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Breastfeeding and maternal attachment: The moderating roles of maternal stress and child behavior

  • Gemma López-Fernández
    Correspondence
    Corresponding author at: Department of gynecology and obstetrics. Corporació Sanitaria Parc Taulí. Parc del Taulí 1, 08208 Sabadell, Barcelona, Spain.
    Affiliations
    Department of gynecology and obstetrics, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain

    Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain
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  • Maite Barrios
    Affiliations
    Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain

    Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
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  • Juana Gómez-Benito
    Affiliations
    Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain

    Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
    Search for articles by this author
Published:December 16, 2022DOI:https://doi.org/10.1016/j.pedn.2022.12.011

      Highlights

      • Studies focusing on the role of breastfeeding in maternal attachment have reached different conclusions.
      • This study provides evidence that breastfeeding is positively related to maternal attachment.
      • Maternal stress and child behavior problems moderate the relationship between breastfeeding and maternal attachment.

      Abstract

      Purpose

      This study examined the effect of breastfeeding on maternal attachment, and explored the moderating role of maternal stress and child behavior in this relationship, in a sample of Spanish mothers with children aged between 2 and 7 years.

      Design and methods

      A total of 432 mothers participated in a cross-sectional online survey. A three-way interaction model was used to test the moderating role of maternal stress and child behavioral problems in the relationship between breastfeeding and maternal attachment.

      Results

      The full model accounted for 19% of the variance of maternal attachment. Breastfeeding was significantly associated with mother-rated attachment, and the moderated moderation analysis confirmed the moderating effects of maternal stress and child behavior on the relationship between breastfeeding and maternal attachment.

      Conclusions

      This study adds to the existing literature that supports the contribution that breastfeeding makes in enhancing maternal attachment, and may help to clarify the role of breastfeeding in shaping maternal attachment. Our findings suggest that breastfeeding is a factor in enhancing maternal attachment, and also identify maternal stress and child behavior as moderators of this relationship.

      Practice implications

      Understanding the mechanisms by which breastfeeding affects maternal attachment will help generate recommendations to improve breastfeeding and maternal attachment.

