Breastfeeding Knowledge Moderates the Relationship Between Perinatal Depressive Symptoms and Breastfeeding Self-Efficacy

Purpose: To investigate the relationship between the timing of perinatal depressive symptoms and breastfeeding self-efficacy, while also exploring the moderating effect of breastfeeding knowledge. Method: The current prospective cohort study was performed from October 2021 to June 2023 at a tertiary hospital in Hunan, China. Depressive symptoms were measured during each trimester of pregnancy and at 1 week, 6 weeks, 3 months, and 6 months postpartum. Breastfeeding knowledge was assessed during the third trimester of pregnancy. Breastfeeding self-efficacy was evaluated at the same postpartum intervals. Participants were grouped into no, antenatal, post-partum, and persistent depressive symptoms. Generalized linear mixed models were used to compare breastfeeding self-efficacy across groups, with interaction terms included to test the moderating role of breastfeeding knowledge. Results: A total of 258 women were included. Antenatal and persistent depressive symptoms were significantly associated with lower breastfeeding self-efficacy scores. Breastfeeding knowledge moderated these effects in antenatal (β = 1.061, 95% confidence interval [CI] [0.428, 1.695], p = .001) and persistent (β = 0.734, 95% CI [0.271, 1.197], p = .002) groups. Conclusion: Breastfeeding knowledge can mitigate the negative effect of antenatal and persistent depressive symptoms on breastfeeding self-efficacy. Clinical nurses should integrate breastfeeding education into antenatal care, routinely screen for persistent depression, and deliver additional educational interventions to affected mothers.