Odds Of Exclusive Breastfeeding Research Articles

Associated factors of breastfeeding practices among mothers in rural Vietnam: A community-based study

PurposeTo examine the factors associated with the early initiation of breastfeeding and exclusive breastfeeding among mothers in Vietnam during the first 6 months postpartum. Design and methodsA cross-sectional study including 200 mother-infant dyads was conducted at community health stations. Information on demographic characteristics, modes of delivery, infant sleep problems, and breastfeeding practices was collected using structured questionnaires. The main independent variable of social support was assessed using the Multidimensional Scale of Perceived Social Support. Multivariable logistic regression analysis was used. ResultsAmong the study cohort, 37.5% of mothers had initiated breastfeeding within 1 h after birth, and 27.5% continued exclusive breastfeeding for the first 6 months postpartum. Mothers living in urban areas or who had undergone cesarean delivery were less likely to have initiated breastfeeding within 1 h after birth (p < 0.05). The odds of exclusive breastfeeding were lower among infants with longer waking hours at night (≥4 h) and sleep problems (p < 0.05). Support from the mother's significant other and friends was significantly associated with exclusive breastfeeding (p < 0.05). ConclusionsEarly initiation of breastfeeding and exclusive breastfeeding were not common in a community sample of Vietnamese mothers. Identifying and assessing mothers who lack breastfeeding support is necessary to promote and sustain breastfeeding practices. Practice implicationFurther comprehensive breastfeeding interventions and support are needed for postpartum women in Vietnam.

How do high ambient temperatures affect infant feeding practices? A prospective cohort study of postpartum women in Bobo-Dioulasso, Burkina Faso

ObjectiveTo examine the effects of high ambient temperature on infant feeding practices and childcare.DesignSecondary analysis of quantitative data from a prospective cohort study.SettingCommunity-based interviews in the commune of Bobo-Dioulasso, Burkina...

Prevalence of early skin-to-skin contact and its impact on exclusive breastfeeding during the maternity hospitalization

BackgroundEarly essential newborn care has been implemented in countries regardless high or low neonatal mortality. This study aims to investigate the current practice of skin-to-skin contact (SSC) and its effect on exclusive breastfeeding during the hospital stay.MethodsThis is a cross-sectional study of 1812 Vietnamese mothers in multicenter. A questionnaire answered by the mothers was used to assess the duration of both SSC and breastfeeding practices. Multivariable logistic regression was used to identify a dose–response relationship between early SSC and prevalence of exclusive breastfeeding in hospital.ResultsThere were 88.7% of mothers experiencing SSC with their infants right after birth and the highest prevalence of SSC was found in district hospitals. Among those experiencing SSC, 18.8% of the infants received more than 90 min of SSC and completed the first breastfeeding during SSC time. Prevalence of exclusive breastfeeding during maternity hospital stay was 46.7%. We found a significant dose–response relation between the duration of SSC and exclusive breastfeeding in hospital. Compared with infants without SSC, the prevalence of exclusive breastfeeding was higher in infants who experienced SSC for 15–90 min (adjusted odds ratio [aOR], 95% confidence interval [95%-CI]: 2.62 [1.61–4.27]) and more than 90 min (aOR [95%-CI]: 5.98 [3.48–10.28]). Completed first breastfeeding during SSC time (aOR [95%-CI]: 4.24 [3.28–5.47]) and being born in district hospitals (aOR [95%-CI]: 2.35 [1.79–3.09]) were associated with increased prevalence of exclusive breastfeeding during hospital stay. On the other hand, mother education level as high school/intermediate (aOR [95%-CI]: 0.58 [0.42–0.82]) and place of residence classified as rural decreased odds of exclusive breastfeeding in hospital (aOR [95%-CI]: 0.78 [0.61–0.99]).ConclusionOur results demonstrate a strong dose–response relationship between duration of SSC and exclusive breastfeeding in hospital. Interventions that support exclusive breastfeeding during hospital stay, especially achieving prolonged uninterrupted SSC, could improve the duration of breastfeeding.

