Abstract
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.
Highlights
Postpartum anxiety (PPA) remains among the most understudied, under-diagnosed, and under-treated complications of childbirth (Smith and Kipnis 2012)
Results demonstrate that higher levels of postpartum-specific anxiety are associated with lower odds of breastfeeding exclusively, and breastfeeding in any quantity in the first 6 months postpartum
These findings provide evidence for the predictive validity of the Postpartum-specific Anxiety Scale (PSAS) as they are comparable with a body of literature which finds that PPA is inversely associated with exclusive breastfeeding (Virden 1988; Groër 2005; Clifford 2006; Britton 2007; Zanardo et al 2009; Adedinsewo et al 2014) and breastfeeding in any quantity (Adedinsewo et al 2014; Britton 2007; Brown and Arnott 2014; Courtois et al 2014; Paul et al 2013)
Summary
Postpartum anxiety (PPA) remains among the most understudied, under-diagnosed, and under-treated complications of childbirth (Smith and Kipnis 2012). Research into PPA currently utilises a range of general self-report measures which are seldom validated for use postpartum This may lead to erroneous data, inaccurate interpretation, and incomparable results across studies (Meades and Ayers 2011). A number of selfreport measures have been developed (e.g. Pregnancy Related Anxiety Questionnaire (PRAQ; Van Den Bergh 1990), and the PRAQ-R (Huizink et al 2004)) Studies using these scales consistently find that pregnancy-specific anxiety is a more efficacious predictor of perinatal outcomes than other general forms of stress, anxiety, and depression (Guardino and Schetter 2014). This is evident across studies of pre-term birth (Dunkel Schetter 2011), cognitive and motor performance (Davis and Sandman 2010), attention regulation (Huizink et al 2002), temperament (Davis et al 2004), and infantfeeding (Fairlee et al 2009)
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