Prenatal Stress, Anxiety, and Depressive Symptoms as Predictors of Intention to Breastfeed Among Hispanic Women

Background: Studies on the relationship between prenatal psychosocial risk factors and breastfeeding are sparse, particularly in Hispanic women. Methods: We evaluated this association among 424 participants in Proyecto Buena Salud, an ongoing prospective cohort of pregnant Hispanic women in Western Massachusetts. The Perceived Stress Scale (PSS), the State-Trait Anxiety Inventory (STAI), and the Edinburgh Postnatal Depression Scale (EPDS) were administered by bilingual interviewers in early pregnancy (mean 13.6 weeks gestation) and midpregnancy (mean 25.7 weeks gestation). Information on sociodemographic, behavioral, and acculturation factors was also collected. Breastfeeding intention was abstracted from medical records. Poisson regression was used to calculate prevalence risk ratios (PRR) and 95% confidence intervals (CI). Results: A total of 274 (64.6%) women reported a positive intention to breastfeed. In multivariate analyses, women in the highest quartile of perceived stress (PRR 0.76, 95% CI 0.62-0.94) in early pregnancy and highest quartile of anxiety in early pregnancy (PRR 0.66, 95% CI 0.54-0.81) and midpregnancy (PRR 0.80, 95% CI 0.64-1.00) were less likely to intend to breastfeed compared to women in the lowest quartile. Women who had at least probable minor depression (EPDS score >= 13) (PRR 0.79, 95% CI 0.65-0.95) or probable major depression (EPDS score >= 15) (PRR 0.77, 95% CI 0.62-0.96) during midpregnancy were less likely to intend to breastfeed compared to women without depressive symptoms. Similarly, women with persistent depressive symptoms over pregnancy were 24%-33% less likely to intend to breastfeed compared to women without depressive symptoms. Conclusions: Psychosocial risk factors during pregnancy are important predictors of breastfeeding intention among Hispanic women.