Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: the mediating role of infant temperament

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Abstract

Successful breastfeeding involves a dyadic interaction between a mother and her infant. The present study was designed to examine the association between breastfeeding and temperament in infants of depressed mothers. Seventy-eight mothers, 31 who were depressed, and their infants participated. Depressed mothers who had stable breastfeeding patterns were less likely to have infants with highly reactive temperaments. Multivariate analyses of variances (MANOVAs) showed that infants of depressed mothers who breastfed did not show the frontal asymmetry patterns, i.e., left frontal hypoactivity, previously reported. Moreover, breastfeeding stability, even in depressed mothers, was related to more positive dyadic interactions. Finally, a model was supported, in which the effects of maternal depression on infant feeding are mediated by infant frontal EEG asymmetry and infant temperament. These findings could provide a foundation for developing intervention techniques, employing breastfeeding promotion and support, directed toward attenuating the affective and physiological dysregulation already noted in infants of depressed mothers.

Introduction

In 1997, the American Academy of Pediatrics recommended that women breastfeed their infants for the first year of life (Gartner, 1998) increasing interest and rates of breastfeeding. However, a substantial portion of women, especially depressed women, do not choose to breastfeed or do so for relatively short periods of time (Field et al., 2002a, Galler et al., 1999). Investigators are now compelled to examine the factors that are associated with the benefits of sustained breastfeeding and to examine whether breastfeeding can benefit the physiological and affective development of infants. Moreover, it is important to investigate whether breastfeeding has positive or negative effects on the affective development of infants of depressed mothers. Previous research has consistently demonstrated that infants of depressed mothers are at increased risk for physiological and affective dysregulation (Field, 1995, Jones et al., 1998) necessitating further inquiry into the benefits of breastfeeding for these infants. In this study, we attempted to examine whether the dysregulated affective and physiological development, noted in infants of depressed mothers, was also evident in infants of depressed mothers with sustained breastfeeding patterns.

Little is know about patterns of breastfeeding in depressed mothers, and it is likely that what may be true of other adults who breastfeed does not hold for breastfeeding depressed mothers. Depressed mothers have been less likely than other adults to choose to breastfeed (Galler et al., 1999, Milligan et al., 1990), making it unclear whether breastfeeding can benefit depressed mothers and their infants. Until recently, inquiry into the benefits of breastfeeding to infants of depressed mothers was largely precluded by a scarcity of research participants since breastfeeding has been more prevalent among psychologically non-symptomatic, college-educated, middle-class women whose infants are at low risk for adverse outcomes. However, due to the resurgence of cultural acceptance of breastfeeding and the enhanced understanding of the physiological importance (Newman, 1995), depressed mothers are now choosing to breastfeed.

Besides the wealth of research that has touted the physiological benefits of breastfeeding on infant health, a number of studies have also assessed the emotional benefits of breastfed compared to bottle fed mother–infant pairs. In parallel with earlier findings highlighting greater reciprocity and affection during breastfeeding (Bernal and Richards, 1970, Dunn and Richards, 1977), recent research has also demonstrated (Lavelli and Poli, 1998) that breastfeeding mothers provide their neonates with less auditory stimulation, but more visual gaze and tactile stimulation. In addition, investigations probing whether the experiences entailed by breastfeeding extend beyond the feeding context have been addressed only rarely. One study compared dyadic interactions of breastfeeding versus bottle-feeding adult mothers in play situation (Kuzela et al., 1990) and reported that breastfeeding mothers touched their infants more frequently, suggesting the benefits of breastfeeding extend to other contexts.

Previous research has typically focused on the characteristics of the mother and her likelihood for continued breastfeeding (Mezzacappa and Katkin, 2002, Mezzacappa et al., 2002, Pugh, 1998) while relative few studies have examined the effects of infant characteristics on breastfeeding. Of those studies that have measured infant behavior, researchers have reported that breastfed newborns are more irritable but show more optimal physiological organization (Dipietro et al., 1987, Zeskind et al., 1992). However, later in infancy, breastfed infants are reported to be more active, temperamentally “easier”, less irritable, more positive, and more sociable (Field et al., 2002a, VanDiver, 1997, Worobey, 1992, Worobey, 1998). These data suggest that breastfeeding may be beneficial to the infant, yet the newborn may not manifest overt behavioral signs that promote continued breastfeeding. This issue is even more important for depressed mothers because these mothers are less likely to feel competent in caring for their infants (Field et al., 2002a). Therefore, if their newborn responds with elevated distress to breastfeeding, depressed mothers are more likely to discontinue breastfeeding.

