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Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression

Published online by Cambridge University Press:  03 July 2013

B. Figueiredo*
School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
C. Canário
School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
T. Field
University of Miami Medical School, Miami, FL, USA
*Address for correspondence: B. Figueiredo, Ph.D., School of Psychology, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal. (Email:



This prospective cohort study explored the effects of prenatal and postpartum depression on breastfeeding and the effect of breastfeeding on postpartum depression.


The Edinburgh Postpartum Depression Scale (EPDS) was administered to 145 women at the first, second and third trimester, and at the neonatal period and 3 months postpartum. Self-report exclusive breastfeeding since birth was collected at birth and at 3, 6 and 12 months postpartum. Data analyses were performed using repeated-measures ANOVAs and logistic and multiple linear regressions.


Depression scores at the third trimester, but not at 3 months postpartum, were the best predictors of exclusive breastfeeding duration (β = −0.30, t = −2.08, p < 0.05). A significant decrease in depression scores was seen from childbirth to 3 months postpartum in women who maintained exclusive breastfeeding for ⩾3 months (F1,65 = 3.73, p < 0.10, ηp2 = 0.05).


These findings suggest that screening for depression symptoms during pregnancy can help to identify women at risk for early cessation of exclusive breastfeeding, and that exclusive breastfeeding may help to reduce symptoms of depression from childbirth to 3 months postpartum.