The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study

BackgroundThe use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth.MethodsThis was a population-based cohort study of singleton livebirths at ≥37 weeks’ gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed.ResultsIn total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86–0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome.ConclusionCommon intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.

Breastfeeding and complementary feeding in fragile settings: the case of Syrian refugees and their host communities in North Lebanon

BackgroundAdequate breastfeeding and complementary feeding practices are paramount in fragile situations where access to food and healthcare is limited. The objectives of this study are to examine breastfeeding and complementary feeding practices among Syrian refugees and their Lebanese host communities and to investigate the correlates of exclusive breastfeeding (EBF) at four and 6 months in these communities.MethodsUsing two-stage stratified sampling, a cross-sectional survey was conducted in Akkar, a region with a high density of Syrian refugees in Lebanon, between April and November 2019. In one-to-one interviews, mothers of children (6–24 months) completed a questionnaire including specific questions about breastfeeding and complementary feeding practices, a 24-h recall, and socio-demographic characteristics for 189 Syrian refugees and 182 Lebanese host community households. Descriptive statistics, simple and multiple logistic regression were used in data analysis.ResultsAmong breastfeeding practices, ever-breastfeeding was most prevalent (90%), followed by early initiation of breastfeeding (64.8%), EBF at four (49.6%), and six (36%) months. One in four children was introduced to solids before 6 months of age, and less than a third was given iron-fortified baby cereals as the first complementary foods. Only 24.4% and 9.2% of children met the minimum dietary diversity and minimum acceptable diet requirements, respectively. Compared to children of the Lebanese host communities, those of Syrian refugees had higher rates of EBF at four and 6 months as well as continued breastfeeding at 1 year, whereas only 17.9% of Syrian refugees’ children met minimum dietary diversity compared to 30.9% of Lebanese host community children (p < 0.05). Among refugees, education and spouse’s employment status were associated with higher odds of EBF at 4 months. As for Lebanese households, female children were less likely to be exclusively breastfed at 4 months and 6 months, while a natural delivery increased the odds of EBF at 6 months.ConclusionBreastfeeding and complementary feeding practices are suboptimal among children of Syrian refugees and their Lebanese host communities in North Lebanon. There is a need for intervention strategies to tackle gaps in services and assistance delivery programs to enhance infant and young child feeding practices among both communities.

Promotion of early and exclusive breastfeeding in neonatal care units in rural Rwanda: a pre- and post-intervention study

BackgroundEarly initiation of breastfeeding after birth and exclusive breastfeeding for the first six months improves child survival, nutrition and health outcomes. However, only 42% of newborns worldwide are breastfed within the first hour of life. Small and sick newborns are at greater risk of not receiving breastmilk and often require additional support for feeding. This study compares breastfeeding practices in Rwandan neonatal care units (NCUs) before and after the implementation of a package of interventions aimed to improve breastfeeding.MethodsThis pre-post intervention study was conducted at two district hospital NCUs in rural Rwanda from October–December 2017 (pre-intervention) and September 2018–March 2019 (post-intervention). Only newborns admitted before their second day of life (DOL) were included. Data were extracted from patient charts for clinical and demographic characteristics, feeding, and patient outcomes. Exclusive breastfeeding at discharge was based on last recorded infant feeding on the day of discharge. Logistic regression analysis was used to evaluate factors associated with exclusive breastfeeding at discharge.ResultsPre-intervention, 255 newborns were admitted in the NCUs and 793 were admitted in post-intervention. Exclusive breastfeeding on the day of birth (DOL0) increased from 5.4% (12/255) to 35.9% (249/793). At discharge, exclusive breastfeeding increased from 69.6% (149/214) to 87.0% (618/710). The mortality rate decreased from 16.1% (41/255) to 10.5% (83/793). Factors associated with greater odds of exclusive breastfeeding at discharge included admission during the post-intervention period (aOR 4.91; 95% CI 1.99, 12.11), and admission for infection (aOR 2.99; 95% CI 1.13, 7.93). Home deliveries (aOR 0.15; 95% CI 0.05, 0.47), preterm delivery (aOR 0.36; 95% CI 0.15, 0.87) and delayed first breastmilk feed (aOR 0.04 for DOL3 vs. DOL0; 95% CI 0.01, 0.35) reduced odds of exclusive breastfeeding at discharge.ConclusionsExpansion and adoption of evidenced-based guidelines, using innovative approaches, aimed at the unique needs of small and sick newborns may help to improve earlier initiation of breastfeeding, decrease mortality, and improve exclusive breastfeeding on discharge from hospital among small and sick newborns. These interventions should be replicated in similar settings to determine their effectiveness.

