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Purpose: To identify risk factors for lack of breastfeeding initiation and duration of <1 month among a racially diverse cohort of women. In particular, our interest was to examine depressive symptoms during pregnancy as a potential risk factor for not initiating or continuing breastfeeding.

Methods: Survey and medical record data from a cohort of pregnant women from the San Francisco Bay area who delivered a singleton infant (n = 1448) were analyzed to examine lack of breastfeeding initiation and duration of <1 month.

Results: In this study, 5.6% of women did not initiate breastfeeding, and 11.1% of women who initiated breastfeeding had a duration of breastfeeding of <1 month. There were no racial or ethnic differences in initiation of breastfeeding after adjusting for demographic and clinical characteristics. At 1 month postpartum, African American women were more likely than white women to have a duration of breastfeeding lasting <1 month. Depressive symptoms during or prior to pregnancy had no effect on initiation of breastfeeding even when symptoms were persistent. Women with persistent depressive symptoms (symptoms at two time points, including one prior to delivery) were more likely to have breastfeeding duration of <1 month (odds ratio [OR] 1.77, 95% confidence interval [95% CI] 1.10-2.86), whereas depressive symptoms at a single time point were not associated with breastfeeding duration of <1 month.

Conclusions: Addressing depressive symptoms experienced by women both during and after pregnancy may improve the duration of breastfeeding.