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Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010–2011 Pregnancy Risk Assessment Monitoring System

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Abstract

Objective Evidence suggests that women with postpartum depression (PPD) are at risk for early breastfeeding cessation, but previous studies have been limited by small samples. The objective of this analysis is to estimate the association between PPD symptoms and breastfeeding using a national, stratified, random sample of U.S. mothers. Methods Data from the 2010–2011 Pregnancy Risk Assessment Monitoring System were analyzed for New York City and the 29 states for which data were available. Multivariable logistic regression was used to explore the association between a pre-pregnancy mental health visit and subsequent breastfeeding initiation as well as PPD and 3-month any and exclusive breastfeeding. To identify state-level variation, we created maps of prevalence and adjusted odds of breastfeeding by PPD and pre-pregnancy mental health status. Results Women reporting a pre-pregnancy mental health visit had 0.61 (95 % CI 0.56, 0.67) times the odds of initiating breastfeeding compared with women who reported no pre-pregnancy visit. At 3 months postpartum, women with PPD symptoms since birth had 0.79 (95 % CI 0.70, 0.88) times the odds of any breastfeeding and reduced odds of exclusive breastfeeding modified by race/ethnicity. We found variation in state-level PPD symptoms and pre-pregnancy mental health prevalence and adjusted odds of breastfeeding. Conclusions for Practice Our results highlight the importance of providing targeted breastfeeding support to women with PPD symptoms, because they are at risk of early breastfeeding cessation. Given the cross-sectional nature of these data, women with early breastfeeding cessation may also be at risk for PPD, requiring screening and treatment.

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Acknowledgments

The study was funded in part by a predoctoral training grant from the National Institute of Child Health and Human Development (5T32HD052468-08). This paper uses data collected by the Centers for Disease Control and Prevention’s surveillance project, the Pregnancy Risk Assessment Monitoring System (PRAMS). The authors would like to acknowledge the PRAMS Working Group: Alabama—Qun Zheng, MS Alaska—Kathy Perham-Hester, MS, MPH Arkansas—Mary McGehee, PhD Colorado—Alyson Shupe, PhD Connecticut—Jennifer Morin, MPH Delaware—George Yocher, MS Florida—Kelsi E. Williams Georgia—Chinelo Ogbuanu, MD, MPH, PhD Hawaii—Jane Awakuni Illinois—Theresa Sandidge, MA Iowa—Sarah Mauch, MPH Louisiana—Amy Zapata, MPH Maine—Tom Patenaude, MPH Maryland—Diana Cheng, MD Massachusetts—Emily Lu, MPH Michigan—Patricia McKane Minnesota—Judy Punyko, PhD, MPH Mississippi—Brenda Hughes, MPPA Missouri—Venkata Garikapaty, MSc, MS, PhD, MPH Montana—JoAnn Dotson Nebraska—Brenda CoufalI New Hampshire—David J. Laflamme, PhD, MPH New Jersey—Ingrid M. Morton, MS New Mexico—Eirian Coronado, MPH New York State—Anne Radigan-Garcia New York City—Candace Mulready-Ward, MPH North Carolina—Kathleen Jones-Vessey, MS North Dakota—Sandra Anseth Ohio—Connie Geidenberger PhD Oklahoma—Alicia Lincoln, MSW, MSPH Oregon—Kenneth Rosenberg, MD, MPH Pennsylvania—Tony Norwood Rhode Island—Sam Viner-Brown, PhD South Carolina—Mike Smith, MSPH Texas—Tanya Guthrie, PhD Tennessee—Ramona Lainhart, PhD Utah—Laurie Baksh, MPH Vermont—Peggy Brozicevic Virginia—Christopher Hill, MPH, CPH Washington—Linda Lohdefinck West Virginia—Melissa Baker, MA Wisconsin—Katherine Kvale, PhD Wyoming—Amy Spieker, MPH CDC PRAMS Team, Applied Sciences Branch, Division of Reproductive Health.

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Authors and Affiliations

  1. Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7445, Chapel Hill, NC, 27599, USA

    Kathryn Wouk & Alison M. Stuebe

  2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Alison M. Stuebe

  3. Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Samantha Meltzer-Brody

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  1. Kathryn Wouk
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  2. Alison M. Stuebe
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Correspondence to Kathryn Wouk.

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Wouk, K., Stuebe, A.M. & Meltzer-Brody, S. Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010–2011 Pregnancy Risk Assessment Monitoring System. Matern Child Health J 21, 636–647 (2017). https://doi.org/10.1007/s10995-016-2150-6

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  • DOI: https://doi.org/10.1007/s10995-016-2150-6

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