Non-initiation Of Breastfeeding Research Articles

Predictors of Breastfeeding among Women Admitted with Severe Preeclampsia before 34 Weeks.

Patients with severe preeclampsia (sPREX) face barriers to successful breastfeeding (BF), including an increased risk of maternal and newborn complications, prematurity, and low birth weight. Patients with early-onset sPREX (before 34 weeks' gestation) may be at even greater risk, yet there are little data available on factors associated with BF challenges in this population. We describe rates of BF initiation at hospital discharge and BF continuation at postpartum (PP) visit and identify factors associated with BF noninitiation and BF cessation among patients admitted with early-onset sPREX. Retrospective cohort study of women with sPREX admitted at less than 34 weeks' gestation to a single tertiary center (2013-2019). Demographic, antepartum, and delivery characteristics were evaluated. Factors associated with BF noninitiation at maternal discharge and with BF cessation at routine PP were assessed. Patients with intrauterine or neonatal demise and those missing BF data were excluded. Bivariate statistics were used to compare characteristics and Poisson regression was used to estimate relative risks (RR). Of 255 patients with early-onset sPREX, 228 (89.4%) had BF initiation at maternal hospital discharge. Initiation of BF occurred less frequently among patients with tobacco use in pregnancy (7.5 vs. 37.0%, χ 2, p < 0.001, RR: 0.69 [95% confidence interval, CI: 0.52-0.92]). At 6 weeks' PP, 159 of 199 (79.9%) patients had BF continuation. Maternal age under 20 years (1.9 vs. 17.5%, χ 2, p = 0.01, RR: 0.36 [95% CI: 0.14-0.91]) and experiencing maternal morbidity (25.2 vs. 45.0%, χ 2, p = 0.01, RR: 0.80 [95% CI: 0.66-0.96]) were associated with BF cessation at the PP visit. Among patients with early sPREX, tobacco use in pregnancy was associated with noninitiation of BF at discharge, whereas young maternal age and maternal morbidity were associated with cessation of BF by routine PP visit. Further research is needed on how to support BF in this population, especially among patients with these associated factors. · Tobacco use was associated with BF noninitiation in patients with early preeclampsia.. · Maternal age < 20 and maternal morbidity were associated with BF cessation by PP visit.. · BF support for patients with risk factors is important for BF success PP..

Why do first-time mothers not intend to breastfeed? \u2014\u2014A qualitative exploratory study on the decision-making of non-initiation in Jingzhou, China

BackgroundAlthough breastfeeding is one of the top priorities for public health in China, the rate of breastfeeding is still low and a large number of women do not initiate breastfeeding due to various reasons. Hence, this study aimed to understand the decision-making of non-initiation and reveal the underlying reasons in order to protect, support, and promote breastfeeding.MethodsIn-depth, exploratory interviews were carried out with 13 new mothers who did not initiate breastfeeding. The collected data were analyzed by inductive content analysis.ResultsAlthough mothers generally understood the protective effects of breastfeeding, they believed that formula milk is a good alternative to human milk and even better in some aspects. Five core themes related to non-initiation decision-making emerged: (1) expected breastfeeding stress; (2) maladjustment to the maternal role; (3) concerns about physiological issues; (4) the lack of knowledge about the risks of artificial feeding; (5) belief that it is better not to initiate than to interrupt.ConclusionsThe environment for mothers to breastfeed in China is not supportive enough, and the medical staff and families should be held responsible for the non-initiation of breastfeeding. More professionals are needed to support mothers to solve their problems and breastfeeding education should be further expanded.

Maternal Body Mass Index and Breastfeeding Non-Initiation and Cessation: A Quantitative Review of the Literature.

This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I2 = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I2 = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I2 = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I2 = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.

Maternal chronic disease and breastfeeding outcomes: a Canadian population-based study

