Objective: The aim of the current study was to determine whether secular changes have occurred in the breastfeeding literature, in terms of number and type of yearly published articles and impact factor of journals publishing these articles.
Research Design and Setting: In order to evaluate all Medline articles related to breastfeeding, we used the Internet URL www.ncbi.nlm.nih.gov/entrez and searched for articles recorded from January 1, 1992 through December 31, 2011 using as a key word “breast milk,” “breast feeding,” or “human milk.” We specifically studied randomized controlled trials (RCTs), clinical trials, case reports, meta-analyses, letters to the editor, reviews, systematic reviews, practice guidelines, and editorials.
Results: There was a linear increase over the years in all articles recorded, from approximately 1,100/year in 1992 to 2,100/year in 2011 (i.e., an approximately 1.9-fold increase [R2=0.995, p=0.001]). Concomitant with the yearly increase in the number of published RCTs per year, there was a linear increase in the number of journals publishing articles on breastfeeding per year (from approximately 20 in 1992 to >60 in 2011 [R2=0.811, p<0.001]) but an overall decrease in the average impact factor every year (R2=0.202, p=0.047). However, the ratio of high-quality articles selected (RCTs+meta-analyses+systematic reviews+CR)/low-quality articles (reviews+editorials+letters to the editor+case reports) increased significantly over time in favor of the former.
Conclusions: There was a linear increase in the number of publications related to the field of breastfeeding and human milk, and the ratio of high-quality/low-quality articles improved over time, indicating a relative and absolute increase in the number of articles usually considered as being of high quality. There was a significant increase in the number of journals publishing breastfeeding-related articles, with a significant decrease of average impact factor of those journals.
Infant colic, or excessive crying of unknown cause in infants less than 3 months old, is common and burdensome. Its aetiology is undetermined, and consensus on its management is still lacking. Recent studies suggest a possible link between infant colic and gut microbiota, indicating probiotics to be a promising treatment. However, only a few strains have been tested, and results from randomised controlled trials are conflicting. It is important to clarify whether probiotics are effective for treating infant colic in general, and to identify whether certain subgroups of infants with colic would benefit from particular strains of probiotics.
Methods and analysis
Through an individual participant data meta-analysis (IPDMA), we aim to identify whether the probiotic Lactobacillus reuteri DSM 17938 is effective in the management of infant colic, and to clarify whether its effects differ according to feeding method (breast vs formula vs combined), proton pump inhibitor exposure, and antibiotic exposure. The primary outcomes are infant crying duration and treatment success (at least 50% reduction in crying time from baseline) at 21 days postintervention. Individual participant data from all studies will be modelled simultaneously in multilevel generalised linear mixed-effects regression models to account for the nesting of participants within studies. Subgroup analyses of participant-level and intervention-level characteristics will be undertaken on the primary outcomes to assess if the intervention effect differs between certain groups of infants.
Ethics and dissemination
Approved by the Royal Children's Hospital Human Research Ethics Committee (HREC 34081). Results will be reported in a peer-reviewed journal in 2015.
Trial registration number
PERINATOLOGY; NUTRITION & DIETETICS; COMPLEMENTARY MEDICINE
A quiet revolution has been taking place in the feeding of US infants in the form of women using electric breast pumps. This revolution in milk expression may be a boon for both mothers and infants if more infants are fed human milk or if they receive human milk for a longer period.
Milk expression may also be problematic for mothers, and it may be particularly problematic for infants if they are fed too much, fed milk of an inappropriate composition, or fed milk that is contaminated.
As a result, the time has come to determine the prevalence of exclusive and periodic breast milk expression and the consequences of these behaviors for the health of mothers and their infants.
Despite research demonstrating the safety and benefit of breastfeeding in opioid substitution therapy, few women in treatment breastfeed. Understanding the factors contributing to the choices women on opioid substitution therapy make about infant feeding is important.
The aim of this study was to better understand and support infant feeding choices and breastfeeding experiences in women on opioid substitution therapy.
A systematic review was conducted on five databases: (1) Ovid MEDLINE(R) without revisions, (2) Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, (3) EMBASE, (4) CINAHL, and (5) FRANCIS. From 1081 articles, 46 articles were reviewed.
The literature supports breastfeeding as an appropriate and safe option for women on opioid substitution treatment. Breastfeeding and rooming-in reduce neonatal abstinence. Women face barriers to breastfeeding due to societal stigma and the lack of patient and health-care provider education.