Association between skin-to-skin contact post-birth and breastfeeding behaviour: a cross-sectional study of Nigerian women using the 2018 Demographic Health Survey

Background The World Health Organisation (WHO) recommends skin-to-skin contact at birth as part of the essential newborn care processes that can help improve breastfeeding behaviours in new mothers. In 2019 Nigeria had the highest number of infant mortalities (270,000 infant deaths), second only to India (522,000 infant deaths). Consequently, the possible benefits of skin-to-skin contact and healthy breastfeeding behaviours to both mother and child cannot be overemphasised. This study seeks to understand the rate of skin-to-skin contact post-birth and how this affects early breastfeeding initiation, breastfeeding duration, and exclusive breastfeeding among Nigerian women. It also seeks to understand if the place of delivery or internet access affects the associations between skin-to-skin contact and breastfeeding behaviours. Methods Data from the Demographic and Health Survey (2018) on Nigerian women were analyzed, and 19,328 women were included in this study. The association between skin-to-skin contact post-birth (independent variable) and breastfeeding initiation, exclusive breastfeeding, and breastfeeding duration (dependent variables) were analyzed with multivariable logistic regression models adjusted for known confounders. The modifying effects of place of delivery and internet use were also assessed. Results Nearly 13% of Nigerian women experienced skin-to-skin contact post-birth. The odds of exclusive breastfeeding were higher for women who experienced skin-to-skin contact with their newborns, compared to those that did not (odds ratio, OR=1.24, 95% confidence interval, CI=1.13-1.36). Conversely, the odds of initiating breastfeeding within the first hour of birth (OR=0.87, 95% CI=0.79-0.96) were lower in women who experienced skin-to-skin contact post-birth. There was no association between skin-to-skin contact and breastfeeding duration. Delivering their baby in private hospitals modified the association between skin-to-skin contact and early breastfeeding initiation (OR=3.27, 95% CI=2.33-4.60, P&lt;0.001), as well as the association between skin-to-skin contact and breastfeeding duration (OR=1.56, 95% CI=1.14-2.15, P=0.008) more strongly than delivering their baby in public hospitals. Conclusions In Nigerian women, skin-to-skin contact post-birth is associated with some breastfeeding behaviours (early initiation and exclusive breastfeeding). However, associations between skin-to-skin contact and breastfeeding behaviours of early breastfeeding initiation and breastfeeding duration may be modified by the place of delivery. Therefore, health interventions to increase skin-to-skin contact practices should target skilled health providers, particularly in public hospitals.

Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study

BackgroundDespite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors.MethodsUsing a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes.ResultsAlmost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum.ConclusionThis study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.

Effectiveness of peer counseling and membership in breastfeeding support groups in promoting optimal breastfeeding behaviors in the Philippines

