High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation

Prenatal and Perinatal Factors of Life's Essential 8 Cardiovascular Health Trajectories

Importance

The American Heart Association put forth the Life's Essential 8 construct to assess cardiovascular health (CVH) based on 8 biological and behavioral factors. Few studies have identified prenatal and perinatal factors of CVH trajectories across childhood and adolescence, life stages where disease precursors and health behaviors are established.

Objective

To examine associations of prenatal and perinatal factors with child CVH trajectory.

Design, setting, and participants

Data from the Project Viva prebirth cohort from April 1999 to August 2021 were used. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Data were analyzed from April 1 to September 30, 2024.

Exposures

Prenatal and perinatal factors.

Main outcomes and measures

CVH score (0-100 points), calculated as the unweighted average of all available CVH metrics at each life stage.

Results

Among 1333 children included, 680 (51.0%) were male, 78 (5.9%) Hispanic, 181 (13.6%) non-Hispanic Black, and 959 (71.9%) non-Hispanic White. The estimated mean (SD) age of inflection when CVH started to decline was 10.2 (0.7) years for male children and 10.0 (0.6) years for female children. Prepregnancy overweight or obesity (vs healthy or underweight), smoking during pregnancy (vs never), and formula-feeding (vs breastfeeding) in the first 6 months were each associated with lower CVH from childhood to adolescence, but gestational diabetes (vs normal glucose tolerance) was not associated with CVH. Prepregnancy obesity was associated with later inflection (β = 0.1; 95% CI, 0.0 to 0.2 years) and slower CVH decline after inflection (β = 0.2; 95% CI, 0.1 to 0.4 points per year). Gestational hypertension or preeclampsia (vs normal blood pressure) was associated with faster CVH gain before inflection (β = 0.3; 95% CI, 0.1 to 0.5 points per year), earlier inflection (β = -0.1; 95% CI, -0.2 to 0.0 years), and faster CVH decline after inflection (β = -0.3; 95% CI, -0.5 to -0.1 points per year), while smoking during pregnancy was associated with later inflection (β = 0.2; 95% CI, 0.1 to 0.3 years).

Conclusions and Relevance

In this cohort study, prepregnancy overweight or obesity, smoking during pregnancy, and formula-feeding in the first 6 months of life were each associated with adverse CVH trajectories early in life. Future work should examine whether interventions that address these factors would be effective in optimizing CVH in children.

Psychological factors affecting breastfeeding during the perinatal period in the UK: an observational longitudinal study

BACKGROUND

Identifying the behavioral determinants of breastfeeding is an important step toward increasing breastfeeding rates, but studies often adopt a limited measurement model. We aimed to identify, in a British population, which behavioral and psychological factors, assessed throughout the perinatal period, were most reliably associated with intent to breastfeed and breastfeeding at 1 and 6 months.

METHODS

This is an observational longitudinal study of a diverse (35.1% non-white) community sample of N = 222 pregnant women attending a maternity hospital in the UK. We assessed self-reported anxiety and depressive symptoms, stressful life events, and coping at 20-22, 28 and 36 weeks gestation and 1 and 6 months postnatally; intention to breastfeed was assessed at 20 weeks gestation. Breastfeeding was assessed at one and six months post-partum. We modelled the associations with logistic regressions, adjusting for socio-demographics.

RESULTS

Antenatal and post-partum depressive and anxiety symptoms were not reliably associated with breastfeeding behavior up to 6 months. In contrast, breastfeeding intention, which was not associated with affective symptoms, stress, and coping, was a reliable predictor of breastfeeding after adjusting for covariates. The association between intention to breastfeed and breastfeeding behavior was not moderated by behavioral/psychological factors (p > 0.5).

CONCLUSIONS

This study extends previous findings about the importance of intention to breastfeed to breastfeeding behaviour and suggests that suffering from affective symptoms does not inhibit breastfeeding. Antenatal intention to breastfeed can play a crucial role in shaping both maternal and child health outcomes.

Impact of an intervention for perinatal anxiety on breastfeeding: findings from the Happy Mother-Healthy Baby randomized controlled trial in Pakistan

BACKGROUND

The study examined the effects of Happy Mother-Healthy Baby (HMHB), a cognitive-behavioural therapy (CBT) intervention on breastfeeding outcomes for Pakistani women with prenatal anxiety.

METHODS

Breastfeeding practices were evaluated in a randomized controlled trial between 2019 and 2022 in a public hospital in Pakistan. The intervention group was randomized to receive six HMHB sessions targeted towards prenatal anxiety (with breastfeeding discussed in the final session), while both groups also received enhanced usual care. Breastfeeding was defined in four categories: early breastfeeding, exclusive early breastfeeding, recent breastfeeding, and exclusive recent breastfeeding. Early breastfeeding referred to the first 24 h after birth and recent breastfeeding referred to the last 24 h before an assessment at six-weeks postpartum. Potential confounders included were mother's age, baseline depression and anxiety levels, stress, social support, if the first pregnancy (or not) and history of stillbirth or miscarriage as well as child's gestational age, gender. Both intent-to-treat and per-protocol analyses were examined. Stratified analyses were also used to compare intervention efficacy for those with mild vs severe anxiety.

RESULTS

Out of the 1307 eligible women invited to participate, 107 declined to participate and 480 were lost to follow-up, resulting in 720 women who completed the postpartum assessment. Both intervention and control arms were similar on demographic characteristics (e.g. sex, age, income, family structure). In the primary intent-to-treat analysis, there was a marginal impact of the intervention on early breastfeeding (OR 1.38, 95% CI: 0.99-1.92; 75.4% (N = 273) vs. 69.0% (N = 247)) and a non-significant association with other breastfeeding outcomes (OR1.42, 95% CI: 0.89-2.27; (47) 12.9% vs. (34) 9.5%, exclusive early breastfeeding; OR 1.48, 95% CI: 0.94-2.35; 90% (N = 327) vs. 86% (N = 309), recent breastfeeding; OR1.01, 95% CI: 0.76-1.35; 49% (N = 178) vs 49% (N = 175) exclusive recent breastfeeding). Among those who completed the intervention's six core sessions, the intervention increased the odds of early breastfeeding (OR1.69, 95% CI:1.12-2.54; 79% (N = 154) vs. 69% (N = 247)) and recent breastfeeding (OR 2.05, 95% CI:1.10-3.81; 93% (N = 181) vs. 86% (N = 309)). For women with mild anxiety at enrolment, the intervention increased the odds of recent breastfeeding (OR 2.41, 95% CI:1.17-5.00; 92% (N = 137) vs. 83% (N = 123).

CONCLUSIONS

The study highlights the potential of CBT-based interventions like HMHB to enhance breastfeeding among women with mild perinatal anxiety, contingent upon full participation in the intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03880032.

Maternal Well-Being in Pregnancy and Breastfeeding Practices: Findings from the ROLO Study

OBJECTIVE

Low mood is common during the perinatal period, which may negatively impact breastfeeding practices. Exploring predictors of successful breastfeeding is a health priority area. This study investigated if maternal well-being during pregnancy is associated with breastfeeding practices.

STUDY DESIGN

This is a secondary analysis of a randomized control trial of a low glycemic index diet in pregnancy. A total of 610 secundigravida women were recruited in the National Maternity Hospital, Dublin, Ireland. Data on maternal education attainment, early pregnancy body mass index (BMI), and age were collected from hospital records. Well-being was self-reported by mothers between 10 and 28 weeks' gestation using the World Health Organization 5-Item well-being index. Scores were transformed to give percentage well-being. Mothers recorded breastfeeding practices at hospital discharge and at the study follow-up appointments. Chi-squares and independent t-tests determined initial differences in breastfeeding practices. Multiple and logistic regression analyses were used to adjust for confounders.

RESULTS

Average maternal age was 32.7 years; average BMI was 26.6 kg/m2, and 56% had achieved third-level education. The average well-being score was 58.2%. In unadjusted analysis, high well-being scores were associated with exclusive breastfeeding (56.2% breastfed vs. 46%, breastfed p < 0.03). After adjusted analysis, these associations were no longer significant (odds ratio: 1.00, 95% confidence interval: 0.99-1.01). No other associations were found.

CONCLUSION

Our findings indicated 25% of pregnant women in the first trimester reported low well-being scores. Associations between maternal well-being and breastfeeding patterns were explained by maternal age and education level, suggesting low mood may not be a barrier to breastfeeding initiation or duration. This trial is registered at: https://www.isrctn.com/ ISRCTN54392969.

KEY POINTS

· Well-being during pregnancy is often diminished and the WHO 5-Item well-being index is a useful measure in clinical settings to assess maternal well-being.. · Breastfeeding is a high-priority research area, particularly in an Irish setting.. · Well-being was not related to breastfeeding, however age, BMI and education were the main predictors of low well-being during pregnancy..

