Abstract
BackgroundBreastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor-related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices.MethodsWe performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011–2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status.ResultsMore than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52–0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with >30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47–0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81–8.94; and AOR = 2.68; 95% CI, 1.70–4.23, respectively).ConclusionsImproving clinical and hospital support for women with complex pregnancies may increase breastfeeding rates and the benefits of breastfeeding for women and infants.
Highlights
Breastfeeding has many advantages to infants [1]
This study examines the relationship between entering pregnancy with complicating health conditions and early infant feeding behaviors, focusing on women’s breastfeeding intentions and supportive hospital practices as potential mediators
About 8% of women were taking blood pressure medications in the month before pregnancy, 19.7% were obese, and 20.4% were diagnosed with diabetes prior to or during pregnancy
Summary
In 2010, approximately 77% of US infants were breastfed at least once, a substantial increase from 64% in 1998 [2,3] Despite this progress, breastfeeding continues to fall short of national goals for duration and exclusivity set in initiatives such as Healthy People 2020 [2,4]. Six percent of births are complicated by diabetes [9], 3%–5% of pregnant women have hypertensive disorders [10,11,12], and 19%–39% of are obese when they become pregnant [13] Clinical management of these conditions and associated complications may necessitate greater intrapartum or neonatal intervention, which could affect care for the woman or infant in the immediate postpartum period, including breastfeeding [14,15,16,17,18,19]. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices
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