Comparison of psycho-sexual factors and the quality of life between breastfeeding and non- breastfeeding women during the COVID-19 pandemic: A cross-sectional study

Comparison of psycho-sexual factors and the quality of life between breastfeeding and non- breastfeeding women during the COVID-19 pandemic: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Comparison of psycho-sexual factors and the quality of life between breastfeeding and non- breastfeeding women during the COVID-19 pandemic: A cross-sectional study Negin MIRZAEI DAMABI, Shahideh Jahanian Sadatmahalleh, Ashraf Moini, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2261419/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background According to the increased preponderance of COVID-19 and its possible effects on psychological health and quality of life (QoL), this study aimed to compare the psycho-sexual factors and the QoL between breastfeeding non-breastfeeding mothers during the COVID-19 pandemic. Method A comparative cross-sectional study was conducted through an online survey of 123 breastfeeding and 87 non-breastfeeding women referred to the gynecology clinic of Arash Hospital in Tehran from May to Jun 2020. Depression, anxiety, general health, female sexual dysfunction, QoL, Corona Disease, Anxiety, obsessions, and compulsions were assessed by an appropriate questionnaire. Result The results showed that breastfeeding women had better mental health, sexual function, and QoL (P < 0.001). The mean general health scores in breastfeeding women were significantly lower than in the non-breastfed group (21.92 ± 11.56 vs. 27.75 ± 16.09, P = 0.003). There were no statistically significant differences in marital satisfaction and Padua inventory between groups (P > 0.05). Multivariate regression analysis shows that the GHQ score of the BF group was 4.5 units higher than the non-BF group (P = 0.02) and the other variables were not significant. Conclusion This study highlights the effect of breastfeeding on the maternal mental health of mothers, especially in the coronavirus pandemic. It is possible to identify the need for more excellent psychological support in general and particularly in lactating mothers. Health sciences/Health care Health sciences/Medical research COVID-19 Breastfeeding Anxiety Sexual function Quality of life Background: Coronavirus Disease (COVID-19), a highly contagious viral infection caused by SARS-CoV-2, has rapidly spread worldwide. Not only could uncertainty anad low predictability of COVID-19 worsen individuals’ mental health and overall well-being ( 1 ), but socio-economic pandemics and lockdowns also put further pressure on them ( 2 ). Also, it is by no means clear that the concerns about exposure to COVID-19, the health of the infants, physical distancing recommendations of this pandemic pose a threat to postpartum women’s mental health ( 3 , 4 ). On the other hand, it can be said that the postpartum period is accompanied by many physical, hormonal, and psychological changes, leading to enhance women’s susceptibility to the onset or relapse of psychological distress ( 5 ). Additionally, it seems that feeling fear, uncertainty, stress, or anxiety because of COVID-19 combined with the pressure of acclimatizing with physical and hormonal changes and transition to motherhood could exacerbate depression and the psychological burden of pandemic ( 3 , 4 ). It is considered that breastfeeding (BF) is an essential factor that can improve psychological well-being by attenuating stress response related to cortisol ( 6 ). Also, frequent skin-to-skin contact during BF can decrease stress levels and improve the mother's emotional states by reducing maternal cortisol and adreno-corticotropic hormone (ACTH) levels ( 7 ). On the contrary, some women may deem BF a difficult, unpleasant, and disruptive experience, making them physically and mentally exhausted ( 8 ). According to amplify post-partum psychiatric disorder by the COVID-19 pandemic and the effects of BF on the mental health of mothers, this study aimed to compare mental health, anxiety, depression, marital satisfaction (MS), sexual function (SF), and quality of life (QoL) among women with and without BF during the COVID-19 pandemic. Material And Method: The study was conducted as a cross-sectional study via convenience sampling method from May to Jun 2020. The participants were divided into BF and non-BF groups. The initial sample consisted of 210 women referred to the gynecology clinic of Arash Hospital in Tehran, 123 of whom belonged to the BF group, and 87 women were non-breastfeeding. According to the home, quarantine to prevent coronavirus transmission, at first, the online link of valid questionnaires was designed and then sent to lactating women who had been referred to the gynecology clinic before pandemic via social media. The first page of the questionnaire provided information about the study’s objectives, methods, and potential outcomes. Participants' demographic and obstetrical characteristics, depression, anxiety, SF, MS, mental health, corona disease anxiety, and QoL information were collected through these questionnaires. Inclusion criteria were defined as married women with infants under one year old between 18 and 45. They could read and write and were willing to participate in the study to complete the online questionnaires; also, they had sexual intercourse in the past four weeks. In addition, to avoid possible confounding factors, exclusion criteria included high-risk people such as: treated with corticosteroids (more than 12.5 mg / dL per week), history of chemotherapy, malignancies, organ transplants, HIV, chronic disease, BMI over 40, addiction to narcotics and alcohol and have a chronic mental illness. Research Ethics Committees of Tarbiat Modares University of Medical Sciences approved the study protocol (IR.MODARES.REC.1399.022). Questionnaires The participants were asked to complete sociodemographic and obstetric characteristics, including women’s age, income amount, educational level, occupational status, duration of the marriage, type of lactation, menstrual status, gravid, and parturition. Anxiety And Depression: The hospital anxiety and depression scale (HADS) was designed to identify depression and anxiety with 14 questions (7-item for measuring depression and 7-item for anxiety). Higher scores show higher anxiety and depression symptoms, a score of 11 and above, considered a clinical disease. The validity and reliability of the Iranian version of HADS have been confirmed ( 9 ). Female Sexual Function: Female sexual function index (FSFI) is a self-report instrument that measures desire, arousal, lubrication, orgasm, satisfaction, and pain ( 10 ). The total FSFI score was made by the sum of 19 questions scores, and an overall score of 28 was used as the cutoff for clinical female sexual dysfunction (FSD). The Persian version of FSFI has also been evaluated for reliability and validity ( 11 ). Marital Satisfaction: The short version of ENRICH Marital Satisfaction Scale (EMS Scale) is a 10-item self-report inventory that is rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 10 to 50, with higher scores indicating more excellent MS ( 12 ). The Persian version of the EMS Scale has been relabeled ( 13 ). Mental Health: Gold Berge General Health Questionnaire (GHQ) involves 28 questions to detect those at risk of developing a psychiatric disorder. It has been divided into four subscales: physical signs, anxiety and insomnia disorder, social performance disorder, and depression symptoms. The total score can vary from 0 to 84, and the total scores > 22 were considered a disorder ( 14 ). The validity and reliability of GHQ- 28 have been confirmed in Iran ( 15 ). Quality Of Life: Short Form Health Survey (SF-12) is a generic instrument for measuring health-related QoL, consisting of 12 physical and mental domains items. The total score ranged from 0 to 100, and higher scores indicated a higher health-related QoL ( 16 ). The validity and reliability of this questionnaire have been confirmed in Iran ( 17 ). Corona Disease Anxiety: The Corona Disease Anxiety Scale (CDAS) has been prepared to measure anxiety caused by the Coronavirus outbreak in Iran. This instrument screened physical and psychological symptoms 18 questions with a 4-degree Likert range (never =, 0 sometimes = 1, most of the time = 2, and Always = 3). The high scores in this questionnaire indicate a higher level of anxiety in individuals ( 18 ). This questionnaire had been ascertained as a valid and reliable measurement in Iran ( 19 ). Obsessions And Compulsions: Padua inventory Washington State University Revision (PI-WSUR) is an obsessive-compulsive questionnaire consisting of five subscales that examined obsessive thoughts about hurting oneself or others, obsessional impulses to harm self/others, contamination obsession, and compulsion wash, check compulsions, and compulsions about dressing and grooming. This study used only contamination obsessions and washing compulsions subscale. The validity and reliability of PI for the Iranian population were established ( 21 ). Statistics All statistical analyses were performed by the SPSS software version 22.0 (SPSS Inc., Chicago, IL, USA). Student’s t-test, Mann-Whitney U, and chi-square test were used to reveal the statistical differences between the groups. Differences