The impact of antenatal depressive symptoms on exclusive breastfeeding intention: A moderating effect analysis

Exclusive breastfeeding intention is an important predictor of exclusive breastfeeding behavior. Antenatal depressive symptoms are a potentially modifiable risk factor for exclusive breastfeeding intention. However, studies of the impact of antenatal depressive symptoms on exclusive breastfeeding intention are sparse and contradictory. Therefore, explorations that evaluate the effects of identical factors of exclusive breastfeeding intention and antenatal depressive symptoms in their relationship are urgently needed. This study aims to (1) investigate the impact of antenatal depressive symptoms on exclusive breastfeeding intention based on confounders related either to antenatal depressive symptoms and/or exclusive breastfeeding intention and (2) explore whether or not identical factors moderate the relationship between antenatal depressive symptoms and exclusive breastfeeding intention.A cross-sectional survey was conducted at a tertiary hospital in Hunan, China.A total of 393 pregnant women completed a self-administered questionnaire, a question on their breastfeeding intention, the Edinburgh Postnatal Depression Scale, and the Perceived Social Support Scale during their first-trimester hospital visit. Logistic regression was used to evaluate the impact of antenatal depressive symptoms on exclusive breastfeeding intention. Moderate analysis was employed to explore whether identical factors moderate the relationship between antenatal depressive symptoms and exclusive breastfeeding intention.Antenatal depressive symptoms negatively affect the exclusive breastfeeding intention after controlling as fully as possible for confounders (adjusted OR = 2.88, 95% CI: [1.06, 7.82]) and it was moderated by one of the identical factors (i.e., social support). The results of the simple slope test showed a negative relationship between antenatal depressive symptoms and exclusive breastfeeding intention among pregnant women with low levels of social support (b =-0.011, p < 0.05).Social support moderates the negative effects of depressive symptoms on exclusive breastfeeding intention. Clinical care practices and future intervention research that focus on improving antenatal depressive symptoms and exclusive breastfeeding intention should consider the moderator.