BackgroundThe prevalence of early initiation of breastfeeding and exclusive breastfeeding (EBF) at 6 months remain low in the Philippines. To help meet the 90% early initiation of breastfeeding target and to improve infant and young child feeding practices in the Philippines, the Millennium Development Goals - Fund 2030 Joint Programme (JP) on Ensuring Food Security and Nutrition for Children 0–24 months old was implemented. We aimed to determine the effectiveness of visits by peer counselors during pregnancy and after delivery, and membership in breastfeeding support groups in promoting these optimal breastfeeding practices.MethodsWe used data from the Endline Survey of the JP to study the effects of prenatal and postnatal peer counselor visits, and membership in breastfeeding support groups, and their possible interactions with initiation of breastfeeding within 1 hour of birth among children aged 0 to 24 months and EBF at 6 months among children aged 6 to 24 months, while adjusting for confounding. We used logistic regression methods for survey data to assess these associations.ResultsOf the 2343 mother-infant pairs, only 1500 (63.1%) practiced early initiation of breastfeeding. Of the 1865 children aged 6 months or older, only 621 (34.7%) were exclusively breastfed at 6 months. After adjusting for confounding variables, there was no strong evidence that peer counselor visits were associated with early initiation or EBF at 6 months. However, members of breastfeeding support groups had 1.49 times higher odds of early initiation of breastfeeding (95% CI [Confidence Interval] 1.12, 1.98) and 1.65 times higher odds of EBF (95% CI 1.20, 2.24) compared to those who were not members of breastfeeding support groups. There was no interaction between the different exposure variables and early initiation and EBF at 6 months.ConclusionsOur findings suggest breastfeeding support groups may be institutionalized to promote both early initiation of breastfeeding and EBF in the Philippines, while the role of peer counselors in promoting optimal breastfeeding behaviors should be further reviewed. Our suggestion to integrate non-healthcare professionals to promote early initiation of breastfeeding and EBF could be tested in future intervention studies.

Social Support, Maternal Agency, Postnatal Depression, and Domestic Violence Influence the Formal Employment-Exclusive Breastfeeding Relationship: Evidence From Kenya

ObjectivesWe previously demonstrated that formal employment among mothers in Kenya is associated with a lower prevalence and odds of exclusive breastfeeding (EBF). This study evaluated the influence of maternal social support, agency, postnatal depression, and domestic violence on the association between formal employment and EBF in Naivasha, Kenya, where many women work in agricultural labor. MethodsUsing cross-sectional data (n = 1,186), we examined validated scales of social support, agency, domestic violence, and postnatal depression as effect modifiers in adjusted, stratified models of the association between employment and EBF. We hypothesized that higher social support and agency would attenuate the odds ratios that evaluated employment and EBF, and domestic violence and depression would further decrease the odds of EBF based on employment. ResultsComparing formally employed to non-formally employed mothers, women with higher social support were more likely to practice EBF at 14 weeks: OR high (95%CI) = 0.22 (0.09, 0.51) and OR low = 0.12 (0.05, 0.29). The same trend was observed at 24 weeks. Among mothers with higher maternal agency compared to those with lower agency, the negative association between formal and EBF was decreased at both 14 weeks [OR high = 0.21 (0.09, 0.47) versus OR low = 0.16 (0.06, 0.44)] and 24 weeks. Comparing mothers who reported experiencing domestic violence to those who had not, the negative association between formal and EBF was increased at both 14 weeks [OR = 0.06 (0.01, 0.31) versus OR No violence = 0.18 (0.09, 0.36)] and 24 weeks. At 14 weeks, mothers with depression decreased the association between employment and EBF: [OR dep = 0.11 (0.03,0.45) versus OR no depression = 0.16 (0.08, 0.33). At 24 weeks, the employment-EBF relationship was non-significant among mothers with depression: [OR dep = 0.31 (0.08, 1.30) but remained significant among mothers without depression: OR no dep = 0.22 (0.12, 0.40). ConclusionsAmong formally employed mothers, maternal social support and agency improve the employment-breastfeeding relationship, while women exposed to domestic violence or postnatal depression experienced a further decrease in the likelihood of EBF. Supportive interventions to improve EBF and other maternal health factors are needed in the postpartum period for employed mothers. Funding SourcesNIH Fogarty International Center

Prevalence and Determinants of Early Initiation (EI), Exclusive Breastfeeding (EBF), and Prelacteal Feeding among Children Aged 0-24 Months in Slums of Pune City, in Maharashtra

