Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 17;16(5):e0251419.
doi: 10.1371/journal.pone.0251419. eCollection 2021.

Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support

Md Jahirul Islam  1   2 , Lisa Broidy  1   3 , Kathleen Baird  4 , Mosiur Rahman  5 , Khondker Mohammad Zobair  6
Affiliations

Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support

Md Jahirul Islam et al. PLoS One. .

Abstract

Background: Early termination of exclusive breastfeeding (EBF) and postpartum depression (PPD) are both recognized as global health problems. Recent literature reviews demonstrate a notable link between PPD and breastfeeding outcomes, however, the underlying mechanisms linking the two remain unclear.

Objectives: The aim of the study is to: 1) explore the comparative risk for PPD among new mothers who terminated EBF before the 6-month mark, compared to those who did not; and 2) test whether maternal stress and social support operate to mediate and/or moderate the relationship between EBF and PPD.

Methods: Between October 2015 and January 2016, a cross-sectional study was carried out among 426 new mothers of Bangladesh who were six months postpartum.

Results: Based on the multivariate logistic regression model, non-exclusively breastfeeding mothers were 7.58-fold more likely to experience PPD (95% CI [3.94, 14.59]) than exclusively breastfeeding mothers. Additionally, maternal stress and social support not only partially mediate the relationship between EBF and PPD but also substantially moderate this relationship. Specifically, the odds of PPD are significantly higher among mothers who had early EBF interruption in conjunction with increased stress levels and limited social support.

Conclusions: Current evidence suggests that concurrent screening for EBF difficulties and maternal stress are important red flags that might hint at complications even before mother's screen positive for PPD. Support and care from family members can provide assistance in overcoming this issue.

PubMed Disclaimer

Conflict of interest statement

NO authors have competing interests.

Figures

Fig 1
Fig 1. Frequency distribution of different feeding practices and the incidence of corresponding postpartum depression rate among postpartum women in Bangladesh (N = 426).
Fig 2
Fig 2. Rates of exclusive breastfeeding and PPD by maternal postpartum age.
Fig 3
Fig 3. Combined effect of EBF and maternal perceived stress on postpartum depression.
Controlling for maternal age, maternal education, place of residence, family monthly income, parity, pregnancy intention, obstetrical complications, mode of childbirth, social support, childhood sexual abuse, and previous depressive symptoms; Here *p < 0.001, **p < 0.01; MS = Maternal stress; EBF = Exclusive breastfeeding.
Fig 4
Fig 4. Combined effect of EBF and social support on postpartum depression.
Controlling for maternal age, maternal education, place of residence, family monthly income, parity, pregnancy intention, obstetric complications, mode of childbirth, childhood sexual abuse, previous depressive Symptoms and maternal stress; Here *p< 0.001; SS = Social Support, EBF = Exclusive Breastfeeding.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. O’hara MW, McCabe JE. Postpartum depression: current status and future directions. Annual Review of Clinical Psychology. 2013;9:379–407. 10.1146/annurev-clinpsy-050212-185612 - DOI - PubMed
    1. Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. The Lancet Psychiatry. 2016;3(10):973–82. 10.1016/S2215-0366(16)30284-X - DOI - PMC - PubMed
    1. Craig M, Howard L. Postnatal depression. Clinical Evidence (Online) 2009;1407. - PMC - PubMed
    1. Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al.. Effects of perinatal mental disorders on the fetus and child. The Lancet. 2014;384(9956):1800–19. 10.1016/S0140-6736(14)61277-0 - DOI - PubMed
    1. Milgrom J, Ericksen J, McCarthy R, Gemmill AW. Stressful impact of depression on early mother–infant relations. Stress and health. 2006;22(4):229–38.