Prenatal anxiety may negatively affect infant health in multiple domains, including infant feeding. However, the relationship between prenatal anxiety and infant feeding is not well understood. Given the benefits of recommended infant feeding practices, clarifying this relationship is important. This review was conducted to examine the relationship between prenatal anxiety and infant feeding outcomes. Electronic searches were performed in relevant databases. A hand search of selected journals and reference lists of included articles was then conducted. All studies were considered that provided information related to infant feeding outcomes and anxiety during pregnancy. Quality assessment and data extraction were conducted by 2 reviewers; 99 studies were identified, of which 6 were eligible. No associations were found between prenatal anxiety and breastfeeding initiation or breastfeeding in any quantity. However, relationships between high levels of prenatal anxiety and a reduction in both breastfeeding intention and breastfeeding exclusivity were identified. The review was limited by the small number of studies included. Sample sizes lacking power and heterogeneous measures and definitions all significantly affected the comparability of findings. It is concluded that there is insufficient evidence to clarify the relationship between prenatal anxiety and infant feeding outcomes.
FurberCMGarrodDMaloneyELovellKMcGowanL. A qualitative study of mild to moderate psychological distress during pregnancy. Int J Nurs Stud. 2009;46(5):669-677. doi:10.1016/j.ijnurstu.2008.12.003.
2.
ZelkowitzPPapageorgiouA. Easing maternal anxiety: an update. Womens Health (Lond Engl). 2012;8(2):205-213. doi:10.2217/whe.11.96.
3.
OhmanSGGrunewaldCWaldenströmU. Women’s worries during pregnancy: testing the Cambridge Worry Scale on 200 Swedish women. Scand J Caring Sci. 2003;17(2):148-152. http://www.ncbi.nlm.nih.gov/pubmed/12753515.
4.
RiniCKDunkel-SchetterCWadhwaPDSandmanCA. Psychological adaptation and birth outcomes: the role of personal resources, stress, and sociocultural context in pregnancy. Health Psychol. 1999;18(4):333-345. http://www.ncbi.nlm.nih.gov/pubmed/10431934.
5.
DevineCMBoveCFOlsonCM. Continuity and change in women’s weight orientations and lifestyle practices through pregnancy and the postpartum period: the influence of life course trajectories and transitional events. Soc Sci Med. 2000;50(1):567-582. http://www.hss.ucsf.edu/PDF/article-Devine1999.pdf.
6.
HuizinkACMulderEJHRoblesdeMedinaPGVisserGHBuitelaarJK. Is pregnancy anxiety a distinctive syndrome?Early Hum Dev. 2004;79(2):81-91. doi:10.1016/j.earlhumdev.2004.04.014.
7.
Van den BerghBRHMulderEJHMennesMGloverV. Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci Biobehav Rev. 2005;29(2):237-258. doi:10.1016/j.neubiorev.2004.10.007.
8.
RiegerMPirkeKMBuske-KirschbaumAWurmserHPapousekMHellhammerDH. Influence of stress during pregnancy on HPA activity and neonatal behavior. Ann N Y Acad Sci. 2004;1032:228-230. doi:10.1196/annals.1314.026.
9.
DavisEPSnidmanNWadhwaPDGlynnLMSchetterCDSandmanCA. Prenatal maternal anxiety and depression predict negative behavioral reactivity in infancy. Infancy. 2004;6(3):319-331. doi:10.1207/s15327078in0603_1.
10.
HuizinkACRoblesdeMedinaPGMulderEJHVisserGHBuitelaarJK. Psychological measures of prenatal stress as predictors of infant temperament. J Am Acad Child Adolesc Psychiatry. 2002;41(9):1078-1085. doi:10.1097/00004583-200209000-00008.
11.
HuizinkACRoblesdeMedinaPGMulderEJHVisserGHBuitelaarJK. Stress during pregnancy is associated with developmental outcome in infancy. J Child Psychol Psychiatry. 2003;44(6):810-818. http://www.ncbi.nlm.nih.gov/pubmed/12959490.
12.
BrouwersEPMvan BaarALPopVJM. Maternal anxiety during pregnancy and subsequent infant development. Infant Behav Dev. 2001;24(1):95-106. doi:10.1016/S0163-6383(01)00062-5.
13.
LaplanteDPBarrRGBrunetA. Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatr Res. 2004;56(3):400-410. doi:10.1203/01.PDR.0000136281.34035.44.
14.
