Literature review for - Flourish Paediatrics

A relationship between postnatal depression and infant feeding outcomes has been found
consistently in many studies. A recent systematic literature review on 49 studies by Dennis
and McQueen found women with postnatal depression in the early postpartum period may be
at heightened risk for negative infant feeding practices. The review categorised the studies
into four groups based on the infant-feeding outcome measure they assessed; (1) infantfeeding
method, (2) breastfeeding initiation, duration, and exclusivity, (3) breastfeeding
difficulties, (4) breastfeeding self-efficacy. Of the studies reviewed, seven found an
association between bottle feeding and higher levels of depressive symptoms. Twelve studies,
including a cohort study in Australia, suggested that mothers with depressive symptoms were
significantly more likely to discontinue breastfeeding earlier than non depressed mothers. A
longitudinal cohort study of 1745 women in Australia found that postnatal depression was
significantly associated with breastfeeding duration (p = 0.025), and that women who
experience postnatal depression at any time have a greater risk (RR=1.25) of stopping
breastfeeding than women who do not experience postnatal depression (Henderson, Evans et
al. 2003).
Despite extensive research, the review by Dennis and McQueen, found only two studies
linking depression among postnatal mothers and breastfeeding initiation. While three studies
found an association between maternal mood and breastfeeding exclusivity one study that
used multivariate analyses did not find this association. Further research is warranted to
examine the likelihood of maternal mood negatively impacting breastfeeding initiation and
exclusivity. The findings from the review indicate that in addition to offering support to
postnatal mothers, health professions should recognise and treat depression in breastfeeding
women to prevent the adoption of negative infant-feeding practices.
Additional notes on Postnatal depression
Postnatal depression is a serious health problem for many women in all cultures (Dennis
2005). It is characterized by desolation, sadness, anxiety, fears, irrational thoughts, feelings
of inadequacy, loss of libido, tiredness, and dependency (Sichel 2000). Epidemiological
studies usually define postnatal depression as occurring within 12 weeks of birth (Wisner,
Parry et al. 2002; Hiltunen, Jokelainen et al. 2004). The onset of postnatal depression is
within the first 4 weeks after delivery (American Psychiatric Association c2000). In addition,
a major depressive episode should be two weeks or longer during which a woman has either
depressed mood or feeling of inadequacy or pleasure in activities which are different from
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