Breastfeeding After Discharge From Hospital Following Childbirth, Yes/no Clinical Trial
Official title:
Prospective Study of Maternal Prenatal Depression as a Risk Factor for Failure to Breastfeed
The purpose of this prospective cohort study is to search for a relationship between maternal depression in the third trimester, as indicated by a score of > 12 on the EPDS, and a choice not to breastfeed at all, defined as no breastfeeding after dismissal from the hospital. The investigators hypothesize that women who screen positive for prenatal depression will be significantly less likely to breastfeed their babies after discharge from the hospital following childbirth.
Introduction
Postpartum depression (PPD) is a form of major depressive disorder (MDD) and affects about
15% of mothers following birth (1). This condition is a serious medical matter, not only
because of the suffering it causes the women, but because it can negatively affect the
infant emotionally, socially, and even cognitively, sometimes far beyond the time of the
depression (2). Many physicians now routinely screen for PPD at the traditional 4-6 week
postpartum visit, and such screening has been the policy at OSU clinics for the past decade.
However, Kim et al (2008) recently reported that testing pregnant women at 24-28 weeks
gestation for depression resulted in a risk status that was identical with risk status after
delivery for 90% of patients studied (3). The author concluded that prenatal screening for
possible later PPD seemed clinically useful.
Various studies have investigated a possible relationship between PPD and failure to
breastfeed, with mixed results. Misri et al (1997) reported that 83% of their subjects with
PPD experienced onset after discontinuing breastfeeding (4). Henderson et al (2003) reported
that a study of 1,745 Australian women revealed that subjects with PPD were more likely to
stop breastfeeding than non-depressed ones (5). In addition, they found that the women
tended to wean after onset of PPD (5). However, McKee et al (2004) found no association
between PPD and beginning or duration of breastfeeding (6). Further, Hatton et al (2005)
found that although women with more depressive symptoms were less likely to breastfeed at 6
weeks postpartum than their counterparts without symptoms, this difference could not be
found at 12 weeks postpartum (7).
Here at OSU, Dr. Sarah McCoy published two studies on breastfeeding and PPD in 2006 and
2008, both of which were retrospective reviews of records (8, 9). The first one was a more
selective and smaller sample than the second, because at the time the data were collected,
PPD screening had not quite become universal. In that first study of 209 subjects, a
significant relationship was found between breastfeeding and scores above 12 on the
Edinburgh Postnatal Depression Scale (EPDS), which indicated PPD (8). However, the second
similarly-designed study of 588 subjects, which was a more representative sample of the
clinic population, failed to confirm those results (9).
To date, little if any studies have been published that deal directly with the topic of
prenatal depression and its relationship to whether a woman chooses to breastfeed after
giving birth. However, McCarter-Spaulding and Horowitz (2007) recently recommended prenatal
screening for PPD in anticipation of potential roadblocks to breastfeeding (10). If it could
be shown that women with prenatal depressive symptoms are less likely to choose
breastfeeding, perhaps early intervention could increase the number of infants that are
breastfed, which is an important public-health goal (11).
Purpose The purpose of this prospective cohort study is to search for a relationship between
maternal depression in the third trimester, as indicated by a score of > 12 on the EPDS, and
a choice not to breastfeed at all, defined as no breastfeeding after dismissal from the
hospital.
Methods The investigators plan to collect data from women that are receiving prenatal care
at the OSU Houston Parke clinic. Upon obtaining informed consent at a prenatal appointment
between 34 weeks + 0 days gestation and 37 weeks + 6 days, (should consent be deemed
necessary), the investigators will ask the subjects to fill out the same EPDS screen that
OSU obstetrics patients already typically fill out at the four-week postpartum appointment.
Filling out that scale at a prenatal appointment is the only activity that the test subjects
will be asked to do that is not already a standard part of their obstetrics' treatment. In
addition, the investigators will note these women's EPDS score at the four-week postpartum
visit and whether or not they choose to breastfeed, as well as the other information listed
under "Data Collection", most of which are already routinely recorded in the chart.
Early Termination Criteria Patient will also be terminated if they do not follow up at their
postpartum visit.
Drugs and Dosages No drugs are used in this project. Devices The only device used in this
study is the EPDS. Surgical Procedures This study does not include any surgical procedures.
Data Collection
Information recorded for the study will include:
1. Gestational age at prenatal EPDS screen
2. Prenatal EPDS score
3. Use of any antidepressants at the time of the prenatal screening
4. Use of any antidepressants after the prenatal screening
5. Age of patient
6. Whether infant was stillborn yes/no
7. Whether infant had birth defects yes/no
8. Whether infant had illness that prevented breastfeeding
9. Whether infant breastfed at all after leaving the hospital
10. Whether infant was still breastfeeding at the four-week postnatal appointment
Confidentiality Data will be de-identified after the four-week postpartum visit by
conversion to numbers. It will be recorded on an Excel spreadsheet.
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Observational Model: Cohort, Time Perspective: Prospective