Examination of the factors that promote breastfeeding and those that act as barriers to sustained breastfeeding should also focus on the role of infant temperament. We adhere to a definition of temperament that involves behavioral reactivity and regulation as a function of tonic biological and/or physiological patterns. Moreover, we contend that we are able to understand variations in temperament by analyzing the manner in which emotions are expressed and regulated during infancy (Calkins et al., 1996, Fox, 1994, Fox et al., 1994, Goldsmith et al., 1987). Our own studies, and those of others (Dawson et al., 1997), have suggested that newborns and infants of depressed mothers demonstrate greater dysregulated affective and physiological patterns (Jones et al., 1997a, Jones et al., 1998, Lundy et al., 1999). Findings from these studies have consistently found that infants of depressed mothers show greater right frontal EEG asymmetry, lower vagal tone, more dysregulated biochemical patterns, more disorganized behavioral, and sleep patterns. Collectively, these data suggest that infant bio-behavioral regulation patterns, associated with maternal depression, may lead to a negative temperamental bias that is likely to influence later development and may predispose the child for later affective disorders (Field, 1995).

Early in infancy, parental behaviors are primarily focused on care taking. Opportunities for breastfeeding benefits are likely warranted to ameliorate the negative behavioral and physiological patterns already identified in infants of depressed mothers. However, we know of no other studies that have examined infants of depressed mothers and the potentially positive outcomes that may be garnered by exposing them to stable breastfeeding patterns during infancy. Within the present study, we examined whether stable breastfeeding patterns in depressed mothers were associated with attenuated negative developmental patterns in their infants. We also examined additional factors that may be related to the positive outcomes, whether affective bonding was increased as a result of stable breastfeeding, whether infants were physiologically benefited by breastfeeding, and whether mothers’ perceptions of their infants’ temperament and their behaviors were associated with feeding stability and depression status.

The purpose of the present study was to examine breastfeeding in infants of depressed mothers. Specifically, we examined individual differences in infant temperament (positive and negative) that may be related to stable breastfeeding patterns in depressed mothers, including infant’s physiological and behavioral reactivity, and the dyads’ socio-emotional interaction patterns. Our goal was to determine whether each factor was associated with breastfeeding stability and whether stable breastfeeding in depressed dyads was associated with attenuated negative outcomes. We hypothesized that maternal depression and more negatively reactive infant temperament would be associated with a shorter duration of breastfeeding. Second, we expected that depressed mothers who discontinued breastfeeding by 3 months of age (or never breastfed) would have infants who show the greatest dysregulation, in affective regulation and physiological activity. Third, we expected that depressed mothers who continued breastfeeding would report more positive perceptions of their infants’ temperament and would demonstrate greater mutual interactive behaviors with their infants. Finally, we tested a model that examined the direct and indirect effects of maternal depression on infant temperament, infant EEG activity, and feeding behaviors. We hypothesized that the effects of maternal depression on feeding patterns are mediated by infant frontal EEG activity and infant temperament (Fig. 1).

Section snippets

Prescreening

Initially, hospital intake information (documenting demographic, feeding, and infant health information) was used to obtain a sample of new mothers who fit the predefined criteria. For the present study, we concentrated our efforts on obtaining middle class (mean of 2–3 on Hollingshead scale (Hollingshead, 1975), adult (age: 20–39 years) women with healthy (>9 on 5 min APGAR), full-term (>37 weeks gestation) infants. We choose to recruit a middle-class, healthy infant sample to rule out other

Maternal depression and infant temperament

In an attempt to determine whether reactive infant temperament and maternal depression were related to the earlier cessation of breastfeeding, we conducted several chi-square analyses. Infants classified as high in reactive during the arm restraint procedure were compared to those low in reactive on the stability of their breastfeeding patterns to 3 months of age. Results showed that 77.8% of the infants who were high reactive and had a depressed mother were predominately bottle fed whereas

Discussion

The goal the present investigation was to examine the factors that promote breastfeeding stability and to examine the physiological and affective development in infants of depressed mothers who breastfed compared to those who bottle fed. Previous research has suggested that depressed mothers are less likely to breastfeed (Galler et al., 1999, Milligan et al., 1990) and infants of depressed mothers demonstrate dysregulated physiological and behavioral patterns as early as the newborn period (

Acknowledgements

We would like to thank the mothers and infants who participated in this study. We would also like to thank all the students at Florida Atlantic University at Jupiter who helped with data collection. This research was supported by a NIMH grant (MH61888) and a FAU Research Initiation Award to Nancy Aaron Jones, Ph.D.

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