were considered significant at P˂0.05 for the two tails. Result: Table 1 describes the characteristics of participants. The mean age of women was 30.52 ± 4.93 years, the mean duration of marriage was 6.83 ± 4.77 years. As can be seen, there were no significant differences between age, parity, number of children, educational level, duration, of menstruation, and marriage(P > 0.05). Table 1 Comparison of demographic characteristics between different types of lactation Variables BF n = 123 Non-BF n = 87 P-value Female’s age* 30.44 ± 5.60 30.63 ± 3.86 0.78 Gravid*** 1.24 ± 0.90 1.21 ± 0.7 0.75 Parity*** 1.20 ± 0.81 1.17 ± 0.68 0.83 Education of female** 0.17 ≤ 12 years 17(14.2) 7(8.0) > 12 years 103(85.8) 80(92.0) Occupation of women ** 0.33 Unemployed 99(85.3) 69(79.3) Employee 17(14.7) 18(20.7) Income (Tomans)*** 0.013 ≤ 1 Million 11(9.3) 10(11.5) 1–3 Million 44(37.3) 38(43.7) > 3 Million 63(53.4) 39(44.8) Duration of marriage (year)* 7.21 ± 4.66 6.31 ± 4.9 0.18 Duration of menstruation* 7.38 ± 2.43 6.91 ± 1.50 0.11 *Values are given as mean ± SD using t-test, ** values are provided as a number (%) using the chi-squared test, ***Mann-Whitney U test Female Sexual Function And Marital Satisfaction: According to the evaluation of FSFI scores showed in Table 2 , the differences of scores between BF and non-BF women were statistically significant in the domains of arousal, lubrication, orgasm, satisfaction, and total FSFI. The women in the non-BF group had more sexual dysfunction in the domains of pain (3.54 ± 2.06 vs. 4.43 ± 2.07, P = 0.003) and desire (3.16 ± 1.03 vs. 3.73 ± 1.00, P 0.05). Table 2 Comparison of FSFI scores between different types of lactation. Variable BF n = 123 Non-BF n = 87 P-value* Desire 3.16 ± 1.03 3.73 ± 1.00 > 0.001 Arousal 3.36 ± 1.94 3.82 ± 1.70 0.07 Lubrication 3.61 ± 1.96 3.84 ± 1.61 0.37 Orgasm 3.60 ± 2.07 3.99 ± 1.64 0.15 Satisfaction 3.84 ± 1.99 4.14 ± 1.72 0.26 Pain 3.54 ± 2.06 4.43 ± 2.07 0.003 Total FSFI 21.08 ± 2.06 23.45 ± 8.62 0.08 EMS Scale 29.14 ± 3.31 28.78 ± 3.27 0.43 FSFI: Female Sexual Function Index. EMS Scale: ENRICH Marital Satisfaction Scale, BF: breastfeeding. Values are mean ± s.d. * t-Test. Mental Health: According to Table 3 , evaluation of the two groups about GHQ showed that mean values of physical symptoms, depression, social dysfunction, and total scores were lower in the BF women (P < 0.05). There was no statistically significant difference in anxiety between the two groups (P = 0.068). Table 3 Comparison of GHQ, CDAS, and PI scores between different types of lactation. Variable BF n = 123 Non-BF n = 87 P-value* GHQ Somatic Symptoms 5.95 ± 3.40 7.13 ± 4.11 0.024 Anxiety 6.33 ± 5.18 7.75 ± 6.03 0.068 Depression 2.51 ± 3.17 4.08 ± 5.11 0.007 Social Dysfunction 6.99 ± 2.95 7.96 ± 2.79 0.020 Total Scores 21.92 ± 11.56 27.75 ± 16.09 0.003 CDAS Psychological Symptoms 17.52 ± 6.24 19.66 ± 8.32 0.035 Physical Symptoms 11.69 ± 4.85 14.33 ± 7.21 0.002 Total Scores 29.22 ± 10.56 34.99 ± 15.10 0.008 PI 33.29 ± 9.87 34.77 ± 9.90 0.305 GHQ: General Health Questionnaire, CDAS: Corona Disease Anxiety Scale, PI: Padua inventory, BF: breastfeeding. Values are mean ± s.d. * t-Test. Corona Disease Anxiety And Obsessive-compulsive Symptoms: The comparison of CDA and Padua inventory scores between BF and non-BF women is shown in Table 3 . Mothers who breastfed their infants had statistically significantly lower physical and psychological symptoms scores and total scores (P 0.05). Anxiety And Depression: Table 4 summarizes the adjusted HADS scores of two different groups. BF mothers reported lower depression scores than mothers in the other group, and the mean scores of depression in BF and non-BF women were 4.79 ± 3.96 and 6.21 ± 4.31, respectively (P = 0.01). However, there were no statistically significant differences between groups in terms of anxiety and total scores of HADS (P > 0.05). Table 4 Comparison of HADS and SF-12 scores between different types of lactation. Variable BF n = 123 Non-BF n = 87 P-value* HADS Anxiety 7.02 ± 4.60 7.45 ± 5.91 0.55 Depression 4.79 ± 3.96 6.21 ± 4.31 0.01 Total scores 11.86 ± 7.86 13.67 ± 9.55 0.13 SF-12 Sum score physical Components (PCS-12) 81.54 ± 12.80 77.41 ± 14.81 0.03 Sum score mental Components (MCS-12) 70.08 ± 14.59 66.78 ± 19.27 0.16 Total score 75.85 ± 11.89 72.09 ± 15.26 0.04 HADS, Anxiety and Depression Hospital Scales; SF-12, Short Form Health Survey, BF: breastfeeding. Values are mean ± s.d. * t-Test. Quality Of Life: Table 4 showed a significant difference in the mean physical dimension and total score between the two groups (P < 0.05). But the sum of the mental scores is 70.08 ± 14.59 and 66.78 ± 19.27, respectively, in BF and non-BF mothers (P = 0.16). Table 5 provides the results obtained from multivariate regression analysis adjusting for female age, gravid, education and occupation of female, income, duration of the marriage, and menstruation shows that the GHQ score of the BF group was 4.5 units higher than non-BF group and the other variables were not significant. Table 5 Adjusted Multivariate regression analysis for comparing two groups. Dependent Variable Parameter B Std. Error t P-value 95% Confidence Interval Lower Bound Upper Bound Total FSFI Intercept 24.812 6.478 3.830 < 0.001 12.023 37.601 BF -2.201 1.402 -1.569 0.118 -4.969 0.568 non_BF reference . . . . . Total HADS Intercept 19.855 5.913 3.358 0.001 8.182 31.527 BF -1.864 1.280 -1.457 0.147 -4.391 0.663 Non-BF reference . . . . . Total EMS Scale Intercept 30.111 2.357 12.776 < 0.001 25.458 34.763 BF 0.099 0.510 0.193 0.847 -0.909 1.106 Non-BF reference . . . . . Total SF-12 Intercept 63.142 9.526 6.628 < 0.001 44.336 81.948 BF 2.940 2.062 1.426 0.156 -1.131 7.011 Non-BF reference . . . . . Total GHQ Intercept 37.322 9.411 3.966 < 0.001 18.744 55.900 BF -4.496 2.037 -2.207 0.029 -8.518 -0.474 Non-BF reference . . . . . Total PI Intercept 44.647 7.002 6.376 < 0.001 30.824 58.470 BF -2.314 1.516 -1.527 0.129 -5.307 0.678 Non-BF reference . . . . . FSFI: Female Sexual Function Index; HADS: Anxiety and Depression Hospital Scales; EMS Scale: ENRICH Marital Satisfaction Scale, SF-12: Short Form Health Survey; GHQ: General Health Questionnaire; PI: Padua inventory; BF: breastfeeding. Discussion: Female Sexual Function and Marital Satisfaction: The current study found that BF women likely had more dysfunction in desire and pain domains than non-BF women. Various studies have shown conflicting evidence on the effect of BF on sexual function. For instance, some studies have demonstrated that sexual activity, sexual arousal, and sexual satisfaction are lower in BF women than women feeding their baby with formula due to fatigue, weakness, and dyspareunia ( 22 ). Neuroendocrine changes have occurred during the postpartum period, such as decreasing levels of androgens due to increased prolactin and increased levels of oxytocin can reduce sexual desire. In addition, low estrogen levels and elevated prolactin levels often cause vaginal dryness and decreased vaginal lubrication, which can lead to dyspareunia ( 23 ). On the other hand, some studies have suggested that BF enhances sexual activity and libido. Indeed, BF can increase sexual desire due to larger breast size or increased sensitivity ( 24 ). Also, close contact between mother and baby and sucking nipples by the baby is enjoyable for some women and can stimulate and increase sexual activity ( 25 ). Nevertheless, some studies have demonstrated that BF does not affect sexual activity ( 22 ). Having a baby through various factors such as the financial burden of childbirth, reduction of sexual intimacy, restriction of freedom has adverse effects on MS as an experience sense of happiness, joy, and satisfaction. Previous studies have reported that postpartum women who had higher body dissatisfaction, sexual dysfunction, and anxiety have decreased MS ( 26 ). According to the critical role of sexual relationships in post-partum women's MS, although significant differences were found in two dimensions of SF, surprisingly, no differences were observed in terms of MS between groups. This result may be explained because overall sexual frequency and activity significantly declined during the height of the COVID-19 outbreak among young men and women ( 27 ). Mental Health: One of the most apparent findings from the analysis is that non-BF mothers indicated poorer general health than BF mothers. Also, multivariate regression analysis revealed that GHQ scores of BF mothers were 4.5 units higher than the non-BF group and the other variables were not significant. The benefits of BF for mothers and infants are widely documented. BF is vigorously associated with decreased infant mortality and morbidity ( 28 ) and also breastfed babies have been demonstrated at reduced risk of respiratory infections ( 29 ). There is overwhelming evidence to suggest that BF offers improved maternal mental well-being ( 30 ). Hence, the affirmative impact of BF during the coronavirus pandemic cannot be ignored. As the proven effects of BF, non-BF mothers can comfort to repentance and shame and hold themselves guilty ( 31 ); thus, it can be aggravated during coronavirus pandemic. Although there is little information about the effect of BF on post-partum mental disorders, previous studies have shown an association between elevated risk of postpartum depression with short duration or lack of BF ( 