Amamentação e depressão pós-parto: revisão do estado de arte / Breastfeeding and postpartum depression: state of the art review

OBJETIVO: Revisar a literatura sobre a associação entre a amamentação e a depressão pós-parto. FONTES: Uma revisão da literatura encontrada na base de dados MEDLINE/Pub-Med. RESUMO DOS ACHADOS: A literatura mostra, de forma consistente, que a amamentação fornece uma ampla quantidade de benefícios tanto para a criança quanto para a mãe. Ainda são necessárias mais pesquisas sobre os benefícios psicológicos para a mãe. Alguns estudos apontam que a depressão na gravidez é um dos fatores que pode contribuir para a não amamentação. Outros estudos sugerem, também, uma associação entre amamentação e depressão pós-parto, não estando clara ainda a direção dessa associação. A amamentação pode promover processos hormonais que protegem as mães contra a depressão pós-parto por atenuar a resposta do cortisol ao estresse. E isso também pode reduzir o seu risco, por auxiliar na regulação dos padrões do sono e vigília da mãe e do filho, melhorando a autoeficácia e o envolvimento emocional da mãe com a criança, reduzindo as dificuldades de temperamento e promovendo uma melhor interação entre eles. CONCLUSÕES: A pesquisa aponta que a amamentação pode proteger as mães da depressão pós-parto e começa a esclarecer que processos biológicos e psicológicos podem explicar essa proteção. Contudo, ainda existem resultados ambíguos na literatura que poderão ser explicados pelas limitações metodológicas apresentadas por alguns estudos.

OBJECTIVE: To review the literature on the association between breastfeeding and postpartum depression. SOURCES: A review of literature found on MEDLINE/ PubMed database. SUMMARY OF FINDINGS: The literature consistently shows that breastfeeding provides a wide range of benefits for both the child and the mother. The psychological benefits for the mother are still in need of further research. Some studies point out that pregnancy depression is one of the factors that may contribute to breastfeeding failure. Others studies also suggest an association between breastfeeding and postpartum depression; the direction of this association is still unclear. Breastfeeding can promote hormonal processes that protect mothers against postpartum depression by attenuating cortisol response to stress. It can also reduce the risk of postpartum depression, by helping the regulation of sleep and wake patterns for mother and child, improving mother's selfefficacy and her emotional involvement with the child, reducing the child's temperamental difficulties, and promoting a better interaction between mother and child. CONCLUSIONS: Studies demonstrate that breastfeeding can protect mothers from postpartum depression, and are starting to clarify which biological and psychological processes may explain this protection. However, there are still equivocal results in the literature that may be explained by the methodological limitations presented by some studies.

Detección de depresión en mujeres embarazadas mexicanas con la CES-D / Depression screening in Mexican pregnant women with the CES-D

Prenatal depressive symptoms, due to their high prevalence (22% to 37%) and negative consequences on the health of the mother, the baby and the course of pregnancy, require early detection to provide support and treatment. The CES-D is a scale to identify symptoms of depression that is easy and quick to apply and has adequate validity among expectant mothers. The purpose of the study was to analyze the validity and reliability of the CES-D in pregnant Mexican women, as well as its sensitivity, specificity and predictive values using the SCID as the gold standard. Method The study was based on the secondary analysis of data. A sample of 98 pregnant women attending antenatal care in health center was selected because they displayed depressive symptoms or previous depression. Results The internal consistency of the CES-D was α=0.81. Factor analysis, which assessed the construct validity, yielded four interpretable factors (depressive affect, lack of energy/somatic symptoms, interpersonal relationships and positive affect), which accounted for 49.10% of the variance. The ROC curve analyses, showed an AUC of 0.81; for a cutoff point of >16, showed 100% sensitivity and 19.6% specificity; and sensitivity of 80.0% and specificity of 76.1% for a >28 cut-off point. Conclusions The CES-D showed excellent internal and construct validity in Mexican pregnant women and appeared to be a suitable tool for detecting depressive symptoms -a requisite for implementing preventive actions. However, it was less accurate, but still acceptable, when diagnosing major depression according to DSM-IV criteria with a score of >28.

La sintomatología depresiva prenatal, por su alta prevalencia (22% a 37%) y consecuencias negativas sobre la salud de la madre, el producto y el curso del embarazo, requiere de detección oportuna para proporcionar apoyo y tratamiento adecuados. La CES-D es una escala para identificar síntomas de depresión, de fácil y rápida aplicación y con validez adecuada en gestantes. El objetivo del trabajo fue analizar la validez y confiabilidad de la CES-D en mujeres mexicanas embarazadas, así como la sensibilidad, especificidad y valores predictivos usando el SCID como estándar de oro. Método El estudio se basó en un análisis secundario de datos. Se obtuvo una muestra de 98 mujeres embarazadas en la sala de espera de un centro de salud que proporcionaba atención prenatal. Fueron seleccionadas por presentar sintomatología depresiva (CES-D>16) o historia de depresión. Resultados La consistencia interna de la CES-D fue de α=0.81. El análisis factorial, que valoró la validez de constructo, mostró que cuatro factores pudieron ser interpretados (afecto depresivo, falta de energía/síntomas somáticos, relaciones interpersonales y afecto positivo), que explicaron 49.10% de la varianza. En el análisis de la curva COR, se obtuvo un ABC de 0.81; para punto de corte >16, mostró 100% de sensibilidad y 20.9% de especificidad y para la puntuación >28, sensibilidad de 80.0% y especificidad de 76.1%. Conclusiones Se encontró que la CES-D tiene excelente validez interna y de constructo en gestantes mexicanas y que es una herramienta adecuada para la detección de sintomatologia depresiva (CES-D>16) -requisito indispensable para instrumentar acciones preventivas-, sin embargo fue menos precisa, aunque adecuada para diagnosticar depresión mayor según criterios del DSM-IV aun en el punto de corte más parsimonioso (>28).

Comparison of nutrient intake, life style variables, and pregnancy outcomes by the depression degree of pregnant women

The aim of this study was to analyse effects that the degree of depression have on the life style variables, nutrient intake, iron indices and pregnancy outcome. Subjects were 114 pregnant women who were receiving prenatal care at a hospital in Seoul. We collected data for general characteristics and lifestyle variables from general survey instrument and for depression score from the questionnaire on depression. Dietary intakes of subjects were estimated by 24 hour dietary recall method. Also we analysed iron indices and pregnancy outcomes. We classified subjects by 10 point, which was the average depression score, into two groups [Low depression score group (LS) : High depression score group (HS)]. As to the intakes of total calcium, plant-calcium, plant-iron, potassium, total folate and dietary folate, LS group was far higher than HS group (P < 0.05, P < 0.05, P < 0.01, P < 0.001, P < 0.05, and P < 0.01, respectively). As to pre-pregnancy alcohol drinking, LS group had 41.9% in non-drinker, which was far higher than 28% in HS group in non-drinker (P < 0.05). As for drinking coffee during pre-pregnancy, pregnant women who don't drink coffee in LS group took 43.6%, which was higher than 38% in HS group (P < 0.01). Regarding delivery type, the cesarean section in LS group (18%) was significantly lower than that in HS group (45%) (P < 0.01). Bivariate analysis showed that birth weight was significantly associated with the gestational age (P < 0.01). The pregnant women with higher depression score tended to have undesirable life habit, which might affect negative pregnancy outcomes. A better understanding of how depression and intake of nutrients work together to modulate behavior will be benefit nutritional research.