Primary Submission Category: Reproductive health
Perinatal Depression Trajectories, Breastfeeding, and Breastfeeding Attitudes in Rural Pakistan
Authors: Sarah Haight Ashley Hagaman Esther Chung Pietro Biroli Sonia Bhalotra Aparna Kachoria Allison Frost Joanna Maselko
Presenting Author: Esther Chung*
The relationship between perinatal depression and breastfeeding is complicated and bi-directional. Prenatal depression may reduce breastfeeding, but a lack of breastfeeding can also increase postpartum depression risk. We used longitudinal data from the pregnancy and 3-month (mo.) postpartum waves of the Bachpan study in Pakistan to better understand this relationship and consider modification by community breastfeeding attitudes (n=885). Inverse probability weighting accounted for loss-to-follow-up and log-binomial regression calculated risk ratios (RR) for self-reported exclusive breastfeeding at 3 mo. (only breast milk in past day) comparing mothers that were depressed (Patient Health Questionnaire-910) during pregnancy and/or postpartum to never depressed mothers. Models controlled for age, education, SES, parity, household structure, and history of physical or sexual intimate partner violence. Results were stratified by negative community breastfeeding attitudes (mothers in my community sometimes or most of the time find breastfeeding tiring or not enjoyable) and non-negative attitudes (mothers in my community rarely or never find breastfeeding tiring or not enjoyable). In our sample, 9.6%, 23.4%, 7.6%, and 59.5% were depressed during pregnancy and postpartum, pregnancy only, postpartum only, and never, respectively. Approximately 42.5% perceived negative community breastfeeding attitudes and 48.6% exclusively breastfed at 3 mo. Those depressed during pregnancy and postpartum were less likely than those never depressed to exclusively breastfeed (aRR=0.7; 95% CI=0.5, 0.9). Mothers depressed during pregnancy or postpartum only were no less likely than those never depressed to exclusively breastfeed. Perception of attitudes did not modify results. Mothers in Pakistan with sustained perinatal depression may be less likely to exclusively breastfeed. Treatment of maternal depression may increase exclusive breastfeeding, with potential gains to the mother and child.