title: Perinatal Depression Among HIV-Infected Women in KwaZulu-Natal South Africa: Prenatal Depression Predicts Lower Rates of Exclusive Breastfeeding.
abstract: Exclusive breastfeeding (EBF) provides infants with optimal nutrition, and together with appropriate antiretroviral therapy has also been shown to decrease mother-to-child transmission of HIV from 45 to less than 1 %. However, rates of EBF are particularly low in South Africa, where rates of HIV are some of the highest in the world. Although perinatal depression has been identified as a potential barrier to EBF, little is known about its impact on EBF among HIV-infected women. A cohort study was conducted as part of a pilot randomized controlled trial (RCT) examining the effect of an Information, Motivation and Behavioral skills-based intervention promoting EBF among South African women living with HIV in their third trimester (28-42 weeks) of pregnancy. At baseline and follow-up, participants were interviewed on depression symptoms (PHQ-9), and breastfeeding intentions and behavior. Multivariate logistic regressions were conducted to determine predictors of EBF at 6-weeks postpartum. A total of 68 women were enrolled and 58 women completed both baseline and follow-up assessments. Most (80.9 %) of the sample reported at least some symptoms of depression prenatally. Rates of depression were lower postpartum (47.1 %). In multivariate models, higher prenatal depression scores significantly predicted lower likelihood of EBF at 6-weeks postpartum after adjusting for demographics, condition, and intentions (AOR = 0.68, p < 0.05). Postpartum depression was not a significant predictor of EBF rates (AOR = 0.99, p = 0.96). These findings demonstrate the negative impact of prenatal depression on breastfeeding behavior. Future interventions focused on depression are warranted to identify those at risk for sub-optimal EBF. Improving maternal psychosocial well-being could be a new frontier to improving infant and young child feeding and reducing pre/postnatal transmission.
authors.affiliation: UCSF School of Nursing, University of California San Francisco, 2 Koret Way, Box 0608, San Francisco, CA, 94143-0608, USA. emily.tuthill@ucsf.edu.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Tuthill
authors.affiliation: Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Pellowski
authors.affiliation: Department of Anthropology, Institute for Policy Research Northwestern University, Evanston, IL, USA.
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, USA.|Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Butler
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D019052:Depression, Postpartum / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D033182:Intention; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis; D016032:Randomized Controlled Trials as Topic; D013019:South Africa / Q000453:epidemiology
keywords: Breastfeeding; HIV; Maternal and child health; Perinatal depression; Prenatal depression; South Africa