Background The prevalence of chronic disease in pregnant women has consistently risen over the past two decades. Substantial evidence demonstrates that maternal chronic disease is associated with adverse medical outcomes like preterm birth, but less research has characterized postpartum outcomes such as infant feeding practices. It is recommended that infants be exclusively breastfed from birth to 6 months given the numerous health benefits it provides. Objective To determine the association between maternal chronic disease and breastfeeding outcomes. Methods We analyzed cross-sectional self-report data from the 2015/2016 Canadian Community Health Survey, restricted to women who gave birth within 2 years of data collection (n = 2100, rounded). The exposure was professionally diagnosed chronic physical disease (e.g. diabetes, arthritis, heart disease). The outcomes were breastfeeding non-initiation and early cessation of breastfeeding before 6 months. Multivariable logistic regression modeling was used to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CIs). Estimates were bootstrapped and weighted to represent the national population. Results Overall, 11.9% (95% CI 9.8–14.1) of women reported chronic disease, and were more likely to be single, be Canadian born, have low education, and be overweight/obese than women without chronic disease. The mean maternal age was approximately 30 years in both groups. Women with chronic disease had similar odds of breastfeeding non-initiation (AOR 0.96, 95% CI 0.54–1.71) and early cessation of any breastfeeding (AOR 1.40, 95% CI 0.82–2.40), but over twice the odds of early cessation of exclusive breastfeeding (AOR 2.48, 95% CI 1.49–4.12) compared to unaffected women. Conclusion Mothers with chronic disease initiate and continue some form of breastfeeding to six months as often as their unaffected peers. However, they have substantially higher odds of ceasing exclusive breastfeeding before the recommended 6 months. Findings suggest a need to investigate the reasons for this disparity to ensure that appropriate breastfeeding support is available for women with chronic disease and their children.

Determinants of suboptimal breastfeeding in Haryana - An analysis of national family health survey-4 data.

Infant and child feeding practices are a prevalent challenge in Haryana. The present study aimed to determine factors associated with non-initiation of breastfeeding within 1 h of birth, no exclusive breastfeeding (EBF) and no continued breastfeeding in Haryana. National Family Health Survey-4 data for the state of Haryana was used for analysis. The outcomes were non-initiation of breastfeeding within 1 h of birth, no EBF, and no continued breastfeeding. Independent variables were categorized as sociodemographic, maternal, and child level factors. Each category of factors was added step-by-step to the logistic regression model for multivariable analysis. Delayed initiation of breastfeeding was higher among poorer wealth quintiles. Home deliveries (adjusted odds ratio [AOR] = 1.90, 95% confidence interval [CI]-1.27-2.84), cesarean section (AOR = 2.22, 95% CI-1.46-3.40), body mass index (BMI) >25 kg/m2 (AOR = 1.62, 95% CI-1.13-2.33), and not receiving postnatal check-up (AOR 1.36, 95% CI-1.40-1.78) increases likelihood of delayed initiation of breastfeeding beyond 1 h of birth. Increased risk of non-EBF was associated with no postnatal check-ups and BMI >25 kg/m2. Risk of discontinuation of breastfeeding was significantly high with birth interval of <2 years (AOR = 1.52, 95% CI-1.08-2.14) and if babies did not receive postnatal check-up (AOR = 1.54, 95% CI-1.04-2.27). The study highlighted need for focused approach to counsel overweight/obese mothers, cesarean section, and home delivered mothers. Community awareness, adequate birth spacing, and postnatal visits are vital for improving exclusive and continued breastfeeding practices. Communities and health-care providers should provide adequate support to mothers for breastfeeding during the antenatal and postnatal periods.

Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study

Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation and continuation. We investigated breastfeeding among mothers by HIV status in South Africa, evaluating predictors of breastfeeding initiation and continuation to identify intervention-targets. Breastfeeding patterns were investigated in a subsample of 899 breastfeeding mothers from the Drakenstein Child Health Study; a prospective birth cohort of 1225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6weeks and 24months' infant age. Cox proportional hazard models evaluated breastfeeding initiation and duration. Logistic regression models with breastfeeding non-initiation as the outcome parameter were performed to determine associations with maternal sociodemographic, psychosocial factors and gestational outcomes. More HIV-uninfected mothers initiated breastfeeding (n=685, 97%) than HIV-infected mothers (n=87, 45%). Median duration of exclusive breastfeeding was short (2months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2months). Despite concerning high rates, mental disorders were not significant predictors of breastfeeding behaviour. Employment and HIV diagnosis during pregnancy predicted a lower likelihood of breastfeeding initiation among HIV-infected mothers, while employment was associated with earlier breastfeeding-discontinuation in HIV-uninfected mothers. Findings indicate that future interventions should target sub-populations such as HIV-infected women because of distinct needs. Workplace interventions appear particularly key for mothers in our study.

Association of Postpartum Predischarge Depot-Medroxyprogesterone Acetate with In-Hospital Breastfeeding Initiation.

