Maternal Depression, Breastfeeding Self‐efficacy, and Breastfeeding Intentions

Abstract

Depressive symptoms (DS) are associated with lower breastfeeding (BF) rates, but the causal direction is not clear. Our objective was to examine whether a high level of DS is predictive of prenatal infant feeding intentions (IFI), and if so, how breastfeeding self‐efficacy (BFSE) may mediate the association. A multi‐ethnic sample of nulliparae (n = 485) were interviewed at 34–40 weeks gestation regarding DS (elevated = CES‐D score ≥ 16), BFSE (low if score below median) and IFI. The (IFI) Scale measured strength of intentions to exclusively breastfeed, which has been shown to be strongly associated with actual BF practices. In a cumulative odds logit model with education level, the adjusted odds (95% Confidence Interval) of being in a higher IFI category were 0.63 (0.40–0.99) for those with elevated DS (ref = not elevated). Controlling for education, a pregnant woman with DS had 1.8 (CI, 1.13–3.11) times the odds of having low BFSE than a woman without DS. Furthermore, the adjusted odds of being in a higher IFI category for a pregnant woman with low BFSE were 0.22 (CI, 0.15–0.33, ref = high BFSE). These results underscore the importance of taking prenatal DS into account when examining how BF practices relate to maternal mood postpartum. They suggest that treating prenatal depressive symptoms may contribute to higher rates of BF success, and that improving a woman's BFSE may attenuate the effects of DS on IFI.