Breastfeeding and postpartum depression 333, PALAVRAS CHAVE Amamentac o e depress o p s parto revis o do estado de arte. Amamentac o,Depress o na Resumo, gravidez Objetivo Revisar a literatura sobre a associac o entre a amamentac o e a depress o p s parto. Depress o p s parto Fontes Uma revis o da literatura encontrada na base de dados MEDLINE Pub Med. Horm nios Resumo dos achados A literatura mostra de forma consistente que a amamentac o fornece. uma ampla quantidade de benef cios tanto para a crianc a quanto para a m e Ainda s o. necess rias mais pesquisas sobre os benef cios psicol gicos para a m e Alguns estudos apontam. que a depress o na gravidez um dos fatores que pode contribuir para a n o amamentac o. Outros estudos sugerem tamb m uma associac o entre amamentac o e depress o p s parto. n o estando clara ainda a direc o dessa associac o A amamentac o pode promover processos. hormonais que protegem as m es contra a depress o p s parto por atenuar a resposta do cor. tisol ao estresse E isso tamb m pode reduzir o seu risco por auxiliar na regulac o dos padr es. do sono e vig lia da m e e do lho melhorando a autoe c cia e o envolvimento emocional. da m e com a crianc a reduzindo as di culdades de temperamento e promovendo uma melhor. interac o entre eles, Conclus es A pesquisa aponta que a amamentac o pode proteger as m es da depress o p s. parto e comec a a esclarecer que processos biol gicos e psicol gicos podem explicar essa. protec o Contudo ainda existem resultados amb guos na literatura que poder o ser explicados. pelas limitac es metodol gicas apresentadas por alguns estudos. 2013 Sociedade Brasileira de Pediatria Publicado por Elsevier Editora Ltda Todos os direitos. reservados, Introduction their babies by the time of hospital discharge At three. months postpartum the percentage of exclusive breast. feeding was 40 3 falling to 14 7 at ve months 22 The. Breastfeeding has been associated with the well being. European rates of breastfeeding initiation vary from 63 in. of both the child and the mother Breastfeeding ben. Belgium to 99 in Norway 23 After hospital discharge rates. e ts for children s physical and psychological status. start to fall and at six months the percentage of mothers. include decreased risk of infectious diseases and obe. who continue to breastfeed varies from 10 in Belgium to. sity decreased blood pressure lower cholesterol levels 1 2. 80 in Norway 23 Scandinavian countries present the high. and increased cognitive and motor performance 3 4 Positive. est rates of breastfeeding at six months postpartum 80 in. health outcomes for the mother s physical health include. Norway 72 in Sweden and 65 in Iceland 23 In Brazil a. decreased blood pressure and risk of breast and ovarian. national survey conducted in 2008 showed a rate of 41 of. cancer 5 7 for the mother s psychological health they include. exclusive breastfeeding in babies from 0 to 6 months 24 In. attenuated stress response8 12 and enhanced sleep 13 14. the same survey the percentage of breastfeeding in babies. However bene ts for the mother s psychological well being. from 9 to 12 months old was approximately 58 7 24,need more supportive empirical evidence 15. Therefore identi cation of women at risk for early ces. The World Health Organization WHO 16 the European, sation of breastfeeding and implementation of effective. Commission for Public Health ECPH 17 and the Ameri. breastfeeding promotion strategies are considered health. can Academy of Pediatrics AAP 18 recommend exclusive. priorities, breastfeeding for the rst six months of life Despite the. established bene ts of breastfeeding rates are still low. and even though rates of breastfeeding initiation are high. there is a marked decline in breastfeeding during the rst Breastfeeding and depression in pregnancy. few weeks after initiation and exclusive breastfeeding is and postpartum depression. rare In Portugal despite the high rate of breastfeeding. at the time of hospital discharge 91 19 and 98 5 20 an Recent literature reviews suggest that breastfeeding is. accentuated decrease is observed in the following months less common among depressed mothers even though their. with only 54 7 19 to 55 20 of mothers breastfeeding at three infants bene t from breastfeeding 25 26 Studies from dif. months postpartum and 34 1 19 to 36 20 at six months ferent socio cultural contexts show almost unequivocally. postpartum The national health surveys provided by the that depressed mothers tend to breastfeed less or for less. Portuguese Health Ministry showed that breastfeeding ini time than non depressed mothers However the association. tiation rates increased from 81 4 in 1995 1996 to 84 9 between breastfeeding and postpartum depression remains. in 1998 1999 21 In 2010 2011 this percentage ascended equivocal 25 27. to 98 5 22 However despite the increase in breastfeeding When depressed during pregnancy women are less likely. rates these surveys also show a decrease in breastfeeding to initiate28 29 or to maintain breastfeeding 30 32 compared. over the months In 2010 2011 in baby friendly hospitals with those with no depressive symptoms In a recent study on. between 65 2 to 72 5 of mothers exclusively breastfeed the association between prenatal psychosocial risk factors. 