Breastfeeding outcomes after assisted conception

Abstract

We appreciate Barrera et al1Barrera C.M. Kawwass J.F. Boulet S.L. Nelson J.M. Perrine C.G. Fertility treatment use and breastfeeding outcomes.Am J Obstet Gynecol. 2019; 220: 261.e7Abstract Full Text Full Text PDF Scopus (10) Google Scholar for their analysis of breastfeeding outcomes among women who conceived spontaneously compared with women who underwent assisted conception. The authors reported shorter breastfeeding durations in women who conceived via assisted reproductive technologies (ART) compared with spontaneous conception, possibly explained by the greater likelihood of multiples birth and preterm infants that are observed in women who have conceived via ART. However, we find it important to draw attention to several limitations of this study. First, we contend that the data that were collected from the cross-sectional surveillance system were inadequate in addressing the objective of the study: assessing breastfeeding outcomes. Given the ambiguity behind this phrase, we believe that a prospective cohort design with multiple questionnaires that are administered at different time points spanning the intrapartum and postpartum periods would be more appropriate in elucidating breastfeeding outcomes. Second, although we acknowledge the predesigned format of the questionnaire, additional information is warranted to analyze clinically relevant factors in breastfeeding cessation. Further clarification is required if breastfeeding cessation originated from the infant or the mother. We propose that additional questions may include (1) exclusivity of breastfeeding, (2) the introduction of formula for nutritional supplementation because it is associated with shorter duration of breastfeeding,2Kim E. Hoetmer S.E. Li Y. Vandenberg J.E. Relationship between intention to supplement with infant formula and breastfeeding duration.Can J Public Health. 2013; 104: 388Crossref Scopus (11) Google Scholar (3) maternal intrapartum conditions, and (4) maternal attitudes toward breastfeeding. Open-ended questions that are not restricted to set options could generate a more meaningful classification regarding reasons behind breastfeeding cessation. Third, despite the authors’ intention to disentangle any causal relationships between ART and early breastfeeding cessation by adjusting for possible confounders, we identified several notable factors that were not included in the study design nor the authors’ discussion. Early breastfeeding cessation is associated with risk factors that include lower breastfeeding self-efficacy, introduction of a pacifier, and work-related factors such as early return to paid work.3Blyth R. Creedy D.K. Dennis C. Moyle W. Pratt J. De Vries S.M. Effect of maternal confidence on breastfeeding duration: an application of breastfeeding self-efficacy theory.Birth. 2002; 29: 278-284Crossref PubMed Scopus (294) Google Scholar, 4Langellier B.A. Pia Chaparro M. Whaley S.E. Social and institutional factors that affect breastfeeding duration among WIC participants in Los Angeles County, California.Matern Child Health J. 2012; 16: 1887-1895Crossref PubMed Scopus (35) Google Scholar Furthermore, it is important to acknowledge the lack of harmonization between breastfeeding policies and support across hospitals where a woman received postpartum care, which could be addressed in future study design. To our knowledge, there is sparse evidence that reports the association between mode of conception and breastfeeding practices in the United Kingdom. Despite the study’s limitations, Barrera et al offered important insights into breastfeeding outcomes in women who conceived via assisted conception that raise the opportunity for intervention and support for breastfeeding in this cohort of women. Further longer term studies are necessary to investigate factors that influence breastfeeding initiation and continuation by mode of conception, taking into account the limitations that we have discussed. Fertility treatment use and breastfeeding outcomesAmerican Journal of Obstetrics & GynecologyVol. 220Issue 3PreviewAbout 15% of women aged 15–44 years in the United States experience infertility. Factors associated with infertility and fertility treatments may also be associated with lactation difficulties. Limited data exist examining the impact of infertility or mode of conception on breastfeeding outcomes. Full-Text PDF