Postpartum Anxiety and Maternal-Infant Health Outcomes

Paul, Ian M.; Downs, Danielle Symons; Schaefer, Eric; Beiler, Jessica S.; Weisman, Carol S.

doi:10.1542/peds.2012-2147

Cited by 179 publications

(178 citation statements)

References 23 publications

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“…We similarly modeled the association between maternal pregravid BMI and both disrupted lactation and undesired, early weaning (Table 3). The prevalence of disrupted lactation was lowest among normal BMI women (9/100 women, 95% CI 8, 10), with higher prevalence among overweight (13/100 women, 95% CI 12, 14) and obese women (14/100, 95% CI 13,16). These associations persisted with adjustment for sociodemographic confounders (adjusted OR overweight vs. normal weight: 1.6, 95% CI 1.1, 2.3; obese vs. normal weight: 1.7, 95% CI 1.2, 2.6).…”

Section: Resultsmentioning

confidence: 97%

“…We also found higher rates of perceived lactation dysfunction among women with postpartum-depression symptoms. Postpartum depression is associated with reduced breastfeeding duration, 15,16,[33][34][35][36] and neuroendocrine mechanisms may underlie this association. 12,21 Moreover, reduced maternal sensitivity 37 in the setting of depression may also contribute to breastfeeding difficulties.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16] Obesity and insulin resistance are associated with differences in prolactin levels, 17 onset of lactogensis, 18 and the human milk fat layer transcriptome. 19 In addition, in animal models, obesity is associated with poor milk production.…”

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confidence: 99%

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Prevalence and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction

Stuebe

Horton²,

Chetwynd³

et al. 2014

Journal of Women's Health

118

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Background: Breastfeeding durations in the United States fall short of public health objectives. We sought to quantify the prevalence and identify risk factors for early, undesired weaning that mothers attribute to physiologic difficulties with breastfeeding. Methods: We analyzed data from the Infant Feeding Practices Study (IFPS) II, a longitudinal study of US women. We defined disrupted lactation as early, undesired weaning attributed to at least two of the following three problems: breast pain, low milk supply, and difficulty with infant latch. We used logistic regression to estimate the association maternal body mass index (BMI), postpartum depressive symptoms, and disrupted lactation. Results: Of 4,902 women enrolled in the IFPS II, we analyzed 2,335 women who reported prenatal intention and breastfeeding initiation. The prevalence of disrupted lactation was 12 per 100 women (95% confidence interval [CI] 11, 13) during the first year of life. Women in this group weaned earlier (median 1.2 months, interquartile range [IQR] 0.5-2.8) than women without disrupted lactation (median 7.0 months, IQR 2.8-2.0, p < 0.01). In multivariable-adjusted (MV-adj.) models, we found increased odds of disrupted lactation among overweight (odds ratio [OR] 1.6, 95% CI 1.1-2.3) or obese (OR 1.7, 95% CI 1.2-2.6) women, compared with women with a normal pregravid BMI. Maternal depressive symptoms at 2 months, defined as Edinburgh Postnatal Depression Scale ‡ 13, were also associated with disrupted lactation (MV-adj. OR 1.7, 95% CI 1.1-2.7). Conclusion: In a longitudinal sample of US women, disrupted lactation affected one in eight mothers who initiated breastfeeding. These findings underscore the need for both improved early breastfeeding support and targeted research to define the underlying pathophysiology and to determine management strategies that will enable more mothers to achieve their breastfeeding goals.

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction

Stuebe

Horton²,

Chetwynd³

et al. 2014

Journal of Women's Health

118

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“…Data show that upward of 20% of parturient women suffer from a postpartum mood disorder with 7.1% of postpartum women experiencing a major depressive disorder, up to 19.2% experiencing any depression within 3 months of childbirth, and 8–12% of postpartum women experiencing an anxiety disorder, including generalized anxiety and obsessive‐compulsive disorder (Fairbrother, Janssen, Antony, Tucker, & Young, 2016; Gavin et al., 2005). Despite the many well‐documented negative effects of PPD/A on both maternal (Eaton, Armenian, Gallo, Pratt, & Ford, 1996; Joynt, Whellan, & O'Connor, 2003; Musselman, Evans, & Nemeroff, 1998; Norhayati, Hazlina, Asrenee, & Emilin, 2015; O'Hara & McCabe, 2013; Paul, Downs, Schaefer, Beiler, & Weisman, 2013; Yim, Tanner Stapleton, Guardino, Hahn‐Holbrook, & Dunkel Schetter, 2015) and child (Ashman, Dawson, & Panagiotides, 2008; Dawson et al., 2003; Elgar, McGrath, Waschbusch, Stewart, & Curtis, 2004; Glasheen, Richardson, & Fabio, 2010; Goodman & Brand, 2008; Goodman & Tully, 2007; Lundy & Field Jeffrey, 1996; Marchand & Hock, 1998; Stein et al., 2014; Zahn‐Waxler, Iannotti, Cummings, & Denham, 1990) health, the biological and psychosocial mechanisms through which PPD/A develop remain unclear (Deecher, Andree, Sloan, & Schechter, 2008; Pawluski, Lonstein, & Fleming, 2017; Payne, Palmer, & Joffe, 2009; Zonana & Gorman, 2005). Complicating our understanding of these mood disorders is the fact that PPD/A often occur comorbidly, with PPA frequently preceding PPD (Falah‐Hassani, Shiri, & Dennis, 2016; Reck et al., 2008), and there is growing consensus that anxiety may be a feature of PPD (Navarro et al., 2007).…”

