Antenatal depressive symptoms and early initiation of breastfeeding in association with exclusive breastfeeding six weeks postpartum: a longitudinal population-based study

Karin Cato,Marios K Georgakis,Sara M Sylvén,Alkistis Skalkidou,Christine Rubertsson,Natasa Kollia

doi:10.1186/s12884-019-2195-9

Abstract

BackgroundDepressive symptoms negatively impact on breastfeeding duration, whereas early breastfeeding initiation after birth enhances the chances for a longer breastfeeding period. Our aim was to investigate the interplay between depressive symptoms during pregnancy and late initiation of the first breastfeeding session and their effect on exclusive breastfeeding at six weeks postpartum.MethodsIn a longitudinal study design, web-questionnaires including demographic data, breastfeeding information and the Edinburgh Postnatal Depression Scale (EPDS) were completed by 1217 women at pregnancy weeks 17–20, 32 and/or at six weeks postpartum. A multivariable logistic regression model was fitted to estimate the effect of depressive symptoms during pregnancy and the timing of the first breastfeeding session on exclusive breastfeeding at six weeks postpartum.ResultsExclusive breastfeeding at six weeks postpartum was reported by 77% of the women. Depressive symptoms during pregnancy (EPDS> 13); (OR:1.93 [1.28–2.91]) and not accomplishing the first breastfeeding session within two hours after birth (OR: 2.61 [1.80–3.78]), were both associated with not exclusively breastfeeding at six weeks postpartum after adjusting for identified confounders. Τhe combined exposure to depressive symptoms in pregnancy and late breastfeeding initiation was associated with an almost 4-fold increased odds of not exclusive breastfeeding at six weeks postpartum.ConclusionsWomen reporting depressive symptoms during pregnancy seem to be more vulnerable to the consequences of a postponed first breastfeeding session on exclusive breastfeeding duration. Consequently, women experiencing depressive symptoms may benefit from targeted breastfeeding support during the first hours after birth.

Highlights

Depressive symptoms negatively impact on breastfeeding duration, whereas early breastfeeding initiation after birth enhances the chances for a longer breastfeeding period
The aim of this study was to assess the interplay between antenatal depressive symptoms and early initiation of breastfeeding on exclusive breastfeeding at 6 weeks postpartum, when there is no obvious reason for introducing other foods or drinks, in a population-based cohort of Swedish pregnant women
Our results show that women experiencing depressive symptoms during pregnancy, as well as those with a postponed first breastfeeding session, are more likely to not exclusively breastfeed at 6 weeks postpartum, which is the current recommendation

Summary

Introduction

Depressive symptoms negatively impact on breastfeeding duration, whereas early breastfeeding initiation after birth enhances the chances for a longer breastfeeding period. As several of the breastfeeding benefits for both mother and infant appear to be further strengthened by longer duration and exclusive breastfeeding, the World Health Organization (WHO) recommends exclusive breastfeeding during the first six months after birth [3]. The Swedish recommendations are in line with the WHO guidelines, they include an amendment declaring that the introduction of “tiny sensations” of solid food from the age of four months is harmless if it does not affect continuous breastfeeding [4]. Rates of exclusive breastfeeding are shown to be decreasing, especially towards the late postpartum period, being around 64% at two months, and plummeting to 16% at six months postpartum [5].

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