Previous studies have found maternal depression to be a major risk factor for poor growth in infants in Pakistan and south Asia. The mediating mechanisms between maternal depression and infant malnutrition are an important area for research.Studies have shown that maternal depression maybe associated with shorter duration of feeding however the evidence is equivocal. The quantity of breast milk could be another factor which has only been tested with relatively inaccurate methods of clinical scoring and test weighing till date. We aim to study the relationship of maternal depression with duration of breastfeeding and infant feeding practices. Moreover, we would also estimate the breast milk production and intake by the infant in depressed versus normal mothers, using the new technology of isotope dilution, in a rural community in Rawalpindi, Pakistan.

A random sample of 100 depressed and 100 non-depressed women will be recruited for the proposed prospective cohort study. The depressive disorder will be diagnosed antenatlly and 6 months postnatally using validated instruments. The duration of exclusive breastfeeding will be assessed prospectively and infant feeding practices will be assessed at 6 months with appropriate tools. Breast-milk intake will be measured in 30 mothers from each group, using the dose-to-the-mother deuterium oxide method also validated in Pakistan by the investigators. Differences in the two groups of mothers will be estimated using appropriate statistical techniques, while controlling for possible confounders.