Third-Trimester Anemia and Early Breastfeeding Outcomes and Postpartum Depressive Symptoms: A Retrospective Comparative Study

Background: Although the impact of maternal anemia on adverse maternal outcomes is well established, its relationship with breastfeeding and maternal mental well-being remains insufficiently characterized. Research Aims: This study aimed to examine the association between anemia severity in the third trimester and early breastfeeding outcomes and postpartum depressive symptoms. Methods: This retrospective comparative observational study included pregnant patients with hemoglobin concentrations of <10.5 g/dL admitted to a tertiary hospital between January 2020 and December 2024. Anemia severity was categorized as mild (9.0–10.5 g/dL; n = 136), moderate (8.0–8.9 g/dL; n = 276), and severe (<8.0 g/dL; n = 96). Breastfeeding outcomes included breastfeeding initiation within 1 hour postpartum, colostrum and milk volume adequacy on postpartum day 1 and at hospital discharge, and exclusive breastfeeding rates at discharge. Postpartum depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale. Results: Patients with severe anemia had lower rates of early breastfeeding initiation than those with moderate and mild anemia (26.0 vs. 31.2% and 52.9%; P < 0.001). Adequate colostrum volume on postpartum day 1 also was less frequent in patients with severe anemia (41.7 vs. 57.2% and 61.0%; P = 0.009). Similar trends were observed at hospital discharge, with lower rates of adequate milk volume ( P = 0.021) and exclusive breastfeeding ( P < 0.001). Patients with severe anemia had a higher proportion of Edinburgh Postnatal Depression Scale scores >10 ( P = 0.043). Conclusion: Greater anemia severity in late pregnancy was associated with poorer breastfeeding outcomes and higher postpartum depressive symptom scores. These findings underscore the need for continued investigation and clinical attention to anemia identification and management during pregnancy.