32 ). A population-based study on 186,452 women who gave birth to a live infant has reported that BF is associated with decreasing the risk of subsequent maternal hospital admissions for schizophrenia and bipolar affective disorders in the first postpartum year ( 30 ). Another study conducted on Bangladeshi and Pakistani women in the southwest of England had shown that exclusive BF women had significantly better (happier) mood responses. Thus, there seems to be a mutual association between maternal mental health and exclusive BF. Mothers who showed more anxiety, depression, and stress symptoms were more susceptible to breastfeeding cessation ( 33 ). These results may be explained by enhanced husband and family support, reduced bleeding by oxytocin secretion, rapid uterine return, and fewer neonatal hospitalizations. More studies are needed on physical and mental health well-being and BF patterns for better judgment, especially in a current pandemic. Corona Disease Anxiety And Obsessive-compulsive Symptoms: This study showed that BF mothers had lower scores in the physical and psychological components of CDAS. The possible explanation for these results may be the positive effects of BF on emotional well-being. For instance, BF mothers have lower blood pressure, reduced heart rate reactivity, decreased cortisol response in a social stress situation, prolonged sleep pattern, and better sleep quality. BF also can increase mother-infant attachment ( 34 ). The most common examples of obsessions are the fear of contamination, causing damage, and fear of not being in order. Studies have shown that preventive behaviors such as washing hands in shorter intervals, hand sanitizers, and social distance were every day during the coronavirus pandemic. Also, more involvement with hygiene behaviors leads to more stress and anxiety ( 35 ). Many studies have reported that Obsessive-compulsive symptoms have been exacerbated during pregnancy and post-partum periods ( 36 ). So concerns and sensitivities about hygiene issues during the COVID-19 pandemic can be soar in the postpartum period. Anxiety And Depression: In this study, we specifically examined BF and non-BF mothers during the COVID-19 pandemic to explore assumptions about the effect of infant feeding on maternal mental health in the current stressful situation. The results showed that non-BF mothers had higher depression symptoms than BF mothers. Maternal stressors such as pain, sleep disturbance, and new motherhood experience tend to be high in the postpartum period, so if there are additional stressors in life, the risk of postpartum depression will be exacerbated ( 37 ). Depression, as the most prevalent childbearing illness, has adverse consequences for both mother and infant and can disrupt parenting behaviors in mothers ( 38 ). Previous researchers had a reasonably good understanding of the effect of BF on protection against depression, but they knew almost nothing about the mechanisms of this relationship. There are several possible explanations for this result, such as soothing effects of oxytocin, modulation of the inflammatory response, higher plasma prolactin levels ( 39 ). Also, in Islamic societies, BF is considered the right of a baby, and family members may pressure the mother to breastfeed. Under these circumstances, the decision to forego BF for any reason can lead to increased stress and depressive symptoms ( 40 ). Due to the well-known benefits of breast milk, especially the strengthening effect on the immune system, if mothers cannot breastfeed their infants, they will feel more anxiety and depression during the COVID-19 pandemic. Quality Of Life: In this study, we compared the QoL between BF and non-BF mothers. Our results indicated that non-BF mothers had lower QoL scores than BF mothers. Mortazavi et al.’s ( 41 ) found that mothers who had continued BF at 2 and 4 months postpartum had better QoL than mothers who discontinued BF exclusively. They reported that BF enhances the QoL of mothers, and the duration of BF was deemed a key factor. Several studies have also noted the association of BF with reduced stress, depression, and negative mood. Brazilian research reported a correlation between BF with self-efficacy and maternal QoL ( 42 ). Therefore, the psychological and physical health dimensions scores are expected to be higher in the BF group. On the other hand, BF is not a good experience for some women. Some problems such as sore nipples, breast problems, mother’s perception of insufficient breast milk, or inappropriate weight gain of the infants can lead to discontinuation or cessation of BF. But BF is a satisfying and enjoyable experience for many people ( 43 ). All these factors can threaten mothers’ QoL. Further studies on QoL and BF patterns are needed for a better and more evidence-based judgment. Based on our knowledge, this study has examined BF's effect on maternal mental health and sexual life in the postpartum period during the coronavirus pandemic. However, the limitation is that our findings may be interpreted within the cross-sectional design. We did not discover all the potential dimensions of maternal mental health, including women's social network, quality of love, and care for the baby, which may interrupt our result. There was also no information on women's mental health status, quality of sex life, and QoL before the coronavirus pandemic. We did not collect data on the experience of the previous BF. In addition, it is challenging to measure sensitive issues such as sexual life in a traditional culture like Iran. Finally, one of the most critical limitations of this study is the lack of sufficient knowledge about the coronavirus pandemic. Thus, further studies are needed to understand better the impact of BF during a crisis like a coronavirus pandemic. Conclusion: The results of this study indicate the importance of BF for mothers and the baby and highlight the effect of BF on mothers' maternal mental health, especially in coronavirus pandemics. These findings emphasize the importance of encouraging and supporting mothers to breastfeed by family and health care providers. List of abbreviations: FSFI: Female Sexual Function Index SF: Sexual Function BF: Breastfeeding HADS: Hospital Anxiety and Depression Scale QoL: Quality of Life GHQ: General Health Questionnaire CDAS: Corona Disease Anxiety Scale SF-12: Short Form Health Survey, PI: Padua Inventory OCD: Obsessive-Compulsive Disorder MS: Marital Satisfaction Declarations: Ethics approval and consent to participate The Ethics Committee approved the study of Tarbiat Modares University of Medical Sciences (IR.MODARES.REC.1399.022). All procedures were by the ethical standards of the Regional research committee and with the Declaration of Helsinki 1964 and its later amendments. After explaining the study's purposes, written consent assent was collected from all participants, and women were informed that their participation was voluntary, confidential, and anonymous and was apprised of their right to withdraw from the research at any time. Consent for publication Not applicable. Availability of data and materials The data sets used and analyzed for the current study are available upon reasonable request of the corresponding author Dr. Shahideh Jahanian ( [email protected] ). Competing interests The authors declare no conflicts of interest. Funding None. Authors' contributions Sh.JS, N.M and A.M contributed to the conception and design of the study; Sh.JS and N.M did the literature search; M.N, and G.O performed the statistical analysis; N.M, Sh.JS, A.M, and G.O wrote the first draft of the manuscript. All authors reviewed the manuscript read, and approved the submitted version. 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Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001;108(4):e67-e. Xu F, Li Z, Binns C, Bonello M, Austin M-P, Sullivan E. Does infant feeding method impact on maternal mental health? Breastfeeding Medicine. 2014;9(4):215–21. Mezzacappa ES, Katkin ES. Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology. 2002;21(2):187. Chung M, Raman G, Chew P, Magula N, Trikalinos T, Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Technol Asses (Full Rep). 2007;153(153):1–186. Assarian F, Moravveji A, Ghaffarian H, Eslamian R, Atoof F. The association of postpartum maternal mental health with breastfeeding status of mothers: a case-control study. Iranian Red Crescent Medical Journal. 2014;16(3). Krol KM, Grossmann T. Psychological effects of breastfeeding on children and mothers. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2018;61(8):977–85. Newby J, O'Moore K, Tang S, Christensen H, Faasse K. Acute mental health responses during the COVID-19 pandemic in Australia. medRxiv. 2020. Burton HA. How women with established obsessive compulsive disorder experience pregnancy and postpartum: an interpretative phenomenological analysis. Journal of Reproductive and Infant Psychology. 2020:1–13. Kendall-Tackett K. A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International breastfeeding journal. 2007;2(1):1–14. Field T. Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behavior and Development. 2010;33(1):1–6. Hamdan A, Tamim H. The relationship between postpartum depression and breastfeeding. The International Journal of Psychiatry in Medicine. 