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

Research output: Contribution to journalArticlepeer-review

Elizabeth C. Braithwaite, Helen Sharp, Andrew Pickles, Jonathan Hill, Nicola Wright

Original languageEnglish
Article number59
Number of pages1
JournalBiology of Sex Differences
Issue number1
Early online date7 Nov 2021
E-pub ahead of print7 Nov 2021
PublishedDec 2021

Bibliographical note

Funding Information: The WCHADS was funded by the Medical Research Council (Grant Number: G0900654). AP is partially supported by NIHR SI award NF-SI-0617-10120 and NIHR Maudsley Biomedical Research Centre. Funding Information: The authors are grateful to all participating families and research staff who contributed to this work and to Wirral University Teaching Hospital NHS Foundation Trust, Wirral Community NHS Foundation Trust, Cheshire and Wirral Partnership NHS Foundation Trust who supported the recruitment into the study in pregnancy and to the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2021, The Author(s).

King's Authors


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 effects might persist into the postnatal period for breastfed infants, as maternal cortisol is expressed in breastmilk and is influenced by maternal psychological distress. We pre-registered hypotheses that maternal postnatal depression would be associated with infant negative emotionality, and that this effect 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 effect 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 significant, in the non-breastfed females. For males, the association was non-significant in both the breastfed and non-breastfed groups. A test of sex difference between breastfed males and females was significant. Conclusions: We provide evidence that effects of maternal postnatal depression on child emotional outcomes are moderated by breastfeeding status and differ by infant sex. Female vulnerability to elevated maternal breastmilk glucocorticoids may, at least in part, explain these effects.

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