Table 1 Summary of published behavioral interventions to improve breastfeeding and maternal mental health outcomes (n = 30 interventions)

Successful Interventions for Mental Health and Breastfeeding Outcomes (n = 12)

 Zhao (2020, 2021, 2021), China [32,33,34]

N = 91 (I); 91 (C)

Age (mean): 30.8 (I); 30.2 (C)

Race/ethnicity: 100% Chinese

Income (household, monthly):

$898–1196: 19% (I); 26% (C)

$1197- ≥ 1495: 81% (I); 74% (C)

Parity: 100% (I and C) primiparous

Mode of birth: 66% (I); 67% (C) vaginal

MH status/history: 98.8% (I); 97.6% (C) with no depression history

I: individualized mixed management intervention consisting of 4 in-person psycho-educational sessions (1 hr.) focused on perinatal MH and BF

C: standard obstetric care

Pregnancy

Psychiatrist and IBCLC

Individual

BF, MH

Initiation: ↑ at 3 days PP*

Exclusivity: ↑ at 3 and 42 days and 3 mos. PP*; No difference at 6 mos. PP

Self-Efficacy: ↑ at 3- and 42-days PP* (BSES)

Effective BF Behavior: ↑ at 3- and 42-days PP*

Depressive Symptoms: ↓ at 3- and 42-days PP* (EPDS); ↓ at 3 and 6 mos. PP* (MINI)

 Bigelow (2014), Canada [35]

N = 26 (I); 51 (C)

Age (mean): 32.1 (I); 28.8 (C)

Race/ethnicity: 100% (I); 98% (C) non-Hispanic White

Income: NR

Parity (mean): 1.1 (I); 1.2 (C)

Mode of birth: NR

MH status/history: NR

I: skin-to-skin contact 6 hrs. Per day during infant’s first week of life, then 2 hrs. Per day through 1 mos. PP (> 4000 min. total)

C: < 4000 min. Total skin-to-skin in the 1st mos. PP

Hospital Stay

Hospital Staff

Individual

BF

Duration: ↑ at 1, 2, and 3 mos. PP*

Exclusivity: ↑ at 1, 2, and 3 mos. PP*

Depressive Symptoms: ↓ at 1 wk. PP*; no difference between groups at 1, 2, and 3 mos. PP (EPDS)

 Liu (2018), China [36]

N = 130 (I); 130 (C)

Age: 40.8% (I); 41.9% (C) between 18 and 34

Race/ethnicity: NR

Income (household, annual):

≤4000: 20% (I and C)

> 4000: 30% (I and C)

Parity: 34.2% (I); 36.5% (C) primiparous

Mode of birth: 100% (I and C) cesarean

MH status/history: NR

I: health education intervention developed according to the Health Belief Model that encouraged milk expression within 1 hr. after cesarean birth; expressed milk via hospital grade electric double pump every 2–3 hrs. For 20–30 min.

C: standard education by obstetric nurses

Hospital Stay

Hospital Staff

Individual

BF

Milk Onset: Earlier lactation time*

Milk Volume: ↑ during 24, 24 to 48, and 48 to 72 hours*

Exclusivity: ↑ at 42 days PP*

Breast Swelling: ↓ at 3 days PP*

Anxiety Symptoms: ↓ at 3 days PP* (STAI)

 Song (2017), China [37]

N = 60 (I); 60 (C)

Age (mean): 30.8 (I); 31.3 (C)

Race/ethnicity: NR

Income: NR

Parity: 100% (I and C) primiparous

Mode of birth: 100% (I and C) cesarean

MH status/history: NR

I: psychological nursing care consisting of appropriate and timely support was offered before, during, and after cesarean birth

C: standard nursing care

Hospital Stay

Hospital Staff

Individual

BF

Initiation: ↑ at 1 day before discharge*

Lactation yield: ↑ at 3 days PP*

Depressive Symptoms: ↓ at 1 day before discharge* (Scale of Depression Score)

