Karen McQueen

The Relationship Between Infant-Feeding Outcomes and Postpartum Depression: A Qualitative Systematic Review

CONTEXT. The negative health consequences of postpartum depression are well documented, as are the benefits of breastfeeding. Despite the detailed research related to these maternal and infant health outcomes, the relationship between maternal mood and breastfeeding remains equivocal. OBJECTIVE. A qualitative systematic review was conducted to examine the relationship between postpartum depressive symptomatology and infant-feeding outcomes. METHODS. We performed electronic searchers in Medline (1966–2007), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982–2007), and Embase (1980–2007) by using specific key words. A hand search of selected specialist journals and reference lists of articles obtained was then conducted. Seventy-five articles were reviewed, of which 49 specifically provided data to be extracted related to postpartum depressive symptomatology and infant-feeding outcomes. Both authors independently extracted data including study design, participants (number and characteristics), and results. RESULTS. The results from this review suggest that women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy. There is also beginning evidence to suggest that depressed women may be less likely to initiate breastfeeding and do so exclusively. CONCLUSIONS. Depressive symptomatology in the postpartum period negatively influences infant-feeding outcomes. These findings have important clinical implications and support the need for early identification and treatment of women with depressive symptomatology. However, strategies to address help-seeking barriers are needed if women are to receive appropriate and timely treatment. Research to determine effective interventions to support depressed breastfeeding women is warranted.

Does maternal postpartum depressive symptomatology influence infant feeding outcomes

Aim: To examine the relationship between diverse infant feeding outcomes, e.g. infant feeding method, maternal satisfaction, infant feeding plans, breastfeeding progress and breastfeeding self‐efficacy) and postpartum depressive symptomatology using a time‐sequenced analysis.

Risk for postpartum depression associated with assisted reproductive technologies and multiple births: a systematic review

BACKGROUND It has been hypothesized that certain obstetrical populations, including women who conceive using assisted reproductive technologies (ART) and women with multiple births, may be at increased risk for postpartum depression. In this systematic literature review, we examine the published evidence for this hypothesis. METHODS The databases Medline, CINAHL, EMBASE, PsycINFO and the Cochrane Library were searched from their start dates through to April 1, 2009 using relevant keywords. All published, peer-reviewed articles in English, Spanish or French including a standardized assessment of depression administered between 2 and 52 weeks postpartum were considered for inclusion. Two independent reviewers abstracted and critically appraised a total of 13 eligible articles. RESULTS The data indicate little or no increased risk for postpartum depression among women who use ART to conceive. In contrast, most studies of adequate quality indicate that mothers of multiples may be at elevated risk for symptoms of depression. However, existing data do not permit differentiation between transient maternal distress and clinically significant postpartum depression. CONCLUSIONS Studies included in this review were often limited by small samples and lack of appropriate comparison groups, making further research in this area essential. In particular, lack of control for maternal psychiatric history and other important sociodemographic predictors of depression is a serious limitation of existing research on this topic. Further, the use of reproductive technologies and multiple births often co-occur, and few study designs enabled separation of the effects of these two variables. However, evidence of increased risk for symptoms of postpartum depression among women with multiple births, if confirmed, may warrant targeted interventions for this population.

Neonatal Abstinence Syndrome

Infants born to mothers who take opioids may have symptoms of opioid withdrawal after birth. Early detection and holistic treatment that incorporates pharmacologic and nonpharmacologic interventions can help improve outcomes for affected infants.

The impact of infant feeding method on neonatal abstinence scores of methadone-exposed infants

PURPOSE:To determine whether neonatal abstinence scores of infants exposed to methadone in utero differed by infant feeding method. DESIGN:A retrospective chart review. SUBJECTS:Twenty-eight term infants that were exposed to methadone in utero and exhibited symptoms of neonatal abstinence syndrome (NAS) prior to hospital discharge were included into the study. The sample was further divided by self-selected infant feeding method including (1) predominately breastfed (n = 8), combination fed (n = 11) or predominately formula fed (n = 9). METHODS:Data were extracted by two independent researchers from both the mothers and infants chart. This included variables such as NAS scores, NAS treatment, infant feeding method and baseline demographic information. MAIN OUTCOME MEASURES:NAS scores were assessed by Registered Nurses according to hospital protocol using a Modified Finnegan Scoring Tool. PRINCIPAL RESULTS:A non-parametric Kruskal-Wallis one way analysis of variance based on ranks revealed statistically significant differences in the number of NAS scores recorded (P = 0.001), magnitude (P < 0.0001) and area score (P = 0.04) by infant feeding method. In particular, infants who were predominantly breastfed had significantly fewer NAS scores done and lower mean scores suggesting decreased severity and duration of NAS symptoms when compared to infants who were combination fed or predominately formula fed. CONCLUSION:Breastfeeding may offer enhanced benefits for infants who have been exposed to methadone in utero. As such, in the absence of contraindications, mothers in methadone maintenance programs should be encouraged and supported to breastfeed their infants.

