Abstract
Objective
Maternal psychological distress in pregnancy has been associated with both breastfeeding duration and child weight at 24 months; however, the potential that breastfeeding duration partially mediates the risk of maternal mental health problems during pregnancy on child weight classification has not been examined. The current study investigated this proposed relationship.
Methods
Data was taken from the All Our Families (AOF) cohort, an ongoing prospective pregnancy cohort located in Calgary, Canada. Psychological distress, defined as clinically significant symptoms of anxiety and depression, was assessed via self-report and measured between 34 and 36 weeks of gestation. Breastfeeding duration was assessed in the postpartum by self-report. Child overweight classification was defined as a weight-for-length/height z-score at or above the 97th percentile as per World Health Organization’s child growth guidelines.
Results
In this sample of 1582 mother−child pairs, there was no direct relationship between psychological distress and child overweight status. Both anxiety (B = − 5.40, p = 0.001) and depression (B = − 6.54, p = 0.008) were associated with decreased weeks breastfeeding. Breastfeeding duration mediated the association between maternal prenatal psychological distress and child overweight status at 24 months, for both anxiety (B(SE) = 0.10(0.05), CI 0.03–0.21) and depression (B(SE) = 0.11(0.07), CI 0.01–0.27). Covariates included maternal age, education, ethnicity, income, pre-pregnancy BMI, gestational weight gain, and infant birth weight.
Conclusions
The results of this longitudinal cohort analysis support an indirect relationship between maternal psychological distress in pregnancy and the childhood overweight/obesity at 24 months old, mediated through breastfeeding duration.
Résumé
Objectif
La détresse psychologique maternelle pendant la grossesse a été associée à l’allaitement et au poids de l’enfant à 24 mois; cependant, la possibilité que la durée de l’allaitement puisse être un médiateur de la relation entre la santé mentale maternelle pendant la grossesse et la classification du poids de l’enfant n’a pas encore été examinée. La présente étude a examiné cette relation proposée.
Méthodes
Les données proviennent de l’étude All Our Families (AOF), une cohorte de grossesse prospective en cours à Calgary, au Canada. La détresse psychologique, définie comme la présence de symptômes d’anxiété et de dépression significatifs sur le plan clinique, a été évaluée à l’aide de questionnaires entre la 34ème et la 36ème semaines de gestation. La durée de l’allaitement a été mesurée pendant le postpartum en s’appuyant sur l’auto-déclaration des mères. La classification du surpoids chez l’enfant a été définie comme un rapport poids-pour-la-longueur/score z pour la hauteur qui est égal ou supérieur au 97e centile, selon les recommandations sur la croissance de l’enfant de l’Organisation mondiale de la Santé.
Résultats
Parmi les 1582 dyades mère−enfant inclus dans l’étude, il n’y avait pas de relation directe entre la détresse psychologique maternelle et le surpoids chez l’enfant. L’anxiété (B = − 5,40, p = 0,001) et la dépression (B = − 6,54, p = 0,008) maternelle étaient associés à une diminution du nombre de semaines d’allaitement. La durée de l’allaitement maternel avait un effet médiateur sur l’association entre la détresse psychologique maternelle prénatale et le surpoids de l’enfant à 24 mois, pour l’anxiété (B(SE) = 0,10(0,05), IC 0,03 – 0,21) et la dépression (B(SE) = 0,11(0,07), IC 0,01 – 0,27). Les covariables comprenaient l’âge maternel, l’éducation, l’origine ethnique, le revenu, l’IMC avant la grossesse, le gain de poids gestationnel et le poids de l’enfant à la naissance.
Conclusions
Les résultats de cette étude longitudinale soutiennent une relation indirecte entre la détresse psychologique maternelle pendant la grossesse et le surpoids/l’obésité de l’enfant à 24 mois, médiée par la durée de l’allaitement.
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References
Arch, J. J. (2014). Cognitive behavioral therapy and pharmacotherapy for anxiety: treatment preferences and credibility among pregnant and non-pregnant women. Behav Res Ther, 52(1), 53–60. https://doi.org/10.1016/j.brat.2013.11.003.
Armstrong, J., Abraham, E. C., Squair, M., Brogan, Y., & Merewood, A. (2014). Exclusive breastfeeding, complementary feeding, and food choices in UK infants. J Hum Lact, 30(2), 201–208. https://doi.org/10.1177/0890334413516383.
