Perinatal Depression Among HIV-Infected Women in KwaZulu-Natal South Africa: Prenatal Depression Predicts Lower Rates of Exclusive Breastfeeding

• Published in: AIDS and behavior Vol. 21; no. 6; pp. 1691 - 1698
• Main Authors: Tuthill, Emily L., Pellowski, Jennifer A., Young, Sera L., Butler, Lisa M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2017; Springer Nature B.V
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Breast feeding; Breastfeeding & lactation; Children; Childrens health; Demographics; Demography; Disease transmission; Feeding; Health Psychology; HIV; Human immunodeficiency virus; Infants; Infectious Diseases; Intervention; Maternal & child health; Maternal and infant welfare; Medicine; Medicine & Public Health; Mental depression; Mothers; Motivation; Nutrition; Original Paper; Postpartum; Postpartum depression; Pregnancy; Prenatal depression; Prescription drugs; Public Health; Symptoms; Well being; Women; Womens health; South Africa; Prenatal depression; South Africa; Maternal and child health; HIV; Breastfeeding; Perinatal depression
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-016-1557-9

Exclusive breastfeeding (EBF) provides infants with optimal nutrition, and together with appropriate antiretroviral therapy has also been shown to decrease mother-to-child transmission of HIV from 45 to less than 1 %. However, rates of EBF are particularly low in South Africa, where rates of HIV are some of the highest in the world. Although perinatal depression has been identified as a potential barrier to EBF, little is known about its impact on EBF among HIV-infected women. A cohort study was conducted as part of a pilot randomized controlled trial (RCT) examining the effect of an Information, Motivation and Behavioral skills-based intervention promoting EBF among South African women living with HIV in their third trimester (28–42 weeks) of pregnancy. At baseline and follow-up, participants were interviewed on depression symptoms (PHQ-9), and breastfeeding intentions and behavior. Multivariate logistic regressions were conducted to determine predictors of EBF at 6-weeks postpartum. A total of 68 women were enrolled and 58 women completed both baseline and follow-up assessments. Most (80.9 %) of the sample reported at least some symptoms of depression prenatally. Rates of depression were lower postpartum (47.1 %). In multivariate models, higher prenatal depression scores significantly predicted lower likelihood of EBF at 6-weeks postpartum after adjusting for demographics, condition, and intentions (AOR = 0.68, p  < 0.05). Postpartum depression was not a significant predictor of EBF rates (AOR = 0.99, p  = 0.96). These findings demonstrate the negative impact of prenatal depression on breastfeeding behavior. Future interventions focused on depression are warranted to identify those at risk for sub-optimal EBF. Improving maternal psychosocial well-being could be a new frontier to improving infant and young child feeding and reducing pre/postnatal transmission.