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The Role of Postpartum Depressive Symptoms and Health Literacy In Breastfeeding Practices

Monday, October 22, 2012: 1:00 PM
Room 346-347 (Morial Convention Center)
Yaray Agosto1, Lee Sanders, MD, MPH2, Lucila Bloise, BA3, Lourdes Q. Forster, MD, FAAP3, Vanessa Elliot, PhD4, Russell Rothman, MD, MPP5, Eliana Perrin, MD, MPH6, H. Shonna Yin, MD, MS7, Svetlana Eden, MS8, Ayumi Shintani, PhD, MPH9 and Anna Maria Patino-Fernandez, PhD3, (1)College of Arts and Sciences, University of Miami, Coral Gables, FL, (2)Department of Pediatrics, Stanford University, Stanford, CA, (3)Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, (4)Family and Community Medicine, Meharry Medical College, Nashville, TN, (5)Department of Pediatrics, Vanderbilt University, Nashville, TN, (6)Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, (7)Department of Pediatrics, NYU School of Medicine / Bellevue Hospital Center, New York, NY, (8)Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, (9)Department of Biostatistics, Vanderbilt University, Nashville, TN

Purpose The CDC’s Healthy People 2020 has prioritized two postpartum outcomes: breastfeeding promotion and early screening and treatment of depression. Reviews have identified low health literacy (HL), which affects at least 1 in 4 women, as an independent risk factor for non-breastfeeding and depressive symptoms (Sanders 2009; Kaufman 2001). Postpartum depressive symptoms may be linked to low breastfeeding initiation rates, short breastfeeding duration, and greater breastfeeding difficulties (Dennis & McQueen, 2009). Little is known about the interaction of demographic and psychosocial factors that affect breastfeeding initiation and early termination of breastfeeding, including the role of HL. The aim of this study was to determine the relationships among postpartum depressive symptoms, HLand breastfeeding practices in mothers of newborn infants.

Methods 689 mothers (M age = 27 years) of diverse racial backgrounds (26% White, 28% Black, and 46% Other; 49% of the sample was Hispanic) participated in a cluster randomized early obesity prevention trial involving pediatric resident clinics at four universitiesTwenty seven percent of mothers reported an annual household income of < $20, 000. Mothers were recruited during their infant’s 2 month well child clinic visit and reported otheir infant's nutrition at 2 months to examine breastfeeding practices and completed the CES-D to assess depressive symptoms postpartumMothers also provided demographic information and completed questionnaires assessing health literacy (STOFHLA), maternal self-efficacy, and social support. The association of breastfeeding practices (exclusively breastfeeding vs. breastfeeding and/or bottle feeding) and depression score were studied by using logistic regressions and adjusting for a priori defined covariates: caregiver’s age, race (White, Black, Other), ethnicity, income, work status, WIC status, and parity.

Results In this sample there was no statistically significant association between depressive symptoms and breastfeeding practices. However, higher health literacy was associated with higher odds of exclusively breastfeeding (OR=1.42, 95%CI (1.01, 2.00)), and lower levels of social support was associated with increased odds of exclusively breastfeeding (OR=1.90, 95%CI (1.16, 3.13)). In addition, caregivers who identified themselves as White (vs. Black OR=3.09, 95%CI (1.54, 6.21)) or Other (vs. Black OR=2.72, 95%CI (1.24, 5.99)) had higher odds of breastfeeding exclusively. Caretakers who were looking for work, or worked part/full time had lower odds of exclusively breastfeeding. The analysis showed no evidence that age, ethnicity, or parity were associated with breastfeeding practices.

Conclusions For this sample of diverse women at risk for poor health outcomes, maternal HL was the most critical modifiable factor associated with supporting breastfeeding. Improving the HL of expectant mothers or adapting breastfeeding-related materials to those with low literacy could contribute to higher likelihood of initiation and continuation of breastfeeding in the first few months of a newborn’s life. Addressing cultural perceptions and attitudes toward breastfeeding will likely also be important.