The primary aim of this study was to examine the association between postpartum predischarge depot-medroxyprogesterone acetate (ppDMPA) and in-hospital breastfeeding initiation, and the secondary exploratory aim was to determine if any racial disparities are associated with ppDMPA receipt or its relationship to breastfeeding initiation. We conducted a cross-sectional retrospective chart review of maternal and newborn records at a large urban academic medical center. Variables extracted included in-hospital feeding choice, obstetrical and sociodemographic variables, infant characteristics, and ppDMPA receipt. The association of ppDMPA and maternal-child characteristics with breastfeeding initiation was examined using logistic regression analysis. Among singleton live births of 919 mother-infant pairs (76.5% African American [AA]), 67% initiated breastfeeding (34% exclusive and 33% mixed) and 31.4% received ppDMPA. Breastfeeding rates differed significantly between AA (60.7%) and non-AA mothers (86.6%), and ppDMPA also differed significantly between AA (37.6%) and non-AA mothers (11.6%). Adjusting for other independent predictors, mothers who received ppDMPA were 1.5 times more likely not to initiate breastfeeding if AA, and 5.2 times more likely not to initiate breastfeeding if non-AA. ppDMPA receipt was independently associated with decreased rates of breastfeeding initiation. Although more AA mothers received ppDMPA than non-AA, the association of ppDMPA with breastfeeding noninitiation was stronger in non-AA than in AA mothers. Future research should examine this question prospectively to ascertain if there is a cause-effect relationship and should address both physiological effects and social perceptions.

Association of missing paternal demographics on infant birth certificates with perinatal risk factors for childhood obesity.

BackgroundThe role of fathers in the development of obesity in their offspring remains poorly understood. We evaluated associations of missing paternal demographic information on birth certificates with perinatal risk factors for childhood obesity.MethodsData were from the Linked CENTURY Study, a database linking birth certificate and well-child visit data for 200,258 Massachusetts children from 1980–2008. We categorized participants based on the availability of paternal age, education, or race/ethnicity and maternal marital status on the birth certificate: (1) pregnancies missing paternal data; (2) pregnancies involving unmarried women with paternal data; and (3) pregnancies involving married women with paternal data. Using linear and logistic regression, we compared differences in smoking during pregnancy, gestational diabetes, birthweight, breastfeeding initiation, and ever recording a weight for length (WFL) ≥ the 95th percentile or crossing upwards ≥2 WFL percentiles between 0–24 months among the study groups.Results11,989 (6.0 %) birth certificates were missing paternal data; 31,323 (15.6 %) mothers were unmarried. In adjusted analyses, missing paternal data was associated with lower birthweight (β -0.07 kg; 95 % CI: −0.08, −0.05), smoking during pregnancy (AOR 4.40; 95 % CI: 3.97, 4.87), non-initiation of breastfeeding (AOR 0.39; 95 % CI: 0.36, 0.42), and with ever having a WFL ≥ 95th percentile (AOR 1.10; 95 % CI: 1.01, 1.20). Similar associations were noted for pregnancies involving unmarried women with paternal data, but differences were less pronounced.ConclusionsMissing paternal data on the birth certificate is associated with perinatal risk factors for childhood obesity. Efforts to understand and reduce obesity risk factors in early life may need to consider paternal factors.

Prevalence and Predictors of Early Breastfeeding Among Late Preterm Mother–Infant Dyads

Although late preterm infants (LPIs), at 34(0/7)-36(6/7) weeks of gestation, are reported to have suboptimal rates of breastfeeding, there is a lack of quantitative evidence describing this trend. This study examined the prevalence of breastfeeding initiation and factors associated with breastfeeding non-initiation within a Pennsylvania population-based cohort of late preterm mother-infant dyads. Descriptive statistics and odds ratios were used to assess and compare breastfeeding initiation rates in 2003-2009 among LPI mothers (n=62,451) and their infants (n=68,886) with moderately preterm (n=17,325) and term (n=870,034) infants. Binary logistic regression was used to determine the association of system/provider, sociodemographic, and medical factors with breastfeeding non-initiation in late preterm mother-infant dyads for the year 2009 (n=7,012). Although LPI breastfeeding initiation in Pennsylvania increased significantly from 2003 (54%) to 2009 (61.8%) (p<0.001), the 2009 prevalence remained well below rates in term infant populations and national standards. The regression model indicated that interactions involving sociodemographic variables, including marital status, age, race/ethnicity, education, parity, Women, Infants and Children Program participation, and smoking status were among the most significant factors associated with LPI breastfeeding non-initiation (p<0.05). The univariate results were similar to those reported in preterm and term populations. Our data suggest that certain, unexpected demographic groups in the late preterm population be prioritized for further analysis and possibly greater breastfeeding support. More research is indicated to understand the effect of modifiable psychosocial factors on LPI breastfeeding initiation.

In the HIV era, is breast always best? Response to ‘Long-term infant health outcomes critical in feeding decisions by HIV-positive mothers’ by Crowe et al.