2012;43(3):243–59. Green K, Broome H, Mirabella J. Postnatal depression among mothers in the United Arab Emirates: socio-cultural and physical factors. Psychology, health & medicine. 2006;11(4):425–31. Mortazavi F, Mousavi SA, Chaman R, Khosravi A. Do maternal quality of life and breastfeeding difficulties influence the continuation of exclusive breastfeeding? International journal of pediatrics. 2014;2014. Zubaran C, Foresti K. The correlation between breastfeeding and maternal quality of life in southern Brazil. Breastfeeding Medicine. 2011;6(1):25–30. Mehrparvar S, Varzandeh M. Investigation of decreasing causes of exclusive breastfeeding in children below six months old, in Kerman city during 2008–2009. Journal of Fasa University of Medical Sciences. 2011;1(1):45–52. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2261419","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":152607187,"identity":"34c873a0-7315-4b2c-a722-5d1e5a94b6a1","order_by":0,"name":"Negin MIRZAEI DAMABI","email":"","orcid":"","institution":"Tarbiat Modares University","correspondingAuthor":false,"prefix":"","firstName":"Negin","middleName":"MIRZAEI","lastName":"DAMABI","suffix":""},{"id":152607189,"identity":"c14d90ce-9973-413b-9242-30b8576630fe","order_by":1,"name":"Shahideh Jahanian Sadatmahalleh","email":"data:image/png;base64,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","orcid":"","institution":"Tarbiat Modares University","correspondingAuthor":true,"prefix":"","firstName":"Shahideh","middleName":"Jahanian","lastName":"Sadatmahalleh","suffix":""},{"id":152607191,"identity":"f2244c42-77c8-44a6-9ff5-4c621e7e629d","order_by":2,"name":"Ashraf Moini","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ashraf","middleName":"","lastName":"Moini","suffix":""},{"id":152607192,"identity":"2746b4c9-f519-4c33-98ef-0ce434698cd1","order_by":3,"name":"malihe nasiri","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"malihe","middleName":"","lastName":"nasiri","suffix":""},{"id":152607193,"identity":"637b8fe1-b302-408c-ac58-6e0823abdc53","order_by":4,"name":"giti ozgoli","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"giti","middleName":"","lastName":"ozgoli","suffix":""}],"badges":[],"createdAt":"2022-11-11 03:44:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2261419/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2261419/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":32631623,"identity":"ff2168d6-dbdd-4393-bf44-90b2399f10d4","added_by":"auto","created_at":"2023-02-08 06:30:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":570587,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2261419/v1/2cfd072c-ad6c-4dd0-acbc-2f85341e658f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of psycho-sexual factors and the quality of life between breastfeeding and non- breastfeeding women during the COVID-19 pandemic: A cross-sectional study","fulltext":[{"header":"Background:","content":"\u003cp\u003eCoronavirus Disease (COVID-19), a highly contagious viral infection caused by SARS-CoV-2, has rapidly spread worldwide. Not only could uncertainty anad low predictability of COVID-19 worsen individuals\u0026rsquo; mental health and overall well-being (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), but socio-economic pandemics and lockdowns also put further pressure on them (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Also, it is by no means clear that the concerns about exposure to COVID-19, the health of the infants, physical distancing recommendations of this pandemic pose a threat to postpartum women\u0026rsquo;s mental health (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, it can be said that the postpartum period is accompanied by many physical, hormonal, and psychological changes, leading to enhance women\u0026rsquo;s susceptibility to the onset or relapse of psychological distress (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Additionally, it seems that feeling fear, uncertainty, stress, or anxiety because of COVID-19 combined with the pressure of acclimatizing with physical and hormonal changes and transition to motherhood could exacerbate depression and the psychological burden of pandemic (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is considered that breastfeeding (BF) is an essential factor that can improve psychological well-being by attenuating stress response related to cortisol (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Also, frequent skin-to-skin contact during BF can decrease stress levels and improve the mother's emotional states by reducing maternal cortisol and adreno-corticotropic hormone (ACTH) levels (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). On the contrary, some women may deem BF a difficult, unpleasant, and disruptive experience, making them physically and mentally exhausted (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to amplify post-partum psychiatric disorder by the COVID-19 pandemic and the effects of BF on the mental health of mothers, this study aimed to compare mental health, anxiety, depression, marital satisfaction (MS), sexual function (SF), and quality of life (QoL) among women with and without BF during the COVID-19 pandemic.\u003c/p\u003e"},{"header":"Material And Method:","content":"\u003cp\u003eThe study was conducted as a cross-sectional study via convenience sampling method from May to Jun 2020. The participants were divided into BF and non-BF groups. The initial sample consisted of 210 women referred to the gynecology clinic of Arash Hospital in Tehran, 123 of whom belonged to the BF group, and 87 women were non-breastfeeding.\u003c/p\u003e\n\u003cp\u003eAccording to the home, quarantine to prevent coronavirus transmission, at first, the online link of valid questionnaires was designed and then sent to lactating women who had been referred to the gynecology clinic before pandemic via social media. The first page of the questionnaire provided information about the study\u0026rsquo;s objectives, methods, and potential outcomes. Participants' demographic and obstetrical characteristics, depression, anxiety, SF, MS, mental health, corona disease anxiety, and QoL information were collected through these questionnaires.\u003c/p\u003e\n\u003cp\u003eInclusion criteria were defined as married women with infants under one year old between 18 and 45. They could read and write and were willing to participate in the study to complete the online questionnaires; also, they had sexual intercourse in the past four weeks. In addition, to avoid possible confounding factors, exclusion criteria included high-risk people such as: treated with corticosteroids (more than 12.5 mg / dL per week), history of chemotherapy, malignancies, organ transplants, HIV, chronic disease, BMI over 40, addiction to narcotics and alcohol and have a chronic mental illness. Research Ethics Committees of Tarbiat Modares University of Medical Sciences approved the study protocol (IR.MODARES.REC.1399.022).\u003c/p\u003e\n\u003ch3\u003eQuestionnaires\u003c/h3\u003e\n\u003cp\u003eThe participants were asked to complete sociodemographic and obstetric characteristics, including women\u0026rsquo;s age, income amount, educational level, occupational status, duration of the marriage, type of lactation, menstrual status, gravid, and parturition.\u003c/p\u003e\n\u003ch3\u003eAnxiety And Depression:\u003c/h3\u003e\n\u003cp\u003eThe hospital anxiety and depression scale (HADS) was designed to identify depression and anxiety with 14 questions (7-item for measuring depression and 7-item for anxiety). Higher scores show higher anxiety and depression symptoms, a score of 11 and above, considered a clinical disease. The validity and reliability of the Iranian version of HADS have been confirmed (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eFemale Sexual Function:\u003c/h3\u003e\n\u003cp\u003eFemale sexual function index (FSFI) is a self-report instrument that measures desire, arousal, lubrication, orgasm, satisfaction, and pain (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). The total FSFI score was made by the sum of 19 questions scores, and an overall score of 28 was used as the cutoff for clinical female sexual dysfunction (FSD). The Persian version of FSFI has also been evaluated for reliability and validity (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eMarital Satisfaction:\u003c/h3\u003e\n\u003cp\u003eThe short version of ENRICH Marital Satisfaction Scale (EMS Scale) is a 10-item self-report inventory that is rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 10 to 50, with higher scores indicating more excellent MS (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e). The Persian version of the EMS Scale has been relabeled (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eMental Health:\u003c/h3\u003e\n\u003cp\u003eGold Berge General Health Questionnaire (GHQ) involves 28 questions to detect those at risk of developing a psychiatric disorder. It has been divided into four subscales: physical signs, anxiety and insomnia disorder, social performance disorder, and depression symptoms. The total score can vary from 0 to 84, and the total scores\u0026thinsp;\u0026gt;\u0026thinsp;22 were considered a disorder (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e). The validity and reliability of GHQ- 28 have been confirmed in Iran (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eQuality