Breast may not always be best: Moderation of effects of postnatal depression by breastfeeding and infant sex

Braithwaite, Elizabeth ORCID: https://orcid.org/0000-0003-4902-2262, Sharp, Helen, Pickles, Andrew, Hill, Jonathan and Wright, Nicola ORCID: https://orcid.org/0000-0002-3285-2051 (2021) Breast may not always be best: Moderation of effects of postnatal depression by breastfeeding and infant sex. Biology of Sex Differences, 12. ISSN 2042-6410

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Abstract

Background: There is good evidence that female infants are particularly vulnerable to poor emotional outcomes following in utero glucocorticoid exposure. It is currently unclear whether such efects might persist into the postnatal period for breastfed infants, as maternal cortisol is expressed in breastmilk and is infuenced by maternal psychological distress. We pre-registered hypotheses that maternal postnatal depression would be associated with infant negative emotionality, and that this efect would be moderated by breastfeeding status and infant sex. Methods: We analysed data from the Wirral Child Health and Development Study (WCHADS), a prospective epidemiological study starting in pregnancy. Nine weeks after birth mothers self-reported depressive symptoms and breastfeeding status, and reported infant negative emotionality using the distress to limits subscale of the infant behaviour questionnaire (IBQ-R) when their infant was aged 9 weeks and 14 months. Maximum likelihood estimations made use of data from 857 mother-infant pairs. Results: At 9 weeks of age, maternal postnatal depressive symptoms were positively associated with infant distress to limits; however, this efect was not moderated by infant sex or breastfeeding. At age 14 months, the association between postnatal depression symptoms and distress to limits was greatest in the breastfed females, whereas the association was smaller, but still signifcant, in the non-breastfed females. For males, the association was non-signifcant in both the breastfed and non-breastfed groups. A test of sex diference between breastfed males and females was signifcant. Conclusions: We provide evidence that efects of maternal postnatal depression on child emotional outcomes are moderated by breastfeeding status and difer by infant sex. Female vulnerability to elevated maternal breastmilk glucocorticoids may, at least in part, explain these efects.