Bartok, C. J., & Ventura, A. K. (2009). Mechanisms underlying the association between breastfeeding and obesity. Int J Pediatr Obes, 4(4), 196–204. https://doi.org/10.3109/17477160902763309.
Benediktsson, I., McDonald, S., & Tough, S. (2016). Examining the psychometric properties of three standardized screening tools in a pregnant and parenting population. Maternal and Child Health Journal, 21, 1–7. https://doi.org/10.1007/s10995-016-2128-4.
Bergink, V., Kooistra, L., Lambregtse-van den Berg, M. P., Wijnen, H., Bunevicius, R., van Baar, A., & Pop, V. (2011). Validation of the Edinburgh Depression Scale during pregnancy. J Psychosom Res, 70(4), 385–389. https://doi.org/10.1016/j.jpsychores.2010.07.008.
Birch, L. L., & Fisher, J. O. (1998). Development of eating behaviors among children and adolescents. Pediatrics, 101(3), 539–549 Retrieved from http://go.galegroup.com.ezproxy.lib.ucalgary.ca/ps/i.do?&id=GALE%7CA20546880&v=2.1&u=ucalgary&it=r&p=HRCA&sw=w.
Braungart-Rieker, J. M., Lefever, J. B., Planalp, E. M., & Moore, E. S. (2016). Body mass index at 3 years of age: Cascading effects of prenatal maternal depression and mother-infant dynamics. Journal of Pediatrics, 177(037224), 128–132.e1. https://doi.org/10.1016/j.jpeds.2016.06.023.
Carling, S. J., Demment, M. M., Kjolhede, C. L., & Olson, C. M. (2015). Breastfeeding duration and weight gain trajectory in infancy. Pediatrics, 135(1), 111–119. https://doi.org/10.1542/peds.2014-1392.
Chalmers, B., Levitt, C., Heaman, M., O’Brien, B., Sauve, R., Kaczorowski, J., et al. (2009). Breastfeeding rates and hospital breastfeeding practices in Canada: a national survey of women. Birth, 36(2), 122–132. https://doi.org/10.1111/j.1523-536X.2009.00309.
Cluxton-Keller, F., & Bruce, M. L. (2018). Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: a systematic review and meta-analysis. PLoS One, 13(6), e0198730. https://doi.org/10.1371/journal.pone.0198730.
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry, 150(6), 782–786. https://doi.org/10.1192/bjp.150.6.782.
Daniels, L., Mallan, K. M., Fildes, A., & Wilson, J. (2015). The timing of solid introduction in an “obesogenic” environment: a narrative review of the evidence and methodological issues. Aust N Z J Public Health, 39(4), 366–373. https://doi.org/10.1111/1753-6405.12376.
de Onis, M. (2008). The new WHO child growth standards. Paediatria Croatica Supplement, 52(SUPP.1), 13–17. https://doi.org/10.4067/S0370-41062009000400012.
Dennis, C. L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry, 210(5), 315–323. https://doi.org/10.1192/bjp.bp.116.187179.
Dias, C. C., & Figueiredo, B. (2015). Breastfeeding and depression: a systematic review of the literature. J Affect Disord, 171, 142–154. https://doi.org/10.1016/j.jad.2014.09.022.
Fallon, V., Halford, J. C. G., Bennett, K. M., & Harrold, J. A. (2018). Postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours: new evidence for childbearing specific measures of mood. Archives of Women’s Mental Health, 21(2), 181–191. https://doi.org/10.1007/s00737-017-0775-0.
Gaillard, R., Durmus, B., Hofman, A., MacKenbach, J. P., Steegers, E. A. P., & Jaddoe, V. W. V. (2013). Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy. Obesity, 21(5), 1046–1055. https://doi.org/10.1002/oby.20088.
Gaudet, L., Ferraro, Z., Wen, S., & Walker, M. (2014). Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. BioMed Research Internation, 2014, 1–22 https://doi.org/10.1155/2014/640291.
Gibbs, B. G., & Forste, R. (2014). Socioeconomic status, infant feeding practices and early childhood obesity. Pediatric Obesity, 9(2), 135–146. https://doi.org/10.1111/j.2047-6310.2013.00155.x.
