Exploring the Relationship between Co-Sleeping, Maternal Mental Health and Expression of Complaints during Infancy, and Breastfeeding.

BACKGROUND: This study explores whether the implementation of co-sleeping in infants aged 6-12 months (a) is associated with maternal complaints and mothers' difficulties regarding their infant's sleep, (b) is associated with maternal mental health, (c) affects infant sleep characteristics and maternal sleep quality, and (d) is associated with breastfeeding. METHODS: This study is a cross-sectional study conducted from July to November 2021. A total of 151 new mothers of infants aged 6-12 months participated. All participants were divided into two different groups, the group of mothers who adopted the co-sleeping method from birth up to the time of the survey and the group of those who did not adopt co-sleeping at that time. The Brief Infant Sleep Questionnaire-Revised Short Form (BISQ-R SF), the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), and a questionnaire on mothers' demographics were administered. RESULTS: Regarding the mothers' complaints, mothers who co-sleep with their children have lower sleep quality than those who do not co-sleep. In respect of the mothers' mental health, there did not seem to be a statistically significant difference in the two groups. Regarding the difficulties during the sleep process, children who sleep with their parents seem to have more difficulties compared to the others (p = 0.008). It was also shown that co-sleeping children seem to have more disturbed sleep compared to those who sleep alone (p = 0.018), and a general trend obtained of a significantly higher number of awakenings for co-sleeping children (p < 0.001). Finally, breastfeeding appeared to be more related to the children of the present sample sleeping with their parents (p < 0.001). CONCLUSIONS: This study showed that co-sleeping is associated with more difficulties in infant and maternal sleep, but no direct correlation with maternal mental health was found. In addition, it showed a positive correlation of co-sleeping with breastfeeding.

The Effect of Antenatal Education on Expectant Fathers' Attitudes toward Breastfeeding and Attachment to the Fetus.

BACKGROUND: This study explores the effect of antenatal education on fathers' attitudes toward: (i) breastfeeding and (ii) attachment to the fetus. A secondary aim is to explore the relationship of fathers' demographic and the psycho-emotional characteristics that come with breastfeeding and attachment. METHODS: This is a longitudinal study involving a group of 216 Greek expectant fathers who participated with their partners in an antenatal educational program performed by midwives in Athens, Greece (September 2020-November 2021). The Iowa Infant Feeding Attitudes Scale (IIFAS) and Paternal Antenatal Attachment Scale (PAAS) were administered at two time points: (a) 24th-28th gestation week and (b) 34th-38th gestation week. The T-test and Univariate Analyses of Variance (ANOVA) were performed. RESULTS: The expectant fathers' scores show that breastfeeding intention/exclusivity and prenatal attachment to the fetus were higher after their participation in the antenatal education program, but the difference was not statistically insignificant. Expectant fathers with a cohabitation agreement (p = 0.026), who felt very much supported by their partners (p = 0.001) and had no relationship difficulties with their partners (p < 0.001), as well as those who reported being very happy during pregnancy (p < 0.001), showed greater paternal antenatal attachment to the fetus. CONCLUSIONS: Although the difference was statistically insignificant, antenatal education appears to have an impact on paternal breastfeeding attitudes and antenatal attachment to the fetus. Additionally, several paternal characteristics were associated with greater antenatal attachment. Future research should be directed toward the investigation of additional factors that impact antenatal-paternal attachment and breastfeeding attitudes so that effective education programs can be designed.

The Association of Breastfeeding Difficulties at the 6th week Postpartum with Maternal Psychological Well-being and Other Perinatal Factors: a Greek Retrospective Longitudinal Study.

