Department of Public Health, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Affect Disord. 2017 Aug 15;218:53-58. doi: 10.1016/j.jad.2017.04.048. Epub 2017 Apr 24.
The relationships between breastfeeding discontinuation and cesarean section delivery, and the occurrence of postpartum depression (PPD) remain unclear. Therefore, we aimed to investigate the association of breastfeeding discontinuation and cesarean section delivery with PPD during the first 6 months after delivery.
Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 81,447 women who delivered during 2004-2013. PPD status was determined using the diagnosis code at outpatient or inpatient visit during the 6-month postpartum period. Breastfeeding discontinuation and cesarean section delivery were identified from prescription of lactation suppression drugs and diagnosis, respectively. Cox proportional hazards models were used to calculate adjusted hazard ratios.
Of the 81,447 women, 666 (0.82%) had PPD. PPD risk was higher in women who discontinued breastfeeding than in those who continued breastfeeding (hazard ratio=3.23, P<0.0001), in women with cesarean section delivery than in those with vaginal delivery (hazard ratio=1.26, P=0.0040), and in women with cesarean section delivery who discontinued breastfeeding than in those with vaginal delivery who continued breastfeeding (hazard ratio=4.92, P<0.0001).
Study limitations include low PPD incidence; use of indirect indicators for PPD, breastfeeding discontinuation, and working status, which could introduce selection bias and errors due to miscoding; and potential lack of adjustment for important confounders.
Breastfeeding discontinuation and cesarean section delivery were associated with PPD during the 6-month postpartum period. Our results support the implementation of breastfeeding promoting policies, and PPD screening and treatment programs during the early postpartum period.
母乳喂养的中断与剖宫产分娩以及产后抑郁症（PPD）的发生之间的关系尚不清楚。因此，我们旨在研究母乳喂养的中断和剖宫产分娩与产后 6 个月内 PPD 的关系。
从韩国国家健康保险服务-全国样本队列中提取了 2004-2013 年间分娩的 81447 名妇女的数据。通过产后 6 个月内门诊或住院就诊时的诊断代码确定 PPD 状况。通过抑制泌乳药物的处方和诊断分别确定母乳喂养的中断和剖宫产分娩。使用 Cox 比例风险模型计算调整后的危险比。
在 81447 名妇女中，有 666 名（0.82％）患有 PPD。与继续母乳喂养的妇女相比，母乳喂养中断的妇女发生 PPD 的风险更高（危险比=3.23，P<0.0001），剖宫产分娩的妇女比阴道分娩的妇女更高（危险比=1.26，P=0.0040），并且剖宫产分娩且母乳喂养中断的妇女比阴道分娩且继续母乳喂养的妇女更高（危险比=4.92，P<0.0001）。
研究的局限性包括 PPD 的发病率低；使用间接指标来表示 PPD、母乳喂养中断和工作状况，这可能会因选择偏倚和错误编码而引入误差；并且可能缺乏对重要混杂因素的调整。
母乳喂养的中断和剖宫产分娩与产后 6 个月内的 PPD 有关。我们的结果支持在产后早期实施促进母乳喂养的政策，以及 PPD 筛查和治疗计划。