LoomansEMvan der SteltOvan EijsdenMGemkeRJBJVrijkotteTVan den BerghBRH. Antenatal maternal anxiety is associated with problem behaviour at age five. Early Hum Dev. 2011;87(8):565-570. doi:10.1016/j.earlhumdev.2011.04.014.
15.
O’ConnorTGCaprarielloPBlackmoreERGregoryAMGloverVFlemingP. Prenatal mood disturbance predicts sleep problems in infancy and toddlerhood. Early Hum Dev. 2007;83(7):451-458. doi:10.1016/j.earlhumdev.2006.08.006.
16.
Lauzon-GuillainBDWijndaeleKClarkM. Breastfeeding and infant temperament at age three months. PLoS One. 2012;7(1):e29326. doi:10.1371/journal.pone.0029326.
17.
MindellJADu MondCTanenbaumJBGunnE. Long-term relationship between breastfeeding and sleep. Child Health Care. 2012;41(3):190-203. doi:10.1080/02739615.2012.685038.
18.
GrayLMillerLWPhilippBLBlassEM. Breastfeeding is analgesic in healthy newborns. Pediatrics. 2002;109(4):590-593.
19.
MezzacappaESKatkinES. Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Health Psychol. 2002;21(2):187-191. doi:10.1037//0278-6133.21.2.187.
20.
AdedinsewoDAFlemingASSteinerMMeaneyMJGirardAW. Maternal anxiety and breastfeeding: findings from the MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) study. J Hum Lact. 2014;30(1):102-109. doi:10.1177/0890334413504244.
21.
SpielbergerCGorsuchRLusheneR. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consultant Psychologists Press; 1970.
22.
PaulIMDownsDSSchaeferEWBeilerJSWeismanCS. Postpartum anxiety and maternal-infant health outcomes. Pediatrics. 2013;131(4):e1218-e1224. doi:10.1542/peds.2012-2147.
23.
HeronJO’ConnorTGEvansJGoldingJGloverV. The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord. 2004;80(1):65-73. doi:10.1016/j.jad.2003.08.004.
24.
ChenDCNommsen-RiversLDeweyKGLönnerdalB. Stress during labor and delivery and early lactation performance. Am J Clin Nutr. 1998;68(4):335-344.
WadwhaPDSandmanCAPortoMDunkel-SchetterCGariteTJ. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol. 1993;169(4):858-865. http://cat.inist.fr/?aModele=afficheN&cpsidt=4229213. Accessed January 15, 2015.
27.
BerleJØMykletunADaltveitAKRasmussenSHolstenFDahlAA. Neonatal outcomes in offspring of women with anxiety and depression during pregnancy. A linkage study from The Nord-Trøndelag Health Study (HUNT) and Medical Birth Registry of Norway. Arch Womens Ment Health. 2005;8(3):181-189. doi:10.1007/s00737-005-0090-z.
28.
LisspersJNygrenASödermanE. Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand. 1997;96(4):281-286. http://www.ncbi.nlm.nih.gov/pubmed/9350957.
29.
RubertssonCHellströmJCrossMSydsjöG. Anxiety in early pregnancy: prevalence and contributing factors. Arch Womens Ment Health. 2014;17(3):221-228. doi:10.1007/s00737-013-0409-0.
30.
MarcITourecheNErnstE. Mind-body interventions during pregnancy for preventing or treating women’s anxiety. Cochrane Database Syst Rev. 2011;(7):CD007559.
31.
DennisCLMcQueenK. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics. 2009;123(4):e736-e751. doi:10.1542/peds.2008-1629.
32.
McAndrewAFThompsonJFellowsLLargeASpeedMRenfrewMJ. Infant Feeding Survey 2010. Health Soc Care Inf Cent. 2012:1-331.
33.
CheungWIpWYChanD. Maternal anxiety and feelings of control during labour: a study of Chinese first-time pregnant women. Midwifery. 2007;23(2):123-130. doi:10.1016/j.midw.2006.05.001.
34.
LevinJS. The factor structure of the Pregnancy Anxiety Scale. J Health Soc Behav. 1991;32(4):368-381.
35.
MaesMOmbeletW. In the puerperium, primiparae exhibit higher levels of anxiety and serum peptidase activity and greater immune responses than multiparae. J Clin Psychiatry. 2004;65(1):71-76.
36.