Of Life:\u003c/h3\u003e\n\u003cp\u003eShort Form Health Survey (SF-12) is a generic instrument for measuring health-related QoL, consisting of 12 physical and mental domains items. The total score ranged from 0 to 100, and higher scores indicated a higher health-related QoL (\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). The validity and reliability of this questionnaire have been confirmed in Iran (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eCorona Disease Anxiety:\u003c/h3\u003e\n\u003cp\u003eThe Corona Disease Anxiety Scale (CDAS) has been prepared to measure anxiety caused by the Coronavirus outbreak in Iran. This instrument screened physical and psychological symptoms 18 questions with a 4-degree Likert range (never =, 0 sometimes\u0026thinsp;=\u0026thinsp;1, most of the time\u0026thinsp;=\u0026thinsp;2, and Always\u0026thinsp;=\u0026thinsp;3). The high scores in this questionnaire indicate a higher level of anxiety in individuals (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e). This questionnaire had been ascertained as a valid and reliable measurement in Iran (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eObsessions And Compulsions:\u003c/h3\u003e\n\u003cp\u003ePadua inventory Washington State University Revision (PI-WSUR) is an obsessive-compulsive questionnaire consisting of five subscales that examined obsessive thoughts about hurting oneself or others, obsessional impulses to harm self/others, contamination obsession, and compulsion wash, check compulsions, and compulsions about dressing and grooming. This study used only contamination obsessions and washing compulsions subscale. The validity and reliability of PI for the Iranian population were established (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eAll statistical analyses were performed by the SPSS software version 22.0 (SPSS Inc., Chicago, IL, USA). Student\u0026rsquo;s t-test, Mann-Whitney U, and chi-square test were used to reveal the statistical differences between the groups. Differences were considered significant at P˂0.05 for the two tails.\u003c/p\u003e"},{"header":"Result:","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e describes the characteristics of participants. The mean age of women was 30.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.93 years, the mean duration of marriage was 6.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.77 years. As can be seen, there were no significant differences between age, parity, number of children, educational level, duration, of menstruation, and marriage(P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of demographic characteristics between different types of lactation\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;87\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFemale\u0026rsquo;s age*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.78\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGravid***\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.75\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eParity***\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducation of female**\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026le;\u0026thinsp;12 years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(14.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(8.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026gt;\u0026thinsp;12 years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e103(85.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80(92.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation of women **\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnemployed\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e99(85.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69(79.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmployee\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17(14.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(20.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIncome (Tomans)***\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd rowspan=\"4\" align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.013\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026le;\u0026thinsp;1 Million\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(9.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(11.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u0026ndash;3\u0026nbsp;Million\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44(37.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38(43.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026gt;\u0026thinsp;3\u0026nbsp;Million\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63(53.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39(44.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDuration of marriage (year)*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDuration of menstruation*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003e*Values are given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD using t-test, ** values are provided as a number (%) using the chi-squared test, ***Mann-Whitney U test\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eFemale Sexual Function And Marital Satisfaction:\u003c/h3\u003e\n\u003cp\u003eAccording to the evaluation of FSFI scores showed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the differences of scores between BF and non-BF women were statistically significant in the domains of arousal, lubrication, orgasm, satisfaction, and total FSFI. The women in the non-BF group had more sexual dysfunction in the domains of pain (3.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06 vs. 4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07, P\u0026thinsp;=\u0026thinsp;0.003) and desire (3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03 vs. 3.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Also, there was no statistical difference in MS between groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of FSFI scores between different types of lactation.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;87\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value*\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDesire\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eArousal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLubrication\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOrgasm\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSatisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePain\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e3.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.003\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal FSFI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e23.45\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEMS Scale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e29.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e28.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eFSFI: Female Sexual Function Index. EMS Scale: ENRICH Marital Satisfaction Scale, BF: breastfeeding. Values are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;s.d. * t-Test.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eMental Health:\u003c/h3\u003e\n\u003cp\u003eAccording to Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, evaluation of the two groups about GHQ showed that mean values of physical symptoms, depression, social dysfunction, and total scores were lower in the BF women (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistically significant difference in anxiety between the two groups (P\u0026thinsp;=\u0026thinsp;0.068).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of GHQ, CDAS, and PI scores between different types of lactation.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;87\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value*\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGHQ\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSomatic Symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e5.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.13\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e6.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.068\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.08\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocial Dysfunction\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e6.99\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal Scores\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e21.92\u0026thinsp;\u0026plusmn;\u0026thinsp;11.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e27.75\u0026thinsp;\u0026plusmn;\u0026thinsp;16.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCDAS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePsychological Symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e17.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e19.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.69\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e14.33\u0026thinsp;\u0026plusmn;\u0026thinsp;7.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal Scores\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e29.22\u0026thinsp;\u0026plusmn;\u0026thinsp;10.56\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e34.99\u0026thinsp;\u0026plusmn;\u0026thinsp;15.