Breastfeeding difficulties and supports and risk of postpartum depression in a cohort of womenwho have given birth in Calgary: a prospective cohort study.
Breastfeeding difficulties and supports and risk of postpartum depression in a cohort of womenwho have given birth in Calgary: a prospective cohort study.
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DOI：
10.9778/cmajo.20150009
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发表时间：
2016-01-01
期刊：
影响因子：
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通讯作者：
Tough, Suzanne C
中科院分区：
文献类型：
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作者：
Chaput, Kathleen H;Nettel-Aguirre, Alberto;Tough, Suzanne C
背景：母乳喂养困难和产后抑郁之间存在联系，有证据表明，一些促进母乳喂养的举措可能会增加母亲的压力，并增加患这种疾病的风险。我们进行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。方法：2010年6月至10月，我们从卡尔加里所有的妇产科医院招募了442名打算在生下足月单胎婴儿72小时内母乳喂养的妇女。我们在出生时、产后6周和6个月进行了问卷调查，测量母乳喂养困难、母乳喂养支持的暴露情况和产后抑郁。我们采用定性调查的方法来测量母乳喂养支持体验。产后抑郁被定义为产后6个月内爱丁堡产后抑郁量表评分大于或等于10分或自我诊断为抑郁。结果：共有386名(87.3%)报告中至重度母乳喂养困难，437名(98.9%)接受过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，那些没有报告负面母乳喂养支持经历的妇女患产后抑郁症的风险较低(风险比0.36)。在最终的回归模型中，消极的母乳喂养支持经历是母乳喂养困难与产后抑郁之间关系的显着影响修饰者。干预：母乳喂养支持的质量不仅对促进母乳喂养很重要，而且对母亲的心理健康也很重要。对一线照顾者进行教育，确保哺乳妇女的支持经历是积极的，可以降低产后抑郁的风险。
BACKGROUND: 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.METHODS: 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.RESULTS: 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.INTERPRETATION: 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.