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The effect of maternal mood on breastfeeding initiation and exclusivity is not clear. Gagliardi et al1 showed that even low levels of depressive symptoms detected by the Edinburgh Postnatal Depression Scale are negatively associated with breastfeeding. This prompted us to look at our data in Mother–Infant Care Study.2 3 In this comprehensive study, mothers voluntarily enrolled within 3 days post partum between July and October 2006 and followed. In the first interview, 577 mothers completed a questionnaire including maternal, gestational and neonatal characteristics, breastfeeding initiation time and the Brief Symptom Inventory (BSI). Of these women, 298 mothers were available at 4–6 weeks post partum for a telephone interview and were questioned about the feeding method of their infants at that time.
In the first study, we investigated the effect of some maternal, gestational and neonatal features (including maternal age, mother's educational level, mother's employment status, family structure, monthly income of the family, number of parity, interval since previous birth, parental harmony, planned pregnancy, maternal smoking or illness during pregnancy, maternal psychological problems within the year, the level of postpartum maternal haemoglobin, gestational age, birth weight and type of birth) on the initiation time of breastfeeding.3 The most important factors, which were associated with breastfeeding within the first 2 h, were determined to be maternal illnesses during pregnancy, maternal anaemia at delivery, caesarean section deliveries and premature births.3 When we analysed the interaction between BSI and breastfeeding initiation time, we detected that mothers who initiated breastfeeding within the first 2 h after delivery had lower positive symptom distress index of BSI than those who initiate later; however, other BSI subscales and indexes including depression were similar (unpublished data, table 1). Interestingly, mothers having any illness during pregnancy period also had high indexes of BSI. Therefore, Safe Motherhood Programmes,4 performing antenatal care effectively to prevent and treat appropriately maternal anaemia and infections and to decrease caesarean section deliveries and premature births, will contribute to early breastfeeding initiation.
The frequency of exclusive breastfeeding was 64.2% at 4–6 weeks post partum.2 Maternal age, education level, maternal illness/anaemia during pregnancy, maternal psychological problems within the last year, birth interval, newborn gender, gestational age, birth weight and delivery method did not influence exclusive breastfeeding during this period. Multivariate logistic regression analysis revealed that higher family income, maternal employment, planned pregnancy, excessive infantile crying, health problems during the first 3 days of life and breastfeeding problems had negative correlations with exclusive breastfeeding between 4 and 6 weeks post partum. However, exclusively and partially breastfed infants had similar maternal scores of BSI subscales and indexes.2 We suppose that some sociodemographic characteristics of the family, health problems of infants and infantile colic might influence exclusive breastfeeding. These problems could be managed by the ‘WHO/UNICEF Baby-Friendly Hospital Initiative’.5 Also, in another study, we showed that maternal participation in a lactation counselling programme increases family support from their husbands, mothers-in-law and sisters which might decrease maternal mental health problems.6
Based on our experiences, all maternal, gestational and neonatal features might be taken into consideration when dealing with breastfeeding, and Programmes of Safe Motherhood and Baby-Friendly Hospital Initiative should be properly implemented.
Competing interests None.
Ethics approval This study was conducted with the approval of the Ethical Committee of the Faculty of Medicine, Hacettepe University (TBK07/07).
Provenance and peer review Not commissioned; externally peer reviewed.
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