The Impact of Excessive Weight on Breastfeeding Intention, Initiation, and Duration

Background: Breastfeeding is widely recognized as the optimal feeding method for infants. However, breastfeeding goals are often unmet, especially in mothers with excessive weight. Potential factors associated with unmet goals could be disparities in care for women with higher body mass index (BMI) or mental health symptomology. Methods: Women enrolled in a longitudinal study were stratified by BMI into three groups: mothers with normal weight (18.5-24.9 kg/m2, n = 101), with overweight (25-29.9 kg/m2, n = 78), and with obesity (OB; 30-35 kg/m2, n = 48). Breastfeeding intention and standardized mental health questionnaires were administered at gestational weeks 12 and 36. The prevalence of initiation and duration of breastfeeding were determined based on self-reported breastfeeding start and end dates. Wilcoxon tests, pairwise proportion test, Cox proportional hazards regression, and linear regression were used. Results: Higher maternal weight status (OB) was significantly associated with lower breastfeeding intention and duration. As expected, higher breastfeeding intention scores were associated with significantly longer breastfeeding duration. Higher scores on the Beck Depression Inventory (BDI), associated with a greater number of depression symptoms, mediated the negative impact of weight status on breastfeeding intention. Conclusions: breastfeeding outcomes are negatively associated with maternal weight status and prenatal mental health with the relationship between the two being interconnected, despite subclinical scores on the BDI. Further research is needed to explore the role of mental health on breastfeeding outcomes. From these findings, targeted prenatal interventions for women with excessive weight and depressive symptoms would likely promote and improve breastfeeding outcomes. ClinicalTrials.gov: www.clinicaltrials.gov, ID #NCT01131117.

Maternal breastfeeding is associated with offspring microbiome diversity; a secondary analysis of the MicrobeMom randomized control trial

Background

Microbial dysbiosis in infancy can influence long-term health outcomes such as childhood obesity. The aim of this study is to explore relationships among maternal well-being during pregnancy, breastfeeding, and the infant gut microbiome.

Methods

This is a secondary analysis of healthy pregnant women from the MicrobeMom study, a double-blind randomized control trial of maternal probiotic supplementation (Bifidobacterium breve 702258) versus placebo antenatally and up to 3 months postpartum. Maternal well-being was assessed using the WHO-5 well-being index at 16 weeks' and 34 weeks' gestation. Breastfeeding practices were recorded at discharge from hospital and at 1 month postpartum. Infant stool samples were obtained at 1 month of age. Next generation shotgun sequencing determined infant microbial diversity. Independent sample t-tests and Mann-Whitney U tests informed adjusted regression analysis, which was adjusted for delivery mode, antibiotics during delivery, maternal age and body mass index (BMI), and probiotic vs. control study group.

Results

Women (n = 118) with at least one measure of well-being were on average 33 years (SD 3.93) of age and 25.09 kg/m2 (SD 3.28) BMI. Exclusive breastfeeding was initiated by 65% (n = 74). Any breastfeeding was continued by 69% (n = 81) after 1 month. In early and late pregnancy, 87% (n = 97/111) and 94% (n = 107/114) had high well-being scores. Well-being was not associated with infant microbial diversity at 1 month. In adjusted analysis, exclusive breastfeeding at discharge from hospital was associated with infant microbial beta diversity (PC2; 0.254, 95% CI 0.006, 0.038). At 1 month postpartum, any breastfeeding was associated with infant microbial alpha diversity (Shannon index; -0.241, 95% CI -0.498, -0.060) and observed species; (-0.325, 95% CI -0.307, -0.060), and infant microbial beta diversity (PC2; 0.319, 95% CI 0.013, 0.045). Exclusive breastfeeding at 1 month postpartum was associated with infant alpha diversity (Shannon index -0.364, 95% CI -0.573, -0.194; Simpson index 0.339, 95% CI 0.027, 0.091), and infant's number of observed microbial species (-0.271, 95% CI -0.172, -0.037).

Conclusion

Breastfeeding practices at 1 month postpartum were associated with lower microbial diversity and observed species in infants at 1 month postpartum, which is potentially beneficial to allow greater abundance of Bifidobacterium.

Clinical trial registration

ISRCTN53023014.

The impact of antenatal depressive symptoms on exclusive breastfeeding intention: A moderating effect analysis

OBJECTIVE

Exclusive breastfeeding intention is an important predictor of exclusive breastfeeding behavior. Antenatal depressive symptoms are a potentially modifiable risk factor for exclusive breastfeeding intention. However, studies of the impact of antenatal depressive symptoms on exclusive breastfeeding intention are sparse and contradictory. Therefore, explorations that evaluate the effects of identical factors of exclusive breastfeeding intention and antenatal depressive symptoms in their relationship are urgently needed. This study aims to (1) investigate the impact of antenatal depressive symptoms on exclusive breastfeeding intention based on confounders related either to antenatal depressive symptoms and/or exclusive breastfeeding intention and (2) explore whether or not identical factors moderate the relationship between antenatal depressive symptoms and exclusive breastfeeding intention.

DESIGN AND SETTING

A cross-sectional survey was conducted at a tertiary hospital in Hunan, China.

PARTICIPANTS

A total of 393 pregnant women completed a self-administered questionnaire, a question on their breastfeeding intention, the Edinburgh Postnatal Depression Scale, and the Perceived Social Support Scale during their first-trimester hospital visit. Logistic regression was used to evaluate the impact of antenatal depressive symptoms on exclusive breastfeeding intention. Moderate analysis was employed to explore whether identical factors moderate the relationship between antenatal depressive symptoms and exclusive breastfeeding intention.

RESULTS

Antenatal depressive symptoms negatively affect the exclusive breastfeeding intention after controlling as fully as possible for confounders (adjusted OR = 2.88, 95% CI: [1.06, 7.82]) and it was moderated by one of the identical factors (i.e., social support). The results of the simple slope test showed a negative relationship between antenatal depressive symptoms and exclusive breastfeeding intention among pregnant women with low levels of social support (b =-0.011, p < 0.05).

CONCLUSION AND IMPLICATION FOR PRACTICE

Social support moderates the negative effects of depressive symptoms on exclusive breastfeeding intention. Clinical care practices and future intervention research that focus on improving antenatal depressive symptoms and exclusive breastfeeding intention should consider the moderator.

Persistent Pregnancy-Related Anxiety Reduces Breastfeeding Exclusiveness and Duration: A Prospective Cohort Study

Objective: Most research has focused on the role of prenatal mental health difficulties on breastfeeding practices, whereas pregnancy-related anxiety (PrA) has been less studied, despite its high prevalence. Identifying new vulnerable subgroups in which the breastfeeding rate remains low is important for health care workers to implement targeted interventions. This study is aimed to explore the association between PrA and breastfeeding practices. Materials and Methods: A total of 3,033 parent-infant dyads from the Ma'anshan Birth Cohort study were included in this research. PrA was assessed by the PrA questionnaire at the second and third trimesters. Breastfeeding practices including the initiation of breastfeeding, delayed lactation, exclusive breastfeeding (EBF), and the duration of breastfeeding were collected at 1, 4, 6, and 12 months postpartum. The associations between PrA and breastfeeding practices were evaluated by multinomial logistic regression and a multivariable Cox proportional hazards model. Results: In total, 9.26% (281/3,033) of participants reported PrA in both trimesters, indicative of persistent PrA. Compared with participants who never suffered from PrA, participants with persistent PrA had a higher risk of giving up EBF at 4 and 6 months postpartum, and a shorter duration of breastfeeding. These results remained the same after excluding participants who gave up EBF due to depression postpartum. Conclusion: Persistent PrA was negatively associated with breastfeeding exclusivity and duration. Addressing PrA might contribute to improved rates of breastfeeding.

Antenatal Classes in the Context of Prenatal Anxiety and Depression during the COVID-19 Pandemic

Perinatal maternal anxiety and depression negatively affect intrauterine fetal development, birth outcome, breastfeeding initiation, duration, and milk composition. Antenatal classes potentially reduce the anxiety of pregnant women and may thus contribute to healthy infant development. The study investigates the relationship between participation in online or in-person antenatal classes and levels of anxiety and depression in Polish women during the COVID-19 pandemic. The study group included 1774 adult, non-smoking pregnant women. We compared the state anxiety (STAI-State) and depression levels (EPDS) in women who (i) attended antenatal classes in-person, (ii) attended online classes, and (iii) did not attend any of them. The statistical analyses included a GLM model and trend analysis, while controlling for maternal trait anxiety, age, pregnancy complications, trimester of pregnancy, previous pregnancies, and COVID-19 infections. We observed statistically significant differences in the level of anxiety (and depression). Women who did attend antenatal classes in person had the lowest levels of anxiety and depression. Considering the importance of maternal mental well-being on fetal development, birth outcome, and breastfeeding, in-person participation in antenatal classes should be recommended to pregnant women.

