Maternal Anxiety and Breastfeeding Self-Efficacy in the Neonatal Intensive Care Unit: A Narrative Review of Their Relationship with Breastfeeding Outcomes.

Mothers of infants cared for in the neonatal intensive care unit (NICU) experience substantial psychological burden related to preterm birth, mother-infant separation, and stressors inherent to the intensive care environment. In this context, maternal anxiety and breastfeeding self-efficacy have been identified as key psychosocial factors influencing the initiation and continuation of breastfeeding. This narrative review examines the relationship between maternal anxiety and breastfeeding self-efficacy during the NICU stay and evaluates how this interaction is reflected in breastfeeding outcomes based on current evidence. The literature search was conducted in March 2025 using PubMed/MEDLINE, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar. Studies published between January 2000 and March 2025 were considered for inclusion in this narrative review. Quantitative, qualitative, and mixed-methods studies were thematically synthesized. The review focused on the theoretical foundations of breastfeeding self-efficacy, the relationships between maternal anxiety and lactation, the impact of the NICU environment on maternal psychological well-being, and factors associated with breastfeeding outcomes in hospitalized term and late preterm infants. The evidence indicates an inverse association between maternal anxiety and breastfeeding self-efficacy and suggests that breastfeeding self-efficacy may serve as an explanatory construct linking maternal psychological status to breastfeeding outcomes. The co-occurrence of high anxiety and low breastfeeding self-efficacy has been associated with less favorable breastfeeding patterns, whereas structured professional support and breastfeeding counseling are associated with more positive breastfeeding trajectories. In conclusion, breastfeeding in the NICU should be understood as a multidimensional process shaped by maternal psychological status, breastfeeding self-efficacy, and professional support. This review highlights the relevance of psychosocial factors for understanding breastfeeding support needs in the NICU.