Antenatal psychological and socioeconomic predictors of breastfeeding in a large community sample

Background: Despite much work to publicise the benefits of breastfeeding most women do not persist for the first 6 months, as recommended by the WHO. Successful breastfeeding for 6 months may depend on several factors, including perinatal mental health. We aimed to investigate the impact of antenatal depressive symptoms, attitudes towards breastfeeding and socio-demographic factors in predicting breastfeeding for 6 months in a large community sample. Methods: The sample was based on the Avon Longitudinal Study of Parents and Children (n = 9479), a large-scale birth cohort. Breastfeeding was assessed at multiple time-points, from postnatal day 1 until 6 months postnatal. Self-reported symptoms of maternal depression were assessed at 18 and 32 weeks gestation and at 8 weeks postnatal. Antenatal attitudes towards breastfeeding were assessed at 32 weeks gestation. Antenatal, obstetric, psychosocial and socio-demographic variables were also assessed. Results: Antenatal depressive symptoms at both 18 and 32 weeks gestation were associated with decreased breastfeeding initiation and duration. However, the prediction of breastfeeding by these symptoms was confounded by socio-demographic and psychosocial covariates. A positive antenatal attitude towards breastfeeding was the strongest predictor and was associated with a 20-30% increase in breastfeeding initiation and maintenance at all time points. Conclusion: This study highlights the wide range of factors that independently predict breastfeeding, and suggests that an intervention program to improve antenatal attitudes especially warrants investigation.