Lactation is not required for maintaining maternal care and active coping responses in chronically stressed postpartum rats: Interactions between nursing demand and chronic variable stress

Women who do not breastfeed or discontinue breastfeeding early are more likely to develop postpartum depression (PPD) and stress is a significant risk factor for depression, including PPD. Using a rat model, we investigated whether the absence of nursing would increase the susceptibility to chronic stress-related behavioral and neural changes during the postpartum period. Adult female rats underwent thelectomy (thel; removal of teats), sham surgery, or no surgery (control) and were paired with males for breeding. All litters were rotated twice daily until postpartum day (PD) 26. Sham rats served as surrogates for thel litters, yielding a higher nursing demand for sham rats. Concurrently, rats received either no stress or chronic variable stress until PD 25. Rats were observed for maternal behaviors and tested in a series of tasks including open field, sucrose preference, and forced swim. We used immunohistochemistry (IHC) for doublecortin (DCX; to label immature neurons) or for mineralocorticoid receptor (MR). Contrary to our expectations, non-nursing thel rats were resistant to the effects of stress in all dependent measures. Our data indicate that even in chronic adverse conditions, nursing is not required for maintaining stable care to offspring or active coping responses in an acutely stressful task. We discuss the possible role of offspring contact and consider future directions for biomedical and clinical research. In rats with high nursing demand, however, chronic stress increased immobility, hippocampal neurogenesis, and MR expression (largely in opposition to the effects of stress in rats with typical nursing demand). We discuss these patterns in the context of energetics and allostatic load. This research highlights the complexity in relationships between stress, nursing, and neurobehavioral outcomes in the postpartum period and underscores the need for additional biomedical and clinical research geared toward optimizing treatments and interventions for women with PPD, regardless of breastfeeding status. SIGNIFICANCE STATEMENT: The goal of this research was to determine how the absence of nursing and higher nursing demand impact stress-coping behaviors and neural changes associated with chronic stress in order to disentangle the complex interplay of factors that contribute to psychological illness during the postpartum period.

Adverse psychosocial factors in pregnancy and preterm delivery

BACKGROUND

Mental health symptoms, stress, and low psychosocial resources are associated with preterm delivery. It is unknown if there are groups of women who experience similar patterns of these adverse psychosocial factors during pregnancy and if the risk of preterm delivery differs among these groups.

OBJECTIVE

To identify groups of women with similar patterns of adverse psychosocial factors during pregnancy and determine whether the risk of preterm delivery differs among these groups.

METHODS

Spontaneous Prematurity and Epigenetics of the Cervix (SPEC) is a prospective cohort study of pregnant women, aged 18 and older. In this analysis, we included women who enrolled after 24 August 2014 and delivered by 20 January 2019. As women could enrol more than once, our cohort included 774 women with 787 pregnancies. We conducted a latent class analysis to identify groups of women with similar patterns of adverse psychosocial factors during pregnancy based on their responses to measures assessing depression, perceived stress, anxiety (pregnancy-related and generalised), stressful life events, resilience, and social support (partner and friend/family). After identifying the latent classes, we used log-binomial regression to compare the incidence of preterm delivery among the classes.

RESULTS

The median age among participants was 33.2 years (interquartile range 30.3-36.3), and the majority were non-Hispanic white (56.9%). We identified three classes of adverse psychosocial factors (few, some, and many factors). In total, 63 (8.0%) pregnancies resulted in a preterm delivery. Compared to participants with few factors, the risk of preterm delivery was no different among participants with some (RR 1.23, 95% CI 0.68, 2.25) and many adverse factors (RR 1.62, 95% CI 0.73, 3.62).

CONCLUSIONS

We identified three groups of pregnant women with similar patterns of adverse psychosocial factors. We did not observe a difference in the risk of preterm delivery among the classes.

Breastfeeding intention and trait mindfulness during pregnancy

OBJECTIVE

Breastfeeding has been associated with many health benefits for both infant and mother. Trait mindfulness during pregnancy may have a beneficial impact on breastfeeding intention. The current study aimed to examine whether trait mindfulness during pregnancy was associated with antenatal breastfeeding intention.

DESIGN, SETTING AND PARTICIPANTS

The current study is part of a large prospective population-based cohort study among pregnant women in the south of the Netherlands.

MEASUREMENTS

A subsample of participants completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy and a question on their breastfeeding intention at 32 weeks of pregnancy (N=790). Moreover, the Edinburgh Depression Scale and Tilburg Pregnancy Distress scale were completed at 32 weeks of pregnancy to assess levels of distress.

FINDINGS

Univariate analyses showed that women with breastfeeding intention during pregnancy had significantly higher scores on the mindfulness facet non-reacting (p<.001, medium effect size) and significantly lower scores on acting with awareness (p=.035, small effect size). A subsequent multiple logistic regression analysis showed that only non-reacting remained significantly associated with antenatal breastfeeding intention (OR=1.09, 95% CI [1.03, 1.15], p=.001), after controlling for confounders. Women who eventually initiated breastfeeding had significantly higher non-reacting scores (p<.001, small to medium effect size).

KEY CONCLUSIONS

The mindfulness facet non-reacting was found to be associated with antenatal breastfeeding intention. More research is needed to confirm our results, since the current study is one of the first assessing the possible relation of trait mindfulness during pregnancy and breastfeeding intention.

IMPLICATIONS FOR PRACTICE

Mindfulness-based programs during pregnancy could be helpful in improving non-reacting in pregnant women, which may enhance breastfeeding intention and ultimately the initiation of breastfeeding.

Perinatal depressive symptoms and breastfeeding behaviors: A systematic literature review and biosocial research agenda

BACKGROUND

Breastfeeding is recommended to improve maternal and infant health globally. Depression has been posited to negatively impact breastfeeding, although potential causal and bidirectional pathways between these two phenomena have not been sufficiently characterized. We therefore conducted a systematic review to critically evaluate available evidence on the relationship between perinatal depressive symptoms and breastfeeding behaviors; to identify knowledge gaps and propose a biosocial research agenda to advance our understanding of this topic.

METHODS

A systematic search strategy was applied across seven databases. Data were extracted and aggregated using the matrix method to provide a narrative synthesis of findings.

RESULTS

Thirty-eight studies from 20 countries spanning 1988 through 2018 fit the inclusion criteria. In general, methods across studies were heterogeneous. Fourteen different tools were used to measure perinatal depressive symptoms. Nearly half the studies did not provide breastfeeding definitions. No studies from low-income countries met inclusion criteria. More than half (63%) of studies demonstrated a negative association between depressive symptoms across the perinatal period and less exclusive breastfeeding and/or shorter breastfeeding durations.

LIMITATIONS

Heterogeneity in study design, definitions, assessment tools, and measurement time points limited the comparability of study findings. Causality cannot be assessed.

CONCLUSIONS

Available evidence suggests perinatal depressive symptoms negatively associated with breastfeeding exclusivity and duration, which can lead to suboptimal infant nutrition and detrimental impacts on maternal mental and physical health. To better understand this relationship, we propose including consistent operationalization and assessment of depression and breastfeeding globally and concurrent repeated measures of key biological and social factors.

Association between Breastfeeding Duration and Long-Term Midwifery-Led Support and Psychosocial Support: Outcomes from a Greek Non-Randomized Controlled Perinatal Health Intervention

BACKGROUND

This study investigates if a non-randomized controlled perinatal health intervention which offers (a) long-term midwife-led breastfeeding support and (b) psychosocial support of women, is associated with the initiation, exclusivity and duration of breastfeeding.

METHODS

A sample of 1080 women who attended a 12-month intervention before and after childbirth, during a five-year period (January 2014-January 2019) in a primary mental health care setting in Greece, was examined. Multiple analyses of variance and logistic regression analysis were conducted.

RESULTS

The vast majority of women (96.3%) initiated either exclusive breastfeeding (only breast milk) (70.7%) or any breastfeeding (with or without formula or other type of food/drink) (25.6%). At the end of the 6th month postpartum, almost half of the women (44.3%) breastfed exclusively. A greater (quantitatively) midwifery-led support to mothers seemed to correlate with increased chance of exclusive breastfeeding at the end of the 6th month postpartum (p = 0.034), and with longer any breastfeeding duration (p = 0.015). The absence of pathological mental health symptoms and of need for receiving long-term psychotherapy were associated with the longer duration of any breastfeeding (p = 0.029 and p = 0.013 respectively).

CONCLUSIONS

Continuous long-term midwife-led education and support, and maternal mental well-being are associated with increased exclusive and any breastfeeding duration.

Maternal Body Mass Index and Breastfeeding Non-Initiation and Cessation: A Quantitative Review of the Literature

This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I² = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I² = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I² = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I² = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.

Becoming a mother: Predicting early dissatisfaction with motherhood at three weeks postpartum

OBJECTIVE

The peripartum period can go along with increased insecurity, strain or frustration, potentially leading to a dissatisfying experience of motherhood, which itself is associated with poorer postnatal adjustment. Identifying prenatal influencing factors on the early postnatal dissatisfaction with motherhood is crucial to enable specific support for parents from pregnancy on. The aim of this study was to investigate the predictive relevance of prenatal levels of anxiety and hostility as manifestations of prenatal strain, and further maternal-fetal bonding, adult attachment style and recalled parenting by the own mother on the dissatisfaction with motherhood.

DESIGN

Data was assessed longitudinally.

SETTING

The study took place at the University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PARTICIPANTS

N=100 pregnant women from the general population.