 Çiftçi and Arikan (2011), Turkey [38]

N = 32 (I); 30 (C)

Age: NR

Race/ethnicity: NR

Income: NR

Parity: NR

Mode of birth: NR

MH status/history: NR

I: one-on-one BF training (1 hr.) + 5 in-home visits from 2 wks. Before returning to work through 6 mos. PP

C: 5 in-home visits, but no BF training

Postpartum

Lactation Specialist

Individual

BF, MH

Duration: ↑ at 6 mos. PP*

Duration per feeding: ↑ at 6 mos. PP*

Exclusivity: ↑ at 3, 4, 5, and 6 mos. PP*

Frequency per day/night: ↑*

Anxiety Symptoms: ↓ at 6 mos. PP* (STAI)

 Franco-Antonio (2022), Spain [39]

N = 44 (I); 44 (C)

Age (mean): 32.4 (I); 33.3 (C)

Race/ethnicity: NR

Income (household, annual):

<$14,000: 16% (I); 11% (C)

>$24,000: 18% (I); 16% (C)

Parity: 34% (I and C) primiparous

Mode of birth:

Vaginal: 91% (I); 93% (C)

Vaginal with forceps/vacuum: 9% (I); 7% (C)

MH status/history: NR

I: Single brief motivational interviewing session immediate PP to promote BF and telephone booster session at 1 mos. PP

C: Education leaflet for successful BF

Postpartum

Midwives

Individual

BF

Duration: ↑ at 3 mos. PP*

Self-Efficacy: No difference between groups at 3 mos. PP (BSES-SF)

Depressive Symptoms: ↓ at 3 mos. PP* (EPDS> 10)

 Vidas (2011), Croatia [40]

N = 50 (I); 50 (C)

Age: NR

Race/ethnicity: NR

Income: NR

Parity: NR

Mode of birth: NR

MH status/history: NR

I: autogenic training as a relaxation technique taught for 12 wks. in small groups from 2 to 6 mos. PP in BFing persons

C: no autogenic training

Postpartum

Research Staff

Group

BF

Duration: ↑ at 6 mos. PP*

Exclusivity: ↑ at 6 mos. PP*

Depressive Symptoms: ↓ at 6 mos. PP* (EPDS)

Anxiety Symptoms: ↓ at 6 mos. PP* (STAI)

 Buultjens (2018), Australia [41]

N = 10 (I); 8 (C)

Age (mean): 32.6 (I); 31.9 (C)

Race/ethnicity: 90% (I); 62.5% (C) White

Income (household, annual):

<$35,654–71,308: 30% (I); 62.5% (C)

>$71,309: 70% (I); 37.5% (C)

Parity: 100% primiparous

Mode of birth: NR

MH status/history: 70% (I); 75% (C) with no history of MH difficulties

I: psycho-educational group program met weekly for 2 hrs. From 3rd trimester through 8 wks. PP

C: standard care with addition of a weekly phone call

Across Pregnancy and Postpartum

Multidiscipli-nary Team

Group

BF, MH

Exclusivity: No difference at 2–5 wks. PP; ↑ 12–14 wks. PP*

Depressive Symptoms: No difference between groups at 34–36 wks. Gestation; ↓ at 38–40 wks. Gestation, 2–5 wks., 5–8 wks., and 12–14 wks. PP* (EPDS)

 Gureje (2019), Nigeria [42]

N = 452 (I); 234 (C)

Age (mean): 24.5 (I); 24.9 (C)

Race/ethnicity: NR

Income: NR

Parity: 56% (I); 49% (C) primiparous

Mode of birth: NR

MH status/history: EPDS score ≥ 12, but no psychotic symptoms, bipolar disorder, or suicidality

I: stepped-care treatment using a manualized psychological intervention package; 8 psychological sessions during pregnancy; 4–8 weekly interventions sessions starting at 6 wks. PP; pharmacotherapy as needed

C: basic specifications of MH Gap Action Program; no structured sessions; no stepped-care procedure