334 Figueiredo B et al, and breastfeeding intention of Hispanic women researchers breastfeeding cessation 55 Another recent study on the asso. found that women who scored higher in depression at the ciation between breastfeeding and depression in pregnancy. middle of gestation about 25 7 weeks and women who and postpartum depression concluded that higher depres. showed persistent depressive symptoms during pregnancy sion scores at the third trimester of pregnancy predicted. presented a lower intention to breastfeed their babies 33 lower exclusive breastfeeding duration 30 This study also. Other studies have shown that 1 5 of pregnant women found a decrease in depressive symptoms in women who ini. are depressed at the third trimester of pregnancy 34 35 and tiated or maintained exclusive breastfeeding for three or. that half of these depressed pregnant women will not ini more months 30. tiate or breastfeed for three months or more 30 Depression The association between breastfeeding and depression. scores at the third trimester were the best predictors of the has also been studied taking into account both parents A. length of exclusive breastfeeding and when considering all study undertaken to trigger the association between breast. the mothers not breastfeeding at three month postpartum feeding and mental health of both the parents concluded. 37 could be easily detected because of depression during that the simultaneous presence of mental disorders in both. pregnancy 30 Results also showed a signi cant decrease in the mother and the father was not associated with the. depression scores from childbirth to three months postpar early breastfeeding cessation before four months 56 How. tum in women who maintained exclusive breastfeeding for ever mothers tended to breastfeed for a longer period of. three or more months 30 time when they felt that their partners actively supported. Exclusive breastfeeding appears to be signi cantly lower breastfeeding 56. among depressed mothers 36 39 Mothers who do not initiate. or maintain breastfeeding are more at risk for depression. during the postpartum period 30 40 43 Moreover when moth Breastfeeding and hormonal protection to. ers are depressed in the postpartum period they tend to postpartum depression. not initiate28 29 or maintain breastfeeding 27 36 44 50. Some studies have shown that postpartum depression Research has been showing that breastfeeding promotes. emerges in the sequence of and may result from breast hormonal and psychological conditions and processes that. feeding interruption 40 43 suggesting that early cessation are inversely associated with postpartum depression How. of breastfeeding may be involved in the cause of post ever the simultaneous study of these dimensions and their. partum depression For example an association between potential explanatory value in the connection between. negative early breastfeeding experiences and depressive breastfeeding and pre and postpartum depression has not. symptoms at two months postpartum was found 51 Another yet been accomplished. study that aimed to assess the association between the It is possible that the positive effects of breastfeed. infant feeding method and depressive symptoms showed ing may outweigh the positive effects of antidepressants 26. that breastfeeding initiation among multiparous mothers Even when the potential harmful effects of medication are. was associated with signi cantly decreased odds of postpar taken into account some studies suggest that women with. tum depression 43 postpartum depression who are taking antidepressant should. Other studies suggest that postpartum depression may be not discontinue breastfeeding 57 Lactogenic hormones oxy. involved in the cause of early breastfeeding cessation and tocin and prolactin are associated with anti depressant and. that depressive symptoms have been observed to precede anxiolytic effects 43 Some studies suggest that breastfeed. the cessation of breastfeeding 27 46 49 52 54 For example a ing may have a protective effect on maternal psychological. recent study screening for depression levels immediately health because it attenuates stress responses 15 58 59 Lacta. after delivery demonstrated that mothers with higher levels tion has been associated with attenuated stress responses. of depressive symptoms have a higher likelihood to bottle especially that of cortisol 8 12 Attenuated cortisol stress. feed their infants at three months postpartum 38 Results responses 8 10 as well as attenuated total cortisol and. also showed that the odds of bottle feeding increased with free cortisol stress responses 11 were observed in lactat. the severity of maternal depression 38 Another recent study ing mothers compared to the non lactating These results. indicated an association between breastfeeding cessation suggest that lactation attenuates neuro endocrine responses. at four months postpartum and higher depressive symp to stress 8 a factor that has been related with fewer post. toms at one month after delivery showing that mothers partum depressive symptoms 60 