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e33.29\u0026thinsp;\u0026plusmn;\u0026thinsp;9.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e34.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.305\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eGHQ: General Health Questionnaire, CDAS: Corona Disease Anxiety Scale, PI: Padua inventory, BF: breastfeeding. Values are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;s.d. * t-Test.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eCorona Disease Anxiety And Obsessive-compulsive Symptoms:\u003c/h3\u003e\n\u003cp\u003eThe comparison of CDA and Padua inventory scores between BF and non-BF women is shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. Mothers who breastfed their infants had statistically significantly lower physical and psychological symptoms scores and total scores (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The differences among these two groups were not statically significant for Padua inventory (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003ch3\u003eAnxiety And Depression:\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes the adjusted HADS scores of two different groups. BF mothers reported lower depression scores than mothers in the other group, and the mean scores of depression in BF and non-BF women were 4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96 and 6.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31, respectively (P\u0026thinsp;=\u0026thinsp;0.01). However, there were no statistically significant differences between groups in terms of anxiety and total scores of HADS (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of HADS and SF-12 scores between different types of lactation.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;123\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;87\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP-value*\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHADS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e7.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.55\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e6.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal scores\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e11.86\u0026thinsp;\u0026plusmn;\u0026thinsp;7.86\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e13.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSF-12\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSum score physical Components (PCS-12)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e81.54\u0026thinsp;\u0026plusmn;\u0026thinsp;12.80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e77.41\u0026thinsp;\u0026plusmn;\u0026thinsp;14.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSum score mental Components (MCS-12)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e70.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e66.78\u0026thinsp;\u0026plusmn;\u0026thinsp;19.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.16\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal score\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e75.85\u0026thinsp;\u0026plusmn;\u0026thinsp;11.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e72.09\u0026thinsp;\u0026plusmn;\u0026thinsp;15.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eHADS, Anxiety and Depression Hospital Scales; SF-12, Short Form Health Survey, BF: breastfeeding.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\"\u003eValues are mean\u0026thinsp;\u0026plusmn;\u0026thinsp;s.d. * t-Test.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eQuality Of Life:\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e showed a significant difference in the mean physical dimension and total score between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). But the sum of the mental scores is 70.08\u0026thinsp;\u0026plusmn;\u0026thinsp;14.59 and 66.78\u0026thinsp;\u0026plusmn;\u0026thinsp;19.27, respectively, in BF and non-BF mothers (P\u0026thinsp;=\u0026thinsp;0.16).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e provides the results obtained from multivariate regression analysis adjusting for female age, gravid, education and occupation of female, income, duration of the marriage, and menstruation shows that the GHQ score of the BF group was 4.5 units higher than non-BF group and the other variables were not significant.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAdjusted Multivariate regression analysis for comparing two groups.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDependent Variable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eParameter\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eStd. Error\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003et\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e95% Confidence Interval\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLower Bound\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUpper Bound\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal FSFI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntercept\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.812\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.478\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.830\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.601\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.201\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.402\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.569\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.118\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-4.969\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.568\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003enon_BF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ereference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal HADS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntercept\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.855\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.913\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.358\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8.182\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.527\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.864\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.280\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.457\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.147\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-4.391\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.663\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ereference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal EMS Scale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntercept\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.111\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.357\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.776\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.458\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.763\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.099\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.510\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.193\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.847\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.909\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.106\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ereference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal SF-12\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntercept\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63.142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.526\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.628\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.336\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81.948\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.940\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.062\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.426\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.156\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.131\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.011\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ereference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal GHQ\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntercept\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.322\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.411\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.966\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.744\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.900\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-4.496\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.037\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.207\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-8.518\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.474\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ereference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal PI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntercept\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.647\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6.376\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.824\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e58.470\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-2.314\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.516\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.527\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.129\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-5.307\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.678\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNon-BF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ereference\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"8\"\u003eFSFI: Female Sexual Function Index; HADS: Anxiety and Depression Hospital Scales; EMS Scale: ENRICH Marital Satisfaction Scale, SF-12: Short Form Health Survey; GHQ: General Health Questionnaire; PI: Padua inventory; BF: breastfeeding.