Across Pregnancy and Postpartum

OB Care Providers

Individual

MH

Exclusivity: ↑ at 6 mos. PP*

Depressive Symptoms: No difference between groups at 6 mos. PP; ↓ 12 mos. PP* (EPDS)

 Johnston (2004, 2006), United States [43, 44]

N = 439 (2004); 239 (I); 104 (C)

Age (mean): NR (2004); 32.5 (I); 30.9 (C)

Race/ethnicity: NR (2004); 78.6% (I); 80.6% (C) White

Income (household, annual):

NR (2004)

< 40,000: 17.1% (I); 13.6% (C)

40,000–75,000: 45.7% (I); 38.8% (C)

> 75,000: 37.2% (I); 47.6% (C)

Parity: 53.4% primiparous (2004); 52.9% (I and C) primiparous

Mode of birth: NR

MH status/history: NR

I: risk-based intervention (Healthy Steps) focused on developmental and behavioral services starting at 1 wk. PP; includes home visits and phone support

I: Healthy Steps plus 3 additional antenatal home visits and phone support starting between 16 and 20 wks. Gestation (PrePare)

C: standard care

Across Pregnancy and Postpartum

Healthcare Provider

Individual

BF, MH

Initiation: No difference between groups (2004); ↑ for all intervention groups* (2006)

Duration: ↑ at 3 and 6 mos. PP for all intervention groups*

Depressive Symptoms: ↓ at 3 mos. PP, but ↑ at 30 mos. PP for all intervention groups* (modified CES-D)

 Kenyon (2016), United Kingdom [45]

N = 662 (I); 662 (C)

Age (mean): 21.8 (I); 21.5 (C)

Ethnicity: 48% (I and C) British

Income: NR

Parity: 100% nulliparous

Mode of birth: NR

MH status/history: 15% with clinical diagnosis of past or present mental illness (I and C)

I: pregnancy outreach worker service providing individual case management with home visits offered from < 28 wks. Gestation through 6 wks. PP. Prenatal services supported healthy lifestyle choices and social/emotional/mental difficulties. PP services supported BF and infant care.

C: standard UK care

Across Pregnancy and Postpartum

Peer Support

Individual

MH

Duration: No difference between groups at 6–8 wks. PP

Self-efficacy: No difference between groups at 8–12 wks. PP (Pearlin Mastery Scale)

Bonding: ↑ at 8–12 wks. PP*

Depressive Symptoms: No difference between groups; ↓ at 8–12 wks. PP for those with more severe baseline symptoms* (EPDS)

 Lutenbacher (2018), United States [46]

N = 91 (I); 87 (C)

Age (mean): 30.4 (I); 28.7 (C)

Race/ethnicity: 100% Hispanic

Income (household, annual):

<$15,000: 96.7% (I); 96.5% (C)

Parity: median of 2 children in home

Mode of birth: NR

MH status/history: NR

I: Maternal Infant Health Outreach Worker model consisting of monthly home visits (1 hr.) and periodic group gatherings focusing on maternal concerns, healthy lifestyle, child development and attachment, and BF offered from < 26 wks. Gestation through 6 mos. PP

C: distribution of printed educational material about maternal and infant health and development

Across Pregnancy and Postpartum

Peer Support

Individual and Group

BF, MH

Initiation: No difference between groups

Duration: No difference between groups through 6 mos. PP

Exclusivity: ↑ through 6 wks. PP*

Self-efficacy: ↑ at 2 wks., 2 and 6 mos. PP* (BSES-SF)

Depressive Symptoms: ↓ at 2 wks., 2 and 6 mos. PP* (EPDS)

Stress: ↓ at 2 wks., 2 and 6 mos. PP* (PSI)

Successful Interventions for Breastfeeding Outcomes Only (n = 6)

 Akbarzadeh (2017), Iran [47]

N = 50 (I); 50 (C)

Age (mean): 23.9 (I); 24.4 (C)

