Risk Factors For Postpartum Depression And The Association Between Postpartum Depression And Breastfeeding

Objective: Postpartum is another special period for women besides pregnancy,which will bring challenges to women in terms of physiology and psychology.Postpartum depression(PPD)and breastfeeding are some of the postpartum problems that may be faced.The purpose of this study was to investigate the incidence and risk factors for PPD among mothers giving birth in Wuhan Maternity and Child Healthcare Hospital and to explore the association between PPD and breastfeeding.Methods: 2944 mother–infant pairs were recruited from December 2015 to March 2018 in this study in the Wuhan birth cohort.We collected information on participants about baseline data,the living habits,the condition of health,nutritional supplements and so on.At 1 month after delivery,maternal depression symptoms were evaluated by using the Edinburgh Postnatal Depression Scale(EPDS).Infant feeding patterns including exclusive breastfeeding(EBF),any breastfeeding(ABF)and breastfeeding duration were investigated at 3-time points: 1 month,6 months,and 12 months after delivery by questionnaires.Potential risk factors for PPD and the relationships between depressive symptoms and infant feeding patterns were explored by multivariate logistic regression models.The Cox proportional hazards model was conducted to investigate the impact of PPD on the risk of cessation of breastfeeding.Results:(1)The incidence of PPD at 1 month postpartum was 13.82%(95%CI:12.58%,15.07%)in our study.(2)Poor sleep quality,high level of mother education,unintended pregnancy,and postnatal pain were risk factors for PPD.Multiparity,high household income,and working during pregnancy were protective factors for PPD.Compared with those with average sleep quality,mothers with fairly poor and very poor sleep quality increased the risk of PPD by 86.6%(OR:1.866;95%CI:1.407,2.474;P<0.0001)and 253.3%(OR:3.533;95%CI:1.461,8.546;P=0.0051)respectively.Compared with those with less than a high school degree,mothers with a high school and a Bachelor’s or advanced degree increased the risk of PPD by 99.2%(OR:1.992;95%CI:1.097,3.616;P=0.0235)and 82.7%(OR:1.827;95%CI:1.045,3.196;P=0.0345)respectively.Women with an unintended pregnancy increased the risk of PPD by 32.5%(OR:1.325;95%CI:1.027,1.709;P=0.0302)compared with those with a planned pregnancy.Mothers with postpartum pain increased the risk of PPD by 56.1%(OR:1.561;95%CI:1.204,2.024;P=0.0008)compared with those without postpartum pain.Primipara had a lower risk of PPD than multipara(OR:0.617;95%CI:0.465,0.819;P=0.0008).In comparison to mothers with a household income of less than ￥50,000/year,the risk of PPD was found to be lower in mothers with a household income between ￥ 50,000 and ￥100,000/year(OR:0.564;95%CI:0.393,0.811;P=0.002),and lower in mothers with a household income over ￥ 100,000/year as well(OR:0.528,95%CI:0.372,0.75;P=0.0004).Mothers working during pregnancy had lower risk of PPD compared with those not working during pregnancy(OR:0.702,95%CI:0.554,0.89;P=0.0034).(3)Mothers with PPD were less likely to carry out EBF than mothers without PPD(OR:0.761;95%CI:0.592,0.977;P=0.0324)at 1 month after childbirth.Similarly,mothers with PPD were less likely to carry out ABF than mothers without PPD at 1 month(OR:0.642;95%CI:0.415,0.991;P=0.0456),6 months(OR:0.641;95%CI:0.493,0.833;P=0.0009)and 12 months(OR:0.606,95%:CI 0.395,0.931;P=0.0221)after childbirth.(4)PPD at 1 month(HR:1.28;95%CI:1.082,1.513;P=0.0039),pre-pregnancy underweight(HR:1.205;95%CI: 1.036,1.401;P=0.0157)and return to work at 6 months after delivery(HR:1.686;95%CI:1.474,1.928;P<0.0001)were significantly associated with the cessation of breastfeeding.Conclusions:(1)The incidence of PPD in this study was similar to the overall incidence of domestic PPD.(2)The risk factors of PPD in this study included: primipara,low household income,high level of mother education,not working during pregnancy,unintended pregnancy,poor sleep quality and postnatal pain.(3)PPD could decrease the likelihood of EBF and ABF.(4)Breastfeeding duration was affected negatively by PPD,pre-pregnancy underweight and return to work at 6 months after delivery.