# Mental health and tobacco use as predictors of breastfeeding duration among Virginia mothers

## TL;DR

The study finds that mental health issues and tobacco use are linked to shorter breastfeeding durations among Virginia mothers.

## Contribution

The study identifies how the co-occurrence of depression and anxiety, along with tobacco use, uniquely impacts breastfeeding trends.

## Key findings

- Mothers with both depression and anxiety breastfed nearly three weeks less than those without these conditions.
- Smoking at any timepoint was linked to nearly six weeks less breastfeeding compared to non-smokers.
- Lactation support significantly improved breastfeeding duration, especially for smokers.

## Abstract

Breastfeeding offers substantial positive health outcomes for both the mother and infant and has been identified as one of the most effective strategies for promoting infant health; however, the United States falls short in sustained breastfeeding rates. Additionally, with mental health conditions and substance use during pregnancy and the postpartum period affect nearly 1 in every 5 women in the U.S., more research is needed to better understand how these behavioral health factors, along with the co-occurrence of these factors, impact breastfeeding trends.

Cross-sectional data from the Virginia Pregnancy Risk Assessment Monitoring System (PRAMS) from 2016 to 2022 were analyzed to assess how maternal mental health and tobacco use before, during, and after pregnancy was associated with breastfeeding duration in Virginia mothers (n = 5,704).

The simultaneous presence of depression and anxiety symptoms was negatively associated with breastfeeding duration; those who reported both depression and anxiety breastfed their infants nearly three weeks less (M = 10.45, SD = 7.82) than those who reported neither (M = 13.34, SD = 7.76, p < .001). The more timepoints a mother reported depressive symptoms (before, during, and after pregnancy) was associated with statistically significant decreases in average breastfeeding duration (p < .001). Mothers who reported smoking at any timepoint breastfed their babies nearly six weeks less (M = 7.63, SD = 7.49) than mothers who did not smoke (M = 13.4, SD = 7.71, p < .001). However, among smokers, statistically significant improvements in breastfeeding duration were found in those who took initiatives to quit smoking during pregnancy (p < .001). Receiving breastfeeding support from a lactation specialist was protective, especially in smokers, as those who met with a lactation consultant had 3.53 times the odds (95% CI: 2.30, 5.43) of breastfeeding at least 12 weeks. Marital status was also protective, as married women breastfed their infants more than a month longer (M = 14.22, SD = 7.11) than non-married women (M = 9.82, SD = 8.49). Additionally, smoking was associated with shorter breastfeeding duration for those with high anxiety (p = .03), particularly among non-Hispanic Whites, Medicaid enrollees, and mothers with a high school diploma or less.

Enhanced smoking cessation, lactation support, and behavioral health services may be important for promoting breastfeeding among new mothers.