Association of Hospital Practices and Early Postnatal Support with Breastfeeding Outcomes in Premature and Term Infants

Higher rates of adverse outcomes have been reported for early term (37 0 to 38 6weeks) versus full term (≥ 39 0weeks) infants, but differences in breastfeeding outcomes have not been systematically evaluated. This study examined breastfeeding initiation and exclusivity in early and full term infants in a large US based sample. This secondary analysis included 743 geographically- and racially-diverse women from the Measurement of Maternal Stress Study cohort, and 295 women from a quality assessment at a hospital-based clinic in Evanston, IL. Only subjects delivering ≥ 37weeks were included. Initiation of breastfeeding (IBF) and exclusive breastfeeding (EBF) were assessed via electronic medical record review after discharge. Associations of IBF and EBF with early and full term delivery were assessed via univariate and multivariate logistic regression. Among 872 women eligible for inclusion, 85.7% IBF and 44.0% EBF. Early term delivery was not associated with any difference in frequency of IBF (p = 0.43), but was associated with significantly lower odds of EBF (unadjusted OR 0.61, 95% CI 0.466, 0.803, p < 0.001). This association remained significant (adjusted OR 0.694, 95% CI 0.515, 0.935, p = 0.016) after adjusting for maternal diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal age, race/ethnicity, parity, Medicaid status, NICU admission, current smoking, and delivery hospital. Despite comparable breastfeeding initiation frequencies, early term infants were significantly less likely to be exclusively breastfed compared to full term infants. These data suggest that women with early term infants may benefit from counseling regarding the potential for breastfeeding difficulties as well as additional breastfeeding support after delivery.

35: Early-term deliveries are associated with a reduced likelihood of exclusive breastfeeding

Introduction: The Baby Friendly Hospital Initiative has had a positive impact on breastfeeding initiation; however, little is known about posthospital infant feeding practices among women who deliver at baby friendly hospitals. Therefore we sought to evaluate posthospital breastfeeding outcomes among women who deliver at a baby friendly hospital (BFH) by (1) estimating exclusive breastfeeding rates at the postpartum visit (PPV), (2) quantifying the exclusive breastfeeding discontinuation rate, and (3) identifying which factors are associated with breastfeeding discontinuation. Methods: This was a prospective cohort study of women aged 14 and over, who delivered at the University of Alabama at Birmingham. The primary outcome was mode of infant feeding categorized as exclusive breastfeeding (EBF), combination breastfeeding and formula feeding (CF), and exclusive formula feeding (EFF) at the PPV. Secondary outcome was EBF discontinuation rate. Patients who initiated formula and/or who stopped breastfeeding were asked what influenced their decision. Results: At hospital discharge, 71.1% of the participants were EBF, 21.7% were CF, and 7.2% were EFF. At the PPV, the frequency of the primary outcome of EBF was 31.6% (95% confidence interval: 25.2-38.8); 34.6% (28.0-41.9) were CF, and 33.8% (27.3-41.1) were EFF. Therefore, the EBF absolute and relative discontinuation rates were 39.5% and 55.6%, respectively. No demographic factors, delivery characteristics, or maternal medical morbidities were associated with EBF in the multivariable logistic regression. However, women in the EBF group were more likely to report a workplace environment conducive to breastfeeding and partner and friend support. Conclusion: Significant breastfeeding discontinuation rates occur even among women who deliver at a BFH. Our findings suggest that multifactorial interventions, including a focus on the prevention of formula introduction, are needed in the early postpartum period to achieve higher EBF rates at the PPV.

Background and Objectives: Exclusive breastfeeding offers optimal nutrition and health benefits for infants, yet many mothers face challenges that impact their ability to breastfeed. This study aimed to explore breastfeeding practices among Romanian mothers and identify factors associated with successful exclusive breastfeeding. Materials and Methods: A cross-sectional online survey was conducted from February to March 2025, targeting Romanian mothers via social media platforms. The questionnaire, developed specifically for this study, collected data on sociodemographics, birth and neonatal variables, hospital practices, feeding intentions, community influences, and breastfeeding outcomes. A total of 874 valid responses were analyzed using Fisher’s exact tests and multivariable logistic regression. Results: While 87.2% of mothers intended to breastfeed, only 56.1% reported exclusive breastfeeding. Factors significantly associated with reduced likelihood of exclusive breastfeeding included maternal age ≥ 30 years (OR = 1.40, p = 0.042), Cesarean delivery (OR = 1.78, p < 0.001), absence of rooming-in (OR = 2.32, p < 0.001), and pacifier use (OR > 4.7, p < 0.001). Protective factors included non-smoking status (OR = 0.52, p < 0.001) and encouragement to breastfeed by medical staff (OR = 1.60, p = 0.004). Despite external advice to use formula, many mothers continued breastfeeding. Conclusions: Although breastfeeding intention was high, exclusive breastfeeding remains suboptimal in Romania. Targeted support—particularly in maternity hospitals and for mothers recovering from Cesarean sections—alongside prenatal education and consistent postnatal guidance are essential to bridge the gap between intention and practice.