Original Articles
Copyright © Cambridge University Press 2013 

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Aarts, C, Kylberg, E, Hornell, A, Hofvander, Y, Gebre-Medhin, M, Greiner, T. (2000). How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data. International Journal of Epidemiology 29, 10411046.Google Scholar
Akman, I, Kuscu, M, Yurdakul, Z, Ozdemir, N, Solakoğlu, M, Orhon, L (2008). Breastfeeding duration and postpartum psychological adjustment: role of maternal attachment styles. Journal of Paediatrics and Child Health 44, 369373.CrossRefGoogle ScholarPubMed
Altemus, M, Deuster, P, Galliven, E, Carter, C, Gold, P (1995). Suppression of hypothalmic-pituitary-adrenal axis responses to stress in lactating women. Journal of Clinical Endocrinology and Metabolism 80, 29542959.Google ScholarPubMed
Amico, JA, Johnston, JM, Vagnucci, AH (1994). Suckling-induced attenuation of plasma cortisol concentrations in postpartum lactating women. Endocrine Research 20, 7987.CrossRefGoogle ScholarPubMed
Astbury, J, Brown, S, Lumley, J, Small, R (1994). Birth events, birth experiences and social differences in postnatal depression. Australian Journal of Public Health 18, 176184.CrossRefGoogle ScholarPubMed
Augusto, A, Kumar, R, Calheiros, JM, Matos, E, Figueiredo, E (1996). Post-natal depression in an urban area of Portugal: comparison of childbearing women and matched controls. Psychological Medicine 26, 135141.Google Scholar
Barnes, M, Cox, J, Doyle, B, Reed, R (2010). Evaluation of a practice-development initiative to improve breastfeeding rates. Journal of Perinatal Education 19, 1723.CrossRefGoogle ScholarPubMed
Chalmers, B, Heaman, M, Sauve, R, Kaczorowski, J (2009). Breastfeeding rates and hospital breastfeeding practices in Canada: a national survey of women. Birth 36, 122132.Google Scholar
Cooper, P, Murray, L, Stein, A (1993). Psychosocial factors associated with the early termination of breast-feeding. Journal of Psychosomatic Research 37, 171176.Google Scholar
Cox, JL, Holden, JM, Sagovsky, R (1987). Detection of postnatal depression: development of the 10-item Edinburgh Depression Scale. British Journal of Psychiatry 150, 782786.CrossRefGoogle Scholar
Cutrona, CE, Troutman, BR (1986). Social support, infant temperament and parenting self-efficacy: a mediational model of postpartum depression. Child Development 57, 15071515.Google Scholar
Dennis, CL (2006). Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period. Research in Nursing and Health 29, 256268.Google Scholar
Dennis, CL, McQueen, K (2007). Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatrica 96, 590594.Google Scholar
Dennis, CL, McQueen, K (2009). The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics 123, 736751.Google Scholar
Doan, T, Gardiner, A, Gay, CL, Lee, KA (2007). Breast-feeding increases sleep duration of new parents. Journal of Perinatal and Neonatal Nursing 21, 200206.Google Scholar
Dørheim, SK, Bondevik, GT, Eberhard-Gran, M, Bjorvatn, B (2009). Sleep and depression in postpartum women: a population-based study. Sleep 32, 847855.CrossRefGoogle ScholarPubMed
EC-Public Health (2002). Promoting, Protecting and Supporting Breastfeeding: An Action Plan for Europe. European Commission, Directorate Public Health: Luxembourg.Google Scholar
Ekström, A, Nissen, E (2006). A mother's feelings for her infant are strengthened by excellent breastfeeding counseling and continuity of care. Pediatrics 118, e309e314.CrossRefGoogle ScholarPubMed
Fairlie, TG, Gilman, MW, Rich-Edwards, J (2009). High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation. Journal of Women's Health 18, 945953.Google Scholar
Faul, F, Erdfelder, E, Lang, A-G, Buchner, A (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavioral Research Methods 39, 175191.Google Scholar
Field, T (2008). Breastfeeding and antidepressants. Infant Behavior and Development 31, 481487.Google Scholar
Field, T, Diego, M, Hernandez-Reif, M, Figueiredo, B, Ezell, S, Siblalingappa, V (2010). Depressed mothers and infants are more relaxed during breastfeeding versus bottlefeeding interactions: brief report. Infant Behavior and Development 33, 241244.CrossRefGoogle ScholarPubMed
Field, T, Hernandez-Reif, M, Feijo, M (2002). Breastfeeding in depressed mother-infant dyads. Early Child Development Care 172, 539545.Google Scholar
Figueiredo, B, Conde, A (2011). Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: parity differences and effects. Journal of Affective Disorders 132, 146157.CrossRefGoogle ScholarPubMed
Figueiredo, B, Costa, R (2009). Mother's stress, mood and emotional involvement with the infant: 3 months before and 3 months after childbirth. Archives of Women's Mental Health 12, 143153.Google Scholar
Figueiredo, B, Teixeira, C, Conde, A, Pinto, AR, Sarmento, P (2009). Outpatients of the Julio Dinis Maternity Hospital Service for adolescent mothers (between 2000 and 2003). Revista Portuguesa de Psicologia 41, 4564.CrossRefGoogle Scholar
Gagliardi, L, Petrozzi, A, Rusconi, F (2012). Symptoms of maternal depression immediately after delivery predict unsuccessful breast feeding. Archives of Disease in Childhood 97, 355357.CrossRefGoogle ScholarPubMed
Galler, JR, Hussain, RH, Biggs, MA (1999). Maternal moods predict breastfeeding in Barbados. Journal of Developmental and Behavioral Pediatrics 20, 8087.CrossRefGoogle ScholarPubMed
Gartner, LM, Morton, J, Lawrence, RA, Naylor, AJ, O'Hare, D, Schanler, RJ, Eidelman, AI; American Academy of Pediatrics Section on Breastfeeding (2005). Breastfeeding and the use of human milk. Pediatrics 115, 496596.Google Scholar
Goyal, D, Gay, C, Lee, K (2009). Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Archives of Women's Mental Health 12, 229237.Google Scholar
Green, JM, Murray, D (1994). The use of the Edinburgh Postnatal Depression Scale in research to explore the relationship between antenatal and postnatal dysphoria. In Perinatal Psychiatry: Use and Misuse of the Edinburgh Postnatal Depression Scale (ed. Cox, J. and Holden, J.), pp. 180199. Gaskell: London.Google Scholar
