Depression is a direct threat to breastfeeding. Does breastfeeding protect women s mental health? 4/11/2018

Transcription

1 Does Breastfeeding Protect Maternal Mental Health? The Role of Oxytocin and Stress Does breastfeeding protect women s mental health? Kathleen Kendall-Tackett, PhD, IBCLC, FAPA Breastfeeding women are less likely to be depressed Are breastfeeding mothers just healthier to begin with? Depression is a direct threat to breastfeeding

2 Stress/oxytocin system Birth interventions Sleep What does breastfeeding mean? Exclusivity is key The Stress/Oxytocin System Paraventricular Nucleus IL-β IL-6 TNF-α 2

3 Breastfeeding protects maternal mood Prospective studies Non-depressed mothers to start, compare by feeding method Physiological changes Inflammation HPA axis Regulation of sleep Prospective study of 2,072 mothers weeks gestation to 3 months postpartum, Sabah, Malaysia Significantly lower EPDS scores at 3 months postpartum for exclusively breastfeeding mothers after controlling for covariates Yusuff et al. 206, J Hum Lact, 32(2),

4 Women breastfeeding at 3 months, significantly lower depression at 24 months Hahn-Holbrook et al. 203, Arch Women s Ment Health, 6, Prospective study, N=205, assessed 5 times during pregnancy, 3,6,2, & 24 months postpartum Mothers who breastfed 9 times/day were less depressed than mothers who breastfed 4 times/day If depressed during pregnancy, mothers are less likely to breastfeed Depressed mothers weaned 2.3 months earlier Hahn-Holbrook et al. 203, Arch Women s Ment Health, 6, Shortterm lessening of the stress response Response to induced stressor ACTH Cortisol Baby at the Breast Lowers Mothers Stress 63 primips, 2 days postpartum Breastfeeding lowered ACTH and cortisol Skin-to-skin contact contributed to this effect ACTH negatively correlated with suckling Longer skin to skin lowered cortisol Oxytocin lowered ACTH and cortisol Heinrichs et al. 200, J Clin Endo Metabol, 86, Handlin et al., 2009,Breastfeeding Med, 4(4), Hypertension Diabetes CVD Lifetime Protection For Mothers High Triglycerides What if there s pain or other problems? 39, 68 postmenopausal women (Mean age=63) Schwartz et al. 2009, Obstet Gyn, 3,

5 Following elective cesarean 25%-28% depression 30%-37% anxiety Depression and Birth Interventions Kuo et al., 204, PLoS ONE, 9, e Depression by Birth Type Contrary to hypothesis, for women with history of depression or anxiety, peripartum oxytocin increased the risk of postpartum depression or anxiety by 36% Among those with no history, oxytocin increased the risk by 32% Retrospective study of peripartum synthetic oxytocin use, populationbased data, n=9,684 exposed, n=37,048 unexposed Kendall-Tackett et al. 205, Clin Lact, 6(3), Kroll-Desrosiers et al. 207, Depress Anxiety, 34(2), Epidurals 24 mothers from China 5 depressed with epidural 37 depressed without epidural Impact of Epidural on PPD Yes No Ding et al., 204, Anesthes Analges, 9, Kendall-Tackett et al. 205, Clin Lact, 6(3), 87 5

6 Controlled for All other birth interventions Primip v multip Number of hours in labor Income Education History of depression History of sexual assault Current anxiety Current anger/irritability Interventions still related to depression Postpartum hemorrhage Postpartum surgery Epidurals Kendall-Tackett et al. 205, Clin Lact, 6(3), Increase oxytocin Skin-to-skin contact Touch Positive social interaction Feelings of safety Warmth Mother-infant sleep 6

7 Hours Mothers Sleep N=6,40, Survey of Mothers Sleep and Fatigue 6.3 Breastfeeding Mixed Formula Mothers Daily Energy N=6,40, Survey of Mothers Sleep and Fatigue 2.79 Breastfeeding Mixed Formula Kendall-Tackett et al. 20, Clin Lactation, 2(2), Mothers Depression.5 N=6,40, Survey of Mothers Sleep and Fatigue 0.5 Breastfeeding Mixed Formula What About Trauma Survivors? Kendall-Tackett et al. 20, Clin Lactation, 2(2), Percentage who are Breastfeeding No Sexual Assault Sexual Assault N=6,40, 994 sexual assault survivors N=6,40, 994 sexual assault survivors Current Depression No Sexual Assault. Sexual Assault Kendall-Tackett et al., 203, Breastfeed Med, 8(), 6-22 Kendall-Tackett et al., 203, Breastfeed Med, 8(),

8 Hours Mothers Sleep Breastfeeding Mixed/Formula Minutes to Get to Sleep Breastfeeding Mixed-/Formula No assault Sexual assault 8 No assault Sexual assault Kendall-Tackett et al., 203, Breastfeed Med, 8(), 6-22 Kendall-Tackett et al., 203, Breastfeed Med, 8(), No Assault Depression Sexual Assault Breastfeeding Mixed/Formula Angry or Irritable No Assault Sexual Assault Breastfeeding Mixed/Formula Kendall-Tackett et al., 203, Breastfeed Med, 8(), 6-22 Kendall-Tackett et al., 203, Breastfeed Med, 8(), 6-22 Increase oxytocin Skin-to-skin contact Touch Positive social interaction Feelings of safety Warmth 8

9 What can we conclude? Breastfeeding protects maternal mood Best protection is from for exclusive breastfeeding Breastfeeding problems can cause depression Apparent contradictions in data disappear when we understand the underlying physiology Birth interventions impact both breastfeeding and maternal mental health Depressed mothers can breastfeed Don t give up on mothers, even when they have risk factors Increase oxytocin! 9

10 Praeclarus Press.com NEW edition of Depression in New Mothers, from Routledge Find Me on Social Media Kathleen Kendall-Tackett Kathy Kathleen Kendall-Tackett 0