***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Although much research has focused on identifying factors that influence breastfeeding initiation and duration , many high-risk factors are nonmodifiable demographic variables . Predisposing factors for low breastfeeding duration rates that are amenable to supportive interventions should be identified . The purpose of this study was to assess the effect of maternal confidence ( breastfeeding self-efficacy ) on breastfeeding duration . METHOD A prospect i ve survey was conducted with 300 women in the last trimester of pregnancy recruited from the antenatal clinic of a large metropolitan hospital in Brisbane , Australia .  Telephone interviews were conducted at 1 week and 4 months postpartum to assess infant feeding methods and breastfeeding confidence using the Breastfeeding Self-Efficacy Scale . RESULTS Although 92 percent of participants initiated breastfeeding , by 4 months postpartum almost 40 percent discontinued and only 28.6 percent were breastfeeding exclusively ; the most common reason for discontinuation was insufficient milk supply . Antenatal and 1-week Breastfeeding Self-Efficacy Scale scores were significantly related to breastfeeding outcomes at 1 week and 4 months . Mothers with high breastfeeding self-efficacy were significantly more likely to be breastfeeding , and doing so exclusively , at 1 week and 4 months postpartum than mothers with low breastfeeding self-efficacy . CONCLUSIONS Maternal breastfeeding self-efficacy is a significant predictor of breastfeeding duration and level . Integrating self-efficacy enhancing strategies may improve the quality of healthcare that healthcare professionals deliver and may increase a new mother 's confidence in her ability to breastfeed , and to persevere if she does encounter difficulties Background & Methods To examine the relationship between  breastfeeding and maternally-rated infant temperament at age 3 months , 316 infants in the prospect i ve Cambridge Baby Growth Study , UK had infant temperament assessed at age 3 months by mothers using the Revised Infant Behavior Question naire , which produces scores for three main dimensions of temperament derived from 14 subscales . Infant temperament scores were related to mode of infant milk feeding at age 3 months ( breast only ; formula milk only ; or mixed ) with adjustment for infant 's age at assessment and an index of deprivation . Results Infant temperament dimension scores differed across the three infant feeding groups , but appeared to be comparable between exclusive breast-fed and mixed-fed infants . Compared to formula milk-fed infants , exclusive breast-fed and mixed-fed infants were rated as having lower impulsivity and positive responses to stimulation ( adjusted mean [ 95 % CI ] “ Surgency/Extraversion ” in formula-fed vs. mixed-fed vs. breast-fed groups : 4.3 [ 4.2–4.5 ] vs. 4.0 [ 3.8–4.1 ] vs. 4.0 [ 3.9–4.1 ] ; p-heterogeneity = 0.0006 ) , lower ability to regulate their own emotions ( “ Orienting/Regulation ” : 5.1 [ 5.0–5.2 ] , vs. 4.9 [ 4.8–5.1 ] vs. 4.9 [ 4.8–5.0 ] ; p = 0.01 ) , and higher emotional instability ( “ Negative affectivity ” : 2.8 [ 2.6–2.9 ] vs. 3.0 [ 2.8–3.1 ] vs. 3.0 [ 2.9–3.1 ] ; p = 0.03 ) . Conclusions Breast and mixed-fed infants were rated by their mothers as having more challenging temperaments in all three dimensions ; particular subscales included greater distress , less smiling , laughing , and vocalisation , and lower soothability . Increased awareness of the behavioural dynamics of breastfeeding , a better expectation of normal infant temperament and support to cope with difficult infant temperament could potentially help to promote successful breastfeeding OBJECTIVE : Postpartum anxiety screening does not typically occur , despite changes in life roles and responsibility after childbirth . We sought to determine the prevalence of postpartum anxiety during the maternity hospitalization and its associations with maternal and child outcomes . We further aim ed to compare correlates of anxiety with correlates of depression . METHODS : For a r and omized controlled trial of mothers with “ well ” newborns ≥34 weeks ’ gestation comparing 2 post – hospital discharge care models , mothers completed baseline in-person interviews during the postpartum stay and telephone surveys at 2 weeks , 2 months , and 6 months to assess health care use , breastfeeding duration , anxiety , and depression . All participants intended to breastfeed  . State anxiety scores ≥40 on the State Trait Anxiety Inventory ( STAI ) and depression scores ≥12 on the Edinburgh Postnatal Depression Survey ( EPDS ) were considered positive . RESULTS : A total of 192 ( 17 % ) of 1123 participating mothers had a positive baseline STAI ; 62 ( 6 % ) had a positive EPDS . Primiparity was associated with a positive STAI ( 20 % vs 15 % , P = .02 ) , but not a positive EPDS ( 4 % vs 7 % , P = .05 ) . Positive STAI scores were associated with cesarean delivery ( 22 % vs 15 % , P = .001 ) , reduced duration of breastfeeding ( P = .003 ) , and increased maternal , but not infant total unplanned health care utilization within 2 weeks of delivery ( P = .001 ) . Positive STAI scores occurred more frequently than positive EPDS scores at each assessment through 6 months postpartum . CONCLUSIONS : Postpartum state anxiety is a common , acute phenomenon during the maternity hospitalization that is associated with increased maternal health care utilization after discharge and reduced breastfeeding duration . State anxiety screening during the postpartum stay could improve these outcomes Several pilot studies have provided evidence that mindfulness-based intervention is beneficial during pregnancy , yet its effects in mothers during the early parenting period are unknown . The purpose of the present pilot study was to examine the effectiveness of a  mindfulness-based intervention in breast-feeding mothers . We developed and tested an 8-week mindfulness-based intervention aim ed at improving maternal self-efficacy , mindfulness , self-compassion , satisfaction with life , and subjective happiness , and at reducing psychological distress . A r and omized controlled , between-groups design was used with treatment and control groups ( n = 26 ) and pretest and posttest measures . ANCOVA results indicated that , compared to the control group , mothers in the treatment group scored significantly higher on maternal self-efficacy , some dimensions of mindfulness ( observing , acting with awareness , non-judging , and non-reactivity ) , and self-compassion ( self-kindness , mindfulness , over- identification , and total self-compassion ) . In addition , mothers who received the treatment exhibited significantly less anxiety , stress , and psychological distress . The results supported previous research findings about the benefits of mindfulness-based intervention in women from the perinatal and postpartum periods through the early parenting period . Additional research is needed to vali date our findings in non-breast-feeding mothers and to examine the intervention ’s indirect benefits in terms of family relationships and child development Background Despite high levels of breastfeeding initiation in Australia , only 47 percent of women are breastfeeding ( exclusively or partially ) six months later , with marked differences between social groups . It is important to identify women who are at increased risk of early cessation of breastfeeding . Methods Data from the three arms of a r and omised controlled trial were pooled and analysed as a cohort using logistic regression to identify which factors predicted women continuing to feed any breast milk at six months postpartum . The original trial included 981 primiparous women attending a public , tertiary , women 's hospital in Melbourne , Australia in 1999–2001 . The trial evaluated the effect of two mid-pregnancy educational interventions on breastfeeding initiation and duration . In the 889 women with six month outcomes available , neither intervention increased breastfeeding initiation nor duration compared to st and ard care . Independent variables were included in the predictive model based on the literature and discussion with peers and were each tested individually against the dependent variable ( any breastfeeding at six months ) . Results Thirty-three independent variables of interest were identified , of which 25 qualified for inclusion in the preliminary regression model ; 764 observations had complete data available . Factors remaining in the final model that were positively associated with breastfeeding any breast milk at six months were : a very strong desire to breastfeed ; having been breastfed oneself as a baby ; being born in an Asian country ; and older maternal age . There was an increasing association with increasing age . Factors negatively associated with feeding any breast milk at six months were : a woman having no intention to breastfeed six months or more ; smoking 20 or more cigarettes per day pre-pregnancy ; not attending childbirth education ; maternal obesity ; having self-reported depression in the six months after birth ; and the baby receiving infant formula while in hospital . Conclusion In addition to the factors commonly reported as being associated with breastfeeding in previous work , this study found a negative association between breastfeeding outcomes and giving babies infant formula in hospital , a high maternal body mass index , and self-reported maternal depression or anxiety in the six months after the baby was born . Interventions that seek to increase breastfeeding should consider focusing on women who wish to breastfeed but are at high risk of early discontinuation Background Very low birthweight infants are at risk for deficits in cognitive and language development , as well as attention and behaviour problems . Maternal sensitive behaviour ( i.e. awareness of infant cues and appropriate responsiveness to those cues ) in interaction with her very low birthweight infant is associated with better outcomes in these domains ; however , maternal