Among premature infants, formula feeding increases the risk for necrotizing enterocolitis, delayed brainstem maturation, decreased scoring on cognitive and developmental tests, and delayed visual development. With this in mind, many interventions are designed to increase breast milk consumption in preterm infants. Breastfeeding initiation rates among US premature infants are not collected nationally, however, and published data on breastfeeding rates in this population are limited. In addition, national surveys calculate breastfeeding rates among term infants according to maternal race/ethnicity, but maternal birthplace is not recorded. This is likely to be important, because breastfeeding is the cultural norm in the countries of origin for many non-US-born US residents. Massachusetts has a diverse racial/ethnic population, including many non-US-born women. The goals of this study were to compare breastfeeding initiation rates among preterm and term infants in Massachusetts in 2002 and to determine the effect of maternal race/ethnicity and birthplace on breastfeeding initiation rates among term and preterm infants. Massachusetts Community Health Information Profile, an online public health database that was created by the Massachusetts Department of Public Health, includes breastfeeding initiation data that are obtained from the electronic birth certificate, which we used to compare breastfeeding rates among preterm and term infants. Birth-linked demographics and data that also were accessed were maternal age, race/ethnicity, birthplace, and health insurance (public or private) as an indicator of socioeconomic status and infant's gestational age. We assessed the association between breastfeeding initiation and maternal birthplace, as well as race/ethnicity and the other potential confounders, using logistic regression. There were 80,624 births in Massachusetts in 2002, and 8.2% (6611) of newborns had a gestational age <37 weeks. The state's overall breastfeeding initiation rate was 74.6%. We excluded records of mothers who were younger than 15 years and older than 39 years, nonsingleton births, infants with a gestational age <24 weeks and >42 weeks, and records with missing data. Of the total births in Massachusetts, 67,884 (84%) met inclusion criteria for this study. Breastfeeding initiation rates were lowest among preterm infants of the youngest gestational ages. Breastfeeding initiation was 76.8% among term infants born at 37 to 42 weeks, 70.1% among infants born at 32 to 36 weeks, and 62.9% among infants born at 24 to 31 weeks. In univariate analysis, among preterm infants, a lower proportion of US-born black, Asian, and Hispanic mothers initiated breastfeeding than US-born white mothers; non-US-born black and non-US-born Hispanic mothers had the highest breastfeeding initiation rates. Among term infants, US-born black mothers had the lowest initiation rates, and non-US-born black and non-US-born Hispanic mothers had the highest. In multivariate logistic regression, however, after controlling for mother's age, race, birthplace, and insurance, US-born white mothers were least likely to breastfeed either term or preterm infants when compared with any other racial/ethnic group, including US-born black mothers. The likelihood that non-US-born Hispanic mothers would breastfeed was almost 8 times greater than that for US-born white mothers for a preterm infant and almost 10 times greater for a term infant. In multivariate logistic regression analysis stratified by gestational age for both preterm and term infants, older mothers and mothers with private health insurance were most likely to breastfeed. In Massachusetts, preterm infants were less likely to receive breast milk than term infants, and the likelihood of receiving breast milk was lowest among the youngest preterm infants. In multivariate logistic regression, mothers who were born outside the United States were more likely than US-born mothers to breastfeed either term or preterm infants in all racial and ethnic groups. In an unexpected finding, US-born white mothers were less likely to breastfeed term or preterm infants than US-born black mothers or mothers of any other racial or ethnic group.

