Breastfeeding and depression: A systematic review of the literature

doi:10.1016/j.jad.2014.09.022

Journal of Affective Disorders

Volume 171, 15 January 2015, Pages 142-154

https://doi.org/10.1016/j.jad.2014.09.022 Get rights and content

Abstract

Background

Research has separately indicated associations between pregnancy depression and breastfeeding, breastfeeding and postpartum depression, and pregnancy and postpartum depression. This paper aimed to provide a systematic literature review on breastfeeding and depression, considering both pregnancy and postpartum depression.

Methods

An electronic search in three databases was performed using the keywords: “breast feeding”, “bottle feeding”, “depression”, “pregnancy”, and “postpartum”. Two investigators independently evaluated the titles and abstracts in a first stage and the full-text in a second stage review. Papers not addressing the association among breastfeeding and pregnancy or postpartum depression, non-original research and research focused on the effect of anti-depressants were excluded. 48 studies were selected and included. Data were independently extracted.

Results

Pregnancy depression predicts a shorter breastfeeding duration, but not breastfeeding intention or initiation. Breastfeeding duration is associated with postpartum depression in almost all studies. Postpartum depression predicts and is predicted by breastfeeding cessation in several studies. Pregnancy and postpartum depression are associated with shorter breastfeeding duration. Breastfeeding may mediate the association between pregnancy and postpartum depression. Pregnancy depression predicts shorter breastfeeding duration and that may increase depressive symptoms during postpartum.

Limitations

The selected keywords may have led to the exclusion of relevant references.

Conclusions

Although strong empirical evidence regarding the associations among breastfeeding and pregnancy or postpartum depression was separately provided, further research, such as prospective studies, is needed to clarify the association among these three variables. Help for depressed pregnant women should be delivered to enhance both breastfeeding and postpartum psychological adjustment.

Introduction

Breastfeeding offers a wide range of benefits for both the child and the mother. The benefits for the infant include a diminished risk of infectious diseases and obesity and decreased blood pressure (Brion et al., 2011, Duijts et al., 2010, Horta et al., 2007). For the mother, breastfeeding confers a lower risk of ovarian and breast cancers and decreased blood pressure (Ebina and Kashiwakura, 2012, González-Jiménez et al., 2013, Jonas et al., 2008). Recognized as the optimal infant feeding method, the guidelines specified by the World Health Organization (WHO), the European Commission for Public Health (ECPH) and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding in the first 6 months postpartum (American Academy of Pediatrics, 2012, EU Project on Promotion of Breastfeeding in Europe, 2008, World Health Organization, 2007).

Although large variability across, most countries do not reach desirable rates of exclusive breastfeeding initiation and exclusive breastfeeding for 6 months (Cattaneo et al., 2005). Several studies have aimed to predict women at risk of no breastfeeding initiation or having an early cessation, given that this recommendation is not followed by most mothers (e.g., Bartick and Reinhold, 2010, Chalmers et al., 2009, Lee et al., 2013).

Pregnancy depression and postpartum depression appear to be possible significant contributors to this issue (Figueiredo et al., 2014, Hahn-Holbrook et al., 2013, Seimyr et al., 2004). It is widely known that pregnancy and postpartum depression have high incidence and that depressed women at pregnancy are usually depressed at the postpartum period (e.g., Figueiredo et al., 2007, Milgrom et al., 2008). Additionally, pregnancy and postpartum depression adverse effects have been consistently pointed out not only in breastfeeding, but also in mothers׳ behavior, health and psychological adjustment (e.g., Groer and Morgan, 2007), in infants׳ behavior and development (e.g., Figueiredo et al., 2010), and in the mother–infant interaction (e.g., Murray and Cooper, 1997).

To our knowledge, there are no published systematic reviews addressing the association among breastfeeding and pregnancy and postpartum depression. Given that pregnancy depression is the best predictor of postpartum depression (Figueiredo et al., 2007, Milgrom et al., 2008, Yonkers et al., 2001), it is important to simultaneously consider both pregnancy and postpartum depression in relation to breastfeeding in a review addressing the associations between these variables. This paper aimed to provide a systematic review of the literature on the association among breastfeeding and pregnancy and postpartum depression. Due to the associative nature of the majority of the published studies, it was not possible to perform a meta-analysis.

