Association between postpartum depressive symptom trajectories and breastfeeding patterns: results from the Mothers, Infants and Lactation Quality-Brazil study

OBJECTIVE: To investigate the association between postpartum depression (PPD) symptom trajectories and breastfeeding patterns (BFP) from 1 to 8.5 months. METHODS: In this prospective cohort study, 97 healthy mother-infant pairs from Brazil were followed at 1-3.49, 3.5-5.9, and 6-8.5 months. PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). BFP patterns were characterized using longitudinal clusters based on breast milk volume (dose-to-mother technique), feeding frequency/duration, and infant age at complementary food introduction (CFI). PPD trajectories were identified using growth mixture modeling, and latent classes were selected based on the Akaike and Bayesian information criteria. Multinomial logistic regression assessed associations with BFP. RESULTS: Two PPD symptom trajectories were identified. The "lower score" (87%) indicated PPD stability throughout follow-up, while the "higher score" (12%) showed more transitions, mainly to PPD remission in later stages. Three BF clusters (C) were identified: C1, with moderate volume/frequency and later CFI (n=37; 38%); C2, with lower volume/frequency and intermediate CFI (n=34; 35%); and C3, with higher volume/frequency and earlier CFI (n=26; 27%). Women with higher PPD symptoms showed a trend toward significance in being associated with C3 (OR = 4.17; 95%CI 0.96-18.50; p = 0.055) compared with C1. CONCLUSIONS: Although the association between higher PPD symptoms and less favorable BF practices presented only a trend toward significance, it suggests that PPD symptoms may influence BF behaviors. Larger samples are needed to confirm these findings, and the use of diagnostic tools rather than EPDS, a screening tool, may strengthen future studies. Clinically, the findings underscore the need for early PPD screening in primary care and stronger BF support.