Incidence, antibiotic treatment and outcomes of lactational mastitis: Findings from The Norwegian Mother, Father and Child Cohort Study (MoBa)

Abstract

Background Mastitis is a common and distressing maternal postpartum condition, but the relationship between mastitis timing and antibiotic treatment and breastfeeding outcomes and postnatal mental health is unclear. Objectives To describe the incidence of mastitis and treatment with antibiotics in first 6 months postpartum, and to investigate the impact of mastitis timing and antibiotic treatment on breastfeeding practices and postnatal mental health. Methods This study is based on 79,985 mother‐infant dyads in the Norwegian Mother, Father and Child Cohort Study (MoBa). Women were classified according to self‐reported mastitis within first month (‘early’) or 1–6 months (‘later’) postpartum and antibiotic treatment. Breastfeeding outcomes included predominant or any breastfeeding and abrupt breastfeeding cessation until 6 months postpartum. Maternal mental health was assessed by self‐report at 6 months postpartum. Results The incidence of mastitis was 18.8%, with 36.8% reporting treatment with antibiotics. Women reporting early mastitis were less likely to report predominant breastfeeding (adjustedd relative risk [aRR] 0.92, 95% confidence interval [CI] 0.86, 0.99) and any breastfeeding for 6 months (aRR 0.97, 95% CI 0.96, 0.98) than women who did not report mastitis, and more likely to report abrupt breastfeeding cessation (aRR 1.37, 95% CI 1.23, 1.53). Late‐onset mastitis was not associated with poorer breastfeeding outcomes. Among women reporting mastitis, the risk of abrupt breastfeeding cessation was higher in those also reporting antibiotic use. Mastitis was associated with an increased risk of mental health problems postpartum which was highest among those reporting no antibiotic use (aRR 1.29, 95% CI 1.18, 1.41), in contrast to those also reporting antibiotic use (aRR 1.08, 95% CI 0.96, 1.22). Conclusions Lactational mastitis and its associated treatment with antibiotics are common. Early (<1 month postpartum) mastitis appears to be a modest risk factor for suboptimal breastfeeding outcomes. In addition, mastitis is associated with poorer mental health.

Perinatal antidepressant use and breastfeeding outcomes: Findings from the Norwegian Mother, Father and Child Cohort Study

“…Categorization of breastfeeding outcomes is consistent with previous MoBa studies. 16 , 17 We could not define exclusive breastfeeding because not all versions of the questionnaire included questions about use of water, water‐based drinks, and fruit juice beyond the first week of the infant’s life.…”

“…The present analyses are based on data from the Norwegian Mother, The first questionnaire (Q1) was sent out during pregnancy (weeks [13][14][15][16][17], and the fourth (Q 4) was sent out at 6 months postpartum. English translations of the questionnaires can be found on the MoBa website (https://www.fhi.no/en/studi es/moba/).…”

“…Categorization of breastfeeding outcomes is consistent with previous MoBa studies. 16,17 We could not define exclusive breastfeeding because not all versions of the questionnaire included questions about use of water, water-based drinks, and fruit juice beyond the first week of the infant's life. In our analysis, "abrupt breastfeeding discontinuation" was defined as cessation of predominant and any breastfeeding within the same month postpartum.…”

Trends in clinical management of lactational mastitis among women attending Australian general practice: a national longitudinal study using MedicineInsight, 2011–2022

“…The largest study evaluated data from almost 80 000 women recruited to the Norwegian Mother, Father and Child Cohort Study between 1999 and 2008. 3 Among the 15 014 who reported experiencing mastitis, 5524 (36.8%) reported using antibiotics. Of those who could remember which antibiotic they received, the most common antibiotics included penicillins (83.8%), followed by macrolides (15.2%) and cephalosporins (2.6%).…”

“…1 2 Mastitis can significantly disrupt activities of daily living and is associated with significant maternal morbidity 1 2 and premature breastfeeding cessation. 3 Mastitis prevalence ranges from 3% to 20% 4 and most commonly occurs within the first 4 weeks postpartum. 5 Diagnosis is based on symptoms, which range from mild inflammation to more severe disease including bacterial infection and abscess development.…”