Abstract
Background: Studies examining direct vs. expressed breast milk feeding are scarce. We explored the predictors of mode of breastfeeding and its association with breastfeeding duration in a multi-ethnic Asian population. Methods: We included 541 breastfeeding mother—infant pairs from the Growing Up in Singapore Toward healthy Outcomes cohort. Mode of breastfeeding (feeding directly at the breast, expressed breast milk (EBM) feeding only, or mixed feeding (a combination of the former 2 modes)) was ascertained at three months postpartum. Ordinal logistic regression analyses identified predictors of breast milk expression. Cox regression models examined the association between mode of breastfeeding and duration of any and of full breastfeeding. Results: Maternal factors independently associated with a greater likelihood of breast milk expression instead of direct breastfeeding were Chinese (vs. Indian) ethnicity, (adjusted odds ratio, 95% CI; 3.41, 1.97–5.91), tertiary education (vs. secondary education or lower) (2.22, 1.22–4.04), primiparity (1.54, 1.04–2.26) and employment during pregnancy (2.53, 1.60–4.02). Relative to those who fed their infants directly at the breast, mothers who fed their infants EBM only had a higher likelihood of early weaning among all mothers who were breastfeeding (adjusted hazard ratio, 95% CI; 2.20, 1.61–3.02), and among those who were fully breastfeeding (2.39, 1.05–5.41). Mothers who practiced mixed feeding, however, were not at higher risk of earlier termination of any or of full breastfeeding. Conclusions: Mothers who fed their infants EBM exclusively, but not those who practiced mixed feeding, were at a higher risk of terminating breastfeeding earlier than those who fed their infants directly at the breast. More education and support are required for women who feed their infants EBM only.
Highlights
WHO recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding for two years and beyond [1,2]
With regard to early breastfeeding behaviours, a higher proportion of mothers who perceived that education,their first-time mothers and mothers who worked during their pregnancy tended to feed their milk production was insufficient to meet the demands of her child, those who fed their infants infants Expressed breast milk (EBM)
Adjusted ordinal logistic at 2–3 hourly intervals, and those who did not breastfeed at night three weeks postpartum, fed their regression analysis revealed that several maternal factors were independently associated with infants EBM
Summary
WHO recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding for two years and beyond [1,2]. In another study conducted in Shanghai, 64% of breastfeeding mothers expressed breast milk at six weeks postpartum [4]. Despite the rise in expressed breast milk feeding [10,11,12], information is sparse on its impact on breastfeeding duration and on infant health outcomes. Few studies have examined associations between expressed breast milk feeding and breastfeeding duration, and the results have been contradictory [7]. One study from Australia reported that expression of breast milk in the early postpartum period was associated with shorter breastfeeding duration [13]. The expression of breast milk was associated with a longer duration of breastfeeding [14]. Even less is known about the impact of partial vs exclusive expressed breast milk feeding on breastfeeding duration. We explore the predictors of mode of breastfeeding and examine its association with duration of breastfeeding in the same cohort
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