Associations between postpartum depressive symptom trajectories and breastfeeding patterns: Results from the MILQ-Brazil study.

OBJECTIVE To investigate the association between postpartum depression (PPD) symptom trajectories and breastfeeding patterns (BFP) between 1-8.5 months.

METHODS A prospective cohort study with 97 healthy mother-infant pairs from Brazil was followed at 1-3.49, 3.5-5.9, and 6-8.5 months. PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). BFP patterns were characterized using longitudinal clusters based on milk volume (dose-to-mother technique), feeding frequency/duration, and age at complementary food introduction (CFI). PPD trajectories were identified using growth mixture modeling, and classes were selected based on AIC/BIC. Multinomial logistic regression assessed associations with BFP.

RESULTS Two PPD symptom trajectories were identified. The "Lower Score" (87%) indicated PPD stability throughout follow-up, while the "Higher Score" (12%) showed more transitions, mainly to PPD remission in later stages. Three breastfeeding clusters (C) were identified. C1 with moderate volume/frequency with later CFI (n=37; 38%); C2 with lower volume/frequency with intermediate CFI (n=34; 35%); and C3 with higher volume/frequency with earlier CFI (n=26; 27%). Women with higher PPD symptoms showed a trend toward significance in being associated with C3 (OR=4.17; 95%CI: 0.96-18.50; p=0.055) compared with C1.

CONCLUSIONS Although the association between higher PPD symptoms and less favorable breastfeeding practices presented only a trend toward significance, it suggests that PPD symptoms may influence breastfeeding behaviors. Larger samples are needed to confirm these findings, and the use of diagnostic tools other than EPDS, a screening tool, may strengthen future studies. Clinically, the findings underscore the need for early PPD screening in primary care and stronger breastfeeding support.