Section: Introductionmentioning

confidence: 99%

Perinatal western‐type diet and associated gestational weight gain alter postpartum maternal mood

et al. 2017

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IntroductionThe role of perinatal diet in postpartum maternal mood disorders, including depression and anxiety, remains unclear. We investigated whether perinatal consumption of a Western‐type diet (high in fat and branched‐chain amino acids [BCAA]) and associated gestational weight gain (GWG) cause serotonin dysregulation in the central nervous system (CNS), resulting in postpartum depression and anxiety (PPD/A).MethodsMouse dams were fed one of four diets (high‐fat/high BCAA, low‐fat/high BCAA, high‐fat, and low‐fat) prior to mating and throughout gestation and lactation. Postpartum behavioral assessments were conducted, and plasma and brain tissues assayed. To evaluate potential clinical utility, we conducted preliminary human studies using data from an extant sample of 17 primiparous women with high GWG, comparing across self‐reported postpartum mood symptoms using the Edinburgh Postnatal Depression Scale (EPDS) for percent GWG and plasma amino acid levels.ResultsMouse dams fed the high‐fat/high BCAA diet gained more weight per kcal consumed, and BCAA‐supplemented dams lost weight more slowly postpartum. Dams on BCAA‐supplemented diets exhibited increased PPD/A‐like behavior, decreased dopaminergic function, and decreased plasma tyrosine and histidine levels when assessed on postnatal day (P)8. Preliminary human data showed that GWG accounted for 29% of the variance in EPDS scores. Histidine was also lower in women with higher EPDS scores.ConclusionsThese findings highlight the role of perinatal diet and excess GWG in the development of postpartum mood disorders.

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“…Postpartum depression and anxiety are relatively common in the general population. [23][24][25] Females are generally more likely to experience depression than males, 26 and mothers with the premutation are at risk of elevated depression and anxiety, risks that could be exacerbated by disclosure of their infant's carrier status. [20][21][22] Research on the impact of parents' learning that their healthy-appearing newborn has a disorder provides mixed evidence of increased depressive symptoms or anxiety (eg, refs 27-31).…”

Section: What This Study Addsmentioning

confidence: 99%

Maternal Consequences of the Detection of Fragile X Carriers in Newborn Screening

et al. 2015

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The possibility of newborn screening for fragile X syndrome is complicated by the potential for identifying premutation carriers. Although knowing the child's carrier status has potential benefits, the possibility of late-onset disorders in carrier children and their parents raises concerns about whether such information would be distressing to parents and potentially more harmful than helpful. This study sought to answer this question by offering voluntary fragile X screening to new parents and returning results for both the full mutation and premutation FMR1 gene expansions. We tested the assumption that such information could lead to adverse mental health outcomes or decision regret. We also wanted to know if child age and spousal support were associated with the outcomes of interest.METHODS: Eighteen mothers of screen-positive infants with the premutation and 15 comparison mothers completed a battery of assessments of maternal anxiety, postpartum depression, stress, family quality of life, decision regret, and spousal support. The study was longitudinal, with an average of 3 assessments per mother. RESULTS:The premutation group was not statistically different from the comparison group on measures of anxiety, depression, stress, or quality of life. A subset of mothers experienced clinically significant anxiety and decision regret, but factors associated with these outcomes could not be identified. Greater spousal support was generally associated with more positive outcomes.CONCLUSIONS: Although we did not find evidence of significant adverse events, disclosure of newborn carrier status remains an important consideration in newborn screening policy.WHAT'S KNOWN ON THIS SUBJECT: Parents generally adapt well to newborn screening results, but reactions to carrier status for X-linked conditions are unknown. WHAT THIS STUDY ADDS:Results suggest that detection and disclosure of FMR1 newborn carrier status may not result in significant adverse events for mothers.

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Postpartum Anxiety and Maternal-Infant Health Outcomes

Cited by 179 publications

References 23 publications

Prevalence and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction

Prevalence and Risk Factors for Early, Undesired Weaning Attributed to Lactation Dysfunction

Perinatal western‐type diet and associated gestational weight gain alter postpartum maternal mood

Maternal Consequences of the Detection of Fragile X Carriers in Newborn Screening

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