Evidence-Based Recommendations for Depressive Symptoms in Postpartum Women

Postpartum depression is a serious health issue affecting 13% of women from diverse cultures. Despite the well-documented consequences of postpartum depression, it remains difficult to identify, and diverse practices relate to its prevention and treatment. Evidence-based interventions are essential to improve both maternal and infant health outcomes associated with pregnancy. This article describes the development process of an evidence-based practice guideline for postpartum depression and highlights the practice recommendations related to the confirmation, prevention, and treatment of depressive symptoms in postpartum mothers.

An All-Purpose Nipple Ointment Versus Lanolin in Treating Painful Damaged Nipples in Breastfeeding Women: A Randomized Controlled Trial

BACKGROUND The negative outcomes associated with painful and damaged nipples have been widely documented in the breastfeeding literature. Numerous studies have been conducted evaluating topical preparations to treat nipple pain and damage with equivocal findings. No studies have evaluated the effectiveness of the increasingly popular all-purpose nipple ointment (APNO). The purpose of this trial is to evaluate the effect of the APNO versus lanolin on nipple pain among breastfeeding women with damaged nipples. SUBJECTS AND METHODS A double-blind, randomized controlled trial was conducted in a large single-site, tertiary-care hospital in Toronto, ON, Canada. Breastfeeding women (n=151) identified as having damage to one or both nipples were randomized to apply either APNO (intervention group) or lanolin (control group) to their nipples according to the trial protocol. The primary outcome was nipple pain at 1 week after randomization measured using the Short Form McGill Pain Questionnaire. Additional outcomes at 1 week after randomization and 12 weeks postpartum included nipple yeast symptoms and/or mastitis, rates of breastfeeding duration and exclusivity, and maternal satisfaction with infant feeding method and treatment ointment. RESULTS There were no significant group differences in mean pain scores at 1 week after randomization. Women in the lanolin group reported significantly greater satisfaction with their infant feeding method and had nonsignificantly higher breastfeeding duration and exclusivity rates at 12 weeks postpartum. CONCLUSION Results suggest that APNO is not superior to lanolin in treating painful, damaged nipples.

Breastfeeding and Aboriginal women: validation of the Breastfeeding Self-Efficacy Scale-Short Form.

The purpose of this methodological investigation, part of a prospective cohort study, was to test the reliability and validity of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among Aboriginal women.The sample comprised 130 breastfeeding Aboriginal women from the postpartum ward of an urban tertiary care hospital or a rural community hospital.The women provided baseline information while in hospital and were telephoned at 4 and 8 weeks postpartum for assessment of their method of infant feeding. The BSES-SF was found to be a valid and reliable tool for assessing breastfeeding self-efficacy among Aboriginal women. Significant differences were found in BSES-SF in-hospital scores among women who at 4 weeks postpartum were exclusively breastfeeding, combination feeding, or solely feeding formula (F(2) = 7.31, p = 0.001).The authors conclude that Aboriginal women with low breastfeeding self-efficacy in the early postpartum period may be at risk for early cessation and could benefit from additional breastfeeding support.

Randomized Controlled Trial of a Prenatal Breastfeeding Self-Efficacy Intervention in Primiparous Women in Iran

Objective: To determine the effects of a prenatal breastfeeding self‐efficacy intervention on breastfeeding self‐efficacy and breastfeeding outcomes. Design: Randomized controlled trial. Setting: Four health centers in Ahvaz, Iran. Participants: A total of 120 low‐risk, nulliparous women between 35 and 37 weeks gestation who intended to breastfeed their singleton infants. Methods: Women were randomly assigned to receive the breastfeeding self‐efficacy intervention (n = 60) or standard care (n = 60). The intervention was multifaceted and included two prenatal group sessions, an information package with breastfeeding images, and text messages until 8 weeks postpartum to promote exclusive breastfeeding. The primary outcome was breastfeeding self‐efficacy measured with the Breastfeeding Self‐Efficacy Scale–Short Form, translated into Persian, at 8 weeks postpartum. Additional outcomes included rates of breastfeeding exclusivity, duration, practices, satisfaction, and problems. Results: At 8 weeks postpartum, participants in the intervention group had significantly higher mean Breastfeeding Self‐Efficacy Scale–Short Form scores and rates of exclusive breastfeeding than those in the control group. No significant group differences were found with regard to breastfeeding duration. Conclusion: Emerging evidence supports the use of breastfeeding self‐efficacy interventions to improve breastfeeding self‐efficacy and rates of exclusive breastfeeding. Further evaluation of this prenatal intervention is warranted.