How does breastfeeding impact postpartum depression in pre-and post- COVID-19 cohorts?

By now you may know that Healthy Children Project made the very difficult decision to cancel the 27th Annual International Breastfeeding Conference in Deerfield Beach, Fla. because of the growing concerns around COVID-19.  Still, we remain enthusiastic about the scheduled presenters’ incredible work and are excited to be able to share some of their findings here on Our Milky Way

A few weeks ago, we shared about Malaika Ludman, MPH, CLC and colleagues’ work titled Infant and Young Child Feeding in Emergencies in Louisiana: Lessons Learned from a Post-Hurricane Laura Response During the COVID-19 Pandemic

The Vozzola Duo

This week we are pleased to highlight work by Amanda Vozzola, BS, David Vozzola, PhD, Johanna McCracken, BS and Dikea Roussos-Ross, MD:   How Does Breastfeeding Impact Postpartum Depression in Pre-and Post- COVID-19 Cohorts?

Amanda Vozzola is a fourth-year medical student at the University of Florida College of Medicine and is applying for an Obstetrics and Gynecology residency position. Amanda shares that her passion for women’s health shaped much of her research and teaching initiatives, which led to work involving maternal morbidity and mortality in the US and transgender reproductive health considerations. 

While women’s health is her primary passion, she has also studied how chemotherapy impacts neural stem cell growth, created an individualized tobacco cessation protocol, and received an NIH-T35 grant for her research in pediatric cardiac imaging modalities. She says her goal as a future physician is to use her diverse background to provide high-quality, compassionate healthcare for her patients.

“Maternal medicine is complex, the patient population is wonderful, and it’s a field where healthcare professionals and researchers can make a tangible difference,” Amanda shares. “As a nation, our maternal morbidity and mortality outcomes and newborn health outcomes are unacceptable. I am interested in helping decrease the disparity gap through research, clinical practice, and education.”

Dr. David Vozzola (admiringly referred to as Dr. Dad by Ms. Vozzola) is the Director of the Information Technology Institute for Advanced Study (ITIAS) which  funds research in health technology, human technology, transportation, logistics, virtual reality, artificial intelligence, and machine learning.

Amanda says she got curious about postpartum depression (PPD) as she continued to see patients with mental health concerns postpartum.

Many blame themselves for ‘feeling down’ or say they do not feel like a good mom because they don’t feel happy,” Amanda explains. “Postpartum women often face an amplified stigma of mental health, and I believe a lack of research, knowledge, and awareness contributes to the amplification.”

Photo by David Veksler on Unsplash

Conversing with her roommate and co-author on this project, Amanda says they discussed how the pandemic impacted many of their patients, friends, and family members during pregnancy and postpartum. 

“Between hospital regulations allowing one (sometimes none) person to be in the room, the anxiety of an unknown virus and worldwide pandemic, isolation, etc.,” she reflects. “We hypothesized that postpartum depression and anxiety would increase in a post-pandemic cohort. We are strong advocates for breastfeeding and wanted to test its protective effect for mothers before and after the pandemic.” 

The authors share their results: 

  • “Both pre-and post-COVID-19 cohorts showed that breastfeeding resulted in lower levels of postpartum depression (PPD) based on the Edinburgh Postnatal Depression Scale (EPDS) scoring than their non-breastfeeding counterparts.
  • The protective effect of breastfeeding from PPD was significant in the pre and post-COVID-19 cohort. However, the pre- cohort exhibited a higher level of protection.
  • In the pre-COVID-19 cohort, 33% of non-breastfeeding patients exhibited PPD (EPDS >= 9) and 17% exhibited severe PPD (EDPS >= 15).  In contrast, only 14% of the breastfeeding patients exhibited PPD, and 4% exhibited severe PPD.
  • In the post-COVID-19 cohort, 45% of non-breastfeeding patients exhibited PPD (EPDS >= 9) and 24% exhibited severe PPD (EDPS >= 15).  In contrast, only 32% of the breastfeeding patients exhibited PPD, and 12% exhibited severe PPD.
  • A significant difference in PPD existed between breastfeeding and non-breastfeeding in the pre-and post-COVID-19 cohorts showing that breastfeeding had significantly lower PPD, based on EPDS scores.” 

Amanda says she hopes these findings will provide a foundation for further research. 

What are other factors protective against PPD? Are there specific factors about breastfeeding that influence EPDS scores, such as duration, exclusivity, and difficulty? Why was breastfeeding less protective in the post-pandemic cohort? she wonders. 

“Ultimately, I hope this research contributes to the knowledge of PPD that helps mothers feel understood and that they are not alone,” she adds. 

Photo by on Unsplash

The Vozzolas are currently working on a few other projects from the same data collection set regarding how insurance type, gestational age, patient demographics, and previous psychiatric diagnoses impact PPD, anxiety, and specific responses on the EPDS survey. 

They have submitted two abstracts to the American College of Obstetricians and Gynecologists (ACOGs) in hopes of presenting their research at an upcoming conference. One abstract looks at the association of COVID-19 and EPDS scores. The second abstract looks at the impact of psychiatric disorders’ history on EPDS scores.

They are also preparing two journal submissions. The first submission looks at COVID-19’s impact on PPD in women with a prior psychiatric history. The second submission looks at developing and validating a model of predictors and outcomes of COVID-19 and postpartum depression.

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