BACKGROUND: The difficulties a woman faces with breastfeeding are among the factors that can lead to its early cessation. OBJECTIVE: The aim of this study was to investigate whether the presence of maternal breastfeeding difficulties at the 6th week postpartum is associated either with maternal psychological well-being and the presence of a mental health disorder in the perinatal period or with other perinatal factors. METHODS: This study was conducted at a primary mental health facility in Athens (Greece), the "Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders)". It is a retrospective longitudinal study, examining a sample of 622 women who used the Day Center's services from January 2015 to May 2018. Statistical analyses included the Spearman rank correlation coefficients and multiple univariate analyses of variance. RESULTS: Increased scores on psychometric tools (EPDS, PHQ-9) during pregnancy or postpartum are associated with increased maternal breastfeeding difficulties at the 6th week postpartum. Other factors such as an unplanned conception (p=.016), maternal dissatisfaction with labor (p=.038) and formula feeding in the hospital (p<.001) or at the end of the 1st month postpartum (p<.001) are associated with the occurrence of breastfeeding difficulties. Also, the mothers who experienced lactation mastitis (p=.009), had sleep difficulties (p=.013), woke up fatigued (p<.001) during the first 6 weeks postpartum, and the mothers whose infants experienced colic (p=.009) were more likely to complain about breastfeeding difficulties at the 6th week postpartum. CONCLUSION: This study demonstrates a relationship between increased scores on maternal psychometric tools in the perinatal period and other perinatal factors with increased breastfeeding difficulties at the 6th weeks postpartum.

Do Maternal Stress and Depressive Symptoms in Perinatal Period Predict the Lactation Mastitis Occurrence? A Retrospective Longitudinal Study in Greek Women.

BACKGROUND: The aim of this study is to investigate whether symptoms of anxiety and depression disorders in women during the perinatal period predict the occurrence of lactation mastitis. METHODS: This is a retrospective longitudinal study of 622 Greek women who were monitored from pregnancy until the first year postpartum (during the period January 2015-May 2018). The Edinburgh Postnatal Depression Scale (EPDS) and the Perinatal Anxiety Screening Scale (PASS) were administered at four time points: (a) 24th-28th gestation week, (b) 34th-38th gestation week, (c) 6 weeks postpartum, and (d) 12 months postpartum. Multivariate binary logistic regression analyses were performed. RESULTS: Results showed that (a) increased EPDS (p < 0.02) and PASS (p < 0.05) scores during the last period before birth, (b) increased EPDS score at 6 weeks postpartum (p < 0.02), (c) PMS symptoms (p < 0.03), (d) traumatic life events during the last year (p < 0.03), and (e) the existence of a history of psychotherapy (before pregnancy) (p = 0.050) appear to be the psycho-emotional factors that can predict the possible occurrence of lactation mastitis in a breastfeeding mother. CONCLUSIONS: The association between women's poor mental health and the occurrence of a physical health problem, such as lactation mastitis, is recognized. This study highlights the important role of early and timely detection of perinatal mental health disorders.

Infant Sleep Difficulties at the 6th Week and the 12th Month Postpartum: What Is their Relationship with Maternal Mental Health and Other Perinatal Factors?

INTRODUCTION: Infant sleep difficulties are often a challenge for new parents and may be related to maternal mood. AIM: The aim of this study was to investigate whether the presence of reported infant sleep difficulties at the 6th week and at the 12th month postpartum is associated with maternal psychological well-being and the presence of a mental health disorder in the perinatal period or with other perinatal factors. METHODS: It is a retrospective longitudinal study, examining a sample of 622 women who attended a 12-month innovative psychosocial intervention. Data were obtained through the EPDS and PHQ-9 psychometric tools, and the completion of a health history. Statistical analyses included Spearman rank correlation coefficients and Chi-square tests. RESULTS: Reported infant sleep difficulties at the 6th week postpartum were associated with a) increased maternal scores on psychometric tools (EPDS and PHQ-9) during pregnancy and at the 6th week postpartum, b) the presence of pathological maternal mental health symptoms in the perinatal period (p =.034), c) high maternal educational level (p <.001), and d) reported maternal breastfeeding difficulties at the 6th week postpartum (p =.031). Reported infant sleep difficulties at the 12th month postpartum were associated with a) increased maternal scores on the EPDS at the 6th week after birth (p =.030), and at the 6th (p =.031) and the 12th month (p =.006) postpartum, b) reported infant sleep difficulties (p <.001) and frequent infant awakenings in the puperperium (p <.001), d) maternal fatigue at the 6th week postpartum (p <.001), e) infant gastro-esophageal reflux problems (p <.001), and f) high maternal educational level (p =.001). CONCLUSIONS: This study demonstrates a positive relationship between infant sleep difficulties at the 6th week and at the 12th months postpartum, with poor maternal mental health in the perinatal period.