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion:","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch3\u003eFemale Sexual Function and Marital Satisfaction:\u003c/h3\u003e\n\u003cp\u003eThe current study found that BF women likely had more dysfunction in desire and pain domains than non-BF women.\u003c/p\u003e\n\u003cp\u003eVarious studies have shown conflicting evidence on the effect of BF on sexual function. For instance, some studies have demonstrated that sexual activity, sexual arousal, and sexual satisfaction are lower in BF women than women feeding their baby with formula due to fatigue, weakness, and dyspareunia (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e). Neuroendocrine changes have occurred during the postpartum period, such as decreasing levels of androgens due to increased prolactin and increased levels of oxytocin can reduce sexual desire. In addition, low estrogen levels and elevated prolactin levels often cause vaginal dryness and decreased vaginal lubrication, which can lead to dyspareunia (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eOn the other hand, some studies have suggested that BF enhances sexual activity and libido. Indeed, BF can increase sexual desire due to larger breast size or increased sensitivity (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e). Also, close contact between mother and baby and sucking nipples by the baby is enjoyable for some women and can stimulate and increase sexual activity (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e). Nevertheless, some studies have demonstrated that BF does not affect sexual activity (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eHaving a baby through various factors such as the financial burden of childbirth, reduction of sexual intimacy, restriction of freedom has adverse effects on MS as an experience sense of happiness, joy, and satisfaction. Previous studies have reported that postpartum women who had higher body dissatisfaction, sexual dysfunction, and anxiety have decreased MS (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e). According to the critical role of sexual relationships in post-partum women's MS, although significant differences were found in two dimensions of SF, surprisingly, no differences were observed in terms of MS between groups. This result may be explained because overall sexual frequency and activity significantly declined during the height of the COVID-19 outbreak among young men and women (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eMental Health:\u003c/h3\u003e\n\u003cp\u003eOne of the most apparent findings from the analysis is that non-BF mothers indicated poorer general health than BF mothers. Also, multivariate regression analysis revealed that GHQ scores of BF mothers were 4.5 units higher than the non-BF group and the other variables were not significant.\u003c/p\u003e\n\u003cp\u003eThe benefits of BF for mothers and infants are widely documented. BF is vigorously associated with decreased infant mortality and morbidity (\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e) and also breastfed babies have been demonstrated at reduced risk of respiratory infections (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). There is overwhelming evidence to suggest that BF offers improved maternal mental well-being (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e). Hence, the affirmative impact of BF during the coronavirus pandemic cannot be ignored. As the proven effects of BF, non-BF mothers can comfort to repentance and shame and hold themselves guilty (\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e); thus, it can be aggravated during coronavirus pandemic.\u003c/p\u003e\n\u003cp\u003eAlthough there is little information about the effect of BF on post-partum mental disorders, previous studies have shown an association between elevated risk of postpartum depression with short duration or lack of BF (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e). A population-based study on 186,452 women who gave birth to a live infant has reported that BF is associated with decreasing the risk of subsequent maternal hospital admissions for schizophrenia and bipolar affective disorders in the first postpartum year (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e). Another study conducted on Bangladeshi and Pakistani women in the southwest of England had shown that exclusive BF women had significantly better (happier) mood responses. Thus, there seems to be a mutual association between maternal mental health and exclusive BF. Mothers who showed more anxiety, depression, and stress symptoms were more susceptible to breastfeeding cessation (\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e). These results may be explained by enhanced husband and family support, reduced bleeding by oxytocin secretion, rapid uterine return, and fewer neonatal hospitalizations. More studies are needed on physical and mental health well-being and BF patterns for better judgment, especially in a current pandemic.\u003c/p\u003e\n\u003ch3\u003eCorona Disease Anxiety And Obsessive-compulsive Symptoms:\u003c/h3\u003e\n\u003cp\u003eThis study showed that BF mothers had lower scores in the physical and psychological components of CDAS. The possible explanation for these results may be the positive effects of BF on emotional well-being. For instance, BF mothers have lower blood pressure, reduced heart rate reactivity, decreased cortisol response in a social stress situation, prolonged sleep pattern, and better sleep quality. BF also can increase mother-infant attachment (\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe most common examples of obsessions are the fear of contamination, causing damage, and fear of not being in order. Studies have shown that preventive behaviors such as washing hands in shorter intervals, hand sanitizers, and social distance were every day during the coronavirus pandemic. Also, more involvement with hygiene behaviors leads to more stress and anxiety (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e). Many studies have reported that Obsessive-compulsive symptoms have been exacerbated during pregnancy and post-partum periods (\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e). So concerns and sensitivities about hygiene issues during the COVID-19 pandemic can be soar in the postpartum period.\u003c/p\u003e\n\u003ch3\u003eAnxiety And Depression:\u003c/h3\u003e\n\u003cp\u003eIn this study, we specifically examined BF and non-BF mothers during the COVID-19 pandemic to explore assumptions about the effect of infant feeding on maternal mental health in the current stressful situation. The results showed that non-BF mothers had higher depression symptoms than BF mothers.\u003c/p\u003e\n\u003cp\u003eMaternal stressors such as pain, sleep disturbance, and new motherhood experience tend to be high in the postpartum period, so if there are additional stressors in life, the risk of postpartum depression will be exacerbated (\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e). Depression, as the most prevalent childbearing illness, has adverse consequences for both mother and infant and can disrupt parenting behaviors in mothers (\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e). Previous researchers had a reasonably good understanding of the effect of BF on protection against depression, but they knew almost nothing about the mechanisms of this relationship. There are several possible explanations for this result, such as soothing effects of oxytocin, modulation of the inflammatory response, higher plasma prolactin levels (\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e). Also, in Islamic societies, BF is considered the right of a baby, and family members may pressure the mother to breastfeed. Under these circumstances, the decision to forego BF for any reason can lead to increased stress and depressive symptoms (\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eDue to the well-known benefits of breast milk, especially the strengthening effect on the immune system, if mothers cannot breastfeed their infants, they will feel more anxiety and depression during the COVID-19 pandemic.\u003c/p\u003e\n\u003ch3\u003eQuality Of Life:\u003c/h3\u003e\n\u003cp\u003eIn this study, we compared the QoL between BF and non-BF mothers. Our results indicated that non-BF mothers had lower QoL scores than BF mothers. Mortazavi et al.