MEASUREMENTS AND FINDINGS

Pregnancy-related anxiety, hostility, maternal-fetal bonding and adult attachment style were assessed in the last trimester of pregnancy, and recalled parenting by the own mother and current dissatisfaction with motherhood at three weeks postpartum. Hierarchical regression analysis showed that lower recalled care by the own mother predicted higher dissatisfaction with overall motherhood, from the perspective as an adult and related to their child. Higher pregnancy-related anxiety predicted higher overall and child-related dissatisfaction. Higher hostility predicted higher child-related dissatisfaction.

KEY CONCLUSION

Prenatal negative emotional states and lower recalled care by the own mother can serve as indicators for maternal dissatisfaction.

IMPLICATION FOR PRACTICE

Shaping professional support around negative emotional states and addressing experiences of own upbringing already prenatally might prevent an early dissatisfaction with motherhood and negative consequences for mother and child.

Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers

Background: During the last decades, fathers have increasingly participated in prenatal care, birth preparation classes, and childbirth. However, comparably little is known about the prenatal emotional well-being of fathers, particularly content and extent of broader paternal concerns that may arise during pregnancy beyond those focusing on childbirth. Thus, the aims of this study were to investigate the manifestation of paternal pregnancy-related worries in a population-based sample and to identify relevant associated factors. Materials and Methods: As part of a longitudinal pregnancy cohort at the University Medical Center Hamburg-Eppendorf, Germany, N = 129 expectant fathers were assessed once during pregnancy. Pregnancy-related worries centering around medical procedures, childbirth, health of the baby, as well as socioeconomic aspects were assessed with the Cambridge Worry Scale (CWS). Additionally, paternal socioeconomic background and maternal obstetrical history, symptoms of generalized anxiety and depression, and level of hostility were investigated, as well as perceived social support. The cross-sectional data were analyzed based on multiple regression analyses. Results: The level of reported worries was overall low. Some fathers reported major worries for individual aspects like the health of a significant other (10.9%) and the baby (10.1%), as well as the current financial (6.2%) and employment situation (8.5%). Pregnancy-related worries were negatively associated with household income and positively associated with anxious and depressive symptoms and low perceived social support. Associations varied for specific pregnancy-related worries. Limitations: Due to the cross-sectional data examined in this study, a causal interpretation of the results is not possible. The sample was rather homogeneous regarding its socioeconomic background. More research needs to be done in larger, more heterogeneous samples. Conclusion: Though overall worries were rather low in this sample, specific major worries could be identified. Hence, addressing those fathers reporting major worries regarding specific aspects already in prenatal care might support their psychosocial adjustment. Fathers with little income, those with elevated levels of general anxious and depressive symptoms, and those with less social support reported higher pregnancy-related worries. Our results indicate the relevance of concerns beyond health- and birth-related aspects that could be relevant for fathers. Measurements developed specifically for expectant fathers are needed to properly capture their perspective already during pregnancy.

Postpartum-specific anxiety and maternal bonding: Further evidence to support the use of childbearing specific mood tools

Background: Research examining the relationship between postpartum anxiety and maternal bonding is limited by the use of general measures of anxiety which may predict perinatal outcomes less effectively than childbearing specific tools. Objectives: This study aimed to investigate the predictive validity of the Postpartum Specific Anxiety Scale [PSAS] and examine whether it is a more effective predictor of maternal bonding than general measures of anxiety. Methods: Two hundred and sixty one mothers (≤6-months postpartum) completed the PSAS alongside general anxiety and depression measures. Maternal bonding was examined via the Postpartum Bonding Questionnaire [PBQ] two-weeks later. Results: Hierarchical regression models demonstrated that higher levels of postpartum specific anxiety were associated with impaired overall bonding scores, and subscales of impaired general bond, rejection and anger, and infant focused anxieties. As hypothesised, the PSAS predicted unique variance in maternal bonding in these domains after controlling for general measures of anxiety and depression. Conclusion: These findings provide further evidence to support the predictive utility of the PSAS and the use of childbearing-specific measures of mood when predicting perinatal outcomes.

The Mood, Mother, and Infant Study: Associations Between Maternal Mood in Pregnancy and Breastfeeding Outcome

Purpose: We sought to determine the role of depression and anxiety in breastfeeding cessation. Materials and Methods: Participants underwent a baseline visit with a structured clinical interview in the third trimester of pregnancy. Monthly phone interviews assessed current mood symptoms and infant feeding status. We assessed the association between baseline mood and infant feeding outcomes using Cox proportional hazards regression, adjusting for infant feeding intention and sociodemographic confounders. Results: We enrolled 222 mother-infant dyads in late pregnancy, of whom 206 completed assessments through 12 months postpartum. We enriched our study with symptomatic women by enrolling 87 women with current depression or anxiety (Current), 64 women with a history of depression or anxiety (Past), and 71 women with no psychiatric history (Never). In multivariable-adjusted analyses, baseline diagnosis was not associated with breastfeeding outcome, but baseline symptoms of depression (Beck Depression Inventory ≥11) or anxiety (Spielberger State Anxiety ≥40) were associated with earlier introduction of formula (depression: adj hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.01-2.30; anxiety: 1.70, 95% CI 1.01-2.87); and any cessation of breastfeeding (depression: adj HR 2.02, 95% CI 1.23-3.31; anxiety: 1.83, 95% CI 1.00-3.33), as were depression symptoms among women who were being treated with antidepressants, compared with untreated asymptomatic women (formula: adj HR 2.27, 95% CI 1.29-4.02; cessation: 2.32, 95% CI 1.17-4.61). History of childhood trauma (adj HR 1.34, 95% CI 1.12-1.61), disordered eating symptoms (adj HR 1.22, 95% CI 1.02-1.46), and poor sleep quality in pregnancy (adj HR 1.32, 95% CI 1.09-1.60) were independently associated with earlier introduction of formula. Conclusions: Baseline mood symptoms were independently associated with earlier formula introduction and cessation of breastfeeding. History of childhood trauma, disordered eating symptoms and poor sleep quality were associated with earlier formula introduction. Targeted support may enable women with these symptoms to achieve their feeding goals.

Impact of Maternal Anxiety on Breastfeeding Outcomes: A Systematic Review

Prenatal and postpartum anxiety may impair maternal functioning and disrupt mother-infant behaviors including breastfeeding. The objective of this narrative review is to examine the association between maternal anxiety from pregnancy to 12 mo postpartum and breastfeeding initiation, duration, and exclusivity. Using a combination of Medical Subject Headings terms and text words, relevant studies were identified through PubMed and PsycINFO. Studies that were conducted in high-income countries, assessed anxiety during gestation and/or postpartum through a standardized measure, and evaluated the impact of anxiety on any of the primary outcomes were included. Sixteen studies met the eligibility criteria although they varied greatly in methodological rigor. A negative association between postpartum anxiety and breastfeeding initiation, duration, and exclusivity was suggested. No associations were found between prenatal anxiety and breastfeeding initiation or exclusivity. Evidence is mixed regarding the association between prenatal anxiety and breastfeeding duration. All studies included in the review were of low or very low quality. Although there was consistency in the association between maternal anxiety and breastfeeding outcomes in the included studies, future studies with greater methodological rigor are needed to determine the extent of the relation between prenatal and/or postpartum anxiety and breastfeeding outcomes.

Consequences of Antepartum Depression

To counsel women about risks and benefits of depression treatment during pregnancy, clinicians must appreciate the potential consequences of untreated depression on the mother and her unborn child. Many studies have demonstrated associations between untreated depression during pregnancy and a range of adverse outcomes, including low birth weight, preterm delivery, preeclampsia, emergent operative delivery, postpartum depression, and both cognitive and behavioral deficits in the child. Although most of these associations are marked by low odds ratios and a host of potential confounding issues, they collectively provide considerable rationale for identifying depression in pregnancy and offering treatment for mothers at risk.

Patterns of body mass index milestones in early life and cardiometabolic risk in early adolescence

BACKGROUND

Few studies have examined the independent and combined relationships of body mass index (BMI) peak and rebound with adiposity, insulin resistance and metabolic risk later in life. We used data from Project Viva, a well-characterized birth cohort from Boston with repeated measures of BMI, to help fill this gap.

METHODS

Among 1681 children with BMI data from birth to mid childhood, we fitted individual BMI trajectories using mixed-effects models with natural cubic splines and estimated age, and magnitude of BMI, at peak (in infancy) and rebound (in early childhood). We obtained cardiometabolic measures of the children in early adolescence (median 12.9 years) and analysed their associations with the BMI parameters.

RESULTS

After adjusting for potential confounders, age and magnitude at infancy BMI peak were associated with greater adolescent adiposity, and earlier adiposity rebound was strongly associated with greater adiposity, insulin resistance and metabolic risk score independently of BMI peak. Children with a normal timing of BMI peak plus early rebound had an adverse cardiometabolic profile, characterized by higher fat mass index {β 2.2 kg/m2 [95% confidence interval (CI) 1.6, 2.9]}, trunk fat mass index [1.1 kg/m2 (0.8, 1.5)], insulin resistance [0.2 units (0.04, 0.4)] and metabolic risk score [0.4 units (0.2, 0.5)] compared with children with a normal BMI peak and a normal rebound pattern. Children without a BMI peak (no decline in BMI after the rise in infancy) also had adverse adolescent metabolic profiles.