Section snippets

Methods

A total of 1673 relevant references were identified in an electronic search of three databases: MEDLINE, Web of Knowledge and PsycINFO. Duplicated references were removed and 771 articles remained. The titles and abstracts of the identified references were screened, and 707 non-relevant references were excluded. The full-text of the 65 remaining studies was then screened, and 17 studies met one or more exclusion criteria. At the final stage, 48 studies were included in the review. A flow

Study characteristics

The included studies were published between 1983 and 2013 in 19 different countries and evaluated a total of 71,245 participants. The majority of the studies were conducted in the United States (n=15) and in the United Kingdom (n=6). The remaining studies were published in Australia (n=3), Brazil (n=3), Canada (n=3), Barbados (n=2), Norway (n=2), Pakistan (n=2), Turkey (n=2), China (n=1), Congo (n=1), Finland (n=1), Iceland (n=1), Italy (n=1), Japan (n=1), Mexico (n=1), Portugal (n=1), Sweden (n

Discussion

This systematic review provides an overview of the current knowledge on the associations among breastfeeding and pregnancy or postpartum depression. It includes studies from several countries published over a 30-year period. However, the four selected keywords may have led to the exclusion of relevant references. The use of broader keywords such as “maternal mental health”, “psychological wellbeing”, or “maternal depression” could have led to the identification of more records. Despite

Role of funding source

This research was supported by FEDER Funds through the ProgramaOperacionalFactores de Competitividade – COMPETE and by National Funds through FCT – Fundaçãopara a Ciência e a Tecnologia under the project: PTDC/SAU/SAP/116738/2010.

The sponsors had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

This work has no conflict of interest.

Acknowledgments

This research was supported by FEDER Funds through the Programa Operacional Factores de Competitividade – COMPETE and by National Funds through FCT – Fundação para a Ciência e a Tecnologia under the project: PTDC/SAU/SAP/116738/2010.

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ReviewBreastfeeding and depression: A systematic review of the literature

Abstract

Background

Methods

Results

Limitations

Conclusions

Introduction

Section snippets

Methods

Study characteristics

Discussion

Role of funding source

Conflict of interest

Acknowledgments

Maternal anxiety and breastfeeding: findings from the MAVAN (maternal adversity, vulnerability and neurodevelopment) study

J. Hum. Lact.

Breastfeeding duration and postpartum psychological adjustment: role of maternal attachment styles

J. Paediatr. Child Health

Breast feeding and post-natal depression

J. Psychosom. Res.

Postpartum anxiety and depression in peri-urban communities of Karachi, Pakistan: a quasi-experimental study

BMC Public Health

Breastfeeding and the use of human milk

Pediatrics

Is maternal depressive symptomatology effective on success of exclusive breastfeeding during postpartum 6 weeks?

Breastfeed. Med.

Birth events, birth experiences and social differences in postnatal depression

Aust. J. Public Health

Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection?

Arch. Women׳s Ment. Health

The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis

Pediatrics

What influences the uptake and early cessation of breast feeding?

Midwifery

Are maternal depression or symptom severity associated with breastfeeding intention or outcomes?

J. Clin. Psychiatry

What are the causal effects of breastfeeding on IQ, obesity and blood pressure? Evidence from comparing high-income with middle-income cohorts

Int. J. Epidemiol.

Protection, promotion and support of breast-feeding in Europe: current situation

Public Health Nutr.

Breastfeeding rates and hospital breastfeeding practices in Canada: a national survey of women

Birth

Predictors, prodromes and incidence of postpartum depression

J. Psychosom. Obstet. Gynaecol.

Maternal depressive symptoms and infant health practices among low-income women

Pediatrics

Psychosocial factors associated with the early termination of breast-feeding

J. Psychosom. Res.

Does maternal postpartum depressive symptomatology influence infant feeding outcomes?

Acta Paediatr.

Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy

Pediatrics

The relationship between vulnerability factors and breastfeeding outcomes

J. Obstet. Gynecol. Neonatal Nurs.

Influence of breastfeeding on maternal blood pressure at one month postpartum

Int. J. Women׳s Health

Postpartum depression in Kinshasa (DR Congo): prevalence and risk factors

Med. Sante Trop.

Promoting, Protecting and Supporting Breastfeeding: A Blueprint for Action (Revised)

High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation

J. Women׳s Health

Risk factors for discontinuing breastfeeding in southern Brazil: a survival analysis

Matern. Child Health J.

Breastfeeding in depressed mother-infant dyads

Early Child Dev. Care

Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression

Psychol. Med.

Anxiety and depression in women and men from early pregnancy to 3-months postpartum

Arch. Women׳s Ment. Health

Depression during pregnancy and the postpartum period in adolescent and adult Portuguese mothers

Arch. Women׳s Ment. Health

Mother׳s anxiety and depression during the third pregnancy trimester and neonate׳s mother versus stranger׳s face/voice visual preference

Early Hum. Dev.

Risk for postpartum depression, breastfeeding practices, and mammary gland permeability

J. Hum. Lact.

Symptoms of maternal depression immediately after delivery predict unsuccessful breast feeding

Arch. Dis. Child.

Maternal moods predict breastfeeding in Barbados

J. Dev. Behav. Pediatr.

Review
Breastfeeding and depression: A systematic review of the literature