Breastfeeding, gestational diabetes and maternal distress in Iran: findings from the PERSIAN cohort

BACKGROUND: Exclusive breastfeeding rates in Iran remain below international recommendations, while gestational diabetes mellitus (GDM) rates are increasing. Evidence from Western countries suggests GDM and postnatal psychological distress may hinder breastfeeding. We assessed associations between postnatal distress and breastfeeding in women with and without GDM in a Southwest Asia and North Africa (SWANA) population where cultural, social, and health system contexts differ. METHODS: = 2,823). GDM was self-reported during pregnancy. Postnatal psychological distress was assessed at two months postnatal using a single-item measure of sadness/helplessness, which, although limited, may reflect the challenges in measuring mental health status in Iran. Breastfeeding outcomes were reported retrospectively at 12 months. Logistic and linear regressions adjusted for maternal age and education. RESULTS: Women with GDM were less likely to initiate breastfeeding (adjusted OR = 0.25, 95% CI = 0.16-0.40) and reported shorter exclusive breastfeeding (adjusted β = -0.47 months, 95% CI = -0.68 to -0.25). Psychological distress was not associated with breastfeeding initiation but was associated with shorter exclusivity (mild distress: β = -0.32 months; moderate - severe distress: β = -0.48 months). Interaction analyses suggested a stronger negative effect of GDM on exclusivity in women without distress, though this finding was exploratory. CONCLUSION: GDM was associated with reduced breastfeeding initiation and shorter exclusivity, while distress modestly reduced exclusivity. The interpretation is limited by lack of validation for the psychological distress measure.