CONCLUSIONS

Early age at BMI rebound is a strong risk factor for cardiometabolic risk, independent of BMI peak. Children with a normal peak-early rebound pattern, or without any BMI decline following infancy, are at greatest risk of adverse cardiometabolic profile in adolescence. Routine monitoring of BMI may help to identify children who are at greatest risk of developing an adverse cardiometabolic profile in later life and who may be targeted for preventive interventions.

Duration of Breastfeeding, Bottle-Feeding, and Parafunctional Oral Habits in Relation to Anxiety Disorders Among Children

OBJECTIVE

The aim of the present study is to investigate the duration of breastfeeding in relation to various parafunctional oral habits in children with anxiety disorders.

MATERIALS AND METHODS

The study includes 195 children and adolescents with anxiety disorders and age- and gender-matched 255 healthy control subjects. Diagnoses were made with semistructured interview (K-SADS). Information about breastfeeding and parafunctional oral habits was investigated via a questionnaire prepared for the study.

RESULTS

The mean age was 11.50 ± 2.50 years for clinical group and 11.27 ± 2.33 years for controls. Fifty-four percent of the clinical group and 56% of the control group were female subjects. Duration of exclusive (4.72 ± 2.86, 5.55 ± 2.36; p = 0.002) and total breastfeeding (12.38 ± 10.32, 15.89 ± 9.09; p < 0.001) was significantly lower and duration of bottle-feeding (22.30 ± 19.54, 16.64 ± 12.79; p = 0.005) was higher than controls in the clinical group. Duration of exclusive breastfeeding was significantly correlated with duration of bottle-feeding (r = -0.263, p < 0.001) and duration of pacifier use (r = -0.249, p = 0.001). Multiple regression analysis showed that duration of exclusive breastfeeding (β = 0.88, p = 0.006) and bottle-feeding (β = 1.02, p = 0.005), as well as various oral habits, was associated with diagnosis of an anxiety disorder.

CONCLUSION

Nutrition methods in early years of life may result in long-term consequences regarding anxiety disorders for children. Clinicians should encourage parents for a shorter duration of bottle-feeding and a longer duration of exclusive breastfeeding.

Prenatal Maternal Depressive Symptoms Predict Early Infant Health Concerns

INTRODUCTION

Recent research suggests that health disparities among low-SES and ethnic minority populations may originate from prenatal and early life exposures. Postpartum maternal depressive symptoms have been linked to poorer infant physical health, yet prenatal depressive symptoms not been thoroughly examined in relation to infant health.

METHODS

In a prospective study of low-income Mexican American mothers and their infants, women (N = 322, median age 27.23, IQR = 22.01-32.54) completed surveys during pregnancy (median gestation 39.50, IQR = 38.71-40.14 weeks) and 12 weeks after birth. We investigated (1) if prenatal depressive symptoms predicted infant physical health concerns at 12 weeks of age, (2) whether these associations occurred above and beyond concurrent depressive symptoms, and (3) if birth weight, gestational age, and breastfeeding were mediators of prenatal depression predicting subsequent infant health.

RESULTS

Higher prenatal depressive symptoms were associated with more infant physical health concerns at 12 weeks (p < .001), after accounting for 12-week maternal depressive symptoms, breastfeeding, gestational age, and birth weight. Twelve-week maternal depressive symptoms were concurrently associated with more infant health concerns (p < .01). Birth weight, gestational age, and breastfeeding were not associated with maternal depression or infant health concerns.

DISCUSSION

Results establish a link between prenatal depressive symptoms and an elevated risk of poor health evident shortly after birth. These findings underscore the importance of the prenatal period as a possible sensitive period for infants' health, and the need for effective interventions for depression during pregnancy to mitigate potentially teratogenic effects on the developing fetus and reduce risks for later health concerns.

Pre-, Perinatal, and Parental Predictors of Body Mass Index Trajectory Milestones

OBJECTIVE

To assess associations of pre-, perinatal, and parental factors with age and magnitude at body mass index (BMI) peak and rebound.

STUDY DESIGN

Among 1681 children with BMI data from birth to mid-childhood in Project Viva, we fitted individual BMI trajectories using mixed-effect models with natural cubic spline functions and estimated age and magnitude at peak in infancy and rebound in early childhood. We used stepwise multivariable regression to identify predictors of peak and rebound in the 1354 (63.6%) children with estimable trajectory milestones.

RESULTS

The mean (SD) of age at BMI peak was 8.4 (2.7) months and at rebound was 59.8 (19.6) months, and the mean (SD) of magnitude at peak was 18.0 (1.4) kg/m² and at rebound was 15.9 (1.2) kg/m². Girls had a later age at peak, earlier age at rebound, and lower magnitudes at peak and rebound than boys. Maternal isolated hyperglycemia (vs normoglycemia: β 0.7 months [95% CI 0.2-1.2]) and pre-eclampsia (vs normal blood pressure: 1.6 months [0.8-2.4]) were associated with a later peak, and impaired glucose tolerance (vs normoglycemia: -0.5 kg/m² [-0.9, -0.1]) was associated with a lower magnitude at peak. Greater maternal first-trimester weight gain, smoking during pregnancy, no breastfeeding, parental obesity, and no university education were associated with greater BMI at rebound.

CONCLUSIONS

We have identified modifiable prenatal and parental predictors of BMI peak in infancy and rebound in childhood. Early-life interventions that address these factors may be effective in changing BMI peak and rebound and potentially preventing later obesity.

Prospective associations of breastfeeding and smoking cessation among low-income pregnant women

Although low-income pregnant women have high rates of smoking and low rates of breastfeeding, few studies have examined prospective associations between these risk factors in community samples. Doing so may help improve breast-feeding support programs in this population. We used a secondary analysis of 247 low-income pregnant smokers in Memphis, Tennessee, who were interviewed up to 4 times (twice during pregnancy and twice through 6 months postpartum). Smoking cessation during prepartum and postpartum was defined as a self-report of not smoking for ≥1 week and an expired carbon monoxide level of <10 ppm. Multivariable logistic regression analyses were used to determine whether intent to breastfeed was associated with smoking cessation and whether smoking cessation was associated with actual breastfeeding. Models were adjusted for sociodemographic, pregnancy-related, and smoking-related confounders. Thirty-nine percent of participants intended to breastfeed, and 38% did so. Women who intended to breastfeed were 2 times more likely to quit smoking prepartum (adjusted OR = 1.99, 95% CI [1.06, 3.74]), but not postpartum (adjusted OR = 1.27, 95% CI [0.57, 2.84]). Quitting smoking at baseline and during pregnancy was associated with subsequent breastfeeding (adjusted OR 2.27, 95% CI [1.05, 4.94] and adjusted OR = 2.49, 95% CI [1.21, 5.11]). Low-income women who intended to breastfeed were more likely to quit smoking during pregnancy and those who quit smoking at baseline and prepartum were more likely to breastfeed. Simultaneously supporting breastfeeding and smoking cessation may be very useful to change these important health behaviours among this high-risk population.

Factors associated with pregnancy-related anxiety in Tanzanian women: a cross sectional study

OBJECTIVE

To identify factors predictive of pregnancy-related anxiety (PRA) among women in Mwanza, Tanzania.

DESIGN

A cross-sectional study was used to explore the relationship between psychosocial health and preterm birth.

SETTING

Antenatal clinics in the Ilemela and Nyamagana districts of Mwanza, Tanzania.

PARTICIPANTS

Pregnant women less than or equal to 32 weeks' gestational age (n=212) attending the two antenatal clinics.

MEASURES

PRA was measured using a revised version of the 10-item PRA Questionnaire (PRA-Q). Predictive factors included social support (Multidimensional Scale of Perceived Social Support), stress (Perceived Stress Scale), depression (Edinburg Postpartum Depression Scale) and sociodemographic data. Bivariate analysis permitted variable selection while multiple linear regression analysis enabled identification of predictive factors of PRA.

RESULTS

Twenty-five per cent of women in our sample scored 13 or higher (out of a possible 30) on the PRA-Q. Perceived stress, active depression and number of people living in the home were the only statistically significant predictors of PRA in our sample.

CONCLUSIONS

Our findings were contrary to most current literature which notes socioeconomic status and social support as significant factors in PRA. A greater understanding of the experience of PRA and its predictive factors is needed within the social cultural context of low/middle-income countries to support the development of PRA prevention strategies specific to low/middle income countries.

Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010-2011 Pregnancy Risk Assessment Monitoring System

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.

Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States

OBJECTIVE

To describe differences in geographic, demographic, treatment, and substance use characteristics by pharmacotherapy receipt among pregnant women entering publically funded treatment for opioid use disorder (OUD) in the United States.

METHODS

1996 to 2014 Treatment Episode Data Set-Admissions data from pregnant admissions with OUD, defined as reporting opioids as the primary substance of use leading to the treatment episode, were analyzed for this cross-sectional study. The proportion of all pregnant admissions with OUD who received pharmacotherapy was calculated by year and U.S. census region. Trends across time were assessed using the Cochrane-Armitage Trend test. Associations between demographic, substance use, and treatment characteristics and pharmacotherapy receipt were assessed using Chi-square tests and multivariable logistic regression.

