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Breastfeeding and Postpartum Depression: A Review of Relationships and Potential Mechanisms

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Abstract

Purpose of Review

Postpartum depression (PPD) and breastfeeding are important, interrelated health factors. It is established that women who breastfeed exclusively have lowered likelihood of developing significant PPD. Yet, many questions remain around what factors are involved. The purpose of this review is to provide updated information about the relationship between PPD and breastfeeding.

Recent Findings

Both psychological and physiological factors have emerged as important moderators and mechanisms of the relationship between postpartum depression and breastfeeding. Breastfeeding self-efficacy, self-compassion, and engagement with the infant during feeding all modify or mediate the relationship, and a complex dynamic relationship among cortisol, oxytocin, progesterone, and estrogen is involved. Importantly, recent intervention studies suggest psychosocial interventions may impact both breastfeeding and mood.

Summary

Providers and researchers should recognize the interrelationship between the breastfeeding and PPD and apply this understanding to patient care through integrated education and care for both mood and breastfeeding enhancement.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wang Z, Liu J, Shuai H, Cai Z, Fu X, Liu Y, Xiao X, Zhang W, Krabbendam E, Liu S, Liu Z, Li Z, Yang BX. Mapping global prevalence of depression among postpartum women. Transl Psychiatr. 2021;11:543. https://doi.org/10.1038/s41398-021-01663-6.

    Article  Google Scholar 

  2. Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: a systematic review of maternal and infant outcomes. Womens Health (Lond). 2019;15:1745506519844044. https://doi.org/10.1177/1745506519844044.

  3. Li R, Ware J, Chen A, et al. Breastfeeding and post-perinatal infant deaths in the United States, a national prospective cohort analysis. Lancet Reg Health Am. 2022;5:100094.

    PubMed  Google Scholar 

  4. • Meek JY, Noble L. American Academy of Pediatrics, Section on Breastfeeding. Technical report: breastfeeding and the use of human milk. Pediatrics. 2022;150:e2022057989. https://doi.org/10.1542/peds.2022-057989This is a comprehensive position statement from the American Academy of Pediatrics summarizing the health benefits of breastfeeding.

  5. Rameez RM, Sadana D, Kaur S, et al. Association of maternal lactation with diabetes and hypertension: a systematic review and meta-analysis. JAMA Netw Open. 2019;2:e1913401.

  6. Chowdhury R, Sinha B, Sankar MJ, et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104:96–113. https://doi.org/10.1111/apa.13102.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Butler MS, Young SL, Tuthill EL. Perinatal depressive symptoms and breastfeeding behaviors: a systematic literature review and biosocial research agenda. J Affect Disord. 2021;283:441–71. https://doi.org/10.1016/j.jad.2020.11.080.

    Article  PubMed  Google Scholar 

  8. Xia M, Luo J, Wang J, Liang Y. Association between breastfeeding and postpartum depression: a meta-analysis. J Affect Disord. 2022;308:512–9. https://doi.org/10.1016/j.jad.2022.04.091.

    Article  PubMed  Google Scholar 

  9. • Alimi R, Azmoude E, Moradi M, Zamani M. The association of breastfeeding with a reduced risk of postpartum depression: a systematic review and meta-analysis. Breastfeed Med. 2022;17:290–6. https://doi.org/10.1089/bfm.2021.0183. This is an excellent recent review establishing the relationship between breastfeeding and PPD.

    Article  PubMed  Google Scholar 

  10. Toledo C, Cianelli R, Villegas Rodriguez N, De Oliveira G, Gattamorta K, Wojnar D, Ojukwu E. The significance of breastfeeding practices on postpartum depression risk. Public Health Nurs. 2022;39:15–23. https://doi.org/10.1111/phn.12969.

    Article  PubMed  Google Scholar 

  11. Liu L, Zhou M, Xiao G, Zhang T, Li X, Owusua T, He W, Qin C. The impact of antenatal depressive symptoms on exclusive breastfeeding intention: a moderating effect analysis. Midwifery. 2023;116:103551. https://doi.org/10.1016/j.midw.2022.103551.

    Article  PubMed  Google Scholar 

  12. Stark EL, Shim J, Ross CM, Miller ES. The association between positive antenatal depression screening and breastfeeding initiation and continuation. Am J Perinatol. 2021;38:171–5. https://doi.org/10.1055/s-0039-1695775.

    Article  PubMed  Google Scholar 

  13. Coo S, García MI, Mira A, Valdés V. The role of perinatal anxiety and depression in breastfeeding practices. Breastfeed Med. 2020;15:495–500. https://doi.org/10.1089/bfm.2020.0091.