Efforts are needed to increase the knowledge that women and health-care professionals have about the safety and benefits of breastfeeding.
breastfeeding; opiate substitution; neonatal abstinence; methadone; buprenorphine
Exclusive breastfeeding for infants up to 6 months is widely recommended, yet breastfeeding rates are relatively low in the US. The most common reason women stop breastfeeding early is a perceived insufficiency of milk. Galactagogues are herbal and pharmaceutical products that can help increase milk supply; however, data on their efficacy and safety is limited. Lactation consultants, obstetricians, and other health providers are an important point of contact for breastfeeding women experiencing challenges with lactation. This study explored providers’ perceptions, experiences, and practices in relation to galactagogue recommendation.
A cross-sectional survey was conducted among a convenience sample of English-speaking health providers in the US who counsel breastfeeding women and their infants.
More than 70% of respondents reported to recommend galactagogues. The most frequently recommended galactagogue was fenugreek with respondents indicating that they recommend it either ‘always’ (8.5%) or ‘most of the time’ (14.9%) and ‘sometimes’ (46.8%). More than 80% of the respondents indicated that galactagogues were useful for their clients and only one-third reported side effects. Reasons for refraining from recommending galactagogues were insufficient evidence of its efficacy and safety. Respondents reported a wide variety of sources of information used for their own education about galactagogues.
Despite little evidence regarding safety and efficacy, some galactagogues are widely recommended and often perceived to be useful. However, concerns about their efficacy and safety remain. In order to assure both providers and users about safety and efficacy, more robust studies as well as better pharmacovigilance systems are needed.
lactation; human milk; nutrition; clinical decision making; lactogenesis
The economic value of breastfeeding to the society at large is under researched and its importance as a preventive public health strategy is underestimated. What little research there is indicates that considerable savings would accrue from following the WHO/UNICEF advice to breastfeed exclusively for six months and continue breastfeeding along with complementary foods for two years or more. Despite relatively high breastfeeding initiation in Germany, neither exclusive breastfeeding nor breastfeeding duration come close to international recommendations. Breastfeeding is mostly regarded as a woman’s personal choice and the government has been slow to engage in breastfeeding promotion, support and research. Some structures in Germany do offer support for breastfeeding women – including the growing number of Baby Friendly Hospital Initiative (BFHI) certified hospitals and a comprehensive maternity leave policy. However, the costs of breastfeeding are mostly borne by the mothers and those for breastfeeding training mostly by the individual health care workers or hospital, while the health insurance companies and society-at-large are profiting from the financial savings from exclusive and long-term breastfeeding. Factors which might improve breastfeeding rates and duration in this country include broad expansion of and financial support for both BFHI hospitals as well as training for the health care personnel who support the mother-infant dyad during the breastfeeding period.
Breastfeeding; Prevention; Support; Education; Breast milk; Economic value
Lactation mastitis is a common, but poorly understood, inflammatory breast disease that is a significant health burden. A better understanding of the aetiology of mastitis is urgently required, and will assist in the development of improved prevention and treatment strategies in both human and animal species. Studies in mice have the potential to greatly assist in identifying new drug candidates for clinical trials, and in developing a better understanding of the disease. Mouse models of mastitis involve administration of a mastitis-inducing agent to the mammary gland usually during lactation to examine the host immune response, and progression through to resolution of the disease. There are important variations in the protocols of these mouse models that critically affect the conclusions that can be drawn from the research. Some protocols involve weaning of offspring at the time of mastitis induction, and there are variations in the mastitis-inducing agent and its carrier. Induction of mammary gland involution through weaning of offspring limits the capacity to study the disease in the context of a lactating mammary gland. Administration of live bacteria in an aqueous carrier can cause sepsis, restricting the physiological relevance of the model. Mouse model research should employ appropriately designed controls and closely monitor the health of the mice. In this commentary, we discuss the advantages and study design limitations of each mouse model, and highlight the potential for further development of physiologically relevant mouse models of mastitis.
Mastitis; Mouse models; Inflammation; Infection; Involution; Mammary gland
The Baby-Friendly Hospital Initiative (BFHI) has been implemented in Ghana since 1995. At the end of 2011, about 325 maternity facilities in Ghana had been designated Baby Friendly. However, none had been re-assessed for adherence to the Ten Steps to successful breastfeeding (Ten Steps). The current study re-assessed six maternity facilities in Accra for adherence to the Ten Steps and the International Code of Marketing of breast milk substitutes (the Code).
