Breastfeeding practices in mothers of high-respiratory-risk NICU infants: impact of depressive symptoms and smoking

Aim: Mothers of infants in the neonatal intensive care unit (NICU) have very low breastfeeding rates and these high-respiratory-risk (HRR) NICU infants may benefit from breastfeeding through decreased risk for respiratory illnesses. This population's increased risk for maternal depression and high rates (22%) of maternal smoking may negatively affect breastfeeding. Objective: This exploratory study investigated associations of breastfeeding with depressive symptoms and maternal smoking in mothers of HRR NICU infants (i.e. presence of one household smoker and birth weight <1500 g or mechanical ventilation >= 12 h). Methods: Breastfeeding, depression and smoking data were collected from 104 mothers in the NICU following delivery. Results: Fifty-five (52.9%) mothers reported breastfeeding, 39 (37.5%) had a Center for Epidemiological Studies Depression Scale (CES-D) score (>= 16) suggestive of depression, and 36 (34.6%) reported smoking. Mothers with CES-D scores >= 16 were less likely to breastfeed compared to those with scores <16 (38.5% versus 61.5%; p = 0.02). Breastfeeding and smoking were not significantly associated (p<0.10). Mothers of HRR infants with significant depressive symptoms who smoke have significantly lower breastfeeding rates (21%) than mothers who are not depressed and do not smoke (65%). Conclusions: Interventions to improve breastfeeding initiation and continuation that target depression and smoking are necessary.