(243) Associations Between Chronic Diseases and Treatments During Lactation and Maternal Mental Health

Background: Depressive disorders have been noted to occur more frequently in those with chronic diseases in the general population. Some medications used to treat chronic diseases have also been associated with depressive symptoms. However, data are sparse on the prevalence of mood disorders breastfeeding individuals with chronic diseases.

Objectives: This study assessed whether lactating persons with selected chronic diseases being treated with prescription medications were more likely than lactating persons without chronic diseases to screen positive on measures of depression, anxiety, or stress.

Methods: Between 2014 and 2024, 3,423 breastfeeding individuals who resided in the U.S. or Canada were enrolled into the UC San Diego Human Milk Research Biorepository. Participants completed an interview to capture demographics, lifestyle factors, and all medications/indications over the previous two weeks. Each participant was asked to complete three mood questionnaires: the Edinburgh Postnatal Depression Scale (EPDS), the state-trait anxiety inventory (STAI) and the perceived stress scale (PSS-10). Twenty-four individuals reported chronic exposure to an asthma medication; 97 to a monoclonal antibody (mAb); 322 to a selective serotonin reuptake inhibitor (SSRI); and 1,208 reported no prescription medication use in the previous two weeks. The proportion with screen-positive cut-off scores for each mood questionnaire were compared between each chronic disease group and the no-disease group using logistic regression, adjusting for maternal race, ethnicity, maternal age and infant age to compute an adjusted odds ratio (aOR) and 95% confidence interval (CI). Statistical analyses were conducted using R.

Results: In the no chronic disease group, 171/1195 (14.3%) screened positive on the EPDS, compared to: 78/320 (24.4%) in the SSRI group (aOR 2.12, 95% CI 1.55, 2.89); 5/23 (21.7%) in the asthma group (aOR 1.71, 95% CI 0.62, 4.74), and 6/97 (6.2%) in the mAb group (aOR 0.42, 95% CI 0.18, 0.97). Findings were similar on the stress and anxiety measures where in all cases the SSRI group was significantly more likely to screen positive than the no chronic disease group and the mAb group was significantly less likely to screen positive than the unexposed group.

Conclusions: SSRI exposure/underlying chronic depression, as expected, was correlated with maternal mental health risks. Those in the mAb group were less likely to screen positive on any of the mood questionnaires, possibly indicating improved symptom management. Treated asthma was associated with non-significant elevated risks for all three mood measures. Clinical implications for this important perinatal period require further research.