      Keywords

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      References

        • Abuhammad S.
        • AlAzzam M.
        • AbuFarha R.
        Infant temperament as a predictor of maternal attachment: A Jordanian study.
        Nursing Open. 2021; 8: 636-645
        • Abuhammad S.
        • Johnson T.
        Potential impact of breastfeeding and maternal sensitivity during the first year of life: An integrative review of the literature.
        International Journal Of Pediatrics. 2018; 6: 12
        • Abuhammad S.
        • Johnson T.
        Breastfeeding and maternal attachment during infancy period among Jordanian mothers: A cross-sectional study.
        Annals of Medicine and Surgery. 2021; 66102395
        • Akman I.
        • Kuscu M.K.
        • Yurdakul Z.
        • Özdemir N.
        • Solakog M.
        • Özek E.
        Breastfeeding duration and postpartum psychological adjustment : Role of maternal attachment styles.
        Journal of Paediatrics and Child Health. 2008; 44: 369-373
        • Arnold D.S.
        • O’leary S.G.
        • Wolff L.S.
        • Acker M.M.
        The parenting scale: A measure of dysfunctional parenting in discipline situations.
        Psychological Assessment. 1993; 5: 137-144
        • Bates J.E.
        • Freeland F.A.B.
        • Lounsbury M.L.
        Measurement of infant difficultness.
        Child Development. 1979; 50: 794-803https://doi.org/10.2307/1128946
        • Bonacquisti A.
        • Geller P.A.
        • Patterson C.A.
        Maternal depression, anxiety, stress, and maternal-infant attachment in the neonatal intensive care unit.
        Journal of Reproductive and Infant Psychology. 2020; 38: 297-310
        • Brown A.
        • Arnott B.
        Breastfeeding duration and early parenting behaviour: The importance of an infant-led, responsive style.
        PLoS One. 2014; 9: 1-7
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        Journal of Health and Social Behavior. 1983; 24: 385-396
        • Cohen S.S.
        • Alexander D.D.
        • Krebs N.F.
        • Young B.E.
        • Cabana M.D.
        • Erdmann P.
        • Saavedra J.M.
        Factors associated with breastfeeding initiation and continuation: A meta-analysis.
        The Journal of Pediatrics. 2018; 203: 190-196.e21
        • Dau A.L.
        • Callinan L.S.
        • Smith M.V.
        An examination of the impact of maternal fetal attachment, postpartum depressive symptoms and parenting stress on maternal sensitivity.
        Infant Behavior and Development. 2019; 54: 99-107
        • Edwards R.C.
        • Thullen M.J.
        • Henson L.G.
        • Lee H.
        • Hans S.L.
        The association of breastfeeding initiation with sensitivity, cognitive stimulation, and efficacy among young mothers: A propensity score matching approach.
        Breastfeeding Medicine. 2015; 10: 13-19
        • Fan H.S.L.
        • Wong J.Y.H.
        • Fong D.Y.T.
        • Lok K.Y.W.
        • Tarrant M.
        Association between early-term birth and breastfeeding initiation, duration, and exclusivity: A systematic review.
        Birth. 2019; 46: 24-34
        • Galbally M.
        • Lewis A.J.
        • Van Ijzendoorn M.
        • Permezel M.
        The role of oxytocin in mother-infant relations : A systematic review of human studies.
        President and Fellows of Harvard College. 2011; 19: 1-14
        • Goodman R.
        The Strengths and Difficulties Questionnaire: A Research Note.
        Journal of Child Psychology and Psychiatry. 1997; 38: 581-586https://doi.org/10.1111/j.1469-7610.1997.tb01545.x
        • Gómez-Beneyto M.
        • Nolasco A.
        • Moncho J.
        • Pereyra-Zamora P.
        • Tamayo-Fonseca N.
        • Munarriz M.
        • Girón M.
        Psychometric behaviour of the strengths and difficulties questionnaire (SDQ) in the Spanish national health survey 2006.
        BMC Psychiatry. 2013; 13: 95
        • Hairston I.S.
        • Handelzalts J.E.
        • Lehman-Inbar T.
        • Kovo M.
        Mother-infant bonding is not associated with feeding type: A community study sample.
        BMC Pregnancy and Childbirth. 2019; 19: 1-12
        • Hattangadi N.
        • Cost K.T.
        • Birken C.S.
        • Borkhoff C.M.
        • Maguire J.L.
        • Szatmari P.
        • Charach A.
        Parenting stress during infancy is a risk factor for mental health problems in 3-year-old children.
        BMC Public Health. 2020; 20: 1-7
        • Hayes A.F.
        Introduction to mediation, moderation, and conditional process analysis: A regression-based approach.
        2nd ed. Gilford Publications, New York2018
        • Horta B.L.
        • Loret De Mola C.
        • Victora C.G.
        Breastfeeding and intelligence: A systematic review and meta-analysis.
        Acta Paediatrica, International Journal of Paediatrics. 2015; 104: 14-19
        • Horta B.L.
        • Victora C.G.
        Long-term health effects of breastfeeding: A systematic review.
        World Health Organization, 2013 (Retrieved from)
        • Kim S.H.
        Factors associated with maternal attachment of breastfeeding mothers.
        Child Health Nursing Research. 2019; 25: 65-73
        • Krol K.M.
        • Grossmann T.
        Psychological effects of breastfeeding on children and mothers.
        Bundesgesundheitsbl. 2018; 8: 977-985
        • Linde K.
        • Lehnig F.
        • Nagl M.
        • Kersting A.
        The association between breastfeeding and attachment : A systematic review.
        Midwifery. 2020; 81
        • López-Fernández G.
        • Barrios M.
        • Goberna-Tricas J.
        • Gómez-Benito J.
        Breastfeeding during pregnancy: A systematic review.
        Women and Birth, 30 (6), e292-e300. 2017;
        • López-Fernández G.
        • Gómez-Benito J.
        • Barrios M.
        The psychometric properties of the parenting scale for Spanish mothers with children aged between 2 and 7 years.
        Journal of Pediatric Nursing. 2021; 62: 60-68https://doi.org/10.1016/j.pedn.2021.11.002
        • López-Fernández G.
        • Barrios M.
        • Gómez-Benito J.
        The maternal attachment inventory : Development and validation of a short form.
        Journal of Advanced Nursing. 2021; January: 1-12
        • Matsushita H.
        • Latt H.M.
        • Koga Y.
        • Nishiki T.
        • Matsui H.
        Oxytocin and Stress: Neural Mechanisms, Stress-Related Disorders, and Therapeutic Approaches.
        Neuroscience. 2019 Oct 1; 417: 1-10https://doi.org/10.1016/j.neuroscience.2019.07.046
        • Mills-Koonce W.R.
        • Gariépy J.L.
        • Propper C.
        • Sutton K.
        • Calkins S.
        • Moore G.
        • Cox M.
        Infant and parent factors associated with early maternal sensitivity: A caregiver-attachment systems approach.
        Infant Behavior and Development. 2007; 30: 114-126
        • Mitra A.K.
        Oxytocin and vasopressin: The social networking buttons of the body.
        AIMS Molecular Science. 2021; 8: 32-50
        • Moe V.
        • von Soest T.
        • Fredriksen E.
        • Olafsen K.S.
        • Smith L.
        The multiple determinants of maternal parenting stress 12 months after birth: The contribution of antenatal attachment style, adverse childhood experiences, and infant temperament.
        Frontiers in Psychology. 2018; 9
        • Muller M.E.
        A questionnaire to measure mother-to-infant attachment.
        Journal of Nursing Measurement. 1994; 2: 122-141
        • Pederson D.R.
        • Gleason K.E.
        • Moran G.
        • Bento S.
        Maternal attachment representations, maternal sensitivity, and the infant–mother attachment relationship.
        Developmental Psychology. 1998; 34: 925-933https://doi.org/10.1037/0012-1649.34.5.925
        • Remor E.
        Psychometric properties of a European Spanish version of the perceived stress scale (PSS).
        The Spanish Journal of Psychology. 2006; 9: 86-93
        • Riem M.M.E.
        • Bakermans-Kranenburg M.J.
        • van IJzendoorn M.H.
        Intranasal administration of oxytocin modulates behavioral and amygdala responses to infant crying in females with insecure attachment representations.
        Attachment & Human Development. 2016; 18: 213-234
        • Schmider E.
        • Ziegler M.
        • Danay E.
        • Beyer L.
        • Bühner M.
        Is it really robust?: Reinvestigating the robustness of ANOVA against violations of the normal distribution assumption.
        Methodology. 2010; 6: 147-151
        • Szymańska A.
        • Aranowska E.
        The child’s “difficult” temperament and its relation with parental stress in groups of parents bringing up boys and girls.
        Psychiatria Polska. 2019; 53: 399-417
        • Takács L.
        • Smolík F.
        • Kaźmierczak M.
        • Putnam S.P.
        Early infant temperament shapes the nature of mother-infant bonding in the first postpartum year.
        Infant Behavior and Development. 2020; 58101428
        • Weaver J.M.
        • Schofield T.J.
        • Papp L.M.
        Breastfeeding duration predicts greater maternal sensitivity over the next decade.
        Developmental Psychology. 2018; 54: 220-227https://doi.org/10.1037/dev0000425