Study shows significant increase in breastfeeding during COVID

Children's Health

In a recent study under consideration at the BMC Pregnancy and Childbirth journal and posted to the Research Square* preprint server, researchers described the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pandemic on mother-baby dyads immediately after the first wave of the pandemic, i.e., between March and August 2020.

The apprehension of SARS-CoV-2 infection and the pandemic-induced lockdown stressed the general population, especially pregnant women and lactating mothers. Consequently, it was expected that the pandemic would hurt the emotional state of expecting mothers, breastfeeding rates, and mother-baby bonding.

Study: Maternal Mental Health and Breastfeeding amidst the Covid-19 Pandemic: outcomes in a Catalan cohort. Image Credit: HTeam / Shutterstock

About the study

In the current prospective observational study, researchers enrolled 91 mothers who gave birth immediately after the lockdown period in a public hospital in Catalonia, Spain. Notably, only 56 mother-baby duos completed the follow-up.

The current study assessed mothers’ perinatal mental health, the establishment of a successful mother-child relationship, and the newborn’s well-being during the first 28 days after birth.

The team executed the study in two sequential steps.

First, the researchers interviewed the mothers using a 36-question questionnaire that explored areas such as personal and family history of psychiatric disorders, breastfeeding intention, the impact of coronavirus disease 2019 (COVID-19) on the patients’ lives, and the economic condition of the household.

They also performed three psychometric tests, including Edinburgh Postnatal Depression Scale (EPDS), Postpartum Bonding Questionnaire (PBQ), and State-Trait Anxiety Inventory (STAI-S), to explore perinatal anxiety.

EPDS consisted of 10 questions in which women rated their emotional state in the last seven days before labor on a scale of 0 to 3. A higher EPDS score indicated a higher likelihood of depression.

The STAI-S test comprised 40 questions and measured both trait and state anxiety, with higher scores indicating greater anxiety. Similarly, the PBQ test diagnosed mother-baby bonding disorders through 25 questions, with scores over 40 indicating severe bonding disturbances.

Next, the team assessed the newborn’s health and well-being during the neonatal period. They telephonically interviewed the mothers on the dates when their newborn was seven, 14, and 28 days old and asked questions about the breastfeeding status, neonatal weight gain, and the child’s overall health.

As a reference set, to compare the data collected for the present study, the researchers used data from the hospital records for the same time in the three previous years- 2017 to 2020.

Study findings

In the STAI test, pregnant women scored below the threshold; however, 25% screened positively in the EPDS test. Additionally, the PBQ test did not detect any anomalies in the quality of bonding established between the mother and the child.

Compared to three years before the pandemic, the number of mothers practicing any form of breastfeeding [exclusive breastfeeding (EBF) or mixed breastfeeding (MBF)] significantly increased during the first few months of the COVID-19 pandemic.

During the follow-up period, the authors observed no major health issues in babies, and the average neonatal weight gain in the first 28 days was adequate, with over 75% of the newborns gaining over 21.4 grams daily.

The incidence of depressive symptoms in the immediate postpartum period was slightly higher, with 25% screening positively in the EPDS against 21% at six weeks postpartum which was reported earlier. However, the study findings did not find substantial alterations in rates and severity of anxiety among pregnant women in response to COVID-19. Since the pandemic had worsened depressive symptoms, closer monitoring of mothers’ mental status might benefit women and their newborns during postpartum.

The stress caused by the pandemic in pregnant women did not adversely affect their newborn’s health, mother’s moods, the establishment of breastfeeding, or impair the development of a strong mother-child relationship. Several care-related factors might have contributed to this positive effect; for instance, home visits by expert midwives 24 hours after early discharge helped closely monitor the newborn and enhanced the breastfeeding rate despite shorter hospital stays.

Over 33.9% of the mothers (19/56) claimed to be misinformed about breastfeeding, highlighting some negative aspects of clinical practice and a potential area for improvement.


The study demonstrated no adverse outcomes in women and newborns in the neonatal period immediately after the COVID-19 pandemic. The authors observed no concerns related to breastfeeding, mother-baby bonding, and neonatal weight gain, despite the difficulties imposed by the pandemic.

Maternal anxiety levels were under normal limits, and there was an improvement in breastfeeding rates than those observed before the beginning of the COVID-19 pandemic.

Nevertheless, the authors advised that the mother-child dyads should have adequate means of accessing all the requisite information to reduce out-of-home visits to the emergency services. Additionally, there should be the highest level of coordination between primary care, multispeciality centers, and all the caregivers involved in the process, such as obstetricians, pediatricians, psychologists, midwives, and nurses.

*Important notice

Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
  • Marta Nicolás-López, Pablo González-Álvarez, Anna Sala-Concepción et al. Maternal Mental Health and Breastfeeding amidst the Covid-19 Pandemic: outcomes in a Catalan cohort. Research Square pre-print 2022, DOI:,

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