Women's Mental Health as a Factor Associated with Exclusive Breastfeeding and Breastfeeding Duration: Data from a Longitudinal Study in Greece.

BACKGROUND: This study investigated the relationship between exclusive breastfeeding and breastfeeding duration, and maternal psychological well-being in the perinatal period. METHODS: A longitudinal study involving a retrospective follow-up of a group of 1080 women from pregnancy to the 1st year postpartum, who gave birth during the 5-year period between January 2014 and January 2019 in Athens, Greece, was designed. Women's history and two psychometric tools-the Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) administered at 5-time points-were used for data collection. Logistic regression analysis and a series of multiple analysis of variance (MANOVA) tests were performed. RESULTS: The chance for exclusive breastfeeding (giving only breast milk) appeared to decrease (a) with an increase of the scores for psychometric tools antenatally (PHQ-9, p = 0.030) or at the 6th week postpartum (EPDS, p < 0.001 and PHQ-9, p < 0.001), (b) with an increase in the number of psychotherapeutic sessions needed antenatally (p = 0.030), and (c) when the initiation of psychotherapy was necessary postpartum (p = 0.002). Additionally, a shorter duration of any breastfeeding (with or without formula or other types of food/drink) seems to be associated with (a) the occurrence of pathological mental health symptoms (p = 0.029), (b) increased PHQ-9 scores antenatally (p = 0.018), (c) increased EPDS scores at the 6th week (p = 0.004) and the 12th month postpartum (p = 0.031), (d) the initiation of psychotherapy postpartum (p = 0.040), and e) the need for more than 13 psychotherapeutic sessions (p = 0.020). CONCLUSIONS: This study demonstrates a negative relationship between exclusive breastfeeding and breastfeeding duration, and poor maternal mental health in the perinatal period.

Association between Breastfeeding Duration and Long-Term Midwifery-Led Support and Psychosocial Support: Outcomes from a Greek Non-Randomized Controlled Perinatal Health Intervention.

BACKGROUND: This study investigates if a non-randomized controlled perinatal health intervention which offers (a) long-term midwife-led breastfeeding support and (b) psychosocial support of women, is associated with the initiation, exclusivity and duration of breastfeeding. METHODS: A sample of 1080 women who attended a 12-month intervention before and after childbirth, during a five-year period (January 2014-January 2019) in a primary mental health care setting in Greece, was examined. Multiple analyses of variance and logistic regression analysis were conducted. RESULTS: The vast majority of women (96.3%) initiated either exclusive breastfeeding (only breast milk) (70.7%) or any breastfeeding (with or without formula or other type of food/drink) (25.6%). At the end of the 6th month postpartum, almost half of the women (44.3%) breastfed exclusively. A greater (quantitatively) midwifery-led support to mothers seemed to correlate with increased chance of exclusive breastfeeding at the end of the 6th month postpartum (p = 0.034), and with longer any breastfeeding duration (p = 0.015). The absence of pathological mental health symptoms and of need for receiving long-term psychotherapy were associated with the longer duration of any breastfeeding (p = 0.029 and p = 0.013 respectively). CONCLUSIONS: Continuous long-term midwife-led education and support, and maternal mental well-being are associated with increased exclusive and any breastfeeding duration.