Exclusive breastfeeding is strongly recommended by the World Health Organization. Given the low rate of exclusive breastfeeding in Canada and the increasing reports of a history of adverse childhood experiences, this study sought to investigate the association between a history of adverse childhood experiences and breastfeeding initiation and breastfeeding. Data used for this study were based on the 2011-2012 Canadian Community Health Survey, collected using a cross-sectional survey. The outcome measures were breastfeeding initiation and exclusive breastfeeding for 6 months or more. History of adverse childhood experiences was the main explanatory variable. Multivariable logistic regression models were developed to investigate the effect on breastfeeding initiation and on exclusive breastfeeding in women who gave birth within 5 years before when the surveys were conducted. The study sample included 697 and 633 women for analyses on breastfeeding initiation and breastfeeding, respectively. The proportion of women with breastfeeding initiation and exclusive breastfeeding for up to 6 months in this study were 96.8% and 42.8%, respectively. After controlling for age and highest level of education, having a history of adverse childhood experiences was not significantly associated with breastfeeding initiation (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.10-1.87), but mothers with such history were less likely to exclusively breastfeed for up to 6 months compared with those without (OR 0.53, 95% CI 0.31-0.90). These findings suggest the need for more breastfeeding monitoring programs beyond the hospital environment to provide more support to Canadian mothers, especially those who have experienced adverse childhood experiences or trauma in the past.

Information on exclusive breastfeeding (BF) and BF initiation following bariatric surgery (BS) among obese women with diabetes mellitus (DM) and without DM (non-DM) is limited. Retrospective cohort study. Obesity was defined by BMI (kg/m2) as grade 1 (30-34.9), grade 2 (35-39.9) or grade 3 (≥40). The 65 women in the DM group (40 women with gestational, 19 with Type 2 and 6 with Type 1) was similar to 84 with non-DM in BS type: Roux-en-Y (51 vs 55%), sleeve gastrectomy (32 vs 35%), laparoscopic gastric banding (17 vs 7%) and gastro-duodenal anastomosis (0 vs 4%). Women with DM were older (35 vs 33y), of advanced age (54 vs 27%), with higher prevalence of grade 3 obesity (66 vs 46%), chronic hypertension (31 vs 10%), delivery of late-preterm infants (23 vs 10%) and neonatal hypoglycemia (25 vs 12%). Although infant feeding intention was similar: BF (66 vs 79%), partial BF (9 vs 7%) or formula (25 vs 14%), at discharge women with DM had lower exclusive BF (29 vs 41%) and BF initiation rates (68 vs 76%) than those with non-DM. Women with grade 3 obesity (52% were DM) differed from those with grades 1-2 (34% were DM) in exclusive BF (27 vs 52%), and BF initiation rates (66 vs 86%). After BS, women with DM, especially those with grade 3 obesity, had higher rates of chronic hypertension and preeclampsia and lower rates of exclusive BF and BF initiation than those who had DM but had less severe obesity.

Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials.

Mothers are encouraged to exclusively breastfeed for the first 6 months. However, cesarean delivery rates have increased worldwide, which may affect breastfeeding. Research aim: This study aimed to determine the potential effects of cesarean delivery on breastfeeding practices and breastfeeding duration. This was a 6-month cohort study extracted from a 24-month prospective cohort study of mother-infant pairs in three communities in Hunan, China. Data about participants' characteristics, delivery methods, breastfeeding initiation, use of formula in the hospital, exclusive breastfeeding, and any breastfeeding were collected at 1, 3, and 6 months following each infant's birth. The chi-square test, logistic regression model, and Cox proportional hazard regression model were used to examine the relationship between breastfeeding practices and cesarean delivery. The number of women who had a cesarean delivery was 387 (40.6%), and 567 (59.4%) women had a vaginal delivery. The exclusive breastfeeding rates at 1, 3, and 6 months were 80.2%, 67.4%, and 21.5%, respectively. Women who had a cesarean delivery showed a lower rate of exclusive breastfeeding and any breastfeeding than those who had a vaginal delivery ( p < .05). In addition, cesarean delivery was related with using formula in the hospital and delayed breastfeeding initiation. Cesarean delivery also shortened the breastfeeding duration (hazard ratio = 1.40, 95% confidence interval [1.06, 1.84]). Healthcare professionals should provide more breastfeeding skills to women who have a cesarean delivery and warn mothers about the dangers of elective cesarean section for breastfeeding practices.

