Department of Anthropology, Northwestern University.
Department of Anthropology, Northwestern University; Institute for Policy Research, Northwestern University.
J Affect Disord. 2021 Mar 15;283:441-471. doi: 10.1016/j.jad.2020.11.080. Epub 2020 Nov 12.
Breastfeeding is recommended to improve maternal and infant health globally. Depression has been posited to negatively impact breastfeeding, although potential causal and bidirectional pathways between these two phenomena have not been sufficiently characterized. We therefore conducted a systematic review to critically evaluate available evidence on the relationship between perinatal depressive symptoms and breastfeeding behaviors; to identify knowledge gaps and propose a biosocial research agenda to advance our understanding of this topic.
A systematic search strategy was applied across seven databases. Data were extracted and aggregated using the matrix method to provide a narrative synthesis of findings.
Thirty-eight studies from 20 countries spanning 1988 through 2018 fit the inclusion criteria. In general, methods across studies were heterogeneous. Fourteen different tools were used to measure perinatal depressive symptoms. Nearly half the studies did not provide breastfeeding definitions. No studies from low-income countries met inclusion criteria. More than half (63%) of studies demonstrated a negative association between depressive symptoms across the perinatal period and less exclusive breastfeeding and/or shorter breastfeeding durations.
Heterogeneity in study design, definitions, assessment tools, and measurement time points limited the comparability of study findings. Causality cannot be assessed.
Available evidence suggests perinatal depressive symptoms negatively associated with breastfeeding exclusivity and duration, which can lead to suboptimal infant nutrition and detrimental impacts on maternal mental and physical health. To better understand this relationship, we propose including consistent operationalization and assessment of depression and breastfeeding globally and concurrent repeated measures of key biological and social factors.
母乳喂养在全球范围内被推荐用于改善母婴健康。抑郁症被认为会对母乳喂养产生负面影响，尽管这两种现象之间的潜在因果和双向关系尚未得到充分描述。因此，我们进行了一项系统评价，以批判性地评估围产期抑郁症状与母乳喂养行为之间关系的现有证据；确定知识空白，并提出一个生物社会研究议程，以促进我们对这一主题的理解。
我们在七个数据库中应用了系统搜索策略。使用矩阵方法提取和汇总数据，以提供研究结果的叙述性综合。
从 1988 年到 2018 年，来自 20 个国家的 38 项研究符合纳入标准。总体而言，研究方法存在异质性。使用了 14 种不同的工具来测量围产期抑郁症状。近一半的研究没有提供母乳喂养的定义。没有来自低收入国家的研究符合纳入标准。超过一半（63%）的研究表明，围产期抑郁症状与不那么完全母乳喂养和/或母乳喂养时间较短之间存在负相关。
研究设计、定义、评估工具和测量时间点的异质性限制了研究结果的可比性。不能评估因果关系。
现有证据表明，围产期抑郁症状与母乳喂养的排他性和持续时间呈负相关，这可能导致婴儿营养不足，并对产妇的心理和身体健康产生不利影响。为了更好地理解这种关系，我们建议在全球范围内包括对抑郁和母乳喂养的一致操作化和评估，以及对关键生物和社会因素的同步重复测量。
