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The effect of treatments for postpartum depression on breastfeeding practices: a systematic review and meta-analysis
Shuyuan Shen1, Bohan Wang1, Yiwei Zhao1
1Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macao.
Background:
Breast milk provides unique health benefits for infants, mothers and supports mother-infant bonding. Postpartum depression (PPD) is prevalent, affecting up to 25% of mothers. Mothers with PPD are less likely to breastfeed than mothers without PPD. Despite the evidence for effective therapies to address depressive symptoms, the impact of these treatments on breastfeeding practices remains unclear. Therefore, this study aimed to evaluate the evidence on the effects of treatments for PPD on breastfeeding practices.
Methods:
This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Inclusion criteria were: randomised controlled trials (RCTs) and observational studies involving individuals with PPD that examined interventions for PPD and reported breastfeeding practices. Databases searched included MEDLINE, Web of Science, ProQuest Nursing & Allied Health, PsycINFO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews (CDSR) from inception to February 28, 2025. The risk of bias was assessed using the Cochrane Risk of Bias tools.
Results:
Thirteen studies (9 RCTs and 4 cohort studies) were included that evaluated 9 different interventions. In the meta-analysis, cognitive behavioural therapy (CBT) resulted in a significantly higher exclusive breastfeeding rate compared to usual care controls (RR=1.54, 95% CI 1.06-2.22). In a combined meta-analysis of all intervention types, psychological education programmes aimed at promoting breastfeeding, esketamine, mental health education, and problem-solving therapy showed a non-significant pooled effect on the exclusive breastfeeding rate (pooled RR=1.13, 95% CI 0.96-1.32, I²=29.2%). Meta-analyses of RCTs evaluating mental health education and crocin showed a non-significant reduction in lactation insufficiency (pooled RR=0.81, 95% CI 0.65-1.01, I²=0%); and a non-significant difference in unsuccessful breastfeeding experience (pooled RR=0.63, 95% CI 0.34-1.16, I²=0%).
Conclusions:
Cognitive behavioural therapy may improve breastfeeding practices compared to usual care; however, the current evidence on the effects of all PPD treatments on breastfeeding practices remains limited. Further research on PPD treatments and breastfeeding is needed to identify interventions that can promote breastfeeding among this vulnerable population.
