Postpartum Depression, Infant Feeding and Weight
Postpartum Depression, Infant Feeding and Weight
Introduction: This study examined postpartum depression (PPD) as a potential risk factor for non-adherence to infant feeding guidelines and subsequent infant weight gain.
Methods: Participants were mother-infant dyads from the Infant Feeding Practices Study II (N = 1447). Main study variables were PPD, breastfeeding intensity, addition of cereal to infant formula, and age of introduction to solid foods.
Results: In logistic models adjusted for sociodemographic factors, mothers with PPD were 1.57 times (95% confidence interval [CI]: 1.16, 2.13) more likely to breastfeed at low intensity and 1.77 times (95% CI: 1.16, 2.68) more likely to add cereal to infant formula. Although PPD was associated with the early introduction to solid foods (odds ratio: 1.42; 95% CI: 1.07, 1.89), this relationship was not significant after adjusting for potential confounders. A small but significantly greater average weight gain at 6 months was observed among infants of mothers with PPD (10.15 lb, SD = 2.32 vs. 9.85 lb, SD = 2.32).
Discussion: Screening for PPD at well-child visits may lead to improved maternal health outcomes and the prevention of early life risk factors for childhood obesity.
Approximately 10% of U.S. infants and toddlers have a ≥ 95th percentile weight-for-recumbent length (Ogden, Carroll, Kit, & Flegal, 2012). This prevalence rate is a significant public health issue because excess weight gain during infancy has been associated with higher body mass index, higher skin fold thickness, and increased odds of obesity at age 3 years (Taveras et al., 2009). In a recent meta-analysis that included 10 cohort studies and more than 47,000 children from six countries, it was found that greater infant weight gain in the first year of life was consistently associated with risk for later obesity after adjusting for sex, age, and birth weight (Druet et al., 2011). This observed pattern for increased weight gain fits the Life Course Health Development model perspective that risk factors which begin during critical and sensitive periods of child development, including early infancy, may have an interactive and cumulative effect over time that leads to long-term poor health outcomes (Halfon & Hochstein, 2002; Halfon, Russ, & Regalado, 2005). To interrupt the trajectory toward lifelong excess weight gain and the concomitant risks for chronic illness, greater focus is needed on the predictors of childhood obesity that begin in early infancy. The Early Childhood Obesity Prevention Policies of the Institute of Medicine (IOM, 2011) has affirmed the recommendations of the American Academy of Pediatrics (AAP, 2005) for infant feeding that include exclusive breastfeeding for the first 6 months of life and continued breastfeeding in conjunction with solid foods for 1 year or more. Research is needed that advances our understanding of factors that influence adherence to these recommended infant feeding practices.
Toward that end, the present study examined adherence to infant feeding guidelines within the context of postpartum depression (PPD), a disorder that affects between 12% and 20% of mothers in the United States during their first few months after delivery (Brett, 2008). Previous research has found that mothers who experience PPD are more likely to discontinue breastfeeding in the first few months after giving birth (Dennis & McQueen, 2009; McLearn, Minkovitz, Strobino, Marks, & Hou, 2006; Taveras et al., 2003). PPD also has been associated with forceful, indulgent, and restrictive infant feeding styles (Hurley, Black, Papas & Caufield, 2008). To our knowledge no previous studies have examined adherence to infant feeding practice recommendations and subsequent infant weight gain within the context of PPD. Understanding these relationships may inform the future design of clinical interventions to reduce the risk of childhood obesity and related lifelong health consequences.
The purpose of this study was to examine the effects of PPD on early infant feeding practices, including breastfeeding intensity at 2 months of age, adding baby cereal to formula at 2 months of age, and early introduction of solid foods (before 4 months of age). We also explored the contribution of sociodemographic, health, and behavioral factors on these infant feeding behaviors and examined the relationship between infant feeding practices and weight gain by 6 months of age for mothers with and without PPD.
Abstract and Introduction
Abstract
Introduction: This study examined postpartum depression (PPD) as a potential risk factor for non-adherence to infant feeding guidelines and subsequent infant weight gain.
Methods: Participants were mother-infant dyads from the Infant Feeding Practices Study II (N = 1447). Main study variables were PPD, breastfeeding intensity, addition of cereal to infant formula, and age of introduction to solid foods.
Results: In logistic models adjusted for sociodemographic factors, mothers with PPD were 1.57 times (95% confidence interval [CI]: 1.16, 2.13) more likely to breastfeed at low intensity and 1.77 times (95% CI: 1.16, 2.68) more likely to add cereal to infant formula. Although PPD was associated with the early introduction to solid foods (odds ratio: 1.42; 95% CI: 1.07, 1.89), this relationship was not significant after adjusting for potential confounders. A small but significantly greater average weight gain at 6 months was observed among infants of mothers with PPD (10.15 lb, SD = 2.32 vs. 9.85 lb, SD = 2.32).
Discussion: Screening for PPD at well-child visits may lead to improved maternal health outcomes and the prevention of early life risk factors for childhood obesity.
Introduction
Approximately 10% of U.S. infants and toddlers have a ≥ 95th percentile weight-for-recumbent length (Ogden, Carroll, Kit, & Flegal, 2012). This prevalence rate is a significant public health issue because excess weight gain during infancy has been associated with higher body mass index, higher skin fold thickness, and increased odds of obesity at age 3 years (Taveras et al., 2009). In a recent meta-analysis that included 10 cohort studies and more than 47,000 children from six countries, it was found that greater infant weight gain in the first year of life was consistently associated with risk for later obesity after adjusting for sex, age, and birth weight (Druet et al., 2011). This observed pattern for increased weight gain fits the Life Course Health Development model perspective that risk factors which begin during critical and sensitive periods of child development, including early infancy, may have an interactive and cumulative effect over time that leads to long-term poor health outcomes (Halfon & Hochstein, 2002; Halfon, Russ, & Regalado, 2005). To interrupt the trajectory toward lifelong excess weight gain and the concomitant risks for chronic illness, greater focus is needed on the predictors of childhood obesity that begin in early infancy. The Early Childhood Obesity Prevention Policies of the Institute of Medicine (IOM, 2011) has affirmed the recommendations of the American Academy of Pediatrics (AAP, 2005) for infant feeding that include exclusive breastfeeding for the first 6 months of life and continued breastfeeding in conjunction with solid foods for 1 year or more. Research is needed that advances our understanding of factors that influence adherence to these recommended infant feeding practices.
Toward that end, the present study examined adherence to infant feeding guidelines within the context of postpartum depression (PPD), a disorder that affects between 12% and 20% of mothers in the United States during their first few months after delivery (Brett, 2008). Previous research has found that mothers who experience PPD are more likely to discontinue breastfeeding in the first few months after giving birth (Dennis & McQueen, 2009; McLearn, Minkovitz, Strobino, Marks, & Hou, 2006; Taveras et al., 2003). PPD also has been associated with forceful, indulgent, and restrictive infant feeding styles (Hurley, Black, Papas & Caufield, 2008). To our knowledge no previous studies have examined adherence to infant feeding practice recommendations and subsequent infant weight gain within the context of PPD. Understanding these relationships may inform the future design of clinical interventions to reduce the risk of childhood obesity and related lifelong health consequences.
The purpose of this study was to examine the effects of PPD on early infant feeding practices, including breastfeeding intensity at 2 months of age, adding baby cereal to formula at 2 months of age, and early introduction of solid foods (before 4 months of age). We also explored the contribution of sociodemographic, health, and behavioral factors on these infant feeding behaviors and examined the relationship between infant feeding practices and weight gain by 6 months of age for mothers with and without PPD.
