Breastfeeding associated with improved maternal mental health outcomes

By Dr. Sanchari Sinha Dutta, Ph.D.May 10 2022Reviewed by Danielle Ellis, B.Sc.

Scientists from the University of Massachusetts, USA, have recently found that breastfeeding is associated with improved maternal mental health overall. However, difficulties experienced during breastfeeding, or a mismatch between feeding expectation and reality, can negatively impact the mental health outcomes of mothers. The review has recently been published in the Journal of Women’s Health.

Background

Breastfeeding is known to have a positive impact on the health of infants. It helps improve the immune system, reduce the risk of pediatric cancer and metabolic disorders, improve cognitive development, and prevent sudden infant death syndrome. According to the World Health Organization (WHO) recommendations, an infant should be breastfed at least up to 6 months after birth.

In addition to creating bonding between mother and newborn, breastfeeding can positively impact the health of mothers as well. It helps post-pregnancy weight loss, protects against diabetes, hypertension, and cardiovascular diseases, and reduces the risk of breast and ovarian cancers.

Despite knowing the benefits of breastfeeding, some mothers could not do so for many reasons. The most common reasons are lack of milk supply, pain sensation during breastfeeding, insufficient latching, and employment needs/obligations. The inability to breastfeed may induce guilt and stress in mothers, which may negatively impact their mental health.

In the current study, the scientists have analyzed the existing literature on breastfeeding and maternal mental health, intending to determine breastfeeding-related mental health outcomes in mothers within one year of delivery.

Study design

They initially collected 1,110 articles from different electronic databases. After extensive screening, they selected a total of 55 articles for the final analysis. The selected studies were from 25 different countries, with sample sizes ranging from 29 participants to more than 180,000 participants.   

Impact of breastfeeding on maternal mental health

A significant association between breastfeeding and mental health was reported by 36 studies; of which 29 stated that breastfeeding is associated with fewer mental health symptoms, one stated an association with increased mental health problems, and 6 stated a mixed association with mental health problems.

Regarding post-pregnancy depression, 34 out of 52 studies had found a significant association with breastfeeding. A large-cohort study conducted on 186,452 participants reported that breastfeeding is not associated with postpartum depression. A considerable number of studies reported a significant association of breastfeeding with reduced postpartum depression.

Regarding post-pregnancy anxiety, four studies have reported that breastfeeding reduces the risk of anxiety and related hospitalization. Regarding other mental health conditions, the large-cohort study had found no significant association between breastfeeding and risk of hospitalization due to adjustment disorder or personality disorder.

However, the study had stated that mothers who do not breastfeed have a higher risk of hospitalization within one year of delivery due to bipolar disorder or schizophrenia. One study reported that exclusive breastfeeding reduces the risk of post-traumatic stress disorder.

Breastfeeding challenges

A total of eight studies reported that post-pregnancy mental health outcomes are associated with breastfeeding difficulties, including lack of milk supply, latching problems, breast infection or pain, and negative emotions during feeding. Similarly, five studies have reported that mothers with physical or other challenges to breastfeeding have a higher risk of mental disorders, including depression and post-traumatic stress disorder.

Regarding breastfeeding self-efficacy, four studies have reported that fear or dissatisfaction about breastfeeding is significantly associated with a higher risk of depression. Mothers with higher self-efficacy had higher breastfeeding duration (more than six months after delivery).

Studies investigating the combined impact of breastfeeding difficulties and self-efficacy have reported that mothers with higher self-efficacy and fewer difficulties are more likely to continue exclusive breastfeeding for more than six months after delivery. In general, breastfeeding difficulties were found to increase the risk of depression independently.

Study significance

The study highlights that breastfeeding, in general, improves the mental health conditions of mothers. However, mothers with breastfeeding difficulties or dissatisfaction are at higher risk of negative mental health outcomes. Personalized breastfeeding counseling by clinicians may help reduce the risk of developing mental health problems.