Does breastfeeding affect maternal postpartum mood?

Abstract

Breastfeeding is well known to be beneficial to both the mother and the baby. To the baby, it is associated with decreased short-term health problems such as diarrhea and respiratory infections, as well as decreased long-term health consequences such as type 2 diabetes, obesity, and raised blood cholesterol levels. To the mother, it is suggested to reduce type 2 diabetes, breast cancer, as well as ovarian cancer. Increasing exclusive breastfeeding rate, in which higher proportion of infants are given breast milk only, could also benefit the society as a whole. It is shown to reduce health care cost and premature deaths. Despite the gradual elevation of ever breastfeeding rate in Hong Kong up to 83% in 2013, the exclusive breastfeeding rate at 2 months postpartum remained relatively low at 21.7%. On the other hand, postpartum depression is a debilitating condition to both the mother and the baby. The prevalence was about 10-15%. And it could lead to deteriorated quality of life to the mother and increased maternal suicidal rate. It could also affect the long-term development of the baby. Previous studies showed controversial results on the association between breastfeeding and postpartum depression. Some suggested breastfeeding being protective against postpartum depression, while other studies did not show significant results. However, there was still no formal study in the local Chinese population about the issue. In view of that, the current study aimed at assessing the association between breastfeeding and postpartum depressive symptoms in the local Chinese population. This was a cross-sectional study which included 600 mothers with data retrieved from MCHCs’ database. Demographic data and breastfeeding status were included in binary logistic regression analysis with Edinburgh Postnatal Depression Scale (EPDS) result of either screened positive or negative as the outcome. The odds ratio of being screened positive in EPDS with more depressive symptoms for mothers with exclusive breastfeeding, compared with mothers not on breastfeeding (OR=0.42, 95% CI=0.19, 0.93) and mothers with non-exclusive breastfeeding (OR=0.40, 95% CI=0.19, 0.85) were both statistically significant after adjusted for the demographic data. Subgroup analysis on those intended for exclusive breastfeeding shortly after delivery also showed significant results. Those who succeeded in maintaining exclusive breastfeeding at 6-8 weeks postpartum were significantly less likely to be screened positive in EPDS (OR=0.07, 95% CI=0.01, 0.41) compared to those who could not maintain exclusive breastfeeding. This study proposed to assess whether there is an association between breastfeeding and decreased maternal postpartum depressive symptoms in local Chinese population. The results reiterated the advantages of breastfeeding and warranted more intense efforts in promoting and protecting breastfeeding. The large effect shown in the subgroup analysis highlighted the importance of maintaining exclusive breastfeeding. Since this study could only establish association, the results could not show causation and future studies should focus on establishing the temporality of causation between breastfeeding and decreased maternal postpartum depressive symptoms. Stricter adjustment for potential confounders should also be achieved with a prospective study better designed to control for temporality and time-varying confounders in the future.