RESULTS

The proportion of pregnant admissions where opioids were the primary substance of use increased from 16.9% to 41.6% during the study period, while the proportion of pregnant admissions with OUD who received pharmacotherapy remained relatively unchanged at around 50%. Overall, pharmacotherapy recipients were generally older and white, more likely to receive treatment in an outpatient setting, be self-referred, and report heroin as the primary substance, daily substance use, and intravenous drug use, and less likely to have a co-occurring psychiatric problem compared to those who did not receive pharmacotherapy. Regional differences in pharmacotherapy utilization exist; the South consistently had the fewest pregnant admissions with OUD receiving pharmacotherapy.

CONCLUSION

Although the proportion of pregnant admissions to substance use treatment centers with OUD has increased since the mid-1990s, the proportion receiving pharmacotherapy has not changed. Significant variations in pharmacotherapy utilization exist by geography and demographic, substance use and treatment characteristics. Utilization of pharmacotherapy at publically funded treatment centers providing care for pregnant women with OUD should be expanded.

Postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours: new evidence for childbearing specific measures of mood

Studies of pregnancy-specific anxiety suggest that it is a distinct construct which predicts perinatal outcomes more effectively than other general measures of anxiety. In response, a novel measure of postpartum-specific anxiety (PSAS) has been developed and validated, but it is not yet clear whether it possesses the same predictive power as its pregnancy-specific counterparts. The aim of this short-term prospective study was to (a) test the predictive validity of the PSAS in the context of one specific perinatal outcome, infant-feeding, and (b) examine whether the PSAS may be more efficacious at predicting infant-feeding outcomes and behaviours than the more commonly used general measures. Eight hundred mothers of infants aged between 0 and 6 months completed the PSAS alongside general measures of anxiety and depression at baseline. A subsample (n = 261) returned to complete a follow-up questionnaire examining infant-feeding outcomes and behaviours two weeks later. Hierarchical regression models revealed that the PSAS was associated with lower odds of breastfeeding exclusively, and breastfeeding in any quantity in the first 6 months postpartum. PSAS scores were also significantly associated with infant-feeding behaviours including a lower perceived enjoyment of food, and greater perceived food responsiveness and satiety responsiveness in the infant. As hypothesised, the PSAS was a stronger predictor of infant-feeding outcomes and behaviours than general anxiety and depression. The findings provide evidence for the predictive validity of the PSAS and call for the use of childbearing specific measures of mood when attempting to predict perinatal outcomes. Replication of these findings across other indices of maternal and infant health is now necessary.

Self-Harm Thoughts Postpartum as a Marker for Long-Term Morbidity

Introduction

Postpartum depression predisposes to maternal affective and somatic disorders. It is important to identify which women are at an increased risk of subsequent morbidity and would benefit from an intensified follow-up. Self-harm thoughts (SHTs), with or without other depressive symptomatology, might have prognostic value for maternal health beyond the postpartum period.

Aim

This study is to investigate the somatic and psychiatric morbidity of postpartum women with SHTs, with or without other depressive symptoms, over a 7-year follow-up period.

Materials and methods

The subjects for this study are derived from a population-based Swedish cohort of women who gave birth at Uppsala University Hospital (May 2006–June 2007) and who answered the Edinburgh Postnatal Depression Scale (EPDS) at 5 days, 6 weeks, and 6 months postpartum. Three groups were included: women reporting SHTs (SHT group, n = 107) on item 10 of the EPDS; women reporting depressive symptoms, i.e., EPDS ≥ 12 at 6 weeks and/or 6 months postpartum, without SHTs (DEP group, n = 94); and randomly selected controls screening negatively for postpartum depression (CTL group, n = 104). The number of diagnostic codes for somatic and psychiatric morbidity according to the International Statistical Classification of Diseases and Related Health Problems system, and the number of medical interventions were retrieved from medical records over 7 years following childbirth and were used as the outcome measures, together with any prescription of antidepressants and sick leave during the follow-up.

Results

The SHT group had the highest psychiatric morbidity of all groups and more somatic morbidity than controls. Affective disorders were more common in the SHT and the DEP groups compared with controls, as well as antidepressant prescriptions and sick leave. One-fifth of women with SHTs did not screen positive for depressive symptoms; nevertheless, they had more somatic and psychiatric morbidity than the control group.

Conclusion

Women reporting thoughts of self-harm in the postpartum period are at an increased risk of somatic and psychiatric morbidity during a follow-up of 7 years after delivery, and this increased risk may not be fully attributed to depressive symptoms. Results underline the importance of screening for self-harm symptoms postpartum and point to a need for individualized follow-up.

Maternal distress in late pregnancy alters obstetric outcomes and the expression of genes important for placental glucocorticoid signalling

The experience of maternal distress in pregnancy is often linked with poorer obstetric outcomes for women as well as adverse outcomes for offspring. Alterations in placental glucocorticoid signalling and subsequent increased fetal exposure to cortisol have been suggested to underlie this relationship. In the current study, 121 pregnant women completed the Perceived Stress Scale, State Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale in the third trimester of pregnancy. Placental samples were collected after delivery. Maternal history of psychiatric illness and miscarriage were significant predictors of poorer mental health in pregnancy. Higher anxiety was associated with an increase in women delivering via elective Caesarean Section, and an increase in bottle-feeding. Birth temperature was mildly reduced among infants of women with high levels of depressive symptomology. Babies of mothers who scored high in all stress (cumulative distress) measures had reduced 5-min Apgar scores. High cumulative distress reduced the expression of placental HSD11B2 mRNA and increased the expression of placental NR3C1 mRNA. These data support a role for prenatal distress as a risk factor for altered obstetric outcomes. The alterations in placental gene expression support a role for altered placental glucocorticoid signalling in the relationship between maternal prenatal distress and adverse outcomes.

Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study

Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation and continuation. We investigated breastfeeding among mothers by HIV status in South Africa, evaluating predictors of breastfeeding initiation and continuation to identify intervention-targets. Breastfeeding patterns were investigated in a subsample of 899 breastfeeding mothers from the Drakenstein Child Health Study; a prospective birth cohort of 1225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6weeks and 24months' infant age. Cox proportional hazard models evaluated breastfeeding initiation and duration. Logistic regression models with breastfeeding non-initiation as the outcome parameter were performed to determine associations with maternal sociodemographic, psychosocial factors and gestational outcomes. More HIV-uninfected mothers initiated breastfeeding (n=685, 97%) than HIV-infected mothers (n=87, 45%). Median duration of exclusive breastfeeding was short (2months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2months). Despite concerning high rates, mental disorders were not significant predictors of breastfeeding behaviour. Employment and HIV diagnosis during pregnancy predicted a lower likelihood of breastfeeding initiation among HIV-infected mothers, while employment was associated with earlier breastfeeding-discontinuation in HIV-uninfected mothers. Findings indicate that future interventions should target sub-populations such as HIV-infected women because of distinct needs. Workplace interventions appear particularly key for mothers in our study.

A qualitative study of pregnancy-related anxiety among women in Tanzania

OBJECTIVES

To explore and understand the experiences and priorities of pregnant women living with fears and worries related to fetal/infant and maternal health, the birthing process and ability to parent the infant (ie, pregnancy-related anxiety (PRA)) in Mwanza, Tanzania.

DESIGN

Descriptive phenomenological approach.

SETTING

Two clinics in the Ilemela and Nyamagana districts of Mwanza.

PARTICIPANTS

Pregnant and postpartum women who obtained high scores on a PRA scale during pregnancy in a larger quantitative study were contacted to participate in an interview (10 women, aged 18-34 years; 3 HIV positive).

MEASURES

Semi-structured interviews were undertaken, with guiding questions related to the women's experience during pregnancy. The Colaizzi method was used with transcripts that had been translated and back translated from Swahili to English and then hand-coded by the interviewer, with independent review by another researcher to verify the analysis.

RESULTS

PRA, as experienced by women in Mwanza, was a state of worry and concern, often causing physical symptoms, and disrupting personal sense of peace. While some themes in the women's experiences reflected the domains examined in the PRA scale used to identify potential participants, others such as lack of knowledge, partner relationship, interactions with the healthcare system, spirituality and fear of HIV/AIDS were otherwise missing. Their prominence in the participants' stories broadens our understanding of PRA.

CONCLUSIONS

The realities and viewpoints of women in low-income and middle-income countries (LMIC) experiencing PRA are still relatively unknown. The findings from this study provided much-needed insight into the perspectives and priorities of women in Mwanza who have experienced PRA and further support the need to explore this phenomenon in other LMIC. The additional domains identified reinforce the need for a PRA tool that accurately and adequately capture the complexities of PRA for women in this region.

Antenatal psychological and socioeconomic predictors of breastfeeding in a large community sample

BACKGROUND

Despite much work to publicise the benefits of breastfeeding most women do not persist for the first 6months, as recommended by the WHO. Successful breastfeeding for 6months may depend on several factors, including perinatal mental health. We aimed to investigate the impact of antenatal depressive symptoms, attitudes towards breastfeeding and socio-demographic factors in predicting breastfeeding for 6months in a large community sample.