62 In a recent study on. who continued to breastfeed at four months had lower maternal adreno corticotropic hormone ACTH and cortisol. depression scores at one month than those who stopped release patterns during a breastfeeding session researchers. breastfeeding 36 found that breastfeeding was associated with a signi cant. Research has also been focusing on the association decrease in ACTH and cortisol levels 63 Skin to skin contact. between breastfeeding and depression in pregnancy and before sucking the breast was shown to play an important. postpartum depression A recent study showed that higher role in the reduction of these levels the longer the dura. levels of depression and anxiety during pregnancy were tion of skin to skin contact the lower the maternal cortisol. associated with breastfeeding cessation and that breast levels 63. feeding cessation predicted higher levels of anxiety and Additionally the usual diurnal pattern of cortisol consist. depression after birth 55 Moreover the results showed an ing of high morning levels and gradual decline throughout. interaction effect between anxiety and depression levels the day also associated with fewer postpartum depres. at pregnancy and six months postpartum and breastfeed sive symptoms 64 was found to be more common in. ing cessation so that baseline levels anxiety and depression multiparous breastfeeding women compared with the non. are increased at six months postpartum by the effect of breastfeeding 12 Despite the fact that some studies did. Breastfeeding and postpartum depression 335, not report differences in daily cortisol levels in depressed Maternal emotional involvement with the infant is. pregnant or postpartum women 8 65 67 cortisol has also been also improved by breastfeeding75 and is negatively cor. found to be lower 10 as well as higher in depressed mothers related with postpartum depression 65 76 In fact feeding. when compared with their non depressed counterparts 60 68 patterns appear to in uence mother child bonding with. A recent study suggested that depressed mothers present non breastfeeding mothers presenting more dif culties to. a down regulated HPA axis showing lower salivary cortisol establish an emotional involvement with the infant than. levels compared with non depressed mothers 62 Conversely breastfeeding mothers 77 Regarding the relationship with. another recent study found signi cantly higher levels of the partner studies relate breastfeeding initiation with. serum cortisol in the group of depressed mothers 69 A dif stronger parental bonds 78. ferent diurnal pattern of cortisol with higher cortisol levels Temperamental dif culties and sleep problems are. at waking and no increase from waking to 30 minutes com reduced when the child is breastfed 79 while the presence. pared to a signi cant increase in cortisol levels from waking of those problems has been associated with postpar. to 30 minutes found in non depressed women was reported tum depression 72 80 Depressed breastfeeding mothers. in postpartum depressed women 64 were less likely to have infants with highly reactive. These data support the possibility that postpartum temperaments 45 79 Infant competencies are enhanced by. depression may be associated with a deregulated HPA axis breastfeeding 4 81 and are adversely affected in the pres. However empirical evidence is equivocal probably due to ence of postpartum depression 80 82. the presence of a variety of procedures for example diur Breastfeeding also facilitates mother infant. nal pattern or daily cortisol levels in saliva blood or urine interaction 45 83 which is poorer when the mother is. to measure different HPA axis functions depressed 78 Breastfeeding is associated with better. Results suggest that breastfeeding might promote a mother infant interactions with breastfed infants show. tighter regulation of diurnal basal cortisol secretion 8 12 and ing more physical contact vocalizations and positive. the stability of diurnal cortisol secretion lowers the risk of play and mothers exhibiting more proximity towards the. postpartum depression 64 However most studies regarding infant 68 79 83 84 Data also speci cally suggests that depressed. postpartum depression do not control for breastfeeding mothers and their infants not unlike non depressed moth. and most studies about breastfeeding do not control for ers and their infants may bene t from breastfeeding. depression In addition to the high correlation between depressed mothers and infants are more relaxed during. breastfeeding and depression in studies there is a possi breastfeeding versus bottle feeding interactions 83 Fur. ble effect of these variables on the functioning of the HPA thermore studies also showed that breastfeeding may. axis act as a protector against maternal child maltreatment. especially child neglect 85 This association may depend. on the protective effect of breastfeeding on maternal. depression as depression is the best predictor of child. Breastfeeding and psychological protection maltreatment and neglect The impact of breastfeeding on. from postpartum depression the maternal attention sensitivity towards infant distress. was also recently