Groer, MW, Davis, MW (2006). Cytokines, infections, stress, and dysphoric moods in breastfeeders and formula feeders. Journal of Obstetric, Gynecologic, and Neonatal Nursing 35, 599607.Google Scholar
Hart, S, Boylan, ML, Carroll, S, Musick, YA, Lampe, RM (2003). Brief report: breast-fed one-week-olds demonstrate superior neurobehavioral organization. Journal of Pediatric Psychology 28, 529534.CrossRefGoogle ScholarPubMed
Hatton, D, Harrison-Hohner, J, Coste, S, Dorato, V, Curet, L, McCarron, D (2005). Symptoms of postpartum depression and breastfeeding. Journal of Human Lactation 21, 444449.Google Scholar
Heinrichs, M, Meinlschmidt, G, Neumann, I, Wagner, S, Kirschbaum, C, Ehlert, U, Hellhammer, DH (2001). Effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychosocial stress in postpartum lactating women. Journal of Clinical Endocrinology and Metabolism 86, 47984804.CrossRefGoogle ScholarPubMed
Heinrichs, M, Neumann, I, Ulrike, E (2002). Lactation and stress: protective effects of breast-feeding in humans. Stress 5, 195203.Google Scholar
Henderson, J, Evans, S, Straton, J, Priest, S, Hagan, R (2003). Impact of postnatal depression on breastfeeding duration. Birth 30, 175180.Google Scholar
Horta, B, Bahl, R, Martines, J, Victora, C (2007). Evidence on the Long-term Effects of Breastfeeding: Systematic Reviews and Meta-analyses. World Health Organization: Geneva.Google Scholar
Insaf, TZ, Fortner, RT, Pekow, P, Dole, N, Markenson, G, Chasan-Taber, L (2011). Prenatal stress, anxiety, and depressive symptoms as predictors of intention to breastfeed among Hispanic women. Journal of Women's Health 20, 11831192.Google Scholar
Jonas, W, Nissen, E, Ransjö-Arvidson, A, Wiklund, I, Henriksson, P, Uvnäs-Moberg, K (2008). Short and long-term decrease of blood pressure in women during breastfeeding. Breastfeeding Medicine 3, 103109.Google Scholar
Jones, N, McFall, B, Diego, M (2004). Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: the mediating role of infant temperament. Biological Psychology 67, 103124.Google Scholar
Kehler, HL, Chaput, KH, Tough, SC (2009). Risk factors for cessation of breastfeeding prior to 6 months postpartum among a community sample of women in Calgary, Alberta. Canadian Journal of Public Health 100, 376380.Google Scholar
Kendall-Tackett, K (2007). A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal 2, 6.Google Scholar
Kinnear, PR, Gray, CD (2010). PASW Statistics 17 Made Simple. Psychology Press: New York.Google Scholar
Kramer, MS, Aboud, F, Mironova, E, Vanilovich, I, Platt, RW, Matush, L (2008). Breastfeeding and child cognitive development: new evidence from a large randomized trial. Archives of General Psychiatry 65, 578584.CrossRefGoogle ScholarPubMed
Labbok, M, Krasovec, K (1990). Toward consistency in breastfeeding definitions. Studies in Family Planning 21, 226230.Google Scholar
Labbok, M, Belsey, M, Coffin, C J (1997). A call for consistency in defining breast-feeding. American Journal of Public Health 87, 10601061.Google Scholar
Li, R, Scanlon, KS, Serdula, MK (2005). The validity and reliability of maternal recall of breastfeeding practice. Nutrition Reviews 63, 103110.CrossRefGoogle ScholarPubMed
Mezzacappa, ES, Endicott, J (2007). Parity mediates the association between infant feeding method and maternal depressive symptoms in the postpartum. Archives of Women's Mental Health 10, 259266.CrossRefGoogle Scholar
Mezzacappa, ES, Katkin, ES (2002). Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology 21, 187193.Google Scholar
Murray, L, Cooper, P (1997). Postpartum Depression and Child Development. Guilford Press: New York.Google Scholar
Newcomb, PA, Storer, BE, Longnecker, MP, Mittendorf, R, Clapp, RW, Burke, KP (1994). Lactation and reduced risk of premenopausal breast cancer. New England Journal of Medicine 330, 8187.Google Scholar
Nierop, A, Bratsikas, A, Zimmermann, R, Ehlert, U (2006). Are stress-induced cortisol changes during pregnancy associated with postpartum depressive symptoms? Psychosomatic Medicine 68, 931937.Google Scholar
Pippins, JR, Brawarsky, P, Jackson, RA, Fuentes-Afflick, E, Haas, JS (2006). Association of breastfeeding with maternal depressive symptom. Journal of Women's Health 15, 754762.Google Scholar
Posmontier, B (2008). Sleep quality in women with and without postpartum depression. Journal of Obstetric, Gynecologic, and Neonatal Nursing 37, 722737.Google Scholar
Sacker, A, Quigley, M, Kelly, Y (2006). Breastfeeding and developmental delay: findings from the Millennium Cohort Study. Pediatrics 118, 682689.Google Scholar
Seimyr, L, Edhborg, M, Lundhand, W, Sjögren, B (2004). In the shadow of maternal depressed mood: experiences of parenthood during the first year after childbirth. Journal of Psychosomatic Obstetrics and Gynecology 25, 2334.Google Scholar
Shields, L, O'Callaghan, M, Williams, G, Najman, J, Bor, W (2006). Breastfeeding and obesity at 14 years: a cohort study. Journal of Paediatrics and Child Health 42, 289296.Google Scholar
Taj, R, Sikander, KS (2003). Effects of maternal depression on breast-feeding. Journal of the Pakistan Medical Association 53, 811.Google Scholar
Taylor, A, Glover, V, Marks, M, Kammerer, M (2009). Diurnal pattern of cortisol output in postnatal depression. Psychoneuroendocrinology 34, 11841188.CrossRefGoogle ScholarPubMed
Tu, M, Lupien, S, Walker, C (2006). Diurnal salivary cortisol levels in postpartum mothers as a function of infant feeding choice and parity. Psychoneuroendocrinology 31, 812824.Google Scholar
WHO (2003). Global Strategy for Infant and Young Child Feeding. World Health Organization: Geneva.Google Scholar
Ystrom, E (2012). Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy and Childbirth 12, 1236.CrossRefGoogle ScholarPubMed