Dysphoric Milk Ejection Reflex: Risk, Prevalence, and Persistence

1. BackgroundDysphoric Milk Ejection Reflex (DMER), which affects a significant proportion of lactating parents and may significantly impact feeding choices, is poorly understood. 2. Objective(s)The primary aim of this study is to characterize prevalence, duration, and factors influencing DMER as well as its effect on parental feeding choices. 3. Study DesignWe conducted a cross-sectional study using an online survey of lactating parents of children under the age of 18 months who were nursed for any period of time. N=1469 survey responses were collected, of which n=209 reported experiencing DMER. The DMER sub-cohort was further queried about their specific experiences. We performed a risk factor analysis using logistic regression. 4. ResultsThe prevalence of DMER in our cohort was 14.2% (n=209/1469). We found a high co-incidence of DMER with both postpartum depression and baby blues. DMER was also associated with a pre-pregnancy mental health history, higher education level, and an immigration background. We found no effect on DMER rates by marital status, household income, BMI, history of medical illness, mode of birth and sex of infant, use of assisted reproductive technology, medication during pregnancy, history of abortion or miscarriage, extended perinatal hospitalization, and spousal parental leave. Among the n=209 women who reported having experienced DMER, 57.7% (n=113/196) reported their symptoms lasted 1-5 minutes, and the most frequently selected descriptions were: tense, hypersensitive, frustrated, irritable, overwhelmed, sad, lonely, and restless. Most women (n=132/180, 73.3%) reported experiencing DMER only at the beginning of a nursing session, while a minority had DMER at every letdown. Of the DMER group, 85.9% (n=158/184) used a pump to express breastmilk. Of these 57.0% (n=90/158) experienced milder or absent DMER symptoms while pumping as compared to nursing. Only 5.7%, (n=9/158) reported more severe symptoms while pumping, and 12.0% (n=19/158) experienced symptoms only when pumping. 40.2% (n=72/179), of respondents with DMER reported that their symptoms remained stable between birth and weaning. In 29.6% (n=53/179), symptoms became milder and in 9.5% (n=17/179) they disappeared completely. In contrast, 17.9% (n=32/179) reported their symptoms worsened over the nursing period. Importantly, 16.9% (n=30/177) of DMER respondents stopped breastfeeding because of DMER symptoms, and a further 19.2% (n=34/177) had considered doing so. The most frequently reported factor worsening DMER symptoms was stress which was selected by 62.1% (n=113/182), closely followed by sleep deprivation (60.4%, n=110/182). Loneliness and conflict with a significant other were also frequently cited DMER aggravation factors (49.5%, n=90/182 and 48.9%, n=89/182, respectively). The factors most likely to ease DMER symptoms were "support from partner" and "sleep" (34.6%, n=63/182 and 29.7%, n=54/182, respectively). 5. Conclusion(s)DMER is a relatively common postpartum condition, affecting approximately one in seven lactating mothers in our study. Those with preexisting mental health and mood disorders were at elevated risk. One in six mothers with DMER stopped breastfeeding because of their symptoms. Further research and effective awareness campaigns targeting both expectant parents and their healthcare providers are needed to address this widespread but understudied problem. Tweetable statementAmong 1469 surveyed new mothers, 14% experienced negative emotions with milk let-down, a Dysphoric Milk Ejection Reflex. Of those, 17% stopped nursing as a result. Baby blues, PPD, or a prior mental health diagnosis increased the likelihood of DMER. AJOG at a GlanceA. Why was this study conducted?Little is known about how many lactating parents are affected by dysphoric milk ejection reflex (DMER), predisposing factors, and what circumstances aggravate or alleviate symptoms. Similarly, the consequences of this disorder, including its effect on breastfeeding rates, are poorly understood. B. What are the key findings?One in seven survey respondents in our study experienced DMER. Importantly, 16.9% of those with DMER reported nursing cessation due to DMER symptoms. Those with baby blues or postpartum depression (PPD) were at significantly elevated risk for DMER, as were those with pre-pregnancy mental health conditions. 79.3% of survey respondents who had experienced DMER reported their symptoms had stabilized, improved, or disappeared prior to weaning. Sleep and partner support were the most frequently reported mitigating factors. C. What does this study add to what is already known?This study is the first to identify risk factors for DMER and explores DMER duration, persistence, timing, and modifying factors in the largest cohort examined to date.