Breastfeeding in Women with Postpartum Depression: A Systematic Review and Meta-Analysis

Postpartum depression has been associated with difficulties in initiating and sustaining breastfeeding. While several observational studies have explored this relationship, their findings remain inconsistent, and comprehensive meta-analyses are limited. This study aimed to evaluate breastfeeding practices among women experiencing postpartum depression.

A systematic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, covering publications from inception through April 2023. Databases searched included MEDLINE via PubMed, Scopus, Web of Science, and Google Scholar. Search terms included both medical subject headings and relevant keywords: "Breast Feeding," "Breast Milk Expression," "Exclusive Breastfeeding," "Breastfeeding," "Postnatal Depression," "Postpartum Depression," "Puerperal Depression," "Lactation," "Human Milk," and "Breast Milk." Only studies utilizing the Edinburgh Postnatal Depression Scale (EPDS) were included. The quality of the included studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

Of the 1,514 articles screened, nine met the eligibility criteria. The findings indicate that women with postpartum depression had significantly higher odds of practicing nonexclusive breastfeeding compared to those without depression (OR = 2.25; 95% CI: 1.46-3.45; P < .001). A subgroup analysis of studies using an EPDS cut-off score of ≥12 revealed that non-exclusive breastfeeding was 71% more likely among women with depressive symptoms (OR = 1.71; 95% CI: 1.40-2.08).

Postpartum depressive symptoms are significantly associated with an increased risk of discontinuing exclusive breastfeeding. These findings underscore the importance of integrating mental health screening and breastfeeding support into routine postpartum care to identify at-risk women and implement timely interventions that can enhance both maternal and neonatal outcomes.