shown 86, Another important associated change during breastfeeding. relates to the regulation of sleep and wake patterns for both. the mother and the child helping the mother to feel less Discussion. tired which could also prevent symptoms of depression. Parents of infants who were exclusively breastfed slept an Literature consistently shows that breastfeeding provides a. average of 40 45 minutes more and self reported less sleep wide amount of bene ts for both the child and the mother. disturbance than parents of infants given formula 14 Women The psychological bene ts for the mother are still in need. with postpartum depression experienced poorer sleep than of further research. women without postpartum depression and sleep quality Despite the high rate of breastfeeding initiation a large. worsened with increasing postpartum depression symptom decrease in the number of mothers who breastfeed from. severity 61 70 71 Maternal sleep patterns are enhanced by the rst few weeks postpartum is observed Public health. breastfeeding 13 while this deregulation may cause postpar authorities efforts to promote breastfeeding initiation have. tum depression 61 70 71 been successful however the same has not been observed. Research also shows that breastfeeding improves some regarding its maintenance for a recommended period of. psychological conditions and processes that can protect time which is for two years or more and exclusively during. mothers from emerging postpartum depression Mater the rst six months 16 18 Identifying the possible underlying. nal self ef cacy a condition inversely associated with factors to this situation is a goal for research in this eld. postpartum depression 72 is improved in mothers who Maternal mental health may be one of the reasons behind. breastfeed 45 73 Regardless of maternal depression moth this reality A recent empirical study conducted in Portu. ers who breastfed rather than bottle fed their infants had gal suggests that screening for depression symptoms during. higher con dence levels and rated their infants as less pregnancy can help identify women at risk for early ces. alert and less irritable during feedings 45 However breast sation of exclusive breastfeeding 30 There is now empirical. feeding self ef cacy appears to play an important role on evidence that pregnancy depression is one of the factors. postpartum depression mothers who show higher levels of that may contribute to breastfeeding failure 29 30 32 33 45 56. breastfeeding self ef cacy present lower levels of postpar Studies suggest an association between breastfeeding. tum depression symptoms 74 and postpartum depression and the direction of this. 336 Figueiredo B et al, association is still unclear While some suggest a References. negative association between breastfeeding and, postpartum depression 40 43 others point to a nega 1 Horta B Bahl R Martines J Victora C Evidence on the long. tive association between postpartum depression and term effects of breastfeeding systematic reviews and meta. breastfeeding 27 46 49 52 54 analyses Geneva World Health Organization 2007. Results from several studies provide empirical evi 2 Shields L O Callaghan M Williams G Najman J Bor W Breast. feeding and obesity at 14 years a cohort study J Paediatr Child. dence that breastfeeding may act as a protective factor. Health 2006 42 289 96, for depression during the postpartum improving both 3 Kramer MS Aboud F Mironova E Vanilovich I Platt RW Matush. maternal psychological well being namely through the reg L et al Breastfeeding and child cognitive development new. ulation of sleep and awake patterns13 14 and increased evidence from a large randomized trial Arch Gen Psychiatry. self ef cacy 45 73 and adequate parenting through the 2008 65 578 84. enhancement of the emotional involvement with the 4 Sacker A Quigley M Kelly Y Breastfeeding and developmental. infant 75 77 mother infant interaction 45 83 attention sensi delay ndings from the Millennium Cohort Study Pediatrics. tivity towards infant stress 86 and protection against child 2006 118 682 9. neglect 85 Breastfeeding can also protect women from 5 Jonas W Nissen E Ransj Arvidson AB Wiklund I Henriks. depressive symptoms by aiding the regulation of the HPA son P Uvn s Moberg K Short and long term decrease of blood. pressure in women during breastfeeding Breastfeed Med. axis throughout the regulation of diurnal basal cortisol. 