    Article  PubMed  Google Scholar 

  14. Scheiber FA, Segre LS, O'Hara MW, Taylor D, Brock RL. Maternal depression and breastfeeding in home visitation. Child Youth Serv Rev. 2020;119:105490. https://doi.org/10.1016/j.childyouth.2020.105490.

  15. Kim S, Park M, Ahn S. The impact of antepartum depression and postpartum depression on exclusive breastfeeding: a systematic review and meta-analysis. Clin Nurs Res. 2022;31:866–80. https://doi.org/10.1177/10547738211053507.

    Article  PubMed  Google Scholar 

  16. Zhu Y, Yin X, Qiu L, Sun N, An R, Gong Y. Association between breastfeeding and perinatal depressive symptoms: a 13-months cross-lagged analysis in China. Asian J Psychiatr. 2023;82:103474. https://doi.org/10.1016/j.ajp.2023.103474.

    Article  PubMed  Google Scholar 

  17. Shimao M, Matsumura K, Tsuchida A, Kasamatsu H, Hamazaki K, Inadera H, The Japan Environment and Children's Study Group. Influence of infants’ feeding patterns and duration on mothers’ postpartum depression: a nationwide birth cohort -The Japan Environment and Children's Study (JECS). J Affect Disord. 2021;285:152–159. https://doi.org/10.1016/j.jad.2021.02.011.

  18. Figueiredo B, Pinto TM, Costa R. Exclusive breastfeeding moderates the association between prenatal and postpartum depression. J Hum Lact. 2021;37:784–94. https://doi.org/10.1177/0890334421991051.

    Article  PubMed  Google Scholar 

  19. ​​Yuen M, Hall OJ, Masters GA, Nephew BC, Carr C, Leung K, Griffen A, McIntyre L, Byatt N, Moore Simas TA. The effects of breastfeeding on maternal mental health: a systematic review. J Womens Health (Larchmt). 2022:31:787–807. https://doi.org/10.1089/jwh.2021.0504.

  20. Rosenbaum DL, Gillen MM, Markey CH. Feeling let down: an investigation of breastfeeding expectations, appreciation of body functionality, self-compassion, and depression symptoms. Appetite. 2020;154:104756. https://doi.org/10.1016/j.appet.2020.104756.

    Article  PubMed  Google Scholar 

  21. Mercan Y, Tari Selcuk K. Association between postpartum depression level, social support level and breastfeeding attitude and breastfeeding self-efficacy in early postpartum women. PLoS One. 2021;16:e0249538. https://doi.org/10.1371/journal.pone.0249538.

  22. Wouk K, Tucker C, Pence BW, Meltzer-Brody S, Zvara B, Grewen K, Stuebe AM. Positive emotions during infant feeding and breastfeeding outcomes. J Hum Lact. 2020;36:157–67. https://doi.org/10.1177/0890334419845646.

    Article  PubMed  Google Scholar 

  23. Gordon LK, Mason KA, Mepham E, Sharkey KM. A mixed methods study of perinatal sleep and breastfeeding outcomes in women at risk for postpartum depression. Sleep Health. 2021;3:353–61. https://doi.org/10.1016/j.sleh.2021.01.004.

    Article  Google Scholar 

  24. Nagel EM, Howland MA, Pando C, Stang J, Mason SM, Fields DA, Demerath EW. Maternal psychological distress and lactation and breastfeeding outcomes: a narrative review. Clin Ther. 2022;44:215–27. https://doi.org/10.1016/j.clinthera.2021.11.007.

    Article  PubMed  Google Scholar 

  25. Moberg K, Prime D. Oxytocin effects in mothers and infants during breastfeeding. Infant. 2013;9(6):201–6.

    Google Scholar 

  26. •• Whitley J, Wouk K, Bauer AE, Grewen K, Gottfredson NC, Meltzer-Brody S, Propper C, Mills-Koonce R, Pearson B, Stuebe A. Oxytocin during breastfeeding and maternal mood symptoms. Psychoneuroendocrinology. 2020;113:104581. https://doi.org/10.1016/j.psyneuen.2019.104581. This is an excellent summary of the role of oxytocin as a common factor of mood and breastfeeding.

    Article  CAS  PubMed  Google Scholar 

  27. Lara-Cinisomo S, McKenney K, Di Florio A, Meltzer-Brody S. Associations between postpartum depression, breastfeeding, and oxytocin levels in latina mothers. Breastfeed Med. 2017;12:436–42. https://doi.org/10.1089/bfm.2016.0213.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Thul TA, Corwin EJ, Carlson NS, Brennan PA, Young LJ. Oxytocin and postpartum depression: a systematic review. Psychoneuroendocrinology. 2020;120:104793. https://doi.org/10.1016/j.psyneuen.2020.104793.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Duthie L, Reynolds RM. Changes in the maternal hypothalamic-pituitary-adrenal axis in pregnancy and postpartum: influences on maternal and fetal outcomes. Neuroendocrinology. 2013;98:106–15. https://doi.org/10.1159/000354702.