Women with obesity breastfeed for shorter durations than women of normal-weight body mass index (BMI). There is also evidence to suggest that women with obesity are less likely to initiate breastfeeding. This is important because breastfeeding is associated with a small, but significant, reduced risk of obesity among offspring; which may be particularly important for the offspring of mothers with obesity as these infants are at an increased risk of obesity. Using data prospectively collected during 2015 by medical staff in a large maternity hospital, we aimed to explore the association between maternal obesity status and early breastfeeding outcomes: breastfeeding initiation and exclusive breastfeeding at hospital discharge (approx. day 2 of life). Data were obtained from electronic records for all births in The National Maternity Hospital, Dublin in 2015. We included data from mothers who delivered a healthy, full-term, singleton infant (n = 7449). At the booking visit (approx. 12 weeks’ gestation), maternal height and weight were objectively measured by nursing staff and subsequently used to calculate BMI; other demographic data were recorded at this time. At delivery, epidural use, mode of delivery, and infant sex and weight were recorded. At discharge, mode of feeding was recorded. In SPSS, we explored unadjusted and adjusted associations between obesity status (BMI &lt; 30kg/m2 [n = 964] vs. BMI ≥ 30kg/m2 [n = 6485]) and breastfeeding outcomes (dichotomous: yes/no) using Chi-squared analysis and multivariate logistic regression, respectively. In unadjusted analyses, there was a significant association between obesity status and breastfeeding initiation; 76% of women without obesity initiated breastfeeding compared with 59% of women with obesity (P &lt; 0.001). There was also a significant association between obesity status and exclusive breastfeeding; 69% of women without obesity were exclusively breastfeeding at discharge compared with 37% of women with obesity (P &lt; 0.001). In logistic regression analyses adjusted for maternal age, ethnicity, marital status, smoking status, parity, epidural use and delivery mode, the odds of women with obesity initiating breastfeeding were 51% lower than women without obesity (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.42–0.57; P &lt; 0.001). Similarly, in adjusted analyses, the odds of women with obesity exclusively breastfeeding at hospital discharge were 54% lower than women without obesity (OR 0.44, 95% CI 0.38–0.51; P &lt; 0.001). Research is needed to understand whether the negative association between obesity and breastfeeding is biological or cultural in origin, or both. Interventions to promote and support breastfeeding among women with obesity may improve breastfeeding outcomes.

BackgroundBreastfeeding practices such as early initiation of breast milk and exclusive breastfeeding are key to the reduction of childhood morbidity and mortality. Despite the importance of these practices, rates of timely initiation of breastfeeding and exclusive breastfeeding remain suboptimal in many sub-Saharan countries. This study aimed to examine the determinants of early initiation of breastfeeding and exclusive breastfeeding in the first 5 months in Malawi.MethodsThis study used the 2015–16 Malawi Demographic and Health Survey data. A total of 6351 children born during the last 24 months and 1619 children aged 0–5 months at the time of the survey were analyzed for early initiation of breastfeeding and exclusive breastfeeding outcomes, respectively. Socio-demographic and socio-economic factors including individual, household and community-level factors were tested for association with early initiation of breastfeeding and exclusive breastfeeding using logistic regression models.ResultsThe proportion of timely initiation of breast milk and exclusive breastfeeding were 76.9 and 61.2%, respectively. Delivering at a health facility (adjusted odds ratio [aOR] 1.77, 95% confidence interval [CI] 1.10, 2.87), vaginal delivery (aOR 3.15, 95% CI 2.40, 4.13), and singleton births (aOR 1.96, 95% CI 1.20, 3.21) were independent factors associated with the increased likelihood of timely initiation of breastfeeding. Age of children was associated with increased odds of exclusive breastfeeding, with children aged 3–5 months being less likely to be exclusively breastfed (aOR 0.24, 95% CI 0.18, 0.31).ConclusionsHealthcare providers and programs aimed at increasing rates of early initiation of breastfeeding should take into consideration women at risk such as those giving birth through caesarean section, giving birth at home, and having multiple births. Further, women with children aged 3–5 months should be targeted with health promotion interventions for exclusive breastfeeding.

