A systematic review of maternal obesity and breastfeeding intention, initiation and duration

Lisa H Amir,Susan Donath

doi:10.1186/1471-2393-7-9

Abstract

BackgroundBreastfeeding behaviour is multifactorial, and a wide range of socio-cultural and physiological variables impact on a woman's decision and ability to breastfeed successfully. An association has been reported between maternal obesity and low breastfeeding rates. This is of public health concern because obesity is rising in women of reproductive age and the apparent association with increased artificial feeding will lead to a greater risk of obesity in children. The aim of this paper is to examine the relationship between maternal overweight and obesity and breastfeeding intention and initiation and duration.MethodsA systematic review was conducted in January and February 2007, using the following databases: Medline, CINAHL and the Australian Breastfeeding Association's Lactation Resource Centre. Studies which have examined maternal obesity and infant feeding intention, initiation, duration and delayed onset of lactation were tabulated and summarised.ResultsStudies have found that obese women plan to breastfeed for a shorter period than normal weight women and are less likely to initiate breastfeeding. Of the four studies that examined onset of lactation, three reported a significant relationship between obesity and delayed lactogenesis. Fifteen studies, conducted in the USA, Australia, Denmark, Kuwait and Russia, have examined maternal obesity and duration of breastfeeding. The majority of large studies found that obese women breastfed for a shorter duration than normal weight women, even after adjusting for possible confounding factors.ConclusionThere is evidence from epidemiological studies that overweight and obese women are less likely to breastfeed than normal weight women. The reasons may be biological or they may be psychological, behavioral and/or cultural. We urgently need qualitative studies from women's perspective to help us understand women in this situation and their infant feeding decisions and behaviour.

Highlights

IntroductionBreastfeeding behaviour is multifactorial, and a wide range of socio-cultural and physiological variables impact on a woman's decision and ability to breastfeed successfully
The majority of large studies found that obese women breastfed for a shorter duration than normal weight women, even after adjusting for possible confounding factors [11,12,13,39,44,48,49]
Obesity remained associated with delayed lactogenesis after adjusting for several possible confounding factors, but infant feeding intention was not included

Summary

Introduction

Breastfeeding behaviour is multifactorial, and a wide range of socio-cultural and physiological variables impact on a woman's decision and ability to breastfeed successfully. An association has been reported between maternal obesity and low breastfeeding rates. This is of public health concern because obesity is rising in women of reproductive age and the apparent association with increased artificial feeding will lead to a greater risk of obesity in children. Looking at the population impact, it has been estimated that 13,639 cases of obesity (95%CI 7,838, 19,308) could be prevented in England and Wales over 9 years if all infants were breastfed for at least three months [5]. Reports of obesity among pregnant women in the USA range from 18.5% to 38.3%, making it one of the most frequent high-risk obstetric situations [7]. It has been recognised that obesity may track across generations, prevention is an urgent priority [10]

Objectives

Methods

Results

Discussion

Conclusion