839 The association between early breastfeeding cessation and postpartum depressive symptoms among women intending to breastfeed

Abstract

An association between sustained breastfeeding and a decrease in postpartum depression has been identified. However, over half of US women cease breastfeeding earlier than desired. Our objective was to evaluate whether early cessation of breastfeeding is associated with postpartum depressive symptoms in women with identified mental health conditions. This retrospective cohort study included women enrolled in an outpatient collaborative care perinatal mental health program (COMPASS) during pregnancy and reported an intent to breastfeed at delivery between 02/2017-02/2020. Women were referred to COMPASS either due to a history of mental health conditions or due to incident mental health concerns. Women completed validated depression screens [Patient Health Questionnaire-9 (PHQ-9)] during pregnancy and at the postpartum visit. Scores were compared between women who intended to breastfeed but were exclusively formula feeding at the postpartum visit and women who reported continued breastfeeding. Worsening depression was defined as an increase of one standard deviation (i.e. 5 or more) on the PHQ-9 between the 2nd or 3rd trimester screen and the postpartum screen, an increase in antidepressant medication requirement, or subjective report of worsening of mood symptoms in the absence of a formalized screen. Bivariable and multivariable analyses were performed. Of the 377 women who met inclusion criteria, 314 (83%) reported continued breastfeeding at the postpartum visit. Women who intended but were not breastfeeding at the postpartum visit were more likely to experience a worsening of postpartum depressive symptoms (19.0% vs 9.2%, p=.02). After controlling for potential confounders, women who ceased breastfeeding by the postpartum visit had a greater odds of worsening depressive symptoms (aOR 2.58, 95% CI 1.15-5.78). Women with known mental health conditions or at risk for perinatal mental health conditions who desire to breastfeed but are unable to continue past the immediate postpartum period are at an increased risk of worsening mood symptoms.