The Impact of the COVID-19 Pandemic on the Association of Breastfeeding’s Protective Effect on Postpartum Depression: A Comparative Analysis of Prepandemic and Pandemic Cohorts

Background: Before the COVID-19 pandemic, research studies indicated that breastfeeding was protective against postpartum depression (PPD). This study aimed to evaluate the impact of the COVID-19 pandemic on the protective association between breastfeeding and PPD. Methods: We performed a retrospective cohort study by comparing the Edinburgh Postnatal Depression Scale (EPDS) scores for patients in two cohorts, pre-COVID-19 (April 2019 to February 2020) and COVID-19 (April 2020 to February 2021). A cross-sectional design using descriptive statistics, Pearson correlations, analysis of variance (ANOVA), and stepwise multiple regression analysis (MRA) analyzed the EPDS scores of a prepandemic cohort (N = 448) and a pandemic cohort (N = 468) of women seen at a tertiary academic medical center for their first postpartum visit. Results: In the prepandemic cohort, 77.3% of breastfeeding women exhibited an unlikely risk for PPD compared with 78.5% in the pandemic cohort. Pearson correlations showed that the breastfeeding group in both cohorts had significantly lower EPDS scores, was less likely to exhibit PPD, and had a lower risk of severe PPD. ANOVA showed that nonbreastfeeding women had significantly higher EPDS scores in both cohorts. Stepwise MRA showed that the EPDS item Q8 ("I have felt sad or miserable") was the most significant predictor of PPD in breastfeeding women (both cohorts) and nonbreastfeeding women (prepandemic cohort) but had escalated to Q9 ("I have been so unhappy that I have been crying") for nonbreastfeeding women in the pandemic cohort. Conclusion: In both the prepandemic and pandemic cohorts, breastfeeding women had significantly lower EPDS scores.