Online Intervention to Prevent Perinatal Depression and Promote Breastfeeding

Despite extensive benefits and high intentions, few women breastfeed exclusively for the recommended duration. At the same time, depression and anxiety are among the most common complications during the perinatal period. Maternal mental health is an important underlying factor associated with barriers and reduced rates of breastfeeding (BF) intent, initiation, exclusivity, and continuation. Black women are more likely to report depressed mood in late pregnancy and early postpartum and have the lowest rates of BF, compared to all other racial groups in the United States. Given the strong evidence of a bidirectional association between maternal mental health and BF, it is important to consider both factors when designing and examining the efficacy of interventions to improve these outcomes. Findings from the systematic review and pilot trial outlined in this document highlight the intersection of maternal mental health and BF. Results from the systematic review on the efficacy of behavioral interventions (n=35) to improve maternal mental health and BF outcomes suggest interventions that extend across pregnancy and postpartum and offer individualized support from both professionals and peers who collaborate through a continuum of settings are most successful. By acknowledging and addressing that mental health and BF both occur in complex settings affected by many factors, we move into a whole-person approach to preventative and supportive services. Internet interventions offer potential in extending preventative and supportive services since they address key barriers, especially for those navigating the complex and vulnerable early postpartum period. At the same time, cognitive behavioral therapy (CBT) has been shown to be effective at preventing perinatal depression. Therefore, an online CBT-based intervention, with and without BF education and support, was developed. To further acknowledge and address racial disparities in maternal mental health and BF, we developed the pilot study using components shown to improve mental health and BF outcomes among Black women. Additionally, many of the suggestions gleaned from the systematic review were also incorporated into the pilot study design. Results from the pilot study (n=22) suggest that Black women at-risk for perinatal depression were receptive to and satisfied with the online CBT-based internet intervention, with and without BF education and support, spanning from mid-pregnancy through six weeks postpartum. Preliminary findings indicate that both Sunnyside and Sunnyside Plus (with BF support) interventions have a positive impact on symptoms of depression and anxiety and on BF outcomes across pregnancy and the first 12 weeks postpartum. Larger-scale, longer-term randomized controlled trials are needed to better understand the intersection between maternal mental health and BF.