\u0026rsquo;s (\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e) found that mothers who had continued BF at 2 and 4 months postpartum had better QoL than mothers who discontinued BF exclusively. They reported that BF enhances the QoL of mothers, and the duration of BF was deemed a key factor. Several studies have also noted the association of BF with reduced stress, depression, and negative mood. Brazilian research reported a correlation between BF with self-efficacy and maternal QoL (\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eTherefore, the psychological and physical health dimensions scores are expected to be higher in the BF group. On the other hand, BF is not a good experience for some women. Some problems such as sore nipples, breast problems, mother\u0026rsquo;s perception of insufficient breast milk, or inappropriate weight gain of the infants can lead to discontinuation or cessation of BF. But BF is a satisfying and enjoyable experience for many people (\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e). All these factors can threaten mothers\u0026rsquo; QoL. Further studies on QoL and BF patterns are needed for a better and more evidence-based judgment.\u003c/p\u003e\n\u003cp\u003eBased on our knowledge, this study has examined BF's effect on maternal mental health and sexual life in the postpartum period during the coronavirus pandemic. However, the limitation is that our findings may be interpreted within the cross-sectional design. We did not discover all the potential dimensions of maternal mental health, including women's social network, quality of love, and care for the baby, which may interrupt our result. There was also no information on women's mental health status, quality of sex life, and QoL before the coronavirus pandemic. We did not collect data on the experience of the previous BF. In addition, it is challenging to measure sensitive issues such as sexual life in a traditional culture like Iran. Finally, one of the most critical limitations of this study is the lack of sufficient knowledge about the coronavirus pandemic. Thus, further studies are needed to understand better the impact of BF during a crisis like a coronavirus pandemic.\u003c/p\u003e"},{"header":"Conclusion:","content":"\u003cp\u003eThe results of this study indicate the importance of BF for mothers and the baby and highlight the effect of BF on mothers' maternal mental health, especially in coronavirus pandemics. These findings emphasize the importance of encouraging and supporting mothers to breastfeed by family and health care providers.\u003c/p\u003e"},{"header":"List of abbreviations:","content":"\u003cp\u003eFSFI: Female Sexual Function Index\u003c/p\u003e\n\u003cp\u003eSF: Sexual Function\u003c/p\u003e\n\u003cp\u003eBF: Breastfeeding\u003c/p\u003e\n\u003cp\u003eHADS: Hospital Anxiety and Depression Scale\u003c/p\u003e\n\u003cp\u003eQoL: Quality of Life\u003c/p\u003e\n\u003cp\u003eGHQ: General Health Questionnaire\u003c/p\u003e\n\u003cp\u003eCDAS: Corona Disease Anxiety Scale\u003c/p\u003e\n\u003cp\u003eSF-12: Short Form Health Survey,\u003c/p\u003e\n\u003cp\u003ePI: Padua Inventory\u003c/p\u003e\n\u003cp\u003eOCD: Obsessive-Compulsive Disorder\u003c/p\u003e\n\u003cp\u003eMS: Marital Satisfaction\u003c/p\u003e"},{"header":"Declarations:","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee approved the study of Tarbiat Modares University of Medical Sciences (IR.MODARES.REC.1399.022). All procedures were by the ethical standards of the Regional research committee and with the Declaration of Helsinki 1964 and its later amendments. After explaining the study\u0026apos;s purposes, written consent assent was collected from all participants, and women were informed that their participation was voluntary, confidential, and anonymous and was apprised of their right to withdraw from the research at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and analyzed for the current study are available upon reasonable request of the corresponding author Dr. Shahideh Jahanian ([email protected]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSh.JS, N.M and A.M contributed to the conception and design of the study; Sh.JS and N.M did the literature search; M.N, and G.O performed the statistical analysis; N.M, Sh.JS, A.M, and G.O wrote the first draft of the manuscript. All authors reviewed the manuscript read, and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out with the kind collaboration of the participants. This study is a part of research work done at Tarbiat Modares University, Tehran, Iran. There were no conflicts of interest.\u003c/p\u003e"},{"header":"References:","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLi S, Wang Y, Xue J, Zhao N, Zhu T. The impact of COVID-19 epidemic declaration on psychological consequences: a study on active Weibo users. International journal of environmental research and public health. 2020;17(6):2032.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. 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Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review. BMC public health. 2013;13(S3):S19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001;108(4):e67-e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu F, Li Z, Binns C, Bonello M, Austin M-P, Sullivan E. Does infant feeding method impact on maternal mental health? Breastfeeding Medicine. 2014;9(4):215\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMezzacappa ES, Katkin ES. Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology. 2002;21(2):187.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChung M, Raman G, Chew P, Magula N, Trikalinos T, Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Technol Asses (Full Rep). 2007;153(153):1\u0026ndash;186.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssarian F, Moravveji A, Ghaffarian H, Eslamian R, Atoof F. The association of postpartum maternal mental health with breastfeeding status of mothers: a case-control study. Iranian Red Crescent Medical Journal. 2014;16(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrol KM, Grossmann T. Psychological effects of breastfeeding on children and mothers. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2018;61(8):977\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewby J, O'Moore K, Tang S, Christensen H, Faasse K. Acute mental health responses during the COVID-19 pandemic in Australia. medRxiv. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurton HA. 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Journal of Fasa University of Medical Sciences. 2011;1(1):45\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Breastfeeding, Anxiety, Sexual function, Quality of life","lastPublishedDoi":"10.21203/rs.3.rs-2261419/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2261419/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAccording to the increased preponderance of COVID-19 and its possible effects on psychological health and quality of life (QoL), this study aimed to compare the psycho-sexual factors and the QoL between breastfeeding non-breastfeeding mothers during the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA comparative cross-sectional study was conducted through an online survey of 123 breastfeeding and 87 non-breastfeeding women referred to the gynecology clinic of Arash Hospital in Tehran from May to Jun 2020. Depression, anxiety, general health, female sexual dysfunction, QoL, Corona Disease, Anxiety, obsessions, and compulsions were assessed by an appropriate questionnaire.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThe results showed that breastfeeding women had better mental health, sexual function, and QoL (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean general health scores in breastfeeding women were significantly lower than in the non-breastfed group (21.92\u0026thinsp;\u0026plusmn;\u0026thinsp;11.56 vs. 27.75\u0026thinsp;\u0026plusmn;\u0026thinsp;16.09, P\u0026thinsp;=\u0026thinsp;0.003). There were no statistically significant differences in marital satisfaction and Padua inventory between groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Multivariate regression analysis shows that the GHQ score of the BF group was 4.5 units higher than the non-BF group (P\u0026thinsp;=\u0026thinsp;0.02) and the other variables were not significant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the effect of breastfeeding on the maternal mental health of mothers, especially in the coronavirus pandemic. It is possible to identify the need for more excellent psychological support in general and particularly in lactating mothers.\u003c/p\u003e","manuscriptTitle":"Comparison of psycho-sexual factors and the quality of life between breastfeeding and non- breastfeeding women during the COVID-19 pandemic: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-19 07:53:10","doi":"10.21203/rs.3.rs-2261419/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d4708445-dc6d-4dec-8f81-41637cd65e75","owner":[],"postedDate":"November 19th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":17013353,"name":"Health sciences/Health care"},{"id":17013354,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2023-02-08T06:29:39+00:00","versionOfRecord":[],"versionCreatedAt":"2022-11-19 07:53:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2261419","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2261419","identity":"rs-2261419","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}