ABSTRACT Infant and young child feeding practices remain a public health challenge in India. We determined the socio-demographic risk factors for early initiation, exclusive breastfeeding and prelacteal feeding in the urban slums of Pune city. A cross sectional survey of mother (N=1443) children (< 2 years) dyads was performed. Socio-demographic, maternal and child characteristics were recorded. Breastfeeding practices were assessed using WHO indicators. Multiple logistic regression was employed to model associations between socio-demographic factors and breastfeeding indicators. Early initiation was reported by 45.2%, prelacteal feeding by 37.5% and exclusive breastfeeding by 23.7%. Caesarean delivery decreased the odds of early initiation (AOR: 0.403; 95% CI; 0.303.-0.536) and exclusive breastfeeding (OR: 0.675; 95% CI: 0. 478-0.953), while it increased the odds of prelacteal feeding (AOR: 3.525; 95% CI: 2.653-4.683). Delivery in a public health care facility increased the odds of early initiation (AOR: 1.439; 95% CI: 1.095-1.891) and exclusive breastfeeding (OR: 0.514; 95% CI: 0.366-0.720), while it decreased the odds of prelacteal feeding (AOR: 0.421; 95% CI: 0.318-0.559). Odds of early initiation decreased significantly in very low-birth-weight (AOR: 0.209; CI: 0.76-0.567) whereas, it increased odds of prelacteal feeding (AOR: 1.389; 95% CI: 0.640-3.019), (AOR: 0.483; 95% CI: 0.262-0.889). Religion other than Hindu or Muslim, age of the mother between 26-30 years increased the odds of exclusive breastfeeding and parity <2 increased the odds of prelacteal feeding. Interventions that address setting specific determinants, focusing on local contexts are essential to improve child feeding practices in urban slums.

Effects of Delayed Newborn Bathing on Breastfeeding, Hypothermia, and Hypoglycemia

ObjectiveTo determine whether delaying the newborn bath by 24 hours increases the prevalence of breastfeeding initiation and exclusive breastfeeding at discharge in healthy full-term and late preterm newborns (34 0/7–36 6/7 weeks gestation) and to examine the effect of delayed newborn bathing on the incidences of hypothermia and hypoglycemia. DesignPre–post implementation, retrospective, cohort study. SettingProvincial children’s hospital with an average of 2,500 births per year. ParticipantsHealthy newborns (N = 1,225) born at 34 0/7 weeks or more gestation who were admitted to the mother–baby unit. MethodsWe compared newborns who were bathed before 24 hours (n = 680, preimplementation group) to newborns who were bathed after 24 hours (n = 545, postimplementation group). ResultsAfter adjustment for confounders, the odds of exclusive breastfeeding at discharge were 33% greater in the postimplementation group than in the preimplementation group (adjusted odds ratio = 1.334; 95% confidence interval [1.049,1.698]; p = .019). Delayed bathing was associated with decreased incidence of hypothermia and hypoglycemia (p = .007 and p = .003, respectively). We observed no difference in breastfeeding initiation between groups. ConclusionDelaying the newborn bath for 24 hours was associated with an increased likelihood of exclusive breastfeeding at discharge and a decreased incidence of hypothermia and hypoglycemia in healthy newborns. The implementation of a delayed bathing policy has the potential to improve breastfeeding rates and reduce the incidence of hypothermia and hypoglycemia.

Breastfeeding Practices of Ethnic Minorities in China: A Population-Based Cross-Sectional Study of 10,408 Mothers

Heterogeneous characteristics of Chinese ethnic groups and their acculturation might contribute to different breastfeeding patterns. This study aimed to explore the breastfeeding practices of ethnic minorities in China considering migration and acculturation. We included 10,408 mothers from a population-based study in China. Ethnic minority was defined as ethnics other than Han. Logistic regression and adjusted prevalence were employed to analyze the association between ethnicity and breastfeeding outcomes. Both Minority group (where both parents were ethnic minorities) had a higher odds of exclusive breastfeeding and predominant breastfeeding. After stratification, this significantly higher odds of exclusive breastfeeding was solely observed among local mothers (those who never immigrated). Husbands caring for mothers “sitting the month”, which could contribute to exclusive breastfeeding, was more common among local Both Minority group. Parental ethnicities and their acculturation could influence breastfeeding practices in China. Interventions should consider ethnic differences as well as acculturation.