Goodman, J. H. (2009). Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth, 36(1), 60–69. https://doi.org/10.1111/j.1523-536X.2008.00296.x.
Gustavson, K., Von Soest, T., Karevold, E., & Roysamb, E. (2012). Attrition and generalizability in longitudinal studies: findings from a 15-year population-based study and a Monte Carlo simulation study. BMC Public Health, 12(1). https://doi.org/10.1186/1471-2458-12-918.
Han, E., Abrams, B., Sridhar, S., Xu, F., & Hedderson, M. (2016). Validity of self-reported pre-pregnancy weight and body mass index classification in an integrated health care delivery system. Paediatr Perinat Epidemiol, 30(4), 314–319. https://doi.org/10.1111/ppe.12286.
Harder, T., Bergmann, R., Kallischnigg, G., & Plagemann, A. (2005). Duration of breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol, 162(5), 397–403. https://doi.org/10.1093/aje/kwi222.
Hayes, A. F. (2009). Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Commun Monogr, 76(4), 408–420. https://doi.org/10.1080/03637750903310360.
Hayes, A. F. (2017). In T. Little (Ed.), Introduction to mediation, moderation, and conditional process analysis (Second ed.). New York: The Guildford Press.
Hayes, A. F., & Rockwood, N. J. (2017). Regression-based statistical mediation and moderation analysis in clinical research: observations, recommendations, and implementation. Behav Res Ther, 98, 39–57. https://doi.org/10.1016/j.brat.2016.11.001.
Ho, Y. J., & McGrath, J. M. (2010). A review of the psychometric properties of breastfeeding assessment tools. JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, 39(4), 386–400. https://doi.org/10.1111/j.1552-6909.2010.01153.x.
Horta, B. L., Bahl, R., Martines, J. C., & Victora, C. G. (2007). Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analyses. World Health Organization, 1–52.
Horta, B., Loret De Mola, C., & Victora, C. (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. International Journal of Paediatrics, 104, 30–37. https://doi.org/10.1111/apa.13133.
Kramer, M. S., & Kakuma, R. (2012). Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews (Online), 8(4), CD003517. https://doi.org/10.1002/14651858.CD003517.pub2.
Kramer, M. S., Matush, L., Vanilovich, I., Platt, R. W., Bogdanovich, N., Sevkovskaya, Z., et al. (2007). Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 y: evidence from a large randomized trial. Am J Clin Nutr, 86(6), 1717–1721. https://doi.org/10.1093/ajcn/86.5.1717.
Llewellyn, A., Simmonds, M., Owen, C. G., & Woolacott, N. (2016). Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev, 17(1), 56–67. https://doi.org/10.1111/obr.12316.
Marchesi, C., Ossola, P., Amerio, A., Daniel, B. D., Tonna, M., & De Panfilis, C. (2016). Clinical management of perinatal anxiety disorders: a systematic review. J Affect Disord, 190, 543–550. https://doi.org/10.1016/j.jad.2015.11.004.
McDonald, S. W., Lyon, A. W., Benzies, K. M., McNeil, D. A., Lye, S. J., Dolan, S. M., et al. (2013). The All Our Babies pregnancy cohort: design, methods, and participant characteristics. BMC Pregnancy and Childbirth, 13(Suppl 1), S2. https://doi.org/10.1186/1471-2393-13-S1-S2.
Rodd, C., & Sharma, A. K. (2016). Recent trends in the prevalence of overweight and obesity among Canadian children. Can Med Assoc J. https://doi.org/10.1503/cmaj.150854.
Rogers, S. L., & Blissett, J. (2017). Breastfeeding duration and its relation to weight gain, eating behaviours and positive maternal feeding practices in infancy. Appetite, 108, 399–406. https://doi.org/10.1016/j.appet.2016.10.020.
Schack-Nielsen, L., Sørensen, T. I. A., Mortensen, E. L., & Michaelsen, K. F. (2010). Late introduction of complementary feeding, rather than duration of breastfeeding, may protect against adult overweight. Am J Clin Nutr, 7, 1–9. https://doi.org/10.3945/ajcn.2008.27078.1.
Shields, M., & Tremblay, M. S. (2010). Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points. Int J Pediatr Obes, 5(3), 265–273. https://doi.org/10.3109/17477160903268282.
Simmonds, M., Llewellyn, A., Owen, C. G., & Woolacott, N. (2016). Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev, 17(2), 95–107. https://doi.org/10.1111/obr.12334.
Spielberger, C. D., Gorsuch, R. L., Lushene, R. E., Vagg, P. R., & Jacobs, G. A. (1970). STAI: manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologist’s Press.
Sridhar, S. B., Darbinian, J., Ehrlich, S. F., Markman, M. A., Gunderson, E. P., Ferrara, A., & Hedderson, M. M. (2014). Maternal gestational weight gain and offspring risk for childhood overweight or obesity. American Journal of Obstetrics and Gynecology, 211(3), 259.e1–259.e8. https://doi.org/10.1016/j.ajog.2014.02.030.
Statistics Canada. (2014). Family income and income of individuals, related variables: sub-provincial data, 2012, 2010–2013. Retrieved from http://www.statcan.gc.ca/daily-quotidien/140723/dq140723c-eng.pdf
Surkan, P. J., Kawachi, I., & Peterson, K. E. (2008). Childhood overweight and maternal depressive symptoms. J Epidemiol Community Health, 62(5), e11. https://doi.org/10.1136/jech.2007.065664.
Thompson, A. L., & Bentley, M. E. (2013). The critical period of infant feeding for the development of early disparities in obesity. Soc Sci Med, 97, 288–296. https://doi.org/10.1016/j.socscimed.2012.12.007.
Tomfohr-Madsen, L. M., Bayrampour, H., & Tough, S. (2016). Maternal history of childhood abuse and risk of asthma and allergy in 2-year-old children. Psychosom Med, 78(9), 1031–1042. https://doi.org/10.1097/PSY.0000000000000419.
Tough, S. C., McDonald, S. W., Collisson, B. A., Graham, S. A., Kehler, H., Kingston, D., & Benzies, K. (2017). Cohort profile: the All Our Babies pregnancy cohort (AOB). Int J Epidemiol. https://doi.org/10.1093/ije/dyw363.
Wang, Y., & Lim, H. (2012). The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. International Review of Psychiatry (Abingdon, England), 24(3), 176–188. https://doi.org/10.3109/09540261.2012.688195.
Woody, C. A. A., Ferrari, A. J. J., Siskind, D. J. J., Whiteford, H. A. A., & Harris, M. G. G. (2017). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord, 219(April), 86–92. https://doi.org/10.1016/j.jad.2017.05.003.
World Health Organization. (2011). WHO anthro.
Yeung, H., Leff, M., & Rhee, K. E. (2017). Effect of exclusive breastfeeding among overweight and obese mothers on infant weight-for-length percentile at 1 year. Breastfeed Med, 12(1), 39–47. https://doi.org/10.1089/bfm.2016.0071.
Zhu, Y., Hernandez, L. M., Dong, Y., Himes, J. H., Hirschfeld, S., & Forman, M. R. (2015). Longer breastfeeding duration reduces the positive relationships among gestational weight gain, birth weight and childhood anthropometrics. J Epidemiol Community Health, 69(7), 632–638. https://doi.org/10.1136/jech-2014-204794.
Acknowledgements
Special thanks to the participant mothers and children of the AOF cohort, as well as all the investigators, research assistants, administrators, and volunteers who helped bring such a large-scale project to life. Thank you to Meredith Brockway, who was consulted on breastfeeding information in Calgary, and to Anna L. MacKinnon for providing the French language translation of the abstract.
Funding
The All Our Babies (AOB) study was funded by Alberta Innovates Health Solutions Interdisciplinary Team grant #200700595, Calgary, Alberta, Canada. Matthew Shay was supported by grants from the Alberta Children’s Hospital Research Initiative, Talisman Energy Fund for Healthy Living and Injury Prevention Studentship Support, and internal awards through the University of Calgary.
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Shay, M., Tomfohr-Madsen, L. & Tough, S. Maternal psychological distress and child weight at 24 months: investigating indirect effects through breastfeeding in the All Our Families cohort. Can J Public Health 111, 543–554 (2020). https://doi.org/10.17269/s41997-020-00312-7
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DOI: https://doi.org/10.17269/s41997-020-00312-7