Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania.
Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.
J Womens Health (Larchmt). 2024 Feb;33(2):187-197. doi: 10.1089/jwh.2023.0076. Epub 2023 Nov 23.
Previous research shows that 61% of children younger than 6 months in low- and middle-income countries (LMICs) are not exclusively breastfed. Although data on the role of pre- and postnatal depression on breastfeeding exclusivity is mixed, fetomaternal attachment might foster breastfeeding exclusivity. Thus, we tested the potential mediating role of fetomaternal attachment and postnatal depression in the relationship between maternal prenatal depression and exclusive breastfeeding. Data were collected as part of a prospective, cross-cultural project, Evidence for Better Lives Study, which enrolled 1208 expectant mothers, in their third trimester of pregnancy across eight sites, from LMICs. Of the whole sample, 1185 women (mean age = 28.32, standard deviation [SD] = 5.77) completed Computer-Aided Personal Interviews on prenatal depressive symptoms, fetomaternal attachment, and socioeconomic status. A total of 1054 women provided follow-up data at 3-6 months after birth, about postnatal depressive symptoms, exclusive breastfeeding, and infant health indicators. Path analysis was used to assess parallel mediation. In the whole sample, the effect of prenatal depression on breastfeeding exclusivity was completely mediated by postnatal depression, whereas fetomaternal attachment did not mediate the relationship. The full mediation effect was replicated individually in Pakistan and Sri Lanka. The study results indicate that prenatal depression symptoms contributed to the development of depressive symptoms after birth, negatively affecting the probability of exclusive breastfeeding. Future research should explore this in early prevention interventions, increasing the chances of healthy child development in LMICs. Considering the mixed results around the sites, it is important to better understand the relationship between maternal depression, fetomaternal attachment and breastfeeding behavior in each site's socio-cultural context.
先前的研究表明，低收入和中等收入国家（LMICs）6 个月以下的儿童中，有 61%没有进行纯母乳喂养。尽管关于产前和产后抑郁对母乳喂养排他性的影响的数据参差不齐，但胎儿-母体依恋可能会促进母乳喂养的排他性。因此，我们测试了胎儿-母体依恋和产后抑郁在母亲产前抑郁与纯母乳喂养之间关系中的潜在中介作用。数据是作为一项前瞻性、跨文化项目“改善生活证据研究”的一部分收集的，该研究在 8 个地点招募了来自 LMICs 的 1208 名孕妇，她们处于妊娠的第三个三个月。在整个样本中，1185 名女性（平均年龄=28.32，标准差[SD]=5.77）完成了关于产前抑郁症状、胎儿-母体依恋和社会经济地位的计算机辅助个人访谈。共有 1054 名女性在分娩后 3-6 个月提供了关于产后抑郁症状、纯母乳喂养和婴儿健康指标的随访数据。路径分析用于评估平行中介作用。在整个样本中，产前抑郁对母乳喂养排他性的影响完全被产后抑郁所中介，而胎儿-母体依恋并没有中介这种关系。在巴基斯坦和斯里兰卡的单独研究中也复制了完全中介效应。研究结果表明，产前抑郁症状导致产后抑郁症状的发展，从而降低了纯母乳喂养的可能性。未来的研究应该在早期预防干预中探索这一点，增加在 LMICs 中促进儿童健康发展的机会。考虑到各研究地点的结果存在差异，了解每个地点社会文化背景下母亲抑郁、胎儿-母体依恋和母乳喂养行为之间的关系非常重要。