Early Term Delivery and Breastfeeding Outcomes.

Higher rates of adverse outcomes have been reported for early term (37 0 to 38 6weeks) versus full term (≥ 39 0weeks) infants, but differences in breastfeeding outcomes have not been systematically evaluated. This study examined breastfeeding initiation and exclusivity in early and full term infants in a large US based sample. This secondary analysis included 743 geographically- and racially-diverse women from the Measurement of Maternal Stress Study cohort, and 295 women from a quality assessment at a hospital-based clinic in Evanston, IL. Only subjects delivering ≥ 37weeks were included. Initiation of breastfeeding (IBF) and exclusive breastfeeding (EBF) were assessed via electronic medical record review after discharge. Associations of IBF and EBF with early and full term delivery were assessed via univariate and multivariate logistic regression. Among 872 women eligible for inclusion, 85.7% IBF and 44.0% EBF. Early term delivery was not associated with any difference in frequency of IBF (p = 0.43), but was associated with significantly lower odds of EBF (unadjusted OR 0.61, 95% CI 0.466, 0.803, p < 0.001). This association remained significant (adjusted OR 0.694, 95% CI 0.515, 0.935, p = 0.016) after adjusting for maternal diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal age, race/ethnicity, parity, Medicaid status, NICU admission, current smoking, and delivery hospital. Despite comparable breastfeeding initiation frequencies, early term infants were significantly less likely to be exclusively breastfed compared to full term infants. These data suggest that women with early term infants may benefit from counseling regarding the potential for breastfeeding difficulties as well as additional breastfeeding support after delivery.

577: Gestational weight gain and initiation and duration of breastfeeding among women with class III obesity

Obese women stand to benefit the most from breastfeeding. Prior studies found an association between maternal obesity, delayed lactogenesis, and shorter duration of breastfeeding. We sought to understand the impact of excessive gestational weight gain (GWG), defined greater than IOM guidelines (>20lbs), on the initiation and duration of breastfeeding in women with class III obesity. Retrospective cohort of women with baseline BMI ≥40 (class III obesity) in the first trimester delivering a singleton term infant at a tertiary care center between 7/2013-7/2017. Pregnancies excluded for preterm delivery, multiple gestation, fetal anomalies, and when postpartum feeding information was unknown. The primary outcome was exclusive breastfeeding at discharge and at the time of 4-6 week postpartum visit. Secondary outcomes included any breastfeeding at discharge and postpartum visit and cessation of breastfeeding by the postpartum visit. Descriptive statistics used to compare women who gained more than IOM guidelines (mIOM) to those who gained <20 lbs (lIOM). Regression models performed to adjust for confounding factors. Of 298 women included in this study, 120 (40.27%) were in the mIOM arm. Women who gained mIOM were less likely to be multiparous and more likely to have a higher delivery BMI, greater delivery blood loss (EBL), and more likely to have a neonate admitted to the NICU (Table 1). Exclusive breastfeeding at hospital discharge was not different between mIOM and lIOM women (58.05% v 41.95%, p=0.45). Nor did gaining mIOM impact likelihood of exclusive breastfeeding at postpartum visit (63.64% v 36.36%, p=0.33) (Table2). When controlling for NICU admission, parity, and EBL, the odds of exclusive breastfeeding at hospital discharge did not differ between women who gained mIOM compared to lIOM (AOR 1.2, 95% CI 0.76, 2.16), nor did breastfeeding rates at postpartum visit (AOR 0.79, 95% CI 0.48, 1.32). Among women with class III obesity, exclusive breastfeeding rates were high at both discharge and postpartum visit, and excessive gestational weight gain did not appear to impact this rate.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Factors That Modify the Association of Maternal Postpartum Smoking and Exclusive Breastfeeding Rates.

