Cláudia Castro Dias

Breastfeeding and postpartum depression: state of the art review

OBJECTIVE To review the literature on the association between breastfeeding and postpartum depression. SOURCES A review of literature found on MEDLINE/PubMed database. SUMMARY OF FINDINGS The literature consistently shows that breastfeeding provides a wide range of benefits for both the child and the mother. The psychological benefits for the mother are still in need of further research. Some studies point out that pregnancy depression is one of the factors that may contribute to breastfeeding failure. Others studies also suggest an association between breastfeeding and postpartum depression; the direction of this association is still unclear. Breastfeeding can promote hormonal processes that protect mothers against postpartum depression by attenuating cortisol response to stress. It can also reduce the risk of postpartum depression, by helping the regulation of sleep and wake patterns for mother and child, improving mothers self-efficacy and her emotional involvement with the child, reducing the childs temperamental difficulties, and promoting a better interaction between mother and child. CONCLUSIONS Studies demonstrate that breastfeeding can protect mothers from postpartum depression, and are starting to clarify which biological and psychological processes may explain this protection. However, there are still equivocal results in the literature that may be explained by the methodological limitations presented by some studies.

Infant sleep-wake behaviors at two weeks, three and six months

Although infant sleep-wake behavior presents several developmental changes during the first six months, literature lacks on reference values and few studies have explored the role of individual change and stability on infant sleep-wake behavior during the first six months. This study aimed (1) to describe infant sleep-wake behaviors during the 24-h period, day and night, at two weeks, three, and six months, (2) and to explore developmental changes and the role of individual change and stability on infant sleep-wake behaviors from two weeks to six months. Ninety-four primiparous mothers completed measures on infant sleep-wake behaviors at two weeks, three and six months. Significant developmental changes were found on infant sleep-wake behaviors from two weeks to six months. Two-week-old infants sleep 13.3h, spend 8.7h awake, awake 6.1 times, have 0.4h of latency to sleep, and 3.2h of longest sleep period. Three-month-old infants sleep 13.0h, spend 9.2h awake, awake 5.5 times, have 0.4h of latency to sleep, and 5.2h of longest sleep period. Six-month-old infants sleep 12.2h, spend 10.0h awake, awake 5.2 times, have 0.4h of latency to sleep, and 5.6h of longest sleep period. Significant individual change and stability were also found on infant sleep-wake behaviors from two weeks to six months. Despite significant developmental and individual changes, individual stability explains a significant amount of the variance on infant sleep-wake behaviors over the first six months of life.

Sleep during the third trimester of pregnancy: the role of depression and anxiety

Depression has been associated with sleep disturbances in pregnancy; however, no previous research has controlled the possible confounding effect of anxiety on this association. This study aims to analyze the effect of depression on sleep during the third trimester of pregnancy controlling for anxiety. The sample was composed by 143 depressed (n = 77) and non-depressed (n = 66) pregnant women who completed measures of depression, anxiety, and sleep. Differences between groups in sleep controlling for anxiety were found. Depressed pregnant women present higher number of nocturnal awakenings and spent more hours trying falling asleep during the night and the entire 24 h period. Present findings point out the effect of depression on sleep in late pregnancy, after controlling for anxiety.

Children's Sleep Habits Questionnaire - Infant Version

OBJECTIVES This study proposed a version of the Childrens Sleep Habits Questionnaire for infants under 12 months (CSHQ-I). METHODS The sample was comprised of 299 infants, aged between 2 weeks and 12 months. RESULTS Exploratory factor analysis revealed four subscales: Bedtime Resistance, Sleep Anxiety, Positive Sleep Habits, and Daytime Sleepiness. The CSHQ-I total scale presented good test-retest reliability and internal consistency. The CSHQ-I also showed good concurrent validity, with significant associations found between the CSHQ-I total scale and subscales and a measure of infant sleep-wake behaviors. CONCLUSIONS The present study suggested the CSHQ-I as a reliable instrument to assess sleep problems in infants during the first year of life.

