How good are physicians at promoting breastfeeding antenatally amongst pregnancies at high-risk for newborn admission to NICU? A cross-sectional study

Abstract

Objectives To determine the prevalence and factors associated with antenatal consults promoting breastfeeding in high-risk pregnancies. Methods This was a cross-sectional study of trends in breastfeeding promotion during antenatal consultation of pregnancies at high-risk for newborn admission to NICU. Between 2017-2020, high-risk pregnant women seen in a tertiary-level hospital and undergoing antenatal consultation by perinatology were identified using an electronic clinic repository. Consult letters and fetal assessment reports were reviewed to determine maternal demographics, pregnancy history, fetal findings, and discussions about breastfeeding or usage of donor milk postnatally, with descriptive statistics used to evaluate prevalence and covariates. Results 316 pregnancies were included for final analysis. Mean maternal age was 28.7 years (SD 6.2), and 62.9% were multiparas. Median gestational age at consult was 32 weeks [IQR 29-34]. The main indication for consultation was fetal anomalies (72.8%), namely cardiac defects (21.2%). There was significant improvement in the prevalence of antenatal discussions about breastfeeding over the study period, from 48.8% early in the study period compared to 73.7% in this past year (p=0.036). However, amongst consults where breastfeeding was discussed, almost one-quarter (23.8%) of patients indicated that they were not interested in breastfeeding postnatally. Conclusions There has been a significant improvement in promoting breastfeeding antenatally amongst high-risk pregnancies; however no follow-up/supports were offered to the one-quarter of women who indicated no intention of breastfeeding or using donor milk postnatally. Ongoing work is required to further advance breastfeeding promotion antenatally, increase parental supports and education, and optimize breastfeeding rates postnatally for improving outcomes in this high-risk group.