Maternal postpartum smoking increases the risk for poor infant health outcomes, while exclusive breastfeeding has been shown to support infant health. Limited population-based research has been published on the interaction between maternal smoking and exclusive breastfeeding. The objective of this study was to examine factors modifying the association between maternal postpartum smoking and exclusive breastfeeding among women in the United States. Secondary data analysis was conducted using the 2009-2011 Pregnancy Risk Assessment Monitoring System. Stratified analyses were used to examine the associations between maternal postpartum smoking and exclusive breastfeeding by sociodemographic factors. The postpartum smoking rate was 17.1%. The relationship between postpartum smoking and exclusive breastfeeding at 12 weeks varied by maternal education level, race/ethnicity, Medicaid use, and pregestational or gestational diabetes. The magnitude of reduction in the odds of exclusive breastfeeding at 12 weeks postpartum among the women who smoked in the postpartum period ranges from odds ratio (95% confidence interval) 0.52 (0.37-0.74) for non-Hispanic blacks to 0.31 (0.22-0.43) for women who had <12 years of education. Women who smoked in the postpartum period, who also suffered from socioeconomic disadvantages, had a higher likelihood of not continuing exclusive breastfeeding. Identification of women at high risk for not exclusively breastfeeding is important for targeting populations in need of appropriate and timely support for prenatal and postpartum smoking cessation and breastfeeding promotion.

Does Caesarean Section Affect Breastfeeding Practices in China? A Systematic Review and Meta-Analysis

Objectives To ascertain the association between caesarean delivery and breastfeeding practices in China. Methods We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Electronic databases of CNKI, Medline, EMBASE, CINAHL, ProQuest and Science Direct were searched and screened to identify relevant articles from January 1990 to June 2015. Both fixed and random effect meta-analysis techniques were used to estimate the pooled effect size between caesarean delivery and breastfeeding outcomes at different time points. Sensitivity analysis and publication bias test were also conducted. Results Forty six studies were eligible for the qualitative synthesis of systematic review; among them, 27 studies were included for the meta-analysis. At the early postpartum period, the odds of exclusive breastfeeding after caesarean section was 47% (pooled OR 0.53, 95% CI 0.41, 0.68) lower than that after vaginal delivery. At 4 months postpartum, the odds of breastfeeding was similarly lower (pooled OR 0.61, 95% CI 0.53, 0.71) for caesarean mothers. Substantial heterogeneity among studies was detected for both breastfeeding outcomes. Subgroup analyses stratified by study design, time points of breastfeeding outcomes and definitions of breastfeeding all confirmed the negative association between caesarean section and breastfeeding prevalence. Conclusions In China, breastfeeding practices were affected adversely by caesarean delivery. Therefore, health policy to improve breastfeeding outcomes should take this into consideration.

Association Between Type of Health Professional at Birth and Exclusive Breastfeeding.

Although benefits of breastfeeding for infants, women, and society are well established, breastfeeding rates in the United States remain below the Healthy People 2020 goals. Various factors are known to influence breastfeeding practices. Limited research has been conducted to examine the influence of type of birth attendant on exclusive breastfeeding. A cross-sectional analysis was conducted using data from the Infant Feeding Practices Study II collected between May 2005 and June 2007. The study sample included 2026 women, aged 18 years or older. At discharge, 74.6% of women exclusively breastfed, and 27.6% exclusively breastfed at 3 months postpartum. Bivariate analysis showed a statistically significant association between type of health professional at birth and exclusive breastfeeding at discharge (P = .001) and 3 months postpartum (P < .001). After adjusting for potential confounders, the association between type of health professional at birth and exclusive breastfeeding at discharge was no longer significant. However, the odds of exclusive breastfeeding at 3 months postpartum were higher among women whose birth was attended by a midwife or nurse-midwife compared to those whose birth was attended by an obstetrician (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.34-2.61; P < .001). Exclusive breastfeeding continuation may be influenced by the type of health professional attending the birth. In addition to having a skilled workforce, health care professionals involved in perinatal care need to be educated and trained to promote and support exclusive breastfeeding as recommended. The complex and multifactorial nature of the maternal decision to exclusively breastfeed requires broader understanding of contextual factors.

