CC BY-NC-ND 4.0 · Am J Perinatol
DOI: 10.1055/s-0043-1772230
Original Article

Maternal Well-Being in Pregnancy and Breastfeeding Practices: Findings from the ROLO Study

Cara A. Yelverton
1   Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
Aisling A. Geraghty
1   Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
Eileen C. O'Brien
1   Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
Sarah L. Killeen
1   Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
Elizabeth Larkin
1   Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
John Mehegan
2   School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
Martina Cronin
1   Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
Fionnuala M. McAuliffe
1   Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
› Author Affiliations
Funding This study was supported by the Health Research Board Ireland, the Health Research Centre for Health and Diet Research, and the European Union's Seventh Framework Program (grant no.: FP7/2007/2013), project EarlyNutrition under grant agreement number 289346.


Objective Low mood is common during the perinatal period, which may negatively impact breastfeeding practices. Exploring predictors of successful breastfeeding is a health priority area. This study investigated if maternal well-being during pregnancy is associated with breastfeeding practices.

Study Design This is a secondary analysis of a randomized control trial of a low glycemic index diet in pregnancy. A total of 610 secundigravida women were recruited in the National Maternity Hospital, Dublin, Ireland. Data on maternal education attainment, early pregnancy body mass index (BMI), and age were collected from hospital records. Well-being was self-reported by mothers between 10 and 28 weeks' gestation using the World Health Organization 5-Item well-being index. Scores were transformed to give percentage well-being. Mothers recorded breastfeeding practices at hospital discharge and at the study follow-up appointments. Chi-squares and independent t-tests determined initial differences in breastfeeding practices. Multiple and logistic regression analyses were used to adjust for confounders.

Results Average maternal age was 32.7 years; average BMI was 26.6 kg/m2, and 56% had achieved third-level education. The average well-being score was 58.2%. In unadjusted analysis, high well-being scores were associated with exclusive breastfeeding (56.2% breastfed vs. 46%, breastfed p < 0.03). After adjusted analysis, these associations were no longer significant (odds ratio: 1.00, 95% confidence interval: 0.99–1.01). No other associations were found.

Conclusion Our findings indicated 25% of pregnant women in the first trimester reported low well-being scores. Associations between maternal well-being and breastfeeding patterns were explained by maternal age and education level, suggesting low mood may not be a barrier to breastfeeding initiation or duration. This trial is registered at: ISRCTN54392969.

Key Points

  • Well-being during pregnancy is often diminished and the WHO 5-Item well-being index is a useful measure in clinical settings to assess maternal well-being.

  • Breastfeeding is a high-priority research area, particularly in an Irish setting.

  • Well-being was not related to breastfeeding, however age, BMI and education were the main predictors of low well-being during pregnancy.

Ethics Approval and Consent to Participate

Ethical approval was granted by the National Maternity Hospital in November 2006; the trial was performed in accordance with the Helsinki Declaration of Human Rights 1975 (revised in 1983). All participants provided informed, written consent.

Authors' Contributions

C.A.Y., A.A.G., E.C.O.B., E.L., and F.M.M. were involved in the conception and design of the study. A.A.G., E.C.O.B., E.L., and M.C. were involved in the acquisition of data. C.A.Y. performed all statistical analysis. C.A.Y., A.A.G., S.L.K., and F.M.M. were involved in the interpretation of the data. J.M. was responsible for the data management. C.A.Y. drafted the manuscript. All authors revised the work critically and approved the final manuscript.