2008 3 103 9, secretion 8 12 which has been consistently shown to be 6 Inumaru LE da Silveira EA Naves MM Fatores de risco e de. deregulated in the presence of depressive symptoms 62 64 69 protec o para c ncer de mama uma revis o sistem tica Cad. Other relevant variables signi cantly related with both Saude Publica 2011 27 1259 70. breastfeeding and postpartum depression that may play 7 Rea MF Os benef cios da amamentac o para a sa de da mulher. a part on this association are also highlighted in the J Pediatr Rio J 2004 80 142 6. literature parity related with breastfeeding12 43 and post 8 Altemus M Deuster P Galliven E Carter C Gold P Suppres. partum depression 35 70 quality of the relationship with sion of hypothalmic pituitary adrenal axis responses to stress. the partner related with breastfeeding75 87 88 and postpar in lactating women J Clin Endocrinol Metab 1995 80 2954 9. tum depression 89 90 and anti depressant use related with 9 Amico JA Johnston JM Vagnucci AH Suckling induced attenu. ation of plasma cortisol concentrations in postpartum lactating. breastfeeding26 91 and postpartum depression 92 It is also. women Endocr Res 1994 20 79 87, important control for potential confounding variables such 10 Groer MW Davis MW Cytokines infections stress and. as parity quality of the relationship with the partner and dysphoric moods in breastfeeders and formula feeders J Obstet. medication use and this has not always been accomplished Gynecol Neonatal Nurs 2006 35 599 607. Moreover few studies have de ned breastfeeding according 11 Heinrichs M Meinlschmidt G Neumann I Wagner S Kirschbaum. to standardized categories few studies included a clini C Ehlert U et al Effects of suckling on hypothalamic. cal diagnosis of postpartum depression and few studies pituitary adrenal axis responses to psychosocial stress in. were prospective and completed adequate statistical analy postpartum lactating women J Clin Endocrinol Metab 2001 86. sis to capture a sequential relationship between depressive 4798 804. symptoms and breastfeeding initiation and duration These 12 Tu M Lupien S Walker C Diurnal salivary cortisol levels in. postpartum mothers as a function of infant feeding choice and. may be some of the reasons for equivocal results in the. parity Psychoneuroendocrinology 2006 31 812 24, literature 13 Doan T Gardiner A Gay CL Lee KA Breast feeding increases. Data in a general way demonstrate that breastfeed sleep duration of new parents J Perinat Neonatal Nur. ing failure is unequivocally associated with the presence of 2007 21 200 6. depression during pregnancy and postpartum Some recent 14 Gay CL Lee KA Lee SY Sleep patterns and fatigue in new. prospective studies clarify that depression during pregnancy mothers and fathers Biol Res Nurs 2004 5 311 8. is a risk factor for unsuccessful breastfeeding and that 15 Heinrichs M Neumann I Ehlert U Lactation and stress. breastfeeding is a protective factor for postpartum depres protective effects of breast feeding in humans Stress. sion Research is also starting to clarify which biological and 2002 5 195 203. psychological processes may explain this protection How 16 World Health Organization Global strategy for infant and young. child feeding Geneva WHO 2003, ever there are still equivocal results in the literature that. 17 EU Project on Promotion of Breastfeeding in Europe Promot. may be explained by the methodological limitations pre ing protecting and supporting breastfeeding an action plan for. sented by some studies Europe Luxembourg European Commission Directorate Public. Health 2002, 18 American Academy of Pediatrics Breastfeeding and the use of. Funding human milk Pediatrics 2005 115 496 596, 19 Sandes AR Nascimento C Figueira J Gouveia R Valente S. This work was supported by Portuguese fundings from Martins S et al Aleitamento materno preval ncia e factores. the FCT MCTES PIDDAC and by the European Community condicionantes Acta Med Port 2007 20 193 200. FEDER COMPETE Breastfeeding and Postpartum Depres 20 Sarafana S Abecassis F Tavares A Soares I Gomes A Aleita. mento materno evoluc o na ltima d cada Acta Pediatr Port. sion PTDC SAU SAP 116738 2010,2006 37 9 14, 21 Branco MJ Nunes B Uma observac o sobre aleitamento. materno Lisboa ONSA and Instituto Nacional de Sa de Dr. Con icts of interest Ricardo Jorge 2003, 22 Direc o Geral de Sa de Registro do aleitamento materno. The authors declare no con icts of interest relat rio Julho de 2010 a Junho de 2011 Lisboa DGS 2012. 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corroboration ,<<corroboratio kuh rob uh RAY shun confirmation Synonyms >> authentication, substantiation, validation, verification Antonym >> refutation Fortunately, I had some co rroboration for my whereabouts on the night of the crime.
Used under license by Laying the Foundation, Inc. www.layingthefoundation.org debase deh BASE to reduce in dignity or quality Synonyms >> abase, corrupt, debauch, demean, deprave, pervert, vitiate Antonym >> to glorify
product. This model works well for projects in which quality control is a major concern because of its intensive documentation and planning .Stages that construct this model are not overlapping stages, which means that the waterfall model begins and ends one stage before starting the next one.
A Comparative Study of Iterative Prototyping vs. Waterfall Process Applied To Small and Medium Sized Software Projects by Eduardo Malaga Chocano B.S., System Engineering National University of Engineering of Peru, 1996 SUBMITTED TO THE SYSTEM DESIGN AND MANAGEMENT PROGRAM ON APRIL 22, 2004 IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
Motzei Shabbat, October 3, 2015 End Shabbat with a musical Havdalah. Come sing and play along as we say farewell to Shabbat and get a jump start on the coming week with music and song. Welcome Back! Tzvi Haber, Dovid Tauber, Adina Weis & Shani Weis Helping Beth Israel Celebrate Simchat Torah! Monday evening, October 5