Race/ethnicity: NR

Income: NR

Parity: 100% primiparous

Mode of birth: NR

MH status/history: NR

I: Behavior-Change Model involving 4 weekly group BF educational sessions (90 min.) based on BASNEF in late pregnancy

C: standard care

Pregnancy

Hospital Staff

Group

BF

Knowledge: ↑ immediately, 1 and 3 mos. After the intervention*

Depressive Symptoms: No difference between groups at 1 and 3 mos. After intervention

(Zung Self-Rating Depression Scale)

 Langer (1998), Mexico [48]

N = 361 (I); 361 (C)

Age (mean): 22.5 (I and C)

Race/ethnicity: NR

Income: NR

Parity: 93.1% (I); 90.6% (C) primiparous; no previous vaginal birth

Mode of birth:

Vaginal with forceps: 2.8% (I); 3.4% (C)

Cesarean: 23.8% (I); 27.2% (C)

MH status/history: NR

I: doula support involving continuous emotional, informational, and physical support through active labor; BF support during the immediate PP

C: standard care

Hospital Stay

Doula

Individual

BF, MH

Exclusivity: ↑ at 1 mos. PP*

Knowledge: ↑ behaviors that promote BF at 1 mos. PP*

Anxiety Symptoms: No difference between groups at immediate PP (STAI)

 Saatsaz (2016), Iran [49]

N = 52 (foot); 52 (hand+foot); 52 (C)

Age (mean): 27 (foot); 26.7 (hand+foot); 27.8 (C)

Race/ethnicity: NR

Income: NR

Parity: 100% primiparous

Mode of birth: 100% cesarean

MH status/history: NR

I: foot massage (5 min./limb) given 4 hrs. After the last dose of analgesic following cesarean birth

I: hand and foot massage (5 min./limb) given 4 hrs. After the last dose of analgesic following cesarean birth

C: no massage

Hospital Stay

Massage Therapist

Individual

MH

Frequency: ↑ after cesarean birth in all intervention groups compared to control*

Anxiety Symptoms: No difference between groups after cesarean birth (STAI)

 Ahmed (2016), United States [50]

N = 49 (I); 57 (C)

Age (mean): 29.9 (I); 29.2 (C)

Race/ethnicity:

White: 73.5% (I); 67.9% (C)

Black: 18.4% (I); 28.3% (C)

Hispanic: 2% (I); 5.3% (C)

Income (individual, annual):

< 10,000: 8.2% (I); 19.3% (C)

≥50,000: 71.4% (I); 47.4% (C)

Parity: 42.9% (I); 57.9% (C) primiparous

Mode of birth: 73.5% (I); 73.7% (C) vaginal

MH status/history: NR

I: online interactive BF monitoring system with automatic feedback via notifications for any reported BF issues within the first mos. PP

C: standard care

Postpartum

Lactation Specialist

Individual

BF

Exclusivity: No difference between groups at discharge; ↑ at 1, 2, and 3 mos. PP*

Daily Frequency (Intensity): ↑ at 1, 2, and 3 mos. PP*

Depressive Symptoms: No difference between groups at 1, 2, and 3 mos. (EPDS)

 Sainz Bueno (2005), Spain [51]

N = 213 (I); 217 (C)

Age: 54.9% (I); 53.1% (C) between 20 and 30

Race/ethnicity: NR

Income: NR

Parity: 18.2% (I); 19% (C) primiparous

Mode of birth: 100% (I and C) vaginal

MH status/history: NR

I: early hospital discharge (24 hrs.), monitored at home by a nurse for 24–48 hrs., in-clinic follow up at 7–10 days PP, and telephone consultation at 1, 3, and 6 mos. PP

C: standard hospital discharge (48h hrs.), in-clinic follow up at 7–10 days PP, and telephone consultation at 1, 3, and 6 mos. PP

Postpartum

Home Health Nurse

Individual

BF, MH

Duration: ↑ at 3 mos. PP*; no difference at 1 wk., 1 mos., 6 mos., or > 9 mos. PP

