data were available. Multivariable logistic regression was used to explore the association between a pre-pregnancy mental health visit and subsequent breastfeeding initiation as well as PPD and 3-month any and exclusive breastfeeding. To identify state-level variation, we created maps of prevalence and adjusted odds of breastfeeding by PPD and pre-pregnancy mental health status. Results Women reporting a pre-pregnancy mental health visit had 0.61 (95 % CI 0.56, 0.67) times the odds of initiating breastfeeding compared with women who reported no pre-pregnancy visit. At 3 months postpartum, women with PPD symptoms since birth had 0.79 (95 % CI 0.70, 0.88) times the odds of any breastfeeding and reduced odds of exclusive breastfeeding modified by race/ethnicity. We found variation in state-level PPD symptoms and pre-pregnancy mental health prevalence and adjusted odds of breastfeeding. Conclusions for Practice Our results highlight the importance of providing targeted breastfeeding support to women with PPD symptoms, because they are at risk of early breastfeeding cessation. Given the cross-sectional nature of these data, women with early breastfeeding cessation may also be at risk for PPD, requiring screening and treatment.
authors.affiliation: Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7445, Chapel Hill, NC, 27599, USA. khouk@live.unc.edu.
authors.forename: Kathryn
authors.identifier: 0000-0003-1568-3564
authors.initials: K
authors.lastname: Wouk
authors.affiliation: Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7445, Chapel Hill, NC, 27599, USA.|Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stuebe
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Meltzer-Brody
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology*; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D009035:Mothers / Q000523:psychology*; D009519:New York City / Q000453:epidemiology; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods
keywords: Breastfeeding; Maps; PRAMS; Perinatal depression