Presented at the Academy of Breastfeeding Medicine Annual Meeting. Atlanta, GA, November 2017.

Alison M. Stuebe1,3, Bharathi Zvara3, Samantha Meltzer-Brody2, Brenda Pearson2, Cheryl Walker2, Karen Grewen2

1Department of Obstetrics and Gynecology, 2Department of Psychiatry, 3Department of Maternal and Child Health,
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina

Background: Adverse childhood experiences are associated with mood disorders and difficulties with early caregiving behaviors. We sought to quantify associations among moderate/severe childhood trauma (MSCT), depression symptoms and breastfeeding intensity.

Methods: Women intending to breastfeed were recruited in the 3rd trimester of pregnancy for an ongoing longitudinal study. Past or current major depressive disorder or anxiety disorders were assessed via Structured Clinical Interview. Trauma history was quantified using the Childhood Trauma Questionnaire. MSCT was quantified using CTQ subscale scores (abuse: emotional≥13, physical≥10, sexual≥8; neglect: emotional≥15, physical≥10).  During monthly interviews, mood was assessed via the Edinburgh Postnatal Depression Scale, and breastfeeding intensity in the past 7 days was assessed via a feeding questionnaire. Mean breastfeeding intensity and EPDS scores over the first 6 months and from birth to 12 months were used to calculate cumulative breastfeeding intensity (CBI) and cumulative EPDS (CEPDS). We used Wilcoxon rank sum tests to quantify the association between MSCT and CBI, and we used linear regression to model associations between CBI and CEPDS. P values <.05 were considered statistically significant.

Results: Among 162 women who had completed data collection, 41 (25.8%) had a history of MSCT. MSCT was associated with lower CBI in the first 6 months postpartum (median vs 0.77 [0.39-0.91] vs [IQR]: 0.87, [0.71-0.97]).  MSCT modified associations between CEPDS and CBI: Among women with MSCT, higher EPDS scores were associated with lower CBI (p for interaction <.01, whereas among women without MSCT, mood scores were not associated with breastfeeding intensity. In the MSCT trauma group, exclusive breastfeeding for 6 months was associated with a 4.4-point reduction in predicted CEPDS score, compared with never breastfeeding.

Conclusions: Among women with a history of MSCT, targeted strategies to reduce mood symptoms and support greater breastfeeding intensity may have synergistic effects on maternal health, wellbeing and early caregiving behavior.

Presented at the Academy of Breastfeeding Medicine Annual Meeting. Atlanta, GA, November 2017.

Alison M. Stuebe1,3, Samantha Meltzer-Brody2, Brenda Pearson2, Cheryl Walker2, Karen Grewen2

1Department of Obstetrics and Gynecology, 2Department of Psychiatry, 3Department of Maternal and Child Health,
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina

Background: During breastfeeding, oxytocin facilitates milk let down. Oxytocin has also been implicated in maternal behavior and perinatal mood disorders. We sought to quantify the association between maternal mood symptoms, antidepressant use, and oxytocin levels during breastfeeding.

Methods: Women intending to breastfeed were recruited in the 3rd trimester of pregnancy for an ongoing longitudinal study, oversampling for women at high risk of depression or anxiety. At two and six months postpartum, dyads attended a lab visit. Following peripheral IV placement, women breastfed, with blood samples collected at baseline, 1, 4, 7, 10 minutes of feeding, and after 10-minute postfeed rest. Oxytocin levels were determined by enzyme immunoassay with extraction. Maternal depressive symptoms were quantified using the Beck Depression Inventory II ( score ≥11 defined as mild symptoms). Maternal medication use was reported via questionnaire. We used repeated measures analysis to quantify OT during breastfeeding among women with and without depressive symptoms and using or not using antidepressants. P values <.05 were considered statistically significant.

Results: Of 138 women who breastfed at the 2-month study visit, 88 were without symptoms and were not taking antidepressants, 17 were without symptoms and taking antidepressants, 23 were symptomatic and not taking antidepressants, and 10 were symptomatic and taking antidepressants.  In repeated measures analysis, we found a significant group * time interaction (p=.01):  At 2 months, OT levels were similar among women not taking antidepressants, regardless of symptoms, whereas women taking antidepressants had lower OT levels after the first few minutes of feeding. At 6 months, OT levels were similar among women without symptoms, and lower among women with symptoms (p = 0.02).

Conclusions: Both depression symptoms and antidepressant use are associated with differences in OT levels during breastfeeding.