Depressive Symptoms: No difference between groups at 1wk. and 1 mos. PP (HAD)

 Hans (2018), United States [52]

N = 156 (I); 156 (C)

Age (mean): 18.5 (I); 18.3 (C)

Race/ethnicity:

African American: 43.6% (I); 46.2% (C)

Latina/Hispanic: 39.1% (I); 35.9% (C)

Income: 100% low income (I and C)

Parity: 97.4% (I); 98.7% (C) primiparous

Mode of birth: 23.2% (I); 21.5% (C) cesarean

MH status/history: CES-D score of 14.2 (I); 13.8 (C) at baseline

I: doula-home-visiting program with weekly prenatal home visits by a home visitor and/or community doula; doula support during labor and birth, and through 6 wks. PP

C: case management

Across Pregnancy and Postpartum

Community Doulas and Peers

Individual

BF, MH

Initiation: ↑ at the hospital stay*

Duration: No difference between groups at 3 mos. PP

Depressive Symptoms: No difference between groups at 3 wks. and 3 mos. PP (CES-D)

Successful Interventions for Mental Health Outcomes Only (n = 5)

 Rossouw (2021), South Africa [53]

N = 50 (I); 50 (C)

Age (mean): 27.2 (I); 27.9 (C)

Race/ethnicity: 90% (I); 88% (C) Black African

Income: 100% living in a low-resource, low employment environment

Parity: 21% (I); 33% (C) primiparous

Mode of birth: NR

MH status/history: NR

I: Community Health Worker program (30–90 min. Monthly visits) and incentive package (baby items, maternity pads, condoms)

C: standard prenatal care

Pregnancy

Community health worker

Individual

BF, MH

Intention to BF exclusively: No difference between groups at 1 wk. PP

Depressive Symptoms: ↓ at 1 wk. PP* (EPDS)

 Zhao (2017), China [54]

N = 176 (I); 176 (C)

Age (mean): 30.4 (I); 30.6 (C)

Race/ethnicity: NR

Income (household, monthly):

<$598–1196: 16% (I); 15.4% (C)

$1197- ≥ 1495: 84% (I); 84.6% (C)

Parity: 100% (I and C) primiparous

Mode of birth: 54.3% (I); 43.1% (C) vaginal

MH status/history: 98.9% (I); 99.4% (C) with no depression history

I: prenatal couple-separated psycho-educational group sessions (6 at 90 min. each) focused on maternal MH and family support; sessions 1–5 were for high-risk pregnant persons, while session 6 was for their partner

C: standard obstetrical care

Pregnancy

Research Staff

Group

MH

Exclusivity: No difference between groups at 42 days PP

Depressive Symptoms: ↓ at 42 days PP* (EPDS)

 Mohd Shukri (2019), Malaysia [55]

N = 33 (I); 31 (C)

Age: 51.5% (I); 67.7% (C) between 26 and 30

Race/ethnicity: 90.9% (I); 96.8% (C) Malay

Income (household, monthly):

$360–1202: 54.5% (I); 54.8% (C)

$1202 → 2405: 45.5% (I); 45.3% (C)

Parity: 100% (I and C) primiparous

Mode of birth: 75% (I and C) vaginal

MH status/history: NR

I: relaxation therapy via audio-guided imagery protocol designed for BF persons provided in-home at 2, 6, and 12 wks. PP; instructed to listen during the subsequent 2 wks.