The breastfeeding self-efficacy scale-short form: Psychometric characteristics in Portuguese pregnant women

BACKGROUND The Breastfeeding Self-Efficacy Scale-Short Form is a reliable instrument to measure mothers confidence in her ability to breastfeed. The Breastfeeding Self-Efficacy Scale-Short Form has traditionally been used postnatally, but evidence suggests that it can be used antenatally to identify mothers at-risk of requiring additional support to improve breastfeeding outcomes. OBJECTIVE The aim of this study was to examine the psychometric characteristics of an antenatal version of the Breastfeeding Self-Efficacy Scale-Short Form, among pregnant Portuguese women. DESIGN Methodological prospective study to examine the psychometric characteristics of the antenatal Portuguese version of the Breastfeeding Self-Efficacy Scale-Short Form. SETTINGS Two public hospital units in the Northern Portugal. PARTICIPANTS The sample was comprised of 373 pregnant women recruited at 30-34 gestational weeks. METHODS The original English version of the antenatal Breastfeeding Self-Efficacy Scale-Short Form was translated into Portuguese and the Portuguese antenatal version of the scale was tested in a sample of 373 pregnant women. To examine the psychometric characteristics of the Portuguese antenatal version of the scale, the maternal demographic variables and the depressive and anxiety symptomatology of the participants were examined. The predictive validity of the Portuguese antenatal version of the scale was studied according to infant feeding method at one, three, and six months postpartum. RESULTS The Cronbachs alpha coefficient was 0.92. The antenatal version of the Breastfeeding Self-Efficacy Scale-Short Form scores were found to be associated with womens parity, educational level, occupational status, time they intend to breastfeed, and previous breastfeeding experience. Also, the antenatal version of the Breastfeeding Self-Efficacy Scale-Short Form scores significantly predicted exclusive breastfeeding at 1 month postpartum. CONCLUSIONS Results provided evidence that the antenatal Portuguese version of the Breastfeeding Self-Efficacy Scale-Short Form is a valid and reliable measure to assess breastfeeding self-efficacy in pregnant women. The antenatal version of the Breastfeeding Self-Efficacy Scale-Short Form could be a useful tool to assist Portuguese health professionals during routine prenatal care appointments to screen women with lower antenatal breastfeeding self-efficacy and, consequently, those that could be at risk for not initiating or early breastfeeding cessation.

Reference values and changes in infant sleep-wake behaviour during the first 12 months of life: a systematic review

This paper is a systematic review on the reference values and changes in infant sleep–wake behaviour during the first 12 months of life. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA). Seventy‐four papers were included, and the reference values and changes in sleep–wake behaviour during the first 12 months of life were identified. Sleep duration during the 24‐h period, and day and sleep periods during the night decreased over the first 12 months of life. Night wakings and bedtime/sleep‐onset time decreased, while the longest sleep period increased at night during the first 6 months. High discrepancy was noted between studies in the reference values of sleep–wake behaviour, while more congruence was noted regarding changes, especially those occurring in the first 6 months of life. Several methodological differences were identified between studies and may partially explain inconsistencies in the results, including the assessment of different sleep–wake behaviours, the focus on specific ages or age ranges, the use of self‐report, observational or direct measures, the recruitment of small or large representative samples, and the countries where the research was conducted. These aspects should be considered in future research and caution should be taken when generalizing results from studies with diverse methodological characteristics. Nonetheless, this review identifies normative reference values and the changes occurring in infant sleep–wake behaviour, and could inform both practitioners and researchers, helping them identify infants with sleep delays or problems.

Exclusive breastfeeding at three months and infant sleep-wake behaviors at two weeks, three and six months

This study assessed infant sleep-wake behavior at two weeks, three and six months as function of feeding method at three months (exclusively breastfed, partially breastfed, and exclusively formula fed infants). Mothers of 163 first-born, full-term, normal birth weight, healthy infants completed socio-demographic, depression, anxiety, and infant sleep-wake behavior measures. No effects were found for sleep arrangements, depression or anxiety, on feeding methods and sleep-wake behavior at three months. At two weeks exclusively breastfed infants at three months spent more hours sleeping and less hours awake during the 24-h period than partially breastfed infants. At three months, exclusively breastfed infants had a shorter of the longest sleep period at night than exclusively formula fed infants. At six months, exclusively breastfed infants at three months spent more hours awake at night than partially breastfed infants, awake more at night than exclusively formula fed infants, and had a shorter sleep period at night than partially breastfed and exclusively formula fed infants. This study showed differences in sleep-wake behaviors at two weeks, three and six months, when exclusively breastfed infants are compared with partially breastfed and exclusively formula fed infants at three months, while no effects were found for sleep arrangements, depression or anxiety.