Submitted to: Journal of Perinatology
Publication Type: Peer reviewed journal
Publication Acceptance Date: 5/11/2007
Publication Date: 7/1/2007
Citation: Lau, C., Hurst, N.M., Smith, E.O., Schanler, R.J. 2007. Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants. Journal of Perinatology. 27(7):399-408. Interpretive Summary: Breastfeeding is an important physiological process that can be influenced by other factors, specifically psychological stress. The goal of this study was to determine if overall lactation performance is affected by frequency of breastfeeding, ethnic background, or psychosocial/socioeconomic factors. Major findings were that when subjects were depressed, milk volume decreased. Additional findings showed that as the frequency of breastfeeding increased, the milk volume also increased. These findings suggest that lactation performance and associated newborn development can be enhanced by more attention to management of maternal mental health and encouragement of frequent breastfeeding.
Technical Abstract: This study compared maternal characteristics and psychological stress profile among African-American, Caucasian, and Hispanic mothers who delivered very low birthweight infants. Our intention was to investigate associations between psychosocial factors, frequency of milk expression, skin-to-skin holding (STS), and lactation performance, defined as maternal drive to express milk and milk volume. Self-reported psychological questionnaires were given every 2 weeks after delivery over 10 weeks. Milk expression frequency, STS, and socioeconomic variables were collected. Infant birthweight, education, and milk expression frequency differed between groups. Trait anxiety, depression, and parental stress in a neonatal intensive care unit (PSS:NICU) were similar. African-American and Caucasian mothers reported the lowest scores in state anxiety and social desirability, respectively. Maternal drive to express milk, measured by maintenance of milk expression, correlated negatively with parental role alteration (subset of PSS:NICU), and positively with infant birthweight and STS. Milk volume correlated negatively with depression, and positively with milk expression frequency, and STS. Differences between groups were observed for certain psychosocial factors. The response bias to self-reported questionnaires between groups may not provide an accurate profile of maternal psychosocial profile. With different factors correlating with maintenance of milk expression and milk volume, lactation performance can be best enhanced with a multi-faceted intervention program, incorporating parental involvement in infant care, close awareness and management of maternal mental health, and encouragement for frequent milk expression and STS.