BackgroundThe global breastfeeding recommendation states that all infants should be put to the breast within one hour of birth, which is defined as timely initiation or early initiation of breastfeeding. Early initiation of breastfeeding is associated with reduced risk in infant illness and death. Understanding the determinants of delay in initiation of breastfeeding might spur health staff and policy makers to foster timely breastfeeding. We assessed the prevalence and determinants of delay in initiation of breastfeeding among mothers in Juba Teaching Hospital.MethodsThe present study enrolled 806 mother-infant pairs within 24 hrs of birth in Juba Teaching Hospital in 2017. The mothers were interviewed about the time of initiation of breastfeeding, sociodemographic and birth characteristics. The independent variables associated with delay in initiation of breastfeeding were identified using multivariable logistic regression analysis.ResultsIn the current study, 52% (418/806) of the mothers initiated breastfeeding later than one hour after birth. Birth by Caesarean section (Adjusted Odds Ratio [AOR] 41; 95% Confidence Interval [CI] 12.21, 138), discarding of colostrum (AOR 9.89; 95% CI 4.14, 23.62), unmarried mothers (AOR 3.76; 95% CI 1.53, 9.24), exposure to infant formula advertisement (AOR 1.82; 95% CI 1.09, 3.02) and no house ownership (AOR 1.52; 95% CI 1.11, 2.09) were independent factors associated with delay in initiation of breastfeeding.ConclusionWe found that more than half of the mothers delayed the initiation of breastfeeding. Therefore, we recommend training on best breastfeeding practices and counselling skills for health staff in Juba Teaching Hospital. Policy dialogue, with the relevant ministries and departments on the promotion and protection of early initiation of breastfeeding is crucial.

The benefits of breastfeeding are known to impact infant and maternal health outcomes. Healthy People 2020 designates several evidence‐based objectives for breastfeeding initiation, duration, and exclusivity. Despite these recommendations, rates of breastfeeding behaviors in the United States (U.S) fall short. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is required to promote and support breastfeeding practices, yet evidence of breastfeeding outcomes among WIC participants are mixed. This study uses nationally representative data to examine the association between breastfeeding initiation, duration, and exclusivity and family WIC participation status.We analyzed data using the combined 2016‐2018 National Survey of Children’s Health, administered by HRSA’s MCHB. Outcome measures included breastfeeding initiation, any breastfeeding at 6 months, and exclusive breastfeeding through 6 months. We conducted weighted bivariate analyses to examine prevalence of breastfeeding practices based on family WIC participation and sociodemographic characteristics, and multivariable logistic regression analyses to assess the association between WIC participation and breastfeeding outcomes. Adjusted analyses controlled for several sociodemographic and health status characteristics.The combined 2016‐2018 dataset contains completed questionnaires from 19,030 children ages 0‐3 years living in the United States. A total of 6,532 were considered to be WIC‐eligible, and 3,174 were from families reported to have participated in WIC within the past 12 months.Rates of breastfeeding outcomes among WIC participants were lower than national rates observed among the general U.S. population—72.8% of children were ever breastfed and 50.3% of children were breastfed ≥ 6 months (versus 83% and 58% nationally, respectively). When examining differences in breastfeeding outcomes between WIC‐eligible participants and non‐participants, we found that participants were less likely to report any breastfeeding ≥ 6 months than WIC‐eligible nonparticipants (Average Marginal Effect (AME) = ‐9.2, P &lt; .05), after adjusting for covariates. When examining breastfeeding outcomes among WIC‐eligible participants while adjusting for covariates, families from predominantly non‐English‐speaking households were more likely to have ever breastfed (AME = 10.7, P &lt; .01), more likely to report any breastfeeding ≥ 6 months (AME = 27.8, P &lt; .001), and more likely to be exclusively breastfeeding ≥ 6 months (AME = 23.3, P &lt; .01), compared with respondents from English‐speaking households. In addition, several sociodemographic characteristics were associated with a lower likelihood of breastfeeding outcomes among children, including Hispanic race/ethnicity, having a single mother, and lower household education.WIC participation was significantly associated with a lower likelihood of breastfeeding duration (any breastfeeding at 6 months), yet had no effect on the likelihood of breastfeeding initiation or exclusivity. Our results on subpopulations of WIC participants with lower rates of breastfeeding outcomes are noteworthy and highlight persistent disparities.Our findings inform potential target areas for interventions to improve breastfeeding outcomes among WIC participants. While anticipatory guidance and education are provided to new mothers through WIC to encourage breastfeeding initiation, additional support and outreach (appropriately timed during the postpartum period) may help overcome barriers that mothers face in maintaining breastfeeding duration. Such initiatives, incorporated with existing WIC programming, may contribute to improvements in breastfeeding rates for WIC populations to more closely align with Healthy People 2020 goals.

