Poster presented at 62nd Annual Meeting of the Society for Reproductive Investigation; San Francisco, CA, March 25-28, 2015.

Marisa Sturza1, Paris Scott1, Karen M Grewen, PhD1, Samantha E Meltzer-Brody, MD1, Stephanie C Zerwas, PhD1, Barbara L Frederickson, PhD2, Kathryn Houk3 and Alison M Stuebe, MD1,3

1School of Medicine, 2Department of Psychology, 3Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States

Introduction: We sought to quantify associations between postpartum eating disorder symptoms, maternal mood, parenting, and infant feeding.

Study Design: We analyzed participants in an ongoing longitudinal study of women intending to breastfeed. At baseline all participants underwent a Structured Clinical Interview (SCID) to determine history of anorexia, bulimia, or binge eating disorder (EDHx). At 2 months postpartum, we quantified current symptoms using the Eating Disorder Examination Questionnaire (EDE-Q4). We measured outcomes using the Beck Depression Inventory (BDI), the Edinburgh Postnatal Depression Scale (EPDS), the Parenting Stress Index – Short Form, the Breastfeeding Self-Efficacy Scale, and the modified Differential Emotions Scale (mDES). We used multivariable linear regression to model associations between outcomes and EDE-Q4, EDHx and interactions between EDHx and EDE-Q4.

Results: Of the 62 women, 1 had a SCID-verified current eating disorder and 8 had an EDHx. At 2 months postpartum, women with EDHx were more likely to meet clinical thresholds for depression indexed by BDI ≥ 17 (33 vs. 6%, Fisher’s exact p=.03). Adjusting for EDHx, higher EDE-Q4 score was associated with higher BDI (R2 = .45, main effect p<.0001) and reduced breastfeeding self-efficacy (R2=.10, main effect p=.02). EDHx moderated other associations: among women without EDHx, higher EDE-Q4 score was associated with higher EPDS score (R2= .27, interaction p.<05), greater parenting stress (R2=.26, interaction p =.06) and more negative emotions during feeding (R2=.32, interaction p=.03).

Conclusion: Maternal eating disorder symptoms were associated with depression symptoms, parenting stress, and negative breastfeeding outcomes. Parenting support may improve outcomes for mothers with disordered eating symptoms.

Poster presented at 62nd Annual Meeting of the Society for Reproductive Investigation; San Francisco, CA, March 25-28, 2015.

Paris Scott1, Marisa Sturza1, Karen M Grewen1, Samantha E Meltzer-Brody1, Barbara L Frederickson2, Kathryn Houk3 and Alison Stuebe1,3

1School of Medicine, 2Department of Psychology, 3Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States.

Objective: We sought to determine the associations between perinatal post-traumatic stress (PPTS) symptoms and maternal mood, parenting, and infant feeding at 2 months postpartum.

Study Design:  Women intending to breastfeed were recruited in the 3rd trimester for an ongoing longitudinal cohort study. Past or current major depressive disorder (MDD) or anxiety disorder (AD: PTSD, generalized anxiety disorder, obsessive compulsive disorder) was assessed via Structured Clinical Interview at enrollment. PPTS symptoms were quantified at 2 months postpartum using the Modified Perinatal Post-traumatic Stress Disorder Questionnaire (MPPQ). We assessed mood symptoms, parental stress, and emotions during feeding at 2 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Parenting Stress Index (PSI), and the modified Differential Emotions Scale (mDES). We used multivariable linear regression to model the associations between MPPQ score and outcome measures, adjusting for SCID-verified active MDD or AD and interactions between active diagnosis and MPPQ score.  P values < .05 were considered statistically significant.

Results: In our sample 11/62 women had SCID-verified MDD or AD during pregnancy (ActiveDx), and 5/62 had MPPQ scores ≥19, the established threshold. In multivariable models adjusting for ActiveDx, we found that MPPQ score was associated with higher EPDS (R2= .31, p<.001), BDI (R2=.34, p<.001), STAI (R2=.15, p<.01), and PSI scores (R2=.16, p<.01), and more negative emotions during feeding (R2=.14, p<.01) at 2 months postpartum. ActiveDx did not modify associations between MPPQ score and outcomes (all p for interaction >.05).

Conclusion: PPTS symptoms are associated with maternal mood, parenting stress, and negative infant feeding experiences at 2 months postpartum, independent of preexisting MDD or AD. Psychological support for women with PPTS symptoms may improve outcomes for mothers and infants.

Presented at the Breastfeeding and Feminism International Conference, March 2015

By Alison Stuebe

Conventional wisdom holds that breastfeeding prevents postpartum depression and increases bonding between mother and infant. Some authors have gone so far as to suggest that not breastfeeding triggers depression because it mimics conditions associated with the death of the infant (Gallup, Nathan Pipitone, Carrone, & Leadholm, 2009). However, emerging evidence suggests that the relationship between lactation and maternal mood is complex. For example, in a recent study, women who achieved their breastfeeding intentions were less likely to be depressed that women who did not breastfeed; however, women who were not able to achieve their intentions were more likely to be depressed than those who neither intended to breastfeed nor initiated (Borra, Iacovou, & Sevilla, 2014). Moreover, women who did not plan to breastfeed but did so were more likely to be depressed at 18 months postpartum than women who formula fed.  These results suggest that intended, successful breastfeeding is protective, but the data raise questions about the impact of promoting breastfeeding among women who are reluctant to initiate or who are at risk for early weaning. Furthermore, this work underscores the need to provide psychological support for women who are unable to achieve their infant feeding intentions. This paper will explore what is known about the relationship between breastfeeding and depression, discuss neuroendocrine mechanisms that may link these two disorders and consider implications for supporting mothers who are experiencing depression and anxiety symptoms. Continue reading →