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282However as a limitation it is worth mentioning this study was a clinical sample and of small sample size Furthermore Huang Vaughn Kremer 2016 suggest rather than confounding factors be responsible it is possible that higher socioeconomic status and supportive parenting behaviours mean the likelihood of breastfeeding occurring is higher and therefore it is the breastfeeding that increases children's cognitive development Kanazawa 2015 showed that breastfeeding was significantly associated with child intelligence taking in account parental IQ and other potential factors such as parental education earnings and social class Fonseca et al 2013 found that children that were breastfed for six months or more had better performance in the general intellectual assessment even after adjusting for the main confounding factors Another aspect of research regarding breastfeeding is the association with postpartum depression
Dias Figueiredo 2015 conducted a systematic review of breastfeeding and depression and found that breastfeeding duration is associated with postpartum depression in almost all studies They also reported that negative breastfeeding experiences can precede the onset of depressive symptoms Ali et al 2009 found difficulties with breastfeeding to be significantly associated with postpartum anxiety and depression Galler et al 2006 study found women with postpartum depression had more negative attitudes towards breastfeeding Watkins et al 2011 reported that women with negative early breastfeeding experiences including pain were more likely to have depressive symptoms at 2 months postpartum Haga et al 2012 conducted a study in Norway where breastfeeding is normative and women with higher self efficacy in breastfeeding had less postpartum depression compared to women