C: no relaxation therapy

Postpartum

Research Staff

Individual

BF, MH

Human milk Intake: No difference between groups

Anxiety Symptoms: ↓ at 2 wks. PP*; no difference between groups at 6–8 wks. and 12–14 wks. PP (BAI)

Stress: No difference between groups at 2 wks. PP; ↓ at 6–8 wks. and 12–14 wks. PP* (PSS)

Stress: ↓ at 2 wks. PP* (hindmilk cortisol); no difference between groups at 6–8 wks. PP (milk cortisol)

 Morrell (2000), United Kingdom [56]

N = 311 (I); 312 (C)

Age (mean): 27.5 (I); 28 (C)

Race/ethnicity: NR

Income: 30% (I); 29% (C) receiving housing benefit

Parity (mean): 1.9 (I); 1.8 (C)

Mode of birth:

Spontaneous vaginal: 68% (I); 73% (C)

Elective cesarean: 8% (I); 7.7% (C)

Emergency cesarean: 9.6% (I); 10.2% (C)

Twin birth: 2.9% (I); 0.32% (C)

MH status/history: NR

I: PP care at home by community midwives plus up to 10 in-home visits from a support worker for up to 3 hrs./day in the first 28 days PP

C: PP care at home by community midwives

Postpartum

Community Midwife and PP Support Worker

Individual

BF, MH

Exclusivity: No difference between groups at 6 wks. and 6 mos. PP

Depressive Symptoms: ↓ at 6 wks. PP*; no difference between groups at 6 mos. PP (EPDS)

 Montazeri (2020), Iran [57]

N = 35 (I); 35 (C)

Age (mean): 28 (I and C)

Race/ethnicity: NR

Income: 17.1% (I); 14.3% (C) with insufficient household income

Parity: NR

Mode of birth: 23.5% (I); 13.3% (C) cesarean

MH status/history: NR

I: In-person group journal therapy sessions (3 at 45–60 min. each) from the 3rd trimester to the end of pregnancy; telephone counseling sessions (3 at 15 min. each) from the 3rd trimester to 1 mos. PP

C: routine care

Across Pregnancy and Postpartum

Research Staff

Group and Individual

MH

Exclusivity: No difference between groups at 2 and 4 mos. PP (Exclusive BF Checklist)

Anxiety Symptoms: ↓ at 6 wks. Post intervention, 2 and 4 mos. PP* (BAI)

Interventions with No Effect (n = 7)

 Rotheram-Fuller (2017), United States [58]

N = 99 (I); 104 (C)

Age (mean): 28.5 (I); 27.8 (C)

Race/ethnicity (language at home): 80% (I); 87% (C) Spanish

Income (household, monthly):

<$1000: 43.5% (I); 47.1% (C)

$1001–2000: 42.4% (I); 41.3% (C)

Parity: NR

Mode of birth: NR

MH status/history: 13.1% (I); 11.5% (C) with EPDS > 13 at baseline

I: home visiting or telephone support addressing maternal daily habits, BF, and depression; offered as needed during pregnancy

C: standard care

Pregnancy

Peer Support

Individual

BF, MH

Duration: No difference between groups at 1 wk. through 6 mos. PP (IFI)

Depressive Symptoms: No difference between groups at 6 mos. (EPDS)

 Tubay (2019), United States [59]

N = 61 (I); 68 (C)

Age (mean): 28.1 (I); 27.8 (C)

Race/ethnicity:

White: 61% (I); 59% (C)

Hispanic: 23% (I); 12% (C)

Asian: 13% (I); 18% (C)

African American: 10% (I); 15% (C)

Income:

E1-E5 Enlisted military rank: 35.7% (I); 31.8% (C)

Parity: NR

Mode of birth: 15% (I); 18% (C) unplanned cesarean

MH status/history: NR

I: group prenatal care (CenteringPregnancy) starting ~ 16 wks. Gestation; 10 sessions (2 hrs.) across pregnancy

C: standard prenatal care

Pregnancy

OB provider

Group

BF, MH

Duration: No difference between groups at 6 wks. PP

Depressive Symptoms: No difference between groups at 6 wks. PP (CES-D)

Anxiety Symptoms: No difference between groups at 6 wks. PP (STAI)

 Boulvain (2004), Switzerland [60]

N = 228 (I); 231 (C)

Age (mean): 29 (I and C)

Race/ethnicity: 31% (I); 30% (C) Swiss origin

Income (household, annual):

<$55,000: 27% (I); 24% (C)

≥$55,000: 57% (I and C)

Parity: 60% (I); 57% (C) nulliparous

Mode of birth:

Spontaneous vaginal: 72% (I); 65% (C)

Instrumental vaginal: 18% (I); 24% (C)

Cesarean: 11% (I); 12% (C)

MH status/history: no history of PP depression

I: home-based PP care by a midwife after shortened hospital stay (24–48 hrs.)

