DOI: 10.5281/zenodo.17391565
title: Exploring the Intricate Nexus Between Postpartum Post-Traumatic Stress Disorder and the Duration of Breastfeeding

description: Objective To model and examine the intricate relationship between postpartum post-traumatic stress disorder and breastfeeding duration, with the ultimate goal of facilitating timely interventions that enhance both breastfeeding longevity and initiation rates. Methods A comprehensive retrospective analysis was undertaken on a cohort of pregnant women who delivered live births at a single hospital in China between January 2021 and January 2023, serving as the focal subjects of this investigation. Within a two-year window following childbirth, data on breastfeeding behaviors and duration were meticulously collected through structured outpatient follow-ups and virtual consultations, employing the Post-Traumatic Stress Disorder Checklist–Civilian Version (PCL-C) questionnaire. Based on their PCL-C responses, participants were stratified into two distinct groups: those exhibiting symptoms indicative of postpartum post-traumatic stress disorder (PTSD-positive) and those without such clinical manifestations (PTSD-negative). To assess dichotomous outcomes across these groups, logistic regression modeling was employed to elucidate intergroup disparities. For continuous outcomes, linear regression analyses were conducted to further delineate differences associated with PTSD status. Moreover, restricted cubic spline (RCS) curves were applied to model the nonlinear relationship between PCL-C score gradients and each outcome variable, offering nuanced insights into dose-response patterns. To mitigate potential biases arising from confounding variables, propensity score matching (PSM) was rigorously implemented. Once adequate balance across covariates was achieved, all analytical procedures were systematically repeated to ensure robustness and validity of the findings. Results In the analysis of binary outcomes, after adjusting for a comprehensive array of confounding factors, women in the PCL-C positive group exhibited a significantly lower likelihood of favorable breastfeeding outcomes at 6 weeks and 3 months postpartum compared to those in the negative group. However, no statistically significant association was observed between PCL-C status and breastfeeding outcomes at 6 months, 1 year, or 2 years postpartum. In the examination of continuous outcomes, a robust statistically significant negative correlation emerged between PCL-C positivity and the duration of exclusive breastfeeding, indicating that higher symptom burden was linked to shorter exclusivity periods. Conversely, no significant associations were detected between the PCL-C group and either partial breastfeeding duration or total breastfeeding duration. These findings were consistently reaffirmed following propensity score matching (PSM) analysis, underscoring their reliability and resilience against selection bias. The restricted cubic spline (RCS) curve evaluation further illuminated these relationships: in binary outcomes, a pronounced and approximately linear negative association was revealed between PCL-C scores and breastfeeding success at 6 weeks postpartum, highlighting a dose-response pattern. Yet, this statistical linkage attenuated and became non-significant at the 3-month mark. For continuous outcomes, the RCS model demonstrated a clear, linearly negative trend between increasing PCL-C scores and diminishing duration of exclusive breastfeeding—suggesting that as psychological distress intensifies, the capacity to sustain exclusive lactation progressively declines. Conclusion Postpartum post-traumatic stress disorder stands as a distinct and independent risk factor that profoundly influences breastfeeding behaviors within the critical first six weeks following childbirth. Concurrently, a robust and statistically significant negative correlation exists between the presence of postpartum post-traumatic stress disorder and the duration of exclusive breastfeeding, revealing a troubling pattern in which psychological distress undermines maternal lactation resilience. These findings offer invaluable insights for clinical practitioners, empowering them to conduct precise, quantitative assessments of breastfeeding trajectories and to implement timely, individualized interventions—ultimately fostering more compassionate, evidence-based care for vulnerable mothers navigating the complex emotional landscape of the postpartum period.