anxiety interferes with the mother 's ability to interact sensitively with her very low birthweight infant . There is a need for brief , cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour . The Cues and Care trial is a r and omized controlled trial of an intervention design ed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants . Methods and design Mothers of singleton infants born at weights below 1500 g are recruited in the neonatal intensive care units of 2 tertiary care hospitals , and are r and omly assigned to the experimental ( Cues ) intervention or to an attention control ( Care ) condition . The Cues intervention teaches mothers to attend to their own physiological , cognitive , and emotional cues that signal anxiety and worry , and to use cognitive-behavioural strategies to reduce distress . Mothers are also taught to underst and infant cues and to respond sensitively to those cues . Mothers in the Care group receive general information about infant care . Both groups have 6 contacts with a trained intervener ; 5 of the 6 sessions take place during the infant 's hospitalization , and the sixth contact occurs after discharge , in the participant mother 's home . The primary outcome is maternal symptoms of anxiety , assessed via self-report question naire immediately post-intervention . Secondary outcomes include maternal sensitive behaviour , maternal symptoms of posttraumatic stress , and infant development at 6 months corrected age . Discussion The Cues and Care trial will provide important information on the efficacy of a brief , skills-based intervention to reduce anxiety and increase sensitivity in mothers of very low birthweight infants . A brief intervention of this nature may be more readily implemented as part of st and ard neonatal intensive care than broad-based , multi-component interventions . By intervening early , we aim to optimize developmental outcomes in these high risk infants . Trial Registration Current Controlled Trials IS RCT N00918472The Cues and Care Trial : A r and omized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight AIM Depressive and anxiety symptoms are common in new mothers . The aim of this study is to explore the link between postpartum psychological adjustment and feeding preferences of the mothers . METHODS Sixty mothers and newborns were enrolled in this prospect i ve , longitudinal study . Maternal depressive symptoms were screened by the  Edinburgh Postpartum Depression Scale ( EPDS ) , and maternal anxiety level was assessed by the State-Trait Anxiety Inventory at 1 month postpartum . The Multidimensional Scale of Perceived Social Support was used for the assessment of maternal social support . The  Adult Attachment Scale  was used to determine the attachment style of the mother . Infants were examined and evaluated at 1 and 4 months of life . RESULTS All mothers started breastfeeding their infants postpartum ; 91 % and 68.1 % continued exclusive breastfeeding at 1 and 4 months , respectively . The first-month median EPDS score of mothers who breastfeed at the fourth month was statistically significantly lower than those who were not breastfeeding ( 6 and 12 , respectively ) ( P = 0001 ) . The first-month median EPDS score of mothers with secure attachment was lower than the median score of mothers with insecure attachment ( 5 and 9 , respectively ) ( P < 0001 ) . Exclusive breastfeeding rate was not statistically different among mothers with secure and insecure attachment styles . The median state and trait anxiety scores and social support scores of mothers were not different between groups according to breastfeeding status . CONCLUSIONS This study has shown an association between higher EPDS scores and breastfeeding cessation by 4 months after delivery BACKGROUND Maternal eating disorders ( ED ) have been shown to increase the risk of feeding difficulties in the offspring . Very few studies , however , have investigated whether the effect of a maternal ED on childhood feeding is a direct effect or whether it can be ascribed to other child or maternal factors . We aim ed to determine the role of maternal anxiety and depression in mediating the risk for feeding difficulties in infants of women with ED . METHODS A prospect i ve study comparing women with lifetime ED ( 441 ) and without any lifetime psych 
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Results indicated that women with symptoms of PPA are less likely to breastfeed exclusively and more likely to terminate breastfeeding earlier .
Some evidence also suggests that those experiencing PPA are less likely to initiate breastfeeding and more likely to supplement with formula in the hospital .
In those who do breastfeed , PPA reduces self-efficacy , increases breastfeeding difficulties , and may negatively affect breastfeeding behaviors and breast milk composition .
However , in combination with a review linking depression with similar negative infant-feeding sequelae , the findings provide evidence for the effect of negative postpartum mood on breastfeeding .