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. 2025 Apr 11;25(1):1366.
doi: 10.1186/s12889-025-22672-w.

Association between infant feeding practices, COVID-19 related cognitive factors, and postpartum depression during the COVID-19 pandemic: a cross-sectional online study in Thailand

Wichukorn Suriyawongpaisal  1 , Punpawee Kittikul  2 , Eun Young Lee  3 , Li-Yin Chien  4 , Yan-Shing Chang  5 , Kelly Pereira Coca  6 , Doungjai Buntup  7 , Seo Ah Hong  8
Affiliations

Association between infant feeding practices, COVID-19 related cognitive factors, and postpartum depression during the COVID-19 pandemic: a cross-sectional online study in Thailand

Wichukorn Suriyawongpaisal et al. BMC Public Health. .

Abstract

Background: Maternal beliefs towards COVID-19 vaccine safety may be associated with infant feeding practice and postpartum depression (PPD). Since there is a paucity of studies, this study aims to identify associations of COVID-19-related cognitive factors (e.g., COVID-19-vaccination-related belief and COVID-19-related knowledge and attitude) with infant feeding practices and their associations with PPD during the COVID-19 pandemic in Thai postpartum mothers.

Methods: A cross-sectional online survey was conducted among 840 postpartum mothers whose infants were less than or equal to 6 months old. Mothers with a score ≥ 13 using the Edinburgh Postnatal Depression Scale (EPDS) were considered to have PPD. Student t-tests were used to measure the association between infant feeding practices and COVID-19-related cognitive factors, and Chi-square tests were used to assess their associations with PPD. Significant variables (p < 0.05) from the chi-square test were included in the logistic regression analysis. Multivariable logistic regression analyses were performed to identify factors associated with PPD. The associations were reported in adjusted odds ratio at 95% confidence interval.

Results: This study showed one-third of the participants (32.4%) were at risk of having PPD. Mothers who fed expressed breastmilk had positive beliefs towards COVID-19 vaccination and higher scores on COVID-19 knowledge and attitude, while mothers who fed infant formula or solid, semi-solid, or soft food had negative beliefs towards the vaccination compared to their counterparts. Multivariable logistic regression showed women who fed their infant with solid, semi-solid, and soft foods (AOR = 3.28; 95% CI = 1.35-10.92) had significantly higher odds of PPD. Among COVID-19-related cognitive factors, negative or moderate COVID-19-related attitudes were associated with higher odds of PPD (1.91; 1.19-3.07 and 1.85; 1.20-2.86, respectively). Socio-demographic factors associated with PPD included living in urban areas, residing outside the Southern region, having food insecurity during the pandemic, having unintended pregnancy, and having health problems during the perinatal period.

Conclusions: The association of COVID-19-related cognitive factors and feeding practices with PPD may suggest that proper education on prevention, control, and vaccination of emerging infectious diseases such as COVID-19, as well as support for appropriate infant feeding practices, should be provided to postpartum mothers, which ultimately contributes to improving their mental health.

Keywords: COVID-19 knowledge and attitude; COVID-19 vaccination; Infant feeding practices; Postpartum depression; Postpartum mothers.

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Conflict of interest statement

Declarations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Conflict of interest: The authors declared no conflict of interests. Ethical approval and informed consent: An ethical committee at Mahidol University in Thailand approved the study protocol (No.: 2021/03–042). The study was in accordance with relevant institutional guidelines in accordance with the declaration of Helsinki. All participants provided an online informed consent prior to survey initiation after explanation of the study objectives, assurance of the confidentiality of their identity and assurance that choosing not to participate would not disadvantage them in any way.

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References

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