Introduction. Breastfeeding (BF) has challenges from preparation, birth, first hour of life (FHL), protection of mothers in hospital, support from counselors and relatives. Exclusive BF in Colombia is 36.1% and in Envigado municipality reached 3.1 months, in 2015. Objective. Compare the practice of BF and factors associated with planning of gestation, onset, type and total duration of BF in young mothers (YW) and adults (AW) of the Municipality of Envigado, Antioquia Department, Colombia. Material and methods. Quantitative, observational study, with probability sampling. From a universe of 3,540 newborns, 288 lactating mothers were selected. Variables associated with health services, practices and times of BF were studied. SPSSv22 was used for data analysis. Study approved by the ethics committee of the CES University. Results. Delivery of the baby to the immediate mother or FHL (83%), favors early BF (74%). Exclusive BF (4.6 months) and total BF (12.6 months) were similar in YW (&lt;27 years) and AW (≥27 years). In YW, having the baby hospitalized (p = 0.00), the number of children (p = 0.04) and a planned pregnancy (p = 0.02) predict BF in FHL, exclusive and total BF. In AW, having the minor hospitalized (p = 0.01), occupation and counseling predict BF in FHL, exclusive and total. The main predictor of exclusive (p = 0.02) and total (p = 0.01) BF is BF counseling. Discussion. BF counseling is the main strategy for the support, promotion and maintenance of BF, which is reflected in the high prevalences of this essential practice. Conclusions. Advice on BF from pregnancy is the main factor that predicts the practice of exclusive and total BF. The hospitalization of the neonate in the postpartum period and type of delivery significantly influences skin-to-skin contact and BF in the first hour of life.

BackgroundBreastfeeding provides unmatched health, developmental, and economic benefits to both infants and mothers, yet breastfeeding continuation rates remain suboptimal in the United States, especially beyond the early postpartum period. Despite well-documented advantages, many mothers face challenges that lead to early cessation, including lack of access to skilled lactation support. International Board Certified Lactation Consultants (IBCLCs) are considered the clinical gold standard in lactation care, but their availability varies widely across states. Understanding how IBCLC access relates to breastfeeding outcomes at the population level is critical to informing equitable public health interventions.ObjectiveThe aim of this study is to determine whether state-level IBCLC density is associated with breastfeeding initiation and exclusive breastfeeding at 3 and 6 months.MethodsThis cross-sectional analysis used publicly available 2022 data from the Centers for Disease Control and Prevention, US Census Bureau, and the International Board of Lactation Consultant Examiners. IBCLC density per 100,000 women of childbearing age (15‐49 years) was calculated for each of the 50 US states. Breastfeeding outcome data included initiation, exclusive breastfeeding at 3 months, and exclusive breastfeeding at 6 months. Simple and multiple linear regressions were conducted to evaluate the association between IBCLC density and breastfeeding outcomes, adjusting for income, education, and insurance coverage.ResultsIBCLC density ranged from 14.4 to 60.7 per 100,000 women of childbearing age across US states, with a national average of 25.5. Pearson correlation analysis indicated significant positive associations between IBCLC density and breastfeeding outcomes, including initiation (r=0.38; P<.001), exclusive breastfeeding at 3 months (r=0.52; P<.001), and exclusive breastfeeding at 6 months (r=0.32; P<.001). In multiple linear regression models adjusting for income, education, and insurance status, IBCLC density remained significantly associated with all 3 outcomes. For breastfeeding initiation, the adjusted β was 0.26 (95% CI 0.08-0.44; P=.005); for exclusive breastfeeding at 3 months, β was 0.43 (95% CI 0.23-0.63; P<.001); and for exclusive breastfeeding at 6 months, β was 0.25 (95% CI 0.12-0.39; P<.001). Adjusted R² values for the models ranged from 0.42 to 0.44, indicating moderate explanatory power.ConclusionsHigher IBCLC density is significantly associated with improved breastfeeding outcomes at the state level, particularly exclusive breastfeeding at 3 months. These findings support initiatives to expand access to professional lactation support as part of public health strategies to improve breastfeeding rates.