Category Archives: DIssertations

Positive Emotions During Infant Feeding and Breastfeeding Outcomes.

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Epublished in the Journal of Human Lactation, May 2019

Wouk K, Gottfredson NC, Tucker C, Pence BW, Meltzer-Brody S, Zvara B, Grewen K, Stuebe AM.

BACKGROUND: Few studies have examined the role of maternal emotions in breastfeeding outcomes.

RESEARCH AIM: We aimed to determine the extent to which positive maternal emotions during human milk feeding at 2 months were associated with time to any and exclusive human milk feeding cessation and overall breastfeeding experience.

METHODS: A sample of 192 women intending to breastfeed for at least 2 months was followed from the third trimester until 12 months postpartum. Positive emotions during infant feeding at 2 months were measured using the modified Differential Emotions Scale. Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHR) for time to any and exclusive human milk feeding cessation associated with a 1-point increase in positive emotions. Linear regression was used to estimate the association between positive emotions and maternal breastfeeding experience reported at 12 months.

RESULTS: Among those human milk feeding at 2 months, positive emotions during feeding were not associated with human milk feeding cessation by 12 months (aHR = 0.94, 95% CI [0.64, 1.31]). However, among women exclusively human milk feeding at 2 months, a 1-point increase in positive emotions was associated with a 35% lower hazard of introducing formula or solid foods by 6 months (aHR = 0.65, 95% CI [0.46, 0.92]). Positive emotions were associated with a significantly more favorable maternal report of breastfeeding experience at 12 months. Results were similar in sensitivity analyses using maternal feelings about breastfeeding in the first week as the exposure.

CONCLUSIONS: A positive maternal emotional experience of feeding is associated with breastfeeding outcomes.

PMID: 31059653

Positive Emotions During Infant Feeding and Postpartum Mental Health.

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E-published in the Journal of Women’s Health, October 2018.

Wouk K, Gottfredson NC, Tucker C, Pence BW, Meltzer-Brody S, Zvara B, Grewen K, Stuebe AM.

BACKGROUND: Research shows that individuals can improve mental health by increasing experiences of positive emotions. However, the role of positive emotions in perinatal mental health has not been investigated. This study explored the extent to which positive emotions during infant feeding are associated with maternal depression and anxiety during the first year postpartum.

MATERIALS AND METHODS: One hundred and sixty-four women drawn from a longitudinal cohort of mother-infant dyads were followed from the third trimester through 12 months postpartum. We measured positive emotions during infant feeding at 2 months using the mean subscale score of the modified Differential Emotions Scale. Depression and anxiety symptoms were assessed with the Beck Depression Inventory-II and State Trait Anxiety Inventory-State subscale at months 2, 6, and 12. Generalized linear mixed models were used to estimate crude and multivariable associations.

RESULTS: Among women with no clinical depression during pregnancy, higher positive emotions during infant feeding at 2 months were associated with significantly fewer depression symptoms at 2, 6, and 12 months and with lower odds of clinically significant depression symptoms at 2 and 6 months. In contrast to depression outcomes, women with clinical anxiety during pregnancy who experienced higher positive emotions had significantly fewer anxiety symptoms at 2, 6, and 12 months and lower odds of clinically significant anxiety at 2 and 6 months.

CONCLUSIONS: Positive emotions during infant feeding are associated with depression and anxiety outcomes during the first year postpartum and may be a modifiable protective factor for maternal mental health.

PMID: 30307779 PMCID:PMC6390657[Available on 2020-02-01]

The Role of Positive Emotions in Perinatal Mental Health and Breastfeeding

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Kathryn Gwinn Wouk’s PhD thesis analyzed data in the Mood, Mother and Infant Cohort

Katie Wouk and Alison Stuebe celebrate her successful dissertation defense.

Katie Wouk completed her undergraduate work at University of Virginia, where she majored in Spanish and Foreign Relations. She spent two years in the Peace Corps, and then went on to complete a Master’s Degree in Nutrition and Science Policy at Tufts University. From 2011-2013, she worked as a clinical nutritionist in the Bronx, and she enrolled in the doctoral program at UNC in 2013. During her time at UNC, she participated in the Mary Rose Tully Training Initiative and become an International Board Certified Lactation Consultant. She has contributed to multiple posters, presentation and publications, and completed her doctoral dissertation, The role of positive emotions during infant feeding in maternal mental health and breastfeeding. In this work, she lifts up the importance of the mother’s lived experience of nurturing her child as an essential component of perinatal health.

The Role of Positive Emotions in Perinatal Mental Health and Breastfeeding

Abstract: Major medical organizations in the U.S. recommend exclusive breastfeeding for six months, with continued breastfeeding through the first year or longer as desired by the woman and her infant. Public health programs have primarily aimed to increase breastfeeding duration and exclusivity without addressing the emotional experience of breastfeeding. Barbara Fredrickson’s broaden-and-build theory of positive emotions suggests that experiences of positive emotions lead to adaptive benefits by broadening thoughts and actions, facilitating the accrual of resources to improve health and well-being. In the context of the postpartum, this theory suggests that positive emotions experienced during infant feeding may broaden the scope of a mother’s thoughts and actions, allowing her to build resources to cope with challenges.

We used longitudinal data from the Mood, Mother and Infant cohort of women followed from the third trimester across the first year postpartum to test the extent to which positive emotions during infant feeding were associated with postpartum depression and anxiety and breastfeeding outcomes. We used generalized linear mixed effects models and time-to-event analyses to explore these associations, exploring modification by women’s baseline psychopathology.

Among women without a diagnosis of prenatal depression, positive emotions during feeding were inversely associated with postpartum depression symptoms. On the other hand, among women with a diagnosis of prenatal anxiety, positive emotions were associated with significantly lower postpartum anxiety symptoms. We speculate that women with prenatal anxiety who neverthess enjoy the experience of infant feeding may benefit from anxiolytic effects of oxytocin during breastfeeding and mother-infant interaction.

Positive emotions were not significantly associated with time to any breast milk feeding cessation; however, positive emotions were significantly associated with a longer time to exclusive breast milk feeding cessation and with a better overall maternal breastfeeding experience, especially with dimensions of maternal enjoyment, role attainment, and lifestyle compatibility. Positive feelings about breastfeeding in the first week were similarly associated with breastfeeding outcomes, suggesting the importance of the early maternal experience of breastfeeding on long-term outcomes.

Mother-centered programs and policies that support the experiential aspects of infant feeding may improve postpartum mental health, breastfeeding rates, and maternal satisfaction with breastfeeding.