Publication History

Received: 09 December 2022

Accepted: 22 May 2023

Article published online:
14 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Kazakovtsev BA, Krasnov VN, Levina NB, Nemtsov AV. WHO European Ministerial Conference on Mental Health. “Facing the Challenges, Building Solutions”. (Helsinki, Finland, January 12–15, 2005). Vol. 105; 2005 :80
  • 2 Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 2010; 202 (01) 5-14
  • 3 Coburn SS, Luecken LJ, Rystad IA, Lin B, Crnic KA, Gonzales NA. Prenatal maternal depressive symptoms predict early infant health concerns. Matern Child Health J 2018; 22 (06) 786-793
  • 4 Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom 2015; 84 (03) 167-176
  • 5 Dieterich CM, Felice JP, O'Sullivan E, Rasmussen KM. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin North Am 2013; 60 (01) 31-48
  • 6 Wang L, Collins C, Ratliff M, Xie B, Wang Y. Breastfeeding reduces childhood obesity risks. Child Obes 2017; 13 (03) 197-204
  • 7 Purdy J, McAvoy H, Cotter N. Breastfeeding on the Island of Ireland. Institute of Public Health in Ireland;. 2017: 1-42
  • 8 World Health Organization. Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization; 2003: 1-5
  • 9 Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. J Affect Disord 2015; 171: 142-154
  • 10 Fairlie TG, Gillman MW, Rich-Edwards J. High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation. J Womens Health (Larchmt) 2009; 18 (07) 945-953
  • 11 Insaf TZ, Fortner RT, Pekow P, Dole N, Markenson G, Chasan-Taber L. Prenatal stress, anxiety, and depressive symptoms as predictors of intention to breastfeed among Hispanic women. J Womens Health (Larchmt) 2011; 20 (08) 1183-1192
  • 12 Hatton DC, Harrison-Hohner J, Coste S, Dorato V, Curet LB, McCarron DA. Symptoms of postpartum depression and breastfeeding. J Hum Lact 2005; 21 (04) 444-449 , quiz 450–454
  • 13 Figueiredo B, Canário C, Field T. Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychol Med 2014; 44 (05) 927-936
  • 14 Pippins JR, Brawarsky P, Jackson RA, Fuentes-Afflick E, Haas JS. Association of breastfeeding with maternal depressive symptoms. J Womens Health (Larchmt) 2006; 15 (06) 754-762
  • 15 Field T, Hernandez-Reif M, Feijo L. Breastfeeding in depressed mother-infant dyads. Early Child Dev Care 2002; 172 (06) 539-545
  • 16 Hahn-Holbrook J, Haselton MG, Dunkel Schetter C, Glynn LM. Does breastfeeding offer protection against maternal depressive symptomatology? A prospective study from pregnancy to 2 years after birth. Arch Women Ment Health 2013; 16 (05) 411-422
  • 17 Bunevicius R, Kusminskas L, Bunevicius A, Nadisauskiene RJ, Jureniene K, Pop VJM. Psychosocial risk factors for depression during pregnancy. Acta Obstet Gynecol Scand 2009; 88 (05) 599-605
  • 18 Walsh JM, McGowan CA, Mahony R, Foley ME, McAuliffe FM. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial. BMJ 2012; 345: e5605
  • 19 Sattler MC, Jelsma JGM, Bogaerts A. et al. Correlates of poor mental health in early pregnancy in obese European women. BMC Pregnancy Childbirth 2017; 17 (01) 404-404
  • 20 Jairaj C, Fitzsimons CM, McAuliffe FM. et al. A population survey of prevalence rates of antenatal depression in the Irish obstetric services using the Edinburgh Postnatal Depression Scale (EPDS). Arch Women Ment Health 2019; 22 (03) 349-355
  • 21 Connelly CD, Hazen AL, Baker-Ericzén MJ, Landsverk J, Horwitz SM. Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women. J Womens Health (Larchmt) 2013; 22 (10) 844-852
  • 22 Ashley JM, Harper BD, Arms-Chavez CJ, LoBello SG. Estimated prevalence of antenatal depression in the US population. Arch Women Ment Health 2016; 19 (02) 395-400
  • 23 Broberg L, Tabor A, Rosthøj S. et al. Effect of supervised group exercise on psychological well-being among pregnant women with or at high risk of depression (the EWE Study): a randomized controlled trial. Acta Obstet Gynecol Scand 2021; 100 (01) 129-138
  • 24 Mortazavi F, Mousavi SA, Chaman R, Khosravi A. [Validation of the World Health Organization-5 Well-Being Index; assessment of maternal well-being and its associated factors]. Turk Psikiyatr Derg 2015; 26 (01) 48-55
  • 25 Haga SM, Lisøy C, Drozd F, Valla L, Slinning K. A population-based study of the relationship between perinatal depressive symptoms and breastfeeding: a cross-lagged panel study. Arch Women Ment Health 2018; 21 (02) 235-242
  • 26 Chung EK, McCollum KF, Elo IT, Lee HJ, Culhane JF, Objectives A. Maternal Depressive Symptoms and Infant Health Practices Among Low-Income Women. Pediatrics 2004; 113 (06) e523-e529
  • 27 Ahlqvist-Björkroth S, Vaarno J, Junttila N. et al. Initiation and exclusivity of breastfeeding: association with mothers' and fathers' prenatal and postnatal depression and marital distress. Acta Obstet Gynecol Scand 2016; 95 (04) 396-404
  • 28 Horan MK, McGowan CA, Doyle O, McAuliffe FM. Well-being in pregnancy: an examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention. Eur J Clin Nutr 2014; 68 (01) 19-24