891: Does a home-based lifestyle intervention improve breastfeeding rates in socioeconomically disadvantaged (SED) obese women?

Abstract

SED, obese women are comparatively less likely to breastfeed. Prior studies suggest the highest increases in breastfeeding (BF) occur from individual-level BF education and support interventions available during pregnancy and after delivery. However, data remain limited on the effectiveness on these interventions among SED women. We aimed to test the efficacy of an antepartum and postpartum home-based lifestyle intervention on BF rates in this population. This prospective study was nested within a randomized control trial occurring at a single university-based tertiary care center from 2013-2016 as part of the LIFE-Moms consortium (NCT01768793). SED, obese women with singleton gestations were randomized by 15 weeks to Parents as Teachers (PAT)—a parenting support and child development intervention—or PAT+, PAT with behavior interventions to decrease excessive weight gain and increase BF rates. Consenting women completed a well-validated BF survey at 6-12 months postpartum. The primary outcome was BF initiation. Secondary outcomes were reasons for not initiating or stopping BF. 118 women completed the survey: 59 in PAT+ and 59 in PAT. BF initiation rates were similar in each group. On a 1-4 scale with higher scores denoting more importance, there were no statistically significant differences among reasons for not initiating BF. On the same scale, women in PAT+ and PAT similarly rated their difficulty latching, concern for low milk supply, or pain during BF as the most important reasons for BF cessation. Comparatively, those in PAT+ were less likely to rate their desire to leave their baby for several hours, their medication use, or their desire to return to prior diet as important reasons for BF cessation (1.49 vs 1.98, aOR 0.39 (95% CI 0.16-0.98); 1.40 vs 1.86; aOR 0.33 (95% CI 0.12-0.93); 1.29 vs 1.72, aOR 0.32 (95% CI 0.11-0.95), respectively). Among SED, obese women, a home-based lifestyle intervention did not improve BF initiation rates or impact views on BF initiation or common reasons for BF cessation. Other educational interventions are needed to improve BF rates in this at-risk population.