Exclusive breastfeeding and associated factors among mothers in Gozamin district, northwest Ethiopia: a community based cross-sectional study

BackgroundExclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, except drops or syrups consisting of vitamins, mineral supplements or medicine. Exclusive breastfeeding is one of the essential actions for infant development and survival. However, the prevalence of exclusive breastfeeding in Ethiopia has been estimated at 52% which is far less than the World Health Organization (WHO) recommendations. Moreover, there are inconsistencies among estimates in different districts of the country. Therefore, this study aimed to assess the prevalence and associated factors of exclusive breastfeeding among mothers in Gozamin district, northwest Ethiopia.MethodsUsing the simple random sampling technique, seven kebeles (lowest administrative units) were selected as the primary sampling unit of the district. Sample mother-infant pairs were then selected using the systematic random sampling technique that involved our moving from house to house in each village. Data were collected from 506 mother-infant pairs using interviews. Factors associated with exclusive breastfeeding were determined using logistic regression. The measure of association used was the odds ratio, and statistical tests with p-values of less than 0.05 were considered as statistically significant.ResultsIn this study, the prevalence of exclusive breastfeeding among mothers was 74.1% (95% CI 70.80, 79.10). For government employee mothers, the odds of exclusive breastfeeding were reduced by half compared to housewives (AOR 0.49, 95% CI 0.26, 0.94). Mothers who did not receive breastfeeding counseling after delivery were 0.43 times less likely to practice exclusive breastfeeding compared with mothers who received the services (AOR 0.43, 95% CI 0.25, 0.72). Mothers who gave birth at health institutions were more likely to practice exclusive breastfeeding.ConclusionEven though the estimated prevalence is relatively high, more effort to meet WHO recommendations is still necessary. Therefore, we suggest health institutions encourage hospital birthing and increase breastfeeding counseling after delivery, and employers needs to give longer maternity leave to improve exclusive breastfeeding practice.

Association Between WIC Enrollment and Exclusive Breastfeeding at 3 Months Postpartum Among Low-Income Mothers.

Existing literature suggests participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the prenatal and postnatal periods is associated with lower rates of breastfeeding among WIC-eligible mothers. However, minimal research has been published on the association between WIC enrollment and exclusive breastfeeding. To examine the association between WIC exposure and exclusive breastfeeding at 3 months postpartum. We conducted a secondary data analysis using information on 784 low-income women who participated in the longitudinal population-based Infant Feeding Practices Study II between May 2005 and June 2007. The main outcome of interest was exclusive breastfeeding at 3 months postpartum. Logistic regression analysis was used to estimate OR and 95% CI for exclusive breastfeeding relative to WIC enrollment status, controlling for the confounding effects of other maternal characteristics. We further conducted a subgroup analysis among those participating in WIC prenatally to examine the association between receipt of information about infant feeding from WIC and exclusive breastfeeding at 3 months postpartum. The crude prevalence of exclusive breastfeeding at 3 months postpartum was 18.1% of women enrolled in WIC and 41.1% of WIC-eligible nonparticipants (P<.0001). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding at 3 months were lower for women enrolled in WIC (OR, 0.57; 95% CI, 0.37-0.88) when compared with women not enrolled in WIC. In the subgroup analysis, receipt of information from WIC about feeding infants during the prenatal period was not significantly associated with exclusive breastfeeding at 3 months (OR, 0.86; 95% CI, 0.39-1.89). Women who were enrolled in WIC and who received information about feeding infants were less likely to exclusively breastfeed than women not in WIC. Continued improvement and adjustment to the existing WIC breastfeeding program could potentially improve these rates. Additional studies that examine the quality of WIC services provided, especially those pertaining to breastfeeding programs, are warranted.