We thank Drs Crowe and colleagues for their comments. The authors state that our paper claims that ‘formula feeding is better than breastfeeding for infants of HIV-positive mothers in less developed countries’ because ‘babies of mothers who chose to formula feed because of preceding morbidity in either mother or infant had lower mortality rates than babies of mothers who chose to formula feed for other reasons'. This is incorrect, we clearly showed that mortality associated with formula feeding as a result of preceding morbidity is higher than formula feeding for voluntary reasons. We repeatedly reported higher child mortality rates in children who were never breastfed, compared with children who had been weaned. Our fundamental point is that the reason for not breastfeeding or weaning is important because mortality was consistently higher among children who were never breastfed or were weaned because of a preceding illness. There is clear evidence of reverse causality, whereby pre-existing morbidity may cause mothers not to breastfeed or to wean, and the resultant higher mortality risk arises from the preceding illness, rather than the mode of feeding per se. Such self-selection and reverse causality is also evident in other studies. The authors also suggested confusion as a result of conflation between previous infant with maternal illness, and a combination of data across countries at different levels of development and healthcare access. The majority of reasons for not breastfeeding or weaning were a result of the child's preceding illness. Omitting cases of maternal illness did not change our findings. The country-specific estimates demonstrated similar patterns, and were therefore combined to get an aggregate measure. They suggest that we disaggregate the excess mortality into components such as health access, as well as formula-related risks. Unfortunately, the DHHS survey data do not provide this information and we have stated this as a limitation of the study. However, it is striking that the findings were consistent in all countries examined, which indicates a consistent effect, irrespective of the level of development or healthcare. They also suggest that maternal immune status, micronutrient deficiencies and maternal symptomatology could increase the risk to the infant via maternal morbidity. We cannot speculate on this question because no data are available. They also recommend that we differentiate between exclusive and partial breastfeeding, but again, DHHS data are not available to address this issue. The authors also question whether our findings can be applied to children of HIV-infected mothers who voluntarily decide not to breastfeed. We suggest that counselling HIV-positive mothers on methods of feeding should recognize that current child mortality estimates for non-breastfeeding are biased overestimates, because they do not adjust for the reverse causality described above. Although breastfeeding results in lower infant and child mortality rates than formula feeding in non-HIV-infected women, this risk/benefit is reversed with HIV because of the high rates of mother-to-child HIV transmission via breast milk. Although we agree with the authors that a more specific definition of breastfeeding (i.e. mixed or exclusive) is important, this information is not available in cross-sectional surveys such as the DHHS and we suggest that prospective studies are needed on methods of feeding and reasons for weaning or the non-initiation of breastfeeding. Finally, it is argued that it is invalid to compare rates of HIV infection, which have long-term consequences for survival with the possible adverse effects of formula feeding, which are likely to be short term. We profoundly disagree with this view. The median survival time of HIV-infected children in Rakai, Uganda, is 2 years [1]. In the absence of antiretroviral therapy, all pediatric HIV infections are likely to be fatal. Given the high rates of mother-to-child transmission via breast milk, and the unconfirmed efficacy of exclusive breastfeeding for the prevention of mother-to-child transmission, based on one observational study [2], we believe that it is only reasonable to offer women the alternative of not breastfeeding in order to select the safest method for feeding infants.

What influences the uptake and early cessation of breast feeding?

Objective: to examine obstetric, maternal and social factors associated with the uptake and early cessation of breast feeding and women's reasons for altering from breast to bottle feeding. Design: women who responded to a postal questionnaire on long-term postpartum health were contacted and asked to participate in a home-based interview. In addition to health problems, the interview obtained information on baby feeding and a number of social factors. Women were also asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and maternal data were obtained from maternity records. Setting: deliveries from a large maternity hospital in Birmingham. Participants: 906 women were interviewed at a mean of 45 weeks after delivery. Findings: 63% of the women said they had breast fed, but 40% of these stopped within three months of delivery. Many of the women gave physical problems with lactation as reasons for stopping. The factors found to be predictors of early cessation were: return to work within three months of birth; regular childcare support from other female relatives, and a high EPDS score. Non-initiation of breast feeding was predicted by a different set of factors: multiparity; general anaesthetic (GA); and unmarried status. Discussion and conclusion: despite evidence of the benefits of breast feeding, this remains an unacceptable long-term option for many women, and for over one-third it is never attempted. Factors within the woman's social environment were found to influence early cessation. Women who had a GA during or immediately following labour and delivery were less likely to initiate breast feeding. Implications for practice: if breast-feeding incidence and duration are to increase, more attention should be paid to establishing early, successful breast feeding and countering the negative influences of factors within the social environment.