TuMTLupienSJWalkerCD. Multiparity reveals the blunting effect of breastfeeding on physiological reactivity to psychological stress. J Neuroendocrinol. 2006;18(7):494-503. doi:10.1111/j.1365-2826.2006.01441.x.
37.
Peñacoba-PuenteCMongeFJCMoralesDM. Pregnancy worries: a longitudinal study of Spanish women. Acta Obstet Gynecol Scand. 2011;90(9):1030-1035. doi:10.1111/j.1600-0412.2011.01208.x.
38.
DipietroJACostiganKASipsmaHL. Continuity in self-report measures of maternal anxiety, stress, and depressive symptoms from pregnancy through two years postpartum. J Psychosom Obstet Gynecol. 2008;29(2):115-124. doi:10.1080/01674820701701546.
39.
TeixeiraCFigueiredoBCondeAPachecoACostaR. Anxiety and depression during pregnancy in women and men. J Affect Disord. 2009;119(1-3):142-148. doi:10.1016/j.jad.2009.03.005.
40.
FordKLabbokM. Who is breast-feeding? Implications of associated social and biomedical variables for research on the consequences of method of infant feeding. Am J Clin Nutr. 1990;52(3):451-456. http://ajcn.nutrition.org/content/52/3/451.short. Accessed November 20, 2014.
41.
ZanardoVGasparettoSGiustardiA. Impact of anxiety in the puerperium on breast-feeding outcomes: role of parity. J Pediatr Gastroenterol Nutr. 2009;49(5):631-634. doi:10.1097/MPG.0b013e31819e6446.
42.
PiperSParksPL. Predicting the duration of lactation: evidence from a national survey. Birth. 1996;23(1):7-12.
43.
BourgoinGLahaieN. Factors influencing the duration of breastfeeding in the Sudbury region. Can J Public Health. 1996;88(4):238-241. http://europepmc.org/abstract/med/9336092. Accessed November 20, 2014.
44.
HigginsJPGreenS, eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 5. London: Cochrane Collaboration; 2011. www.cochranehandbook.org.
MehtaUJSiega-RizAMHerringAHAdairLSBentleyME. Pregravid body mass index, psychological factors during pregnancy and breastfeeding duration: is there a link?Matern Child Nutr. 2012;8(4):423-433. doi:10.1111/j.1740-8709.2011.00335.x.
49.
FairleeTGillmanMWRich-EdwardsJ. High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation. J Womens Health. 2009;18(7):945-943.
50.
InsafTZFortnerRTPekowPDoleNMarkensonGChasan-TaberL. Prenatal stress, anxiety, and depressive symptoms as predictors of intention to breastfeed among Hispanic women. J Womens Health (Larchmt). 2011;20(8):1183-1192. doi:10.1089/jwh.2010.2276.
51.
GuestGBunceAJohnsonLAkumateyBAdeokunL. Fear, hope and social desirability bias among women at high risk for HIV in West Africa. J Fam Plann Reprod Health Care. 2005;31(4):285-287. doi:10.1783/1471189054.
52.
LinaresAMRayensMKGomezMLGokunYDignanMB. Intention to breastfeed as a predictor of initiation of exclusive breastfeeding in Hispanic women. J Immigr Minor Health. 2015;17(4):1192-1198.
53.
KimEHoetmerSELiYVandenbergJE. Relationship between intention to supplement with infant formula. Can J Public Health. 2013;104(5):388-393.
YstromE. Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childbirth. 2012;12:36. doi:10.1186/1471-2393-12-36.
56.
KehlerHLChaputKHToughSC. Risk factors for cessation of breastfeeding prior to six months postpartum among a community sample of women in Calgary, Alberta. Can J Public Health. 2009;100(5):376-380. http://www.ncbi.nlm.nih.gov/pubmed/19994742.
57.
van RossemLOenemaASteegersEA. Are starting and continuing breastfeeding related to educational background? The generation R study. Pediatrics. 2009;123(6):e1017-e1027. doi:10.1542/peds.2008-2663.
58.
HauffLLeonardSARasmussenKM. Associations of maternal obesity and psychosocial factors with breastfeeding intention, initiation, and duration. Am J Clin Nutr. 2014;99(3):524-534. doi:10.3945/ajcn.113.071191.
59.
GuelinckxIDevliegerRBogaertsAPauwelsSVansantG. The effect of pre-pregnancy BMI on intention, initiation and duration of breast-feeding. Public Health Nutr. 2012;15(5):840-848. doi:10.1017/S1368980011002667.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