METHODS

The sample was based on the Avon Longitudinal Study of Parents and Children (n=9479), a large-scale birth cohort. Breastfeeding was assessed at multiple time-points, from postnatal day 1 until 6months postnatal. Self-reported symptoms of maternal depression were assessed at 18 and 32weeks gestation and at 8weeks postnatal. Antenatal attitudes towards breastfeeding were assessed at 32weeks gestation. Antenatal, obstetric, psychosocial and socio-demographic variables were also assessed.

RESULTS

Antenatal depressive symptoms at both 18 and 32weeks gestation were associated with decreased breastfeeding initiation and duration. However, the prediction of breastfeeding by these symptoms was confounded by socio-demographic and psychosocial covariates. A positive antenatal attitude towards breastfeeding was the strongest predictor and was associated with a 20-30% increase in breastfeeding initiation and maintenance at all time points.

CONCLUSION

This study highlights the wide range of factors that independently predict breastfeeding, and suggests that an intervention program to improve antenatal attitudes especially warrants investigation.

Psychological Distress Moderates the Intention-Behavior Association for Sexual Partner Concurrency Among Adults

Research suggests that intentions are an important determinant of sexual risk behavior. However, this association is often weaker than hypothesized. This research investigated whether psychological distress (i.e., depression, anxiety) can help to explain the intentions-behavior gap. We used data from 397 patients seeking care at an STI clinic to test whether the association between partner concurrency intentions and behavior 3 months later was moderated by distress. Intentions predicted concurrency behavior only among less-distressed individuals; however, exploratory analyses for condom use did not demonstrate this effect. Comprehensive sexual health intervention programs should address affective determinants of risk behavior.

Positive feelings during pregnancy, early feeding practices, and infant health

BACKGROUND

Early parenting practices, such as infant feeding, can affect children's physical health. Additionally, negative prenatal maternal affect can influence feeding choices, such as breast-feeding, and can have a detrimental effect on children's health. Little is known, however, about the contribution of positive maternal affect during pregnancy on feeding practices and children's health.

METHODS

This study explored whether positive prenatal feelings influenced children's health during the first 18 months, and whether early feeding practices mediated the relationship between these two variables. Low-income, ethnically diverse, primiparous women (n = 114) reported their feelings of pregnancy uplifts and hassles during their third trimester. These women were interviewed again at 2, 4, 6, 9, 12, and 18 months post-partum about their feeding practices. A retrospective audit of their infants' medical charts was completed from birth to 18 months.

RESULTS

Using structural equation modeling, having more uplifts than hassles during pregnancy was associated with longer breast-feeding duration and greater adherence to recommended schedules for introducing fruits and vegetables, solids, and baby cereal. These feeding practices were linked to better child health outcomes, including reduced risk of upper respiratory tract infections, conjunctivitis, otitis media, and thrush.

CONCLUSIONS

Positive maternal feelings during pregnancy were associated with better feeding practices, and these better feeding practices were associated with fewer common childhood illnesses. Helping expectant women focus on the positive aspects of their pregnancy may lead to postnatal care methods that are fiscally advantageous, preventive of detrimental postnatal choices, and medically beneficial for children.

The Relation of Pre and Postnatal Depression and Anxiety with Exclusive Breastfeeding

Introduction

Studies on the relationship between prenatal psychosocial risk factors and breastfeeding are disjointed. Maternal health status has a great influence on breastfeeding, growth, and general health of the neonates. The aim of this study was to ascertain the relation between maternal mental health and breastfeeding status of mothers in Kazerun (Fars province, Iran).

Methods

This cross-sectional study was conducted on a total of 92 pregnant women recruited from clinics in Kazerun in 2015. Participants were divided into two groups subject to exclusive breastfeeding. Spielberger Anxiety Inventory, Beck Depression Inventory and Edinburgh Postnatal Depression Scale (EPDS) were used for data collection. Data analysis was performed by the SPSS version 16 using descriptive statistics, Chi-square, and Fisher’s exact test.

Results

The average of state anxiety score according to Spielberger Anxiety Inventory was 1.97±0.51 in the exclusive breastfeeding group versus 1.77±0.66 in the non-exclusive breastfeeding group (p = 0.229). The mean trait anxiety score according to Spielberger Anxiety Inventory was 1.98±0.44 in the exclusive breastfeeding group versus 2.22±0.44 in the non-exclusive breastfeeding group (p=0.132). An average of Beck Depression Inventory score was 1.35±0.84 totally (1.33±0.81 in the exclusive breastfeeding group vs. 1.33±1.00, P=0.584). An average of EPDS score was 1.65±1.11, 1.64±1.11, and 1.44±0.88 in total, in the exclusive breastfeeding and non-exclusive breastfeeding groups, respectively (p=0.604).

Conclusions

Screening anxiety and depression before and during pregnancy appeared to be necessary.

Maternal weight status, diet, and supplement use as determinants of breastfeeding and complementary feeding: a systematic review and meta-analysis

CONTEXT

Infant feeding practices are influenced by maternal factors.

OBJECTIVE

The aim of this review is to examine the associations between maternal weight status or dietary characteristics and breastfeeding or complementary feeding.

DATA SOURCES

A systematic literature search of the Embase, Cochrane Library, Google Scholar, MEDLINE, PubMed, and Web of Science databases was performed.

STUDY SELECTION

Interventional and cohort studies in healthy mothers and infants that reported on maternal weight status, diet, or supplement use were selected.

DATA EXTRACTION

Outcomes assessed included delayed onset of lactogenesis; initiation, exclusivity, duration, and cessation of breastfeeding; and timing of complementary feeding.

DATA ANALYSIS

Eighty-one studies were included. Maternal underweight, diet, and supplement use were not associated with infant feeding practices. Obese women had a relative risk of failure to initiate breastfeeding (risk ratio [RR] = 1.23; 95%CI, 1.03-1.47) and a delayed onset of lactogenesis (RR  =  2.06; 95%CI, 1.18-3.61). The RR for breastfeeding cessation was 1.11 (95%CI, 1.07-1.15) per increase in category of body mass index.

CONCLUSIONS

Prevention of obesity in women of reproductive age, as well as counseling of obese women after delivery, could be targeted to improve infant feeding practices.

A Prospective Investigation of Prenatal Mood and Childbirth Perceptions in an Ethnically Diverse, Low-Income Sample

INTRODUCTION

Few studies have examined prenatal mood as a means to identify women at risk for negative childbirth experiences. We explore associations between prenatal mood and birth perceptions in a socioeconomically diverse, American sample.

METHODS

We conducted a prospective study of 136 predominantly low-income and ethnic minority women of mixed parity. Prenatal measures of perceived stress, pregnancy-related anxiety, and depressive symptoms were used to predict maternal perceptions of birth experiences 1 month postpartum, using the childbirth experience questionnaire (CEQ; 1).

RESULTS

After adjusting for sociodemographic variables and mode of delivery, higher third-trimester stress predicted worse CEQ total scores. This association was predominantly explained by two CEQ domains: own capacity (e.g., feelings of control and capability), and perceived safety. Pregnancy-related anxiety and depressive symptoms correlated with perceived stress, though neither independently predicted birth experience. An unplanned cesarean delivery was associated with a worse CEQ total score. Vaginal delivery predicted greater perceived safety. Altogether, sociodemographic covariates, mode of delivery, and prenatal mood accounted for 35 percent of the variance in birth experience (p < 0.001).

DISCUSSION

Our finding that prenatal stress explains a significant and likely clinically meaningful proportion of the variance in birth experience suggests that women perceive and recall their birth experiences through a lens that is partially determined by preexisting personal circumstances and emotional reserves. Since childbirth perceptions have implications for maternal and child health, patient satisfaction, and health care expenditures, these findings warrant consideration of prenatal stress screening to target intervention for women at risk for negative birth experiences.

Acculturation and Intention to Breastfeed among a Population of Predominantly Puerto Rican Women

BACKGROUND

Latinas have high overall breastfeeding initiation rates, yet Puerto Ricans have among the lowest exclusive breastfeeding rates. This study sought to determine if acculturation was associated with intent to breastfeed in a predominantly Puerto Rican population.

METHODS

A cohort of Latina women were enrolled in Proyecto Buena Salud, and provided information on infant feeding intent (n = 1,323). Acculturation was assessed via the Psychological Acculturation Scale (PAS), language preference, and generation in the United States.

RESULTS

Increasing acculturation as measured by English language preference (aOR 0.61 [95% CI 0.42-0.88]) and second or third generation in the United States (aOR 0.70 [95% CI 0.52-0.95)] was inversely associated with odds of intending to exclusively breastfeed. Similarly, women with higher levels of acculturation as measured by the PAS (aOR 0.67 [95% CI 0.45-0.99]), English language preference (aOR 0.48 [95% CI 0.33-0.70]) and second or third generation in the United States (aOR 0.42 [95% CI 0.31-0.58]) were less likely to report intent to combination feed as compared with women with lower acculturation.

CONCLUSIONS

Acculturation was inversely associated with intent to exclusively breastfeed and intent to combination feed in this predominantly Puerto Rican sample.