Three independent assessors performed the re-assessment using the revised WHO/UNICEF external re-assessment tool (ERT) between April and June, 2011. All sections of the ERT were implemented, except for the HIV/infant feeding section. Assessors interviewed 90 clinical staff of the facilities, 60 pregnant women, and 150 women who had given birth and waiting to be discharged from the hospital. Additionally, observations were completed on neonate feeding and compliance with the Code. Data was analyzed to assess adherence to the Ten Steps and the Code.
In 2010, the six facilities recorded a total of 26,339 deliveries. At discharge, the weighted exclusive breastfeeding rate was 93.8%. None of the facilities adhered completely to the Ten Steps. Overall, the rate of adherence to the Ten Steps was 42% (range = 30 - 70%). No facility met the criteria for Steps One and Two. Only Step Seven was adhered to by all facilities. Overall compliance with the Code was about 54%. Trained staff attrition, high client-staff ratios, inadequate in-service training for new staff, and inadequate support for regional and national program monitoring were identified as barriers to adherence.
Poor adherence to Baby-Friendly practices in designated BFHI facilities was observed in urban Accra. Renewed efforts to support monitoring of designated facilities is recommended.
Adherence; Baby-Friendly; Breastfeeding; Monitoring; Re-assessment
Gestational diabetes increases the risk of a range of adverse perinatal outcomes, including breastfeeding failure, but the best cut-off point for gestational diabetes is unknown. The purpose of this study was to evaluate the association between mild gestational glucose tolerance impairment and the early cessation of exclusive breastfeeding (EBF). This is an observational study of 768 women with full term pregnancies that were screened for gestational diabetes at 24–28 weeks gestation. Subjects were divided into two groups: those with a normal 1-h glucose challenge test and those with an elevated 1-h glucose challenge test but still did not qualify for gestational diabetes. We constructed multivariable logistic regression models using data from 616 women with normal gestational glucose tolerance and 152 women with an isolated positive 1-h glucose challenge test. The risk of early exclusive breastfeeding cessation was found to increase in women with mildly impaired glucose tolerance during pregnancy (adjusted OR, 1.65; 95% CI: 1.11, 2.45). Risks of early EBF cessation were also independently associated with the amount of neonatal weight loss and admission to the neonatal ward. Instead, parity was associated with a decreased risk for shorter EBF duration. Insulin resistance—even in the absence of gestational diabetes mellitus—may be an impeding factor for EBF.
breastfeeding; gestational diabetes; neonate; glucose tolerance test; prediabetes; insulin resistance; pregnancy outcomes
Cleft lip and palate patients have all rights like other normal individuals, to enjoy the benefits of nourishment. Knowledge has to be there about the different feeding positions like straddle, dancer hand position along with the use of specially designed bottles and nipples. Parent's should be trained about the correct positions of feeding, in extreme of the cases in which parents are not able to follow these instructions, feeding obturators can be given.
How to cite this article: Jindal MK, Khan SY. How to Feed Cleft Patient? Int J Clin Pediatr Dent 2013;6(2):100-103.
Cleft lip and palate; Infancy; Feeding
In the second article of a five-part series providing a global perspective on integrating mental health, Atif Rahman and colleagues argue that integrating maternal mental health care will help advance maternal and child health.
Please see later in the article for the Editors' Summary
Many clinicians do not encourage breastfeeding in hepatitis B virus (HBV) carriers, since HBV DNA can be detected in breast milk and breast lesions may increase exposure of infants to HBV. The aim of this study was to determine whether breastfeeding may add risk for perinatal HBV transmission.
Totally 546 children (1–7-year-old) of 544 HBV-infected mothers were investigated, with 397 breastfed and 149 formula-fed; 137 were born to HBeAg-positive mothers. All children had been vaccinated against hepatitis B but only 53.3% received hepatitis B immune globulin (HBIG). The overall prevalence of HBsAg+, HBsAg−/anti-HBc+, and anti-HBs (≥10 mIU/ml) in children was 2.4%, 3.1%, and 71.6% respectively. The HBsAg prevalence in breast- and formula-fed children was 1.5% and 4.7% respectively (P = 0.063); the difference was likely due to the higher mothers' HBeAg-positive rate in formula-fed group (formula-fed 49.0% vs. breastfed 15.9%, P<0.001). Further logistic regression analyses showed that breastfeeding was not associated with the HBV infection in the children, adjusting for the effect of maternal HBeAg status and other factors different between the two groups.
