Reduced Breast-feeding Linked to Postpartum Anxiety

Yael Waknine

March 05, 2013

High postpartum anxiety is linked to increased maternal healthcare use and decreased breast-feeding, particularly among new mothers, according to a study published online March 4 in Pediatrics.

Assessing 1123 women during their maternal hospital stay, Ian M. Paul, MD, from the Department of Pediatrics and the Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, and colleagues found that 192 (17.1%) women screened positive on the State Trait Anxiety Inventory (STAI ≥ 40), whereas only 62 (5.5%) had high Edinburgh Postnatal Depression Survey (EPDS) scores (≥12; P < .0001).

As might be expected, given the stressful nature of childbirth and its effect on a woman's life and responsibilities, new moms were significantly more likely to screen positive for anxiety than multiparous women (20% vs 15%; P = .02), as were those having undergone cesarean delivery (22% vs 15%; P = .001).

Anxiety was linked to a significant increase in maternal (but not infant) use of hospital-based services within the first 2 weeks of childbirth (P = .03) and to a reduction in breast-feeding duration during the first 6 months (P = .003).

"Postpartum state anxiety is...far more prevalent than depression in the first few days after childbirth. Its association with adverse maternal and child health outcomes makes it relevant for both maternal and pediatric health care providers, who have ample opportunity to screen for state anxiety and potentially intervene," the authors note.

Anxiety and Depression Weakly Correlated

For the study, investigators performed baseline interviews with 1123 mothers with "well" newborns during a 3-year period from September 2006 to August, 2009; telephone follow-ups were conducted at 2 weeks, 2 months, and 6 months.

The prevalence of positive STAI scores was highest during the postpartum stay (192/1123) and then dropped sharply by 2 weeks, when only 30 (17.7%) of the 192 women continued to screen positive. Positive STAI rates remained stable thereafter, ranging from 5.8% to 7.2%.

In contrast, the proportion of women with a positive EPDS remained unchanged from baseline to 2 weeks (5.5%), dropping to less than 3% by 2 and 6 months.

Only 42 women (3.7%) screened positive for both anxiety and depression at baseline, with this double diagnosis being more common among new mothers undergoing cesarean delivery than among those delivering vaginally (STAI, 22% vs 7% [P = .001]; EPDS, 7% vs 5% [P = .07]).

Although moms positive for depression at baseline were more likely to have unplanned outpatient visits during the first 2 weeks (P = .009), the investigators observed only a marginal decrease in breast-feeding duration (P = .06), with the exception of first-time mothers (P < .001) and those delivering via cesarean delivery (P = .03).

"[A]lthough state anxiety and depression screening scores are moderately correlated [correlation coefficient, 0.53; 95% confidence interval, 0.49 - 0.57], in most instances the 2 conditions affect different women with very few having positive screens for both," the authors write, noting that the disparity could help clinicians target their screening procedures.

The study is limited by lack of data on causality, use of a single medical center, lack of information on preexisting anxiety and depression, and the exclusion of women who planned to formula-feed their infants.

This study was supported by the Maternal Child Health Bureau and the Children’s Miracle Network. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online March 4, 2013. Abstract