Initiation and exclusivity of breastfeeding: association with mothers' and fathers' prenatal and postnatal depression and marital distress

INTRODUCTION

This study explored the effects of mothers' and fathers' prenatal and postnatal depressive symptoms and marital distress on breastfeeding initiation and exclusive breastfeeding (EBF) duration.

MATERIAL AND METHODS

This was a prospective follow-up of a cohort sample of 873 families participating to an intensive follow-up cohort of longitudinal Steps to the Healthy Development and Well-being of Children study (The STEPS study) in Southwestern Finland. The depressive symptoms were evaluated by The Edinburgh Postpartum Depression Scale and marital distress by the Revised Dyadic Adjustment Scale at 20th gestational week and at 4 months postpartum. EBF was self-reported real-time and defined as an infant receiving no food or drink other than mother's breast milk since birth, except occasionally water.

RESULTS

Neither parents' prenatal depressive symptoms predicted breastfeeding initiation or EBF duration. The mothers' prenatal depressive symptoms, in turn, predicted their postnatal depressive symptoms, which were associated with shorter duration of EBF. The EBF duration was shortest amongst the mothers who had depressive symptoms both pre- and postnatally compared to mothers who had depressive symptoms only in either time point alone (M = 1.54, 2.06 and 2.04 months, respectively). Higher prenatal maternal marital distress was associated with longer EBF duration.

CONCLUSIONS

The findings suggest that the continuity of maternal depressive symptoms throughout the perinatal period has adverse effect on EBF duration. Identification and treatment of mothers' depressive symptoms already during the prenatal period may improve breastfeeding practices. The finding of mothers' marital distress having positive impact on breastfeeding practices requires further investigation.

The Influence of Antenatal Partner Support on Pregnancy Outcomes

BACKGROUND

While there has been considerable attention given to the multitude of maternal factors that contribute to perinatal conditions and poor birth outcomes, few studies have aimed to understand the impact of fathers or partners. We examined associations of antenatal partner support with psychological variables, smoking behavior, and pregnancy outcomes in two socioeconomically distinct prebirth cohorts.

MATERIALS AND METHODS

Data were from 1764 women recruited from an urban-suburban group practice (Project Viva) and 877 women from urban community health centers (Project ACCESS), both in the Boston area. Antenatal partner support was assessed by the Turner Support Scale. Multivariable linear and logistic regression analyses determined the impact of low antenatal partner support on the outcomes of interest.

RESULTS

In early pregnancy, 6.4% of Viva and 23.0% of ACCESS participants reported low partner support. After adjustment, low partner support was cross-sectionally associated with high pregnancy-related anxiety in both cohorts (Viva AOR 1.8; 95% CI: 1.0-3.4 and ACCESS AOR 1.9; 95% CI: 1.1-3.3) and with depression in ACCESS (AOR 1.9; 95% CI: 1.1-3.3). In Viva, low partner support was also related to depression mid-pregnancy (AOR 3.1; 95% CI: 1.7-5.7) and to smoking (AOR 2.2; 95% CI: 1.3-3.8). Birth weight, gestational age, and fetal growth were not associated with partner support.

CONCLUSIONS

This study of two economically and ethnically distinct cohorts in the Boston area highlights higher levels of antenatal anxiety, depression, and smoking among pregnant women who report low partner support. Partner support may be an important and potentially modifiable target for interventions to improve pregnancy outcomes.

Prenatal Anxiety and Infant Feeding Outcomes: A Systematic Review

Prenatal anxiety may negatively affect infant health in multiple domains, including infant feeding. However, the relationship between prenatal anxiety and infant feeding is not well understood. Given the benefits of recommended infant feeding practices, clarifying this relationship is important. This review was conducted to examine the relationship between prenatal anxiety and infant feeding outcomes. Electronic searches were performed in relevant databases. A hand search of selected journals and reference lists of included articles was then conducted. All studies were considered that provided information related to infant feeding outcomes and anxiety during pregnancy. Quality assessment and data extraction were conducted by 2 reviewers; 99 studies were identified, of which 6 were eligible. No associations were found between prenatal anxiety and breastfeeding initiation or breastfeeding in any quantity. However, relationships between high levels of prenatal anxiety and a reduction in both breastfeeding intention and breastfeeding exclusivity were identified. The review was limited by the small number of studies included. Sample sizes lacking power and heterogeneous measures and definitions all significantly affected the comparability of findings. It is concluded that there is insufficient evidence to clarify the relationship between prenatal anxiety and infant feeding outcomes.

Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research

Emerging research suggests that a relationship exists between breastfeeding and postpartum depression; however, the direction and precise nature of this relationship are not yet clear. The purpose of this paper is to provide an overview of the relationship between breastfeeding and postpartum depression as it has been examined in the empirical literature. Also, the potential mechanisms of action that have been implicated in this relationship are also explored. PubMed and PsycINFO were searched using the keywords: breastfeeding with postpartum depression, perinatal depression, postnatal depression. Results of this search showed that researchers have examined this relationship in diverse ways using diverse methodology. In particular, researchers have examined the relationships between postpartum depression and breastfeeding intention, initiation, duration, and dose. Due to a number of methodological differences among past studies we make some recommendations for future research that will better facilitate an integration of findings. Future research should (1) use standardized assessment protocols; (2) confirm diagnosis through established clinical interview when possible; (3) provide a clear operationalized definition for breastfeeding variables; (4) clearly define the postpartum period interval assessed and time frame for onset of symptoms; (5) be prospective or longitudinal in nature; and (6) take into consideration other potential risk factors identified in the empirical literature.

Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important?

PURPOSE

This study aimed to investigate socio-demographic, medical and psychological factors that have an impact on breastfeeding.

METHODS

Questionnaires were administered to 330 women prenatally (TI third trimester) and postpartum (TII 3-4 days, TIII 4 months). Medical data were collected from the hospital records. Self-reported data on initiation and maintenance of breastfeeding was collected simultaneously. Primary endpoint was breastfeeding initiation and maintenance. Data analyses were performed using Spearman's ρ correlations between breastfeeding and other study variables and generalized multiple ordinal logistic regression analysis.

RESULTS

Neonatal admission to the NICU, high BMI, cesarean section, difficulties with breastfeeding initiation and high maternal state anxiety were the strongest predictors of impaired breastfeeding initiation, explaining together 50 % of variance. After 4 months, the strongest predictors of impaired maintenance of breastfeeding were maternal smoking, a high BMI and a history of postpartum anxiety disorder, explaining 30 % of variance.

CONCLUSIONS

Successful initiation and maintenance of breast feeding is a multifactorial process. Our results underline the need of interdisciplinary approaches to optimise breastfeeding outcomes by demonstrating the equality of medical and psychological variables. Whereas practices on maternity wards are crucial for optimal initiation, continuous lifestyle modifying and supporting approaches are essential for breastfeeding maintenance. Healthcare providers can also significantly influence breastfeeding initiation and maintenance by counselling on the importance of maternal BMI.

New evidence on breastfeeding and postpartum depression: the importance of understanding women's intentions

This study aimed to identify the causal effect of breastfeeding on postpartum depression (PPD), using data on mothers from a British survey, the Avon Longitudinal Study of Parents and Children. Multivariate linear and logistic regressions were performed to investigate the effects of breastfeeding on mothers' mental health measured at 8 weeks, 8, 21 and 32 months postpartum. The estimated effect of breastfeeding on PPD differed according to whether women had planned to breastfeed their babies, and by whether they had shown signs of depression during pregnancy. For mothers who were not depressed during pregnancy, the lowest risk of PPD was found among women who had planned to breastfeed, and who had actually breastfed their babies, while the highest risk was found among women who had planned to breastfeed and had not gone on to breastfeed. We conclude that the effect of breastfeeding on maternal depression is extremely heterogeneous, being mediated both by breastfeeding intentions during pregnancy and by mothers' mental health during pregnancy. Our results underline the importance of providing expert breastfeeding support to women who want to breastfeed; but also, of providing compassionate support for women who had intended to breastfeed, but who find themselves unable to.

Obesity and breastfeeding: The strength of association

Obesity and attendant co-morbidities are an emergent problem in public health. Much attention has focused on prevention, especially during the perinatal period. Breastfeeding is considered a possible protective factor for obesity in childhood, influencing gene-neuroendocrine-environment-lifestyle interaction. Therefore, breastfeeding and its longer duration are probably associated with lower development of childhood obesity. Through human milk, but not formula, the child assumes greater bioactive factors contributing to immunological, endocrine, development, neural and psychological benefits. Contrarily, other studies did not confirm a critical role of breast milk. Confounding factors, especially maternal pre-pregnancy overweight, may influence breastfeeding effects. This review summarises what is known about the possible relationship between breastfeeding and prevention of obesity development.

CONCLUSION

Breastfeeding appears to represent a protective factor for obesity in childhood, although evidence is still controversial and underlying mechanisms unclear. Further research is needed to improve knowledge on overweight/obesity and breastfeeding.

Pregnancy anxiety: A systematic review of current scales

BACKGROUND

Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap.

METHODS

Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified.

RESULTS

Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scale's strengths and limitations were discussed.

LIMITATIONS

Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties.

CONCLUSIONS

Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale.