Date of Award

Summer 2023

Document Type

Open Access Thesis


Epidemiology and Biostatistics

First Advisor

Jihong Liu


Background: Breastfeeding has health benefits for both mother and child, but breastfeeding practices among Black and lower-income women are the poorest in the United States. Few studies have examined the associations between maternal prenatal depression and breastfeeding duration, even fewer among a predominantly low-income Black population. Objective: To explore the association between prenatal depression and breastfeeding practices among low-income Black women during the COVID-19 pandemic.

Methods: Prospective cohort data from Midlands Healthy Start (MHS) was analyzed to examine women’s depression symptoms during pregnancy and their breastfeeding initiation and duration through two and six months. Perinatal depressive symptoms were identified using validated instruments: the Center for Epidemiologic Studies-Depression Scale (CES-D) or Edinburgh Postpartum Depression Scale (EPDS) over time. Standardized depressive symptoms scores were calculated. For categorical analysis of depression, we utilized cut-off scores of 10 or higher and 16 or higher for the EPDS and CES-D, respectively. Bivariate analyses and multiple logistic regression modeling were completed.

Results: Of MHS participants included in this study (initiation: n=400; two months: n=355; six months: n=326), 21% had prenatal depression, 72.5% initiated breastfeeding, 31.8% breastfed through two months, and 15.0% breastfed at least six months. The mean standardized prenatal depression scores were lower among women who initiated breastfeeding (p=0.827) and had longer breastfeeding duration (two months: p=0. 459; six months: p=0. 226) than those who did not. Prenatal depression was associated with a lack of breastfeeding for six months (p = 0.047), as 17.2% of women without prenatal depression breastfed through six months, while 7.9% of women with depression breastfed for six months. The odds of each breastfeeding practice decreased (initiation: AOR 0.94, 95% CI 0.75-1.17; two months: AOR 0.90, 95% CI 0.71-1.13; six months: OR 0.83, 95% CI 0.61-1.12) for every one-point increase in standardized depression scores. Conclusions: This study suggests that low-income Black women with prenatal depression have poorer breastfeeding practices than those who do not have depression. Future research with larger sample sizes is needed to determine if this association is significant.


© 2023, Peyton Ashleigh Mosher

Available for download on Saturday, August 31, 2024

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