Chaput Kathleen H, Nettel-Aguirre Alberto, Musto Richard, Adair Carol E, Tough Suzanne C
Department of Community Health Sciences (Chaput, Nettel-Aguirre, Musto, Adair, Tough), Cumming School of Medicine; Department of Paediatrics (Chaput, Nettel-Aguirre, Tough), Cumming School of Medicine, University of Calgary; Alberta Health Services - Calgary Zone (Musto); Department of Psychiatry (Adair), Cumming School of Medicine, University of Calgary, Calgary, Alta.
CMAJ Open. 2016 Mar 21;4(1):E103-9. doi: 10.9778/cmajo.20150009. eCollection 2016 Jan-Mar.
A link exists between breastfeeding difficulties and postpartum depression, and evidence shows that some breastfeeding promotion initiatives may increase maternal stress and contribute to risk of the condition. We conducted a prospective cohort study to determine whether breastfeeding difficulties affect the risk of postpartum depression and whether breastfeeding support modifies the relationship between breastfeeding difficulties and postpartum depression.
Between June and October 2010, we recruited 442 women who intended to breastfeed from all maternity hospitals in Calgary within 72 hours of giving birth to full-term, singleton infants. We administered questionnaires at birth and 6 weeks and 6 months postpartum, measuring breastfeeding difficulties, exposure to breastfeeding supports and postpartum depression. We used qualitative inquiry to measure breastfeeding support experiences. Postpartum depression was defined as a score of 10 or greater on the Edinburgh Postnatal Depression Scale or a self-reported diagnosis of depression in the first 6 months postpartum.
A total of 386 women (87.3%) reported moderate to severe breastfeeding difficulties and 437 (98.9%) received some form of breastfeeding advice, help or support. Among women with breastfeeding difficulties, those who did not report a negative breastfeeding support experience were at decreased risk of postpartum depression (risk ratio 0.36). In the final regression model a negative breastfeeding support experience was a significant effect modifier of the relationship between breastfeeding difficulties and postpartum depression.
The quality of breastfeeding support is important not only for breastfeeding promotion but also for maternal mental health. Educating front-line caregivers to ensure that support experiences of breastfeeding women are positive can reduce the risk of postpartum depression.
母乳喂养困难与产后抑郁之间存在关联，且有证据表明，一些母乳喂养促进举措可能会增加母亲的压力，并导致患产后抑郁的风险。我们开展了一项前瞻性队列研究，以确定母乳喂养困难是否会影响产后抑郁的风险，以及母乳喂养支持是否会改变母乳喂养困难与产后抑郁之间的关系。
2010年6月至10月期间，我们从卡尔加里所有妇产医院招募了442名打算进行母乳喂养的妇女，她们均在分娩足月单胎婴儿后的72小时内入院。我们在产妇分娩时、产后6周和6个月时进行问卷调查，评估母乳喂养困难情况、接受母乳喂养支持的情况以及产后抑郁情况。我们采用定性调查方法来衡量母乳喂养支持体验。产后抑郁的定义为在爱丁堡产后抑郁量表上得分达到或超过10分，或在产后前6个月内自我报告有抑郁诊断。
共有386名妇女（87.3%）报告有中度至重度母乳喂养困难，437名妇女（98.9%）接受了某种形式的母乳喂养建议、帮助或支持。在有母乳喂养困难的妇女中，那些没有负面母乳喂养支持体验的妇女患产后抑郁的风险较低（风险比为0.36）。在最终回归模型中，负面母乳喂养支持体验是母乳喂养困难与产后抑郁之间关系的一个显著效应修饰因素。
母乳喂养支持的质量不仅对促进母乳喂养很重要，对母亲的心理健康也很重要。对一线护理人员进行培训，以确保母乳喂养妇女获得积极的支持体验，可以降低产后抑郁的风险。
