The relationship between dietary elimination and maternal psychopathology in breastfeeding mothers of infants with food allergy

Abstract

Background: There has been no study evaluating the psychopathology in breastfeeding mothers of infants with food allergy (FA). Objective:The aim of the study was to investigate the relationship between dietary elimination and maternal psychopathology, specifically anxiety, depression, and mother-to-infant bonding, in breastfeeding mothers of infants with food allergy. Methods: Breastfeeding mothers following an elimination diet due to FA in their children aged 1-to-12 months were compared with the healthy controls. The physiciandiagnosed FA group was divided into IgE-, non-IgE-mediated, and infants with some minor symptoms which were not enough to make the diagnosis of FA were classified as Indecisive symptoms for FA group. Mothers completed standardized questionnaires including Symptom Checklist 90R, Beck Depression/Anxiety Inventories (BDI/ BAI), Postpartum Bonding Questionnaire (Bonding).Results: Of 179 mother and infants, 64 were healthy, 89 were FA, 16 were indecisive symptoms for FA. The mean age of the mothers and infants were 31.1 ± 4.7 years and 6.3 ± 3.6 months, respectively. The physician-diagnosed FA groups had higher scores for anxiety (p = .008), anger (p = .042), depression (p < .001), obsession (p = .002), phobia (p = .008), somatization (p = .002), general symptom index (GSI) (p = .001), BDI (p < .001), BAI (p = .008), and Bonding (attachment [p = .001], anger [p = .019], and total [p = .036]) than the healthy ones. The indecisive symptoms for FA group had a similar score pattern to physician-diagnosed FA, except interpersonal sensitivity, BDI, and attachment. Conclusion:Breastfeeding mothers of infants with FA were more anxious, with higher depression scores than controls, and had many psychopathologies which affected bonding. Interventions targeting negativity in caregivers' social relationships are urgently needed.

Detection and management of milk allergy: Delphi consensus study

“…Milk elimination diets can be burdensome, and dietary exclusion advice may cause maternal anxiety or depression, weight loss, reduced breastfeeding confidence and early breastfeeding cessation 25 . In some high‐income countries, there is up to 10‐fold excess prescription of specialized formula for managing milk allergy in formula fed infants which is costly to public health systems 2,3 .…”

“…[8][9][10][11][12][13][14][15][16][17][18][19] Milk elimination diets can be burdensome, and dietary exclusion advice may cause maternal anxiety or depression, weight loss, reduced breastfeeding confidence and early breastfeeding cessation. 25 In some high-income countries, there is up to 10-fold excess prescription of specialized formula for managing milk allergy in formula fed infants which is costly to public health systems. 2,3 Unnecessary exposure to specialized formula could potentially have deleterious effects for young children, although long-term outcomes have not yet been fully characterized.…”

Single low‐dose exposure to cow’s milk at diagnosis accelerates cow’s milk allergic infants’ progress on a milk ladder programme

“…Any new diagnosis in a child can cause parents' great anxiety, and a link has also been proposed between adverse antenatal events or stressors and atopic conditions, including food allergy. [14][15][16] Allergists often meet parents whose anxiety appears disproportionate to their child's allergic condition 17 and many parents report living in fear of their child's death due to food allergy, when that is an extremely rare outcome. 18 We undertook this study to formally evaluate the clinical impression that infants who received a supervised single dose of the ED 05 of milk, had achieved both partial and full resolution of CMPA and were drinking whole cow's milk sooner than expected, irrespective of the outcome of the supervised feed.…”

“…Any new diagnosis in a child can cause parents’ great anxiety, and a link has also been proposed between adverse antenatal events or stressors and atopic conditions, including food allergy 14‐16 . Allergists often meet parents whose anxiety appears disproportionate to their child's allergic condition 17 and many parents report living in fear of their child's death due to food allergy, when that is an extremely rare outcome 18 …”

Dietary management of breastfed children with food allergy

“…However, exclusion diets can be difficult to adhere to, symptoms may persist leading to ever more restrictive diets and families advised to use maternal dietary exclusion may suffer adverse nutritional, emotional and economic outcomes. Women using dietary exclusions to manage food allergy in their child were reported in one study to have increased depression and anxiety symptoms, and over three‐quarters of mothers reported weight loss and two‐thirds a reduction in breastmilk supply 9 . Larger and more representative studies are needed to better understand the impact of dietary exclusions on breastfeeding women; however, these preliminary findings of adverse effects are supported by anecdotal reports of such diets undermining confidence in breastfeeding 7 …”