Under the recommended prophylaxis, breastfeeding is not a risk factor for mother-to-child transmission of HBV. Therefore, clinicians should encourage HBV-infected mothers to breastfeed their infants.
There has been a recent increase in availability of banked donor milk for feeding of preterm infants. This milk is pooled from donations to milk banks from carefully screened lactating women. The milk is then pasteurized by the Holder method to remove all microbes. The processed milk is frozen, banked, and sold to neonatal intensive care units (NICUs). The nutrient bioavailability of banked donor milk has been described, but little is known about preservation of immune components such as cytokines, chemokines, and growth factors (CCGF).
The objective was to compare CCGF in banked donor milk with mother's own milk (MOM).
Aliquots (0.5 mL) were collected daily from MOM pumped by 45 mothers of NICU-admitted infants weighing < 1500 grams at birth. All daily aliquots of each mother's milk were pooled each week during 6 weeks of an infant's NICU stay or for as long as the mother provided MOM. The weekly pooled milk was measured for a panel of CCGF through multiplexing using magnetic beads and a MAGPIX instrument. Banked donor milk samples (n = 25) were handled and measured in the same way as MOM.
Multiplex analysis revealed that there were levels of CCGF in banked donor milk samples comparable to values obtained from MOM after 6 weeks of lactation.
These data suggest that many important CCGF are not destroyed by Holder pasteurization.
breastfeeding; chemokines; cytokines; donor milk; growth factors
This retrospective study aimed to identify factors associated with breastfeeding duration among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) of Hartford, Connecticut. The authors included mothers whose children were younger than 5 years and had stopped breastfeeding (N = 155). Women who had planned their pregnancies were twice as likely as those who did not plan them to breastfeed for more than 6 months (odds ratio, 2.15; 95% confidence interval, 1.00–4.64). One additional year of maternal age was associated with a 9% increase on the likelihood of breastfeeding for more than 6 months (odds ratio, 1.09; 95% confidence interval, 1.02–1.17). Time in the United States was inversely associated with the likelihood of breastfeeding for more than 6 months (odds ratio, 0.96; 95% confidence interval, 0.92–0.99). Return to work, sore nipples, lack of access to breast pumps, and free formula provided by WIC were identified as breastfeeding barriers. Findings can help WIC improve its breastfeeding promotion efforts.
acculturation; breastfeeding; pregnancy intention; support system; Special Supplemental Nutrition Program for Women; Infants; Children (WIC)
human colostrum; human milk; microbiota; diversity; microbial interactions; ecosystem homeostasis; functionality
Breastfeeding is negatively associate with behavioral and internalization problems, psychological stress, and depressive/anxiety symptoms. However, studies evaluating specific mental health disorders are scarce. We aimed to assess the association between breastfeeding and mental health outcomes in young adults.
In 1982, hospital deliveries in Pelotas (Southern Brazil) were identified; liveborns were examined and their mothers interviewed (n=5914). Information on breastfeeding was collected in early childhood. In 2012–13, at 30 years of age, we used the Mini International Neuropsychiatric Interview (MINI) for the diagnosis of major depression (MD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD). In addition, we used the Beck Depression Inventory (BDI-II) and the Self-reported Questionnaire (SRQ-20), to evaluate depressive symptoms severity and common mental disorders (CMD), respectively. We used multivariable regression models to evaluate the association between breastfeeding and mental health outcomes.
We evaluated 3657 individuals. Prevalence of CMD, MD, GAD and SAD was 24.3%, 7.9%, 12.7% and 3.6%, respectively. In multivariable models the odds of having a more severe case of depression (BDI-II) was smaller among those breastfed for 6 or more months (OR=0.69 95%CI [0.53–0.89]). We observed a similar pattern for MD and CMD, however, confidence intervals included the reference.
We had no information on home environment characteristics during childhood. Lack of power and a small effect size could explain why we did not detect an association between breastfeeding and MD.
Breastfeeding reduced the odds of having more severe depressive symptoms.
•Breastfeeding reduced the odds having more severe depressive symptoms in young adults.•The pattern of association was similar in all depressive like outcomes.•The effect of breastfeeding over major depression might be small.•Socioeconomic residual confounding is unlikely in this cohort.
