ReviewBreastfeeding and depression: A systematic review of the literature
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.
References (76)
- et al.
Breast feeding and post-natal depression
J. Psychosom. Res.
(1983) - et al.
Birth events, birth experiences and social differences in postnatal depression
Aust. J. Public Health
(1994) - et al.
What influences the uptake and early cessation of breast feeding?
Midwifery
(1998) - et al.
Psychosocial factors associated with the early termination of breast-feeding
J. Psychosom. Res.
(1993) - et al.
The relationship between vulnerability factors and breastfeeding outcomes
J. Obstet. Gynecol. Neonatal Nurs.
(2006) - et al.
Mother׳s anxiety and depression during the third pregnancy trimester and neonate׳s mother versus stranger׳s face/voice visual preference
Early Hum. Dev.
(2010) - et al.
Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados
Infant Behav. Dev.
(2006) - et al.
Immune, health and endocrine characteristics of depressed postpartum mothers
Psychoneuroendocrinology
(2007) - et al.
Antenatal risk factors for postnatal depression: a large prospective study
J. Affect. Disord.
(2008) - et al.
A prospective study of the relationship between breastfeeding and postpartum depressive symptoms appearing at 1–5 months after delivery
J. Affect. Disord.
(2011)
A population-based study of exclusive breastfeeding in Icelandic women: is there a relationship with depressive symptoms and parenting stress?
Int. J. Nurs. Stud.
The correlation between breastfeeding self-efficacy and maternal postpartum depression in southern Brazil
Sex Reprod. Healthc.
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
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.
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
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
Does maternal postpartum depressive symptomatology influence infant feeding outcomes?
Acta Paediatr.
Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy
Pediatrics
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
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.
Cited by (334)
Discrimination and perinatal depressive symptoms: The protective role of social support and resilience
2024, Journal of Affective DisordersPrevalence and risk factors of postpartum depressive symptoms at 42 days among 2462 women in China
2024, Journal of Affective DisordersMaternal outcomes related to Genetic and epigenetic Variation in the oxytocin system: A scoping review
2023, Comprehensive PsychoneuroendocrinologyPerinatal Depression: A Review and an Update
2023, Psychiatric Clinics of North America