The association between engagement in a perinatal collaborative care program and breastfeeding among people with identified mental health conditions

Abstract

Untreated antenatal mental health conditions are associated with noninitiation and early discontinuation of breastfeeding. Whether interventions designed to optimize perinatal mental health can mitigate this association is unknown. This study aimed to examine whether engagement of pregnant people with mental health conditions in a perinatal mental health collaborative care program was associated with differences in breastfeeding initiation and continuation and whether any observed association was mediated by changes in depressive symptoms. This retrospective cohort study included all pregnant people who were referred antenatally by their obstetrical clinician to a perinatal collaborative care program and who delivered viable neonates between January 2017 and June 2018. Pregnant people were dichotomized by whether they engaged in collaborative care services. Breastfeeding initiation (endorsed at delivery) and continuation at the postpartum visit were compared between individuals who did and did not engage in collaborative care using bivariable and multivariable analyses. Mediation analyses were performed to determine if any observed associations were mediated by improvements or remission in depressive symptoms. During the study period, 350 eligible pregnant people were referred to the perinatal collaborative care program because of an identified mental health condition. Of these people, 264 (75.4%) engaged in collaborative care. Compared with those who did not engage in collaborative care, people who engaged in collaborative care were more likely to initiate breastfeeding (168 [95%] vs 47 [87%]; P=.046) and continue breastfeeding at the postpartum visit (92 [74%] vs 20 [53%]; P=.012). These associations persisted after controlling for potential confounders (adjusted odds ratio for initiation, 3.30; 95% confidence interval, 1.09-9.98; adjusted odds ratio for continuation, 3.08; 95% confidence interval, 1.29-7.36). Neither association was mediated by improvements or remission in depressive symptoms. Although antenatal mental health conditions are a risk factor for lack of initiation or early cessation of breastfeeding, engagement in a collaborative care program was associated with improvements in both breastfeeding initiation and continuation. This association was independent of improvement in depressive symptoms, suggesting that the benefits of perinatal collaborative care may extend beyond its psychological impact.