Depression; Mental health; Anxiety; Breastfeeding; Cohort; Brazil
To evaluate intestinal barrier function in neonates undergoing cardiac surgery using lactulose/mannitol (L/M) ratio measurements and to determine correlations with early breast milk feeding.
This was a single-center, prospective, randomized pilot study of 27 term neonates (≥37 weeks gestation) requiring cardiac surgery who were randomized to one of two pre-operative feeding groups: 1) nil per os (NPO) vs. 2) trophic (10 cc/kg/day) breast milk feeds. At three time points (pre-op, post-op day 7, and post-op day 14), subjects were administered an oral lactulose/mannitol solution and subsequent L/M ratios were measured using gas chromatography, with higher ratios indicative of increased intestinal permeability. Trends over time in the mean urine L/M ratios for each group were estimated using a general linear mixed model.
There were no adverse events related to pre-operative trophic feeding. In the NPO group (n=13), the mean urine L/M ratios at pre-op, post-op day 7, and post-op day 14 were 0.06, 0.12, and 0.17, respectively. In the trophic breast milk feeds group (n=14), the mean urine L/M ratios at pre-op, post-op day 7, and post-op day 14 were 0.09, 0.19, and 0.15, respectively. Both groups had significantly higher L/M ratios at post-op day 7 and 14 compared with pre-op (p<0.05).
Neonates have increased intestinal permeability after cardiac surgery extending to at least post-op day 14. This pilot study was not powered to detect differences in benefit or adverse events comparing NPO with breast milk feeds. Further studies to identify mechanisms of intestinal injury and therapeutic interventions are warranted.
Registered with ClinicalTrials.gov: NCT01475357.
Nutrition; growth failure; congenital heart disease
Objectives: Recent reports have highlighted the benefits of surgical division of tongue-tie (frenulotomy) in infants with breastfeeding difficulties. There is no clear consensus defining the appropriate age for this procedure to be undertaken in selected infants.
We aimed to evaluate the impact of delays in time between referral and frenulotomy in relation to maternal abandonment of breastfeeding.
Materials and Methods: This was a prospective cohort study done in out-patient Neonatal Surgery Department, Birmingham Heartlands Hospital, Birmingham, UK, between April 2013 and July 2013.
All infants, referred to our tongue-tie clinic between April and July 2013, were studied prospectively. Referral time lags were calculated using computer records; details regarding breastfeeding were collected by an independent interviewer completing a questionnaire.
Results: Seventy patients were included. The median infant age at clinic was 28.5 days [range 1-126]. Fifty eight [82%] of mothers had breastfeeding difficulty and their infants were confirmed to have a prominent tongue-tie. By the time of their clinic attendance, breastfeeding had either not been established or abandoned in 21%. Despite difficulty, 61% of mothers persisted breastfeeding and all these mothers consented for frenulotomy. At time of clinic, median age of infants whose mothers had abandoned breastfeeding was 37 days [range 1-80] compared to 27 days [range 1-126] in infants whose mothers had persisted.
Conclusions: We demonstrated a time-critical dimension for frenulotomy: delay beyond 4-weeks from referral to assessment of neonatal tongue-tie is more likely to be associated with abandonment of breastfeeding. Timely assessment and division of tongue-tie in selected infants can therefore play an important role in a birthing unit’s breastfeeding strategy.
Frenulotomy; Tongue-tie; Breast-feeding
To determine the efficacy of topical curcumin in reducing breast inflammation in women suffering from lactational mastitis.
A randomized double-blind, placebo-controlled study including 63 breastfeeding women with lactational mastitis were randomly assigned to receive curcumin topical cream, one pump every 8 hours for 3 days (n=32) or topical moisturizer as placebo (n=31). Using an index for severity of breast inflammation, all of the patients had moderate breast inflammation before entering the study. The outcome of treatment was evaluated using the same index at 24, 48 and 72 hours of starting the treatment.
There was no significant difference between two study groups regarding the baseline characteristics such as age (p=0.361) and duration of lactation (p=0.551). After 72-hour of therapy, patients in curcumin groups had significantly lower rate of moderate (p=0.019) and mild (p=0.002) mastitis. Patients in curcumin group had significantly lower scores for tension (p<0.001), erythema (p<0.001) and pain (p<0.001), after 72-hour of treatment.
