Randomized Clinical Trial of a Prenatal Breastfeeding and Mental Health Mixed Management Intervention

Abstract

Background The continuity of maternal depressive symptoms throughout the perinatal period and breastfeeding problems have adverse influences on breastfeeding. Research aim To compare the feeding patterns and breastfeeding experiences, maternal health and mental health, and breastfeeding self-efficacy between women with depressive symptoms who participated in a prenatal individualized mixed management intervention and those who received usual care. Methods Chinese primigravida ( N = 182) with an Edinburgh Postnatal Depression Scale score ≥ 9 in late pregnancy (≥ 28 weeks and < 35 weeks) were randomly assigned to the intervention group ( n = 84) or the control group ( n = 84). Intervention group participants received four sessions of individualized mixed management combining psycho-education and breastfeeding education. Breastfeeding self-efficacy, feeding patterns, maternal depression, and health status were evaluated in both groups. Results Significant differences were noted between the groups in breastfeeding self-efficacy at 42 days postpartum ( p < .05) and feeding patterns at 3 months and 6 months postpartum ( p < .05). Repeated measures analysis of variance showed significant differences in the EPDS scores between groups at three postpartum time points ( p < .05). The intervention group had significantly lower postpartum depression as diagnosed by the MINI ( p < .05). Conclusions A prenatal individualized mixed management intervention holds promise as an effective prevention and health promotion program addressing breastfeeding outcomes and maternal mental health. This RCT was registered (ChiCTR-IOR-17013761) with Chinese Clinical Trial Registry, http://www.chictr.org.cn/enIndex.aspx on 12/7/2017.

Efficacy of behavioral interventions to improve maternal mental health and breastfeeding outcomes: a systematic review

“…Of the 30 interventions included in this review, eight were conducted in the U.S. [ 43 , 44 , 46 , 50 , 52 , 58 , 59 , 61 , 62 ], four in China [ 32 – 34 , 36 , 37 , 54 ], three in Iran [ 47 , 49 , 57 ], two each from South Africa [ 53 , 63 ], Spain [ 39 , 51 ], and the United Kingdom [ 45 , 56 ], and one each from Canada [ 35 ], Switzerland [ 60 ], Australia [ 41 ], Turkey [ 38 ], New Zealand [ 64 ], Nigeria [ 42 ], Mexico [ 48 ], Malaysia [ 55 ], and Croatia [ 40 ]. Of the eight studies conducted in the U.S., five (63%) had a sample primarily consisting of white non-Hispanic participants [ 43 , 44 , 50 , 59 , 61 , 62 ], two studies had primarily Hispanic and/or Spanish-speaking participants [ 46 , 58 ], and one study had primarily Black and Hispanic participants [ 52 ].…”

“…Sample size varied greatly across studies from 18 to 1324 participants. Eight interventions were conducted in first-time parents only [ 32 – 34 , 37 , 41 , 45 , 47 , 49 , 54 , 55 ]. Five studies did not state the parity of the sample [ 38 , 40 , 57 – 59 ].…”

“…Twelve of the 30 studies reported statistically significant positive effect of the intervention on both maternal mental health and breastfeeding outcomes. Successful interventions included psychoeducational group programs [ 32 – 34 , 41 ], relaxation therapy [ 40 ], skin-to-skin contact between mother and infant [ 35 ], psychological nursing [ 37 ], motivational interviewing [ 39 ], a health and infant care education program [ 36 ], stepped-care psychological treatment [ 42 ], peer support with home visits [ 45 , 46 ], breastfeeding training with home visits [ 38 ], and risk-based treatment with home visits [ 43 , 44 ].…”

“…Common characteristics among the successful interventions for mental health and breastfeeding outcomes were a) occurring across both pregnancy and the postpartum period (5/12, 42%) [ 41 – 46 ], b) delivered by hospital staff (3/12, 25%) [ 35 – 37 ] or by multidisciplinary teams of mental health and lactation specialists (3/12, 25%) [ 32 – 34 , 41 , 42 ], c) offered individually rather than in a group setting (9/12, 75%), and d) designed to focus on both breastfeeding and maternal mental health (5/12, 45%) [ 32 – 34 , 38 , 41 , 43 , 44 , 46 ] or focused primarily on breastfeeding only (5/12, 45%) [ 35 – 37 , 39 , 40 ].…”

“…Initiation of breastfeeding was measured in four studies, three of which indicated a statistically significant increased rate of initiation among the intervention participants compared with control [ 32 , 37 , 44 ]. Breastfeeding self-efficacy was measured in four studies, two of which indicated a statistically significant enhanced self-efficacy between 3 days to 6 months postpartum in intervention versus control participants [ 32 – 34 , 46 ]. Earlier milk onset [ 36 ], decreased breast swelling [ 36 ], greater levels of effective breastfeeding behavior (e.g., noticing changes in breast fullness, visualizing and hearing baby swallowing, etc.)…”