    Article  CAS  PubMed  Google Scholar 

  30. Mizuhata K, Taniguchi H, Shimada M, Hikita N, Morokuma S. Effects of breastfeeding on stress measured by saliva cortisol level and perceived stress. Asian Pac Isl Nurs J. 2020;5:128–38. https://doi.org/10.31372/20200503.1100.

    Article  PubMed  PubMed Central  Google Scholar 

  31. •• Ziomkiewicz A, Babiszewska M, Apanasewicz A, Piosek M, Wychowaniec P, Cierniak A, Barbarska O, Szołtysik M, Danel D, Wichary S. Psychosocial stress and cortisol stress reactivity predict breast milk composition. Sci Rep. 2021;11:11576. https://doi.org/10.1038/s41598-021-90980-3. This is a good example of research examining the interaction of mood and breastfeeding from a physiological framework.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Cox EQ, Stuebe A, Pearson B, Grewen K, Rubinow D, Meltzer-Brody S. Oxytocin and HPA stress axis reactivity in postpartum women. Psychoneuroendocrinology. 2015;55:164–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Pang WW, Hartmann PE. Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia. 2007;12:211–21. https://doi.org/10.1007/s10911-007-9054-4.

    Article  PubMed  Google Scholar 

  34. Gust K, Caccese C, Larosa A, Nguyen TV. Neuroendocrine effects of lactation and hormone-gene-environment interactions. Mol Neurobiol. 2020;57:2074–84. https://doi.org/10.1007/s12035-019-01855-8.

    Article  CAS  PubMed  Google Scholar 

  35. •• Pezley L, Cares K, Duffecy J, Koenig MD, Maki P, Odoms-Young A, Clark Withington MH, Lima Oliveira M, Loiacono B, Prough J, Tussing-Humphreys L, Buscemi J. Efficacy of behavioral interventions to improve maternal mental health and breastfeeding outcomes: a systematic review. Int Breastfeed J. 2022;17:67. https://doi.org/10.1186/s13006-022-00501-9. This is a good summary of the current efficacy of mixed interventions for breastfeeding and depression.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Franco-Antonio C, Santano-Mogena E, Chimento-Díaz S, Sánchez-García P, Cordovilla-Guardia S. A randomised controlled trial evaluating the effect of a brief motivational intervention to promote breastfeeding in postpartum depression. Sci Rep. 2022;12:373. https://doi.org/10.1038/s41598-021-04338-w.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Chrzan-Dętkoś M, Pietkiewicz A, Żołnowska J, Pizuńska D. The program of psychological and breastfeeding support “Maternity step by step”: an example of effective solution for the prevention, diagnostics and treatment of prenatal and postpartum depression. Psychiatr Pol. 2020;54(3):613–29. https://doi.org/10.12740/PP/105494.

    Article  PubMed  Google Scholar 

  38. Massa K, Ramireddy S, Ficenec S, Mank C, Josephsen J, Babbar S. A randomized control trial of meditation for mothers pumping breastmilk for preterm infants. Am J Perinatol. 2022;1055/a-1787–7576. https://doi.org/10.1055/a-1787-7576.

  39. Zhao Y, Lin Q, Wang J. An evaluation of a prenatal individualised mixed management intervention addressing breastfeeding outcomes and postpartum depression: a randomized controlled trial. J Clin Nurs. 2021;30:1347–59. https://doi.org/10.1111/jocn.15684.

    Article  PubMed  Google Scholar 

  40. • Zhao Y, Lin Q, Zhu X, Wang J. Randomized clinical trial of a prenatal breastfeeding and mental health mixed management intervention. J Hum Lact. 2021;37(4):761–74. https://doi.org/10.1177/0890334421991058. This RCT provides a model of mixed management of depression and breastfeeding.

    Article  PubMed  Google Scholar 

  41. Gómez L, Verd S, de-la-Banda G, Cardo E, Servera M, Filgueira A, Ponce-Taylor J, Mulet M. Perinatal psychological interventions to promote breastfeeding: a narrative review. Int Breastfeed J. 2021;16:8. https://doi.org/10.1186/s13006-020-00348-y.

  42. Breastfeeding challenges. ACOG Committee Opinion No. 820. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2021;137:e42–53.

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Henshaw, E.J. Breastfeeding and Postpartum Depression: A Review of Relationships and Potential Mechanisms. Curr Psychiatry Rep 25, 803–808 (2023). https://doi.org/10.1007/s11920-023-01471-3

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