The results of the current study indicate that topical preparation of curcumin successfully decrease the markers of lactational mastitis such as pain, breast tension and erythema within 72 hours of administration without side effects. Thus, topical preparation of curcumin could be safely administered for those suffering from lactational mastitis after excluding infectious etiologies.
Lactational Mastitis; Puerperal Mastitis; Curcumin; Turmeric
Despite the passage of state laws promoting breastfeeding, a formal evaluation has not yet been conducted to test whether and/or what type of laws may increase breastfeeding. The enactment of breastfeeding laws in different states in the US creates a natural experiment. We examined the impact of state breastfeeding laws on breastfeeding initiation and duration as well as on disparities in these infant feeding practices.
Using data from the Pregnancy Risk Assessment Monitoring System, we conducted differences-in-differences models to examine breastfeeding status before and after the institution of laws between 2000 and 2008 among 326,263 mothers from 32 states in the US. For each mother we coded the presence of two types of state breastfeeding laws. Mothers reported whether they ever breastfed or pumped breast milk (breastfeeding initiation) and if so, how long they continued. We defined breastfeeding duration as continuing to breastfeed for ≥4 weeks.
Breastfeeding initiation was 1.7 percentage points higher in states with new laws to provide break time and private space for breastfeeding employees (p=0.01), particularly among Hispanic mothers (adjusted coefficient 0.058). While there was no overall effect of laws permitting mothers to breastfeed in any location, among Black mothers we observed increases in breastfeeding initiation (adjusted coefficient 0.056). Effects on breastfeeding duration were in the same direction, but slightly weaker.
State laws that support breastfeeding appear to increase breastfeeding rates. Most of these gains were observed among Hispanic and Black women and women of lower educational attainment suggesting that such state laws may help reduce disparities in breastfeeding.
Breast Feeding; Public Policy
Delayed onset of lactogenesis II (initiation of copious milk production) is frequently been utilized as an outcome but only twice as a hypothesis-testing exposure variable. It remains unclear if previous results are replicable in a large nationally representative population. We evaluated the association between delayed lactogenesis II (>3 days postpartum; DLII) and the cessation of any and exclusive breastfeeding at 4-weeks postpartum.
We constructed multivariable logistic regression models using data from 2491 mothers enrolled in the prospective Infant Feeding Practice Study II cohort. Models included DLII, known risk factors for breastfeeding cessation (age, education, race, parity/previous breastfeeding and exclusive breastfeeding plan) and potential confounders identified in bivariate analyses (p≤ 0.1). Backward selection processes (p≤ 0.1) determined risk factor retention in the final model.
DLII was associated with cessation of any and exclusive breastfeeding at 4-weeks postpartum (OR: 1.62; CI: 1.14–2.31; OR: 1.62; CI 1.18–2.22 respectively); numerous independent risk factors qualified for inclusion in the multivariable model(s) and were associated with the outcome(s) of interest (e.g. WIC enrollment, onset of prenatal care, feeding on-demand, time initiated first breastfeed, hospital rooming-in, obstetric provider preference for exclusive breastfeeding and maternal tobacco use).
Women experiencing DLII may be less able to sustain any and/or exclusive breastfeeding in the early postpartum period. These findings have significant clinical and programmatic implications. Routine assessment of DLII in postpartum breastfeeding follow-up is warranted, and women with DLII may benefit from additional early postpartum interventions to support favorable breastfeeding outcomes.
lactation; infant feeding; lactogenesis; maternal child nursing
Postpartum depression (PPD) is a common, potentially disabling and, in some cases, life-threatening condition. Fortunately, PPD is also readily detectable in routine practice, and is amenable to treatment by a wide variety of modalities that are effective for treating non-puerperal major depression. PPD screening can improve case identification (an Edinburgh Postnatal Depression Scale score of ≥ 13 indicates high risk of PPD) and when associated with a diagnostic and follow-up program, lead to improved clinical outcomes. Symptom severity, patient preference, past response to treatment, availability of local mental healthcare resources, and patient decisions about breastfeeding will drive management decisions. In general, cognitive-behavioral (CBT) and interpersonal therapy (IPT) are preferred psychotherapies for women with mild to moderate PPD, while antidepressants are appropriate in more severe cases. Many patients will require other types of assistance, such as parenting support, case management or care coordination, as many barriers to receiving adequate PPD treatment must still be overcome.
postpartum depression; perinatal depression; diagnosis; treatment; management; primary care