Relationships among Socioeconomic Status, Dietary Intake, and Stress in Breastfeeding Women.

BACKGROUND As breastfeeding duration increases, it is important to understand diets of breastfeeding women and other factors salient to maternal/offspring health, including stress. It is important to further consider sociodemographic factors, given their associations with nutritional deficiencies and perceived stress. OBJECTIVE We cross-sectionally compared breastfeeding women's dietary intakes from a food frequency questionnaire (assessing from pregnancy through 3 months postpartum) with Estimated Average Requirements (EARs). We hypothesized that dietary intake was related to sociodemographic variables and parenting stress. DESIGN We examined a cohort of predominately breastfeeding women. Food frequency questionnaire results were compared with EARs, the Parenting Stress Index: Short Form, and a demographic questionnaire. PARTICIPANTS/SETTING Participants included 101 women (of 289 recruited) who breastfed singleton, full-term infants for the first 3 months while using <28 oz formula/wk. The study included community recruitment in rural Oklahoma from 2008 to 2012. STATISTICAL ANALYSES Mean and standard deviation or frequencies were reported. One-sample t tests compared EARs with mean dietary intakes over the past 12 months. Pearson correlations and one-way analyses of variance explored relationships among dietary, sociodemographic, and stress variables. RESULTS Twenty-two percent of women did not meet EAR minimum energy recommendations and >40% did not meet protein recommendations. Despite widespread supplement use, some consumed less than the EAR for vitamin E (35%), calcium (22%), and vitamin C (19%). Carbohydrate consumption was positively related to the difficult child scale (r=0.19; P=0.05). Dietary riboflavin (r=-0.19; P=0.05) and vitamin D intake (r=-0.19; P=0.05) were negatively related to the parent-child dysfunction scale. CONCLUSIONS Despite efforts to enhance education and counseling regarding adequate perinatal nutrition-related practices, even well-educated women may not meet EARs. This poor dietary intake may be associated with parenting stress and have potential long-term implications for child health.

[1]  Mahmoud A. Mohammad,et al.  Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation. , 2009, The American journal of clinical nutrition.

[2]  E. Barker.  The duration and timing of maternal depression as a moderator of the relationship between dependent interpersonal stress, contextual risk and early child dysregulation , 2012, Psychological Medicine.

[3]  D. Warburton,et al.  Comparison of the dietary intakes of new parents, second-time parents, and nonparents: a longitudinal cohort study. , 2014, Journal of the Academy of Nutrition and Dietetics.

[4]  P. Autier,et al.  Vitamin D status and ill health: a systematic review. , 2014, The lancet. Diabetes & endocrinology.

[5]  D. Midthune,et al.  Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires : the Eating at America's Table Study. , 2001, American journal of epidemiology.

[6]  Adam Drewnowski,et al.  Does social class predict diet quality? , 2008, The American journal of clinical nutrition.

[7]  Katrina M. Krause,et al.  Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding. , 2011, Journal of the American Dietetic Association.

[8]  L. Allen.  B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function. , 2012, Advances in nutrition.

[9]  M. Freer,et al.  Nutrition during lactation. , 2002 .

[10]  T. Wachs.  Models linking nutritional deficiencies to maternal and child mental health. , 2009, The American journal of clinical nutrition.

[11]  J. Freeland-Graves,et al.  Food choices of low-income women during pregnancy and postpartum. , 2005, Journal of the American Dietetic Association.

[12]  D. Benton.  The influence of dietary status on the cognitive performance of children. , 2010, Molecular nutrition & food research.

[13]  D. Midthune,et al.  Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. , 2003, American journal of epidemiology.

[14]  W. Maclean,et al.  Relation Between Maternal Characteristics and Child Behavior Ratings , 1992, Clinical pediatrics.

[15]  Katrina M. Krause,et al.  Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program. , 2013, Journal of the Academy of Nutrition and Dietetics.

[16]  N. Adler,et al.  Socioeconomic Status and Health: What We Know and What We Don't , 1999, Annals of the New York Academy of Sciences.

[17]  J. Jobe,et al.  Cognitive research enhances accuracy of food frequency questionnaire reports: results of an experimental validation study. , 2002, Journal of the American Dietetic Association.

[18]  Ann L. Yaktine,et al.  Weight Gain During Pregnancy , 2009 .

[19]  S. Donath,et al.  Maternal diet and breastfeeding: a case for rethinking physiological explanations for breastfeeding determinants. , 2012, Early human development.

[20]  D. Medeiros,et al.  Dietary Reference Intakes: the Essential Guide to Nutrient Requirements edited by JJ Otten, JP Hellwig, and LD Meyers, 2006, 560 pages, hardcover, $44.96. The National Academies Press, Washington, DC. , 2007 .

[21]  Brendan Miller,et al.  Dietary supplements for preventing postnatal depression. , 2013, The Cochrane database of systematic reviews.

[22]  E. Mezzacappa.  Breastfeeding and maternal stress response and health. , 2004, Nutrition reviews.

[23]  N. Board..  Dietary Reference Intakes for Calcium and Vitamin D , 2011, Pediatric Clinical Practice Guidelines & Policies.

[24]  H. M. Shearer.  Malnutrition in middle-class pregnant women. , 1980 .

[25]  M. Groer.  Differences Between Exclusive Breastfeeders, Formula-Feeders, and Controls: A Study of Stress, Mood, and Endocrine Variables , 2005 .

[26]  Sarah K. G. Jensen,et al.  DEVELOPMENTAL INTER‐RELATIONS BETWEEN EARLY MATERNAL DEPRESSION, CONTEXTUAL RISKS, AND INTERPERSONAL STRESS, AND THEIR EFFECT ON LATER CHILD COGNITIVE FUNCTIONING , 2014, Depression and anxiety.

[27]  D. Mitchell,et al.  Self-selected diets of lactating women often fail to meet dietary recommendations. , 1998, Journal of the American Dietetic Association.

[28]  A. Ramel,et al.  A population-based study of exclusive breastfeeding in Icelandic women: is there a relationship with depressive symptoms and parenting stress? , 2006, International journal of nursing studies.

[29]  Katherine Newman,et al.  Socioeconomic disparities in health: pathways and policies. , 2002, Health affairs.

[30]  Edgar Erdfelder,et al.  G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences , 2007, Behavior research methods.