Breastfeeding and maternal wellbeing

Context The benefits of breastfeeding for both the mother and the child are well documented, as are the negative health consequences of perinatal depression. Objective To explore causality in the relationships between breastfeeding and perinatal depression. In particular the causal effect of breastfeeding on postpartum maternal mental health was investigated together with the causal effect of antenatal maternal wellbeing on breastfeeding intentions, prevalence, and duration. Methods We used the Avon Longitudinal Study of Parents and Children (ALSPAC) dataset which offers longitudinal information on mothers and their children. Multivariate linear and logistic regression analyses were performed to explore the effects of any and exclusive breastfeeding initiation and duration on postpartum mental health, measured at different time moments (8 weeks, 8 months, 21 months and 32 months post partum) We also explored the effects of antenatal mental health measured at 18 and 33 weeks pregnancy on the different breastfeeding outcomes. Results We found first that, even though there was a strong bivariate relationship between breastfeeding and maternal wellbeing, once potential confounders were controlled for, especially maternal mental and physical health during pregnancy, breastfeeding ceased to exert a significant effect on maternal wellbeing. Therefore apparently breastfeeding did not causally affect maternal postnatal wellbeing. Second, antenatal mental health was positively related to breastfeeding. This effect remained statistically significant after all potential confounders were controlled for with respect to breastfeeding duration, though not for other measures of breastfeeding. Third, the usual screening value for perinatal depression of EPDS greater than 13 may be unnecessarily high. A value of 14 to 15 EPDS was enough to capture the negative impact of prenatal depression on breastfeeding duration. Conclusion Depressive symptomatology in the perinatal period negatively influences infant-feeding outcomes. Prenatal identification of depression-prone mothers may allow targeting breastfeeding promotion interventions to this highly vulnerable grou