C: hospital-based PP standard care lasting 4–5 days PP

Postpartum

Midwives

Individual

BF

Duration: No difference between groups at 7 days, 28 days, and 6 mos. PP

Depressive Symptoms: No difference at 7- and 28-days PP (EPDS)

 Escobar (2001), United States [61]

N = 508 (I); 506 (C)

Age (mean): 29 (I); 29.1 (C)

Race/ethnicity:

White: 48.8% (I); 50.6% (C)

Hispanic: 21.7% (I); 21.2% (C)

Asian/Pacific Islander: 23.2% (I); 22.4% (C)

Income (household, annual):

>$60,000: 50.2% (I); 53.3% (C)

Parity 1: 46.6% (I); 45.4% (C)

Mode of birth: 100% vaginal

MH status/history: NR

I: home health nurse visits (60–90 min.) starting 48 hrs. After hospital discharge

C: hospital-based follow-up anchored in group visits

Postpartum

Home Health Nurse

Individual and Group

BF, MH

Duration: No difference between groups at 2 wks. PP

Depressive Symptoms: No difference between groups at 2 wks. PP (CES-D)

 Lieu (2000), United States [62]

N = 580 (I); 583 (C)

Age (mean): 27.9 (I); 27.8% (C)

Race/ethnicity:

White: 62.9% (I); 58.8% (C)

Hispanic: 13.4% (I); 11.5% (C)

Income (household): 71.1% (I); 72.7% (C) above 200% of federal poverty level

Parity: 39% (I); 39.3% (C) primiparous

Mode of birth: NR

MH status/history: NR

I: home visits (60–90 min.) starting within 48 hrs. After discharge

C: standard individual PP clinic follow-up

Postpartum

Home Health Nurse

Individual

BF, MH

Duration: No difference between groups at 2 and 12 wks. PP

Depressive Symptoms: No difference between groups at 2 wks. PP (CES-D)

 Nikodem (1993), South Africa [63]

N = 83 (I); 79 (C)

Age (mean): 25.4 (I); 24.5 (C)

Race/ethnicity: NR

Income (monthly):

<$68.25: 75.3% (I); 69.5% (C)

Parity: 37.3% (I); 48.1% (C) primigravida

Mode of birth: NR

MH status/history: NR

I: audiovisual intervention featuring BF and health education videos within 72 hrs. After birth

C: no audiovisual intervention

Postpartum

Hospital Staff

Individual

BF

Duration: No difference between groups at 6 wks. PP

Exclusivity: No difference between groups at 6 wks. PP

Depressive Symptoms: No difference between groups at 6 wks. PP (Pitt’s Depression Questionnaire)

 Galland (2017), New Zealand [64]

N = 802

Age (mean): 32

Ethnicity: 77.9% European

Income (household, annual):

>$46,645: 50.6%

Parity: 48% primiparous

Mode of birth: NR

MH status/history: EPDS within normal range at baseline

I: sleep intervention with a single antenatal education group session (1 hr.) followed by a home visit at 3 wks. PP with an infant sleep training specialist

I: Food, Activity and BF (FAB) intervention with BF education and support antenatally and at 1 wk. and 4 mos. PP provided by an IBCLC; physical activity support at 3 mos. PP

I: combined sleep and FAB intervention

C: standard care

Across Pregnancy and Postpartum

Sleep Specialist, IBCLC

Individual and Group

BF, MH

Exclusivity: No difference between groups at 4 and 6 mos. PP

Depressive Symptoms: No difference between groups at 4 mos. PP (EPDS)