Available online 30 November 2023

Author links open overlay panel, , , , , AbstractBackground

Anxiety symptoms increase for some mothers in the perinatal period. Little is known about how increasing anxiety relates to infant feeding beliefs or weight-for-length.

Objective

To examine relationships between clinically meaningful increases in maternal anxiety symptoms and perceptions of infant feeding behaviors and weight-for-length.

Methods

Participants were 237 mothers with singleton pregnancies enrolled from obstetric care between 2015-2020 who completed the Infant Feeding Questionnaire (IFQ) at 6 months. Anxiety symptoms were measured during pregnancy (M=24.6wks, SD=6.3) and 6 weeks postpartum using the PROMIS-6A. Linear regression was used to test associations of prenatal, postpartum, or clinically meaningful increases in anxiety symptoms (i.e., 3 T-score increase) with two outcomes: IFQ (7 factors) and infant weight-for-length at age 6 months.

Results

Prenatal symptoms were unrelated to IFQ factors. Postpartum symptoms predicted IFQ factors related to worry, such as concern for infant undereating/becoming underweight (B=0.012, p=0.022). Increasing symptoms predicted worry-related concerns as well as concern for infant hunger (B=0.60, p=<0.001) and greater preference for feeding on a schedule (B=0.65, p=<0.001). In a model including both increasing symptoms and postpartum symptoms, increasing anxiety symptoms drove associations with IFQ factors (e.g., preference for feeding on a schedule, (B=0.81, p=0.001). Anxiety was unrelated to infant weight-for-length at 6 months.

Conclusions

Clinically meaningful increases in anxiety symptoms were associated with feeding beliefs related to worry. Increasing anxiety was a better predictor of feeding beliefs than the presence of pre- or postpartum symptoms alone. Mothers with increasing anxiety may benefit from support establishing health-promoting infant feeding practices.

Section snippetsINTRODUCTION

Infant nutrition can have important long-term consequences for health and developmental outcomes. Timing of nutritional inadequacies (e.g., vitamin or iron deficiencies) has been shown to be formative for neurodevelopment.1 Infant weight gain in the first year of life has been associated with childhood and adult obesity,2 and, in turn, childhood obesity has been linked to health outcomes such as fatty liver disease, sleep apnea, and Type 2 diabetes.3

Infant feeding, broadly defined as

Participants and setting

Participants were from the Prospective Research on Early Determinants of Illness and Children’s Health Trajectories (PREDICT) Cohort. PREDICT enrolled women from an obstetric practice at an academic medical center in South Florida between 2015 and 2020. Pregnant women were eligible if they were 18 to 45 years old, spoke and read English, and planned to deliver at the hospital associated with the obstetric practice. Pregnancies were excluded if the fetus had a known congenital anomaly or

RESULTS

As shown in Table 1, the mean age of mothers was 30.7 years (SD 5.1). The sample was 85.2% White, and about half of participants (51.0%) had at least a four-year college degree. Mean maternal BMI was 27.3 (SD 7.7). For 35.4% of the sample, this was their first pregnancy. Mean child birthweight was 3.3 kg (SD 0.49). 92.0% of mothers reported any breastfeeding, including breastmilk in a bottle, during their infant’s first six months of life. Mean infant weight-for-length percentile at 6 months

DISCUSSION

In this study, we investigated the relationship between change in maternal anxiety during the pre- to postpartum transition and maternal perceptions of infant feeding behaviors at 6 months of age. Our work extends prior research examining the relationship between maternal psychosocial distress at discrete points during pregnancy and postpartum and infant feeding factors.10, 19 To our knowledge, no prior study of infant feeding has considered the relative change in anxiety symptoms across the

Funding

This work was supported by funding from Johns Hopkins Dean’s Summer Research Fund, the All Children’s Hospital Foundation, and NIH/NIMHD R01MD011746 to SBJ.

Declaration of Competing Interest

None.

Acknowledgments

Juliana Fan and Molly Kuehn conceptualized the study, analyzed and interpreted the data, and wrote the paper. Dr. Sara B. Johnson coordinated and supervised data acquisition, collaborated on study design, and critically revised the paper. Dr. Kristin Voegtline and Dr. Radhika Raghunathan interpreted the data and critically revised the paper. Dr. Raquel Hernandez coordinated and supervised data acquisition and critically revised the paper. All authors reviewed and gave final approval of the

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© 2023 Published by Elsevier Inc. on behalf of Academic Pediatric Association