Risk Of Breastfeeding Cessation Research Articles

Comparing factors associated with overall satisfaction for different forms of remote breastfeeding support in the UK

BackgroundRemote forms of breastfeeding support, such as helplines and social media, offer a flexible and convenient form of support to offer help at critical points, e.g., when the risk of breastfeeding cessation is high. Currently, there is little known about who accesses different forms of remote breastfeeding support and what factors impact overall satisfaction. As part of an evaluation of the UK National Breastfeeding Helpline (NBH) (which offers breastfeeding support via a helpline and online media), we aimed to (a) understand who accesses different forms of NBH support, and (b) identify key factors associated with overall satisfaction for helpline and online media support.MethodsAll service users who contacted the NBH between November 2021 and March 2022 were invited to participate in the evaluation via an online survey. Survey questions explored the type and timing of support, reasons for the contact, attitudes towards the help and support received, impact of the support on breastfeeding experiences and demographic factors. Chi-squared and Mann–Whitney tests explored variations in who accessed the helpline or online media. Multiple linear regression models were fitted to explore the factors related to the service users’ ‘overall satisfaction’. The quantitive data were combined with qualitative comments into descriptive themes.ResultsOverall, online media users were significantly more likely to be younger, White, multiparous, less educated and have English as a first language compared to those who contact the helpline. Similar factors that significantly influenced overall satisfaction for both support models were the service being easy to access, receiving helpful information that met expectations, resolving breastfeeding issues, and feeling reassured and more confident. Significant factors for the helpline were callers feeling understood and more knowledgeable about breastfeeding following the call, being able to put into practice the information provided, feeling encouraged to continue breastfeeding, feeling that the volunteer gave the support that was needed, and seeking out additional support.ConclusionsOnline and helpline forms of breastfeeding support suit different demographics and call purposes. While optimal breastfeeding support needs to be accessible, flexible and instrumental, helpline users need real-time relational support to deal with more complex challenges.

Gestational diabetes and breastfeeding-related pain as major contributors to early breastfeeding cessation

Purpose: This study aimed to determine the effects of gestational diabetes mellitus, breastfeeding-related pain, and infant growth on the cessation of breastfeeding. Methods: This is secondary data analysis. This study included 60 pregnant women from 3 prenatal breastfeeding clinics. Pregnant women aged 20–49 years, with or without a diagnosis of gestational diabetes mellitus were enrolled. The participants were administered four self-reported questionnaires, one at 5 days, 14 days, 3 months, and 6 months postpartum. A linear mixed model and Cox regression analysis were used. Data were collected between May 25, 2020 and June 14, 2021. Results: The rate of breastfeeding cessation was 55.0% (n=33). The average maternal ages were 32.30 (±4.61) and 31.33 (±7.05) years in the cessation and maintenance groups, respectively. The average duration of breastfeeding in the cessation group was 56.27 (±37.48) days. After adjusting for all covariates, the risk of breastfeeding cessation was 2.5 times greater among participants diagnosed with gestational diabetes mellitus (p=.042). Additionally, the risk of breastfeeding cessation was 1.3 times greater among those with severe breastfeeding-related pain (p=.015). Conclusion: The first two months postpartum is the most essential time for healthcare workers to provide support and address difficulties associated with breastfeeding for mothers with gestational diabetes mellitus.

Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes: a cross-sectional analysis

BackgroundIt is well established that mothers with above-normal pre-pregnancy BMI are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain (PWG) is less well-defined. Excess PWG may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. Cesarean-section, gestational diabetes), and may make effective latch more difficult to achieve.MethodsOur objective was to determine the impact of PWG and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine’s 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N = 1207). PWG category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of PWG). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models. Results: After adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended PWG had 1.39 (1.03–1.86) and 1.48 (1.06–2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended PWG were at increased risk of cessation, although not significantly (aHR [95% CI]: 1.29 [0.95–1.75]). No significant relationship was observed for exclusive breastfeeding cessation.ConclusionsPre-pregnancy BMI and PWG may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.

Association between Maternal Pre-pregnancy Body Mass Index and Breastfeeding Duration in Taiwan: A Population-Based Cohort Study.

An association between high pre-pregnancy body mass index (BMI) and early breastfeeding cessation has been previously observed, but studies examining the effect of underweight are still scant and remain inconclusive. This study analyzed data from a nationally representative cohort of 18,312 women (mean age 28.3 years; underweight 20.1%; overweight 8.2%; obesity 1.9%) who delivered singleton live births in 2005 in Taiwan. Comprehensive face-to-face interviews and surveys were completed at 6 and 18 months postpartum. BMI status and breastfeeding duration were calculated from the self-reported data in the questionnaires. In the adjusted ordinal logistic regression model, maternal obesity and underweight had a higher odds of shorter breastfeeding duration compared with normal-weight women. The risk of breastfeeding cessation was significantly higher in underweight women than in normal-weight women after adjustments in the logistic regression model (2 m: aOR = 1.11, 95% CI = 1.03–1.2; 4 m: aOR = 1.32, 95% CI = 1.21–1.43; 6 m: aOR = 1.3, 95% CI = 1.18–1.42). Our findings indicated that maternal underweight and obesity are associated with earlier breastfeeding cessation in Taiwan. Optimizing maternal BMI during the pre-conception period is essential, and future interventions to promote and support breastfeeding in underweight mothers are necessary to improve maternal and child health.

Perceptions of Breastfeeding for Women with Perinatal Depression: A Descriptive Phenomenological Study

Women with perinatal depression have an increased risk for breastfeeding cessation, yet few studies have explored their lived experience. In this qualitative study, semistructured interviews were conducted with a purposeful sample of women (N = 10) who self-reported perinatal depression. Using Giorgi’s descriptive phenomenological method of data analysis, five components were found to embody their lived experience of breastfeeding: (a) choosing selflessness, (b) harboring inadequacy, (c) deliberate persevering, (d) discerning meaning, and (e) cherishing intimacy. Findings contribute to understanding the experience of breastfeeding for this population and could provide guidance to improve lactation management and perinatal mental health education for nurses.

Validation of the Breastfeeding Score-A Simple Screening Tool to Predict Breastfeeding Duration.

Easy to use screening tools to identify mothers in risk of early breastfeeding cessation are needed. The purpose was to validate a revised version of the breastfeeding score, consisting of four questions addressing completed education, earlier breastfeeding duration, self-efficacy, and sense of security not knowing the exact amount of milk the baby ingests. We used two cohorts from 2004 (n = 633) and 2017 (n = 579) to explore the predictive validity of the breastfeeding score to identify mothers at risk of breastfeeding cessation within the first 17 weeks postpartum. The analyses included sensitivity and specificity, clinically relevant cut-points, and calibrations plots. A cut-point ≥5 points identified 61% of first-time and 42% of multiparous mothers in the validation cohort 2017 to be at risk of early breastfeeding cessation with a sensitivity and specificity of 80% and 60% for first-time, and 69% and 82% for multiparous, respectively. The corresponding numbers in the 2004 cohort were almost identical. The area under the receiver operating characteristic (ROC) curves were 0.77 and 0.78 and the calibration plots showed good agreement for the two cohorts. The breastfeeding score indicated good ability to discriminate between mothers at risk of early exclusive breastfeeding cessation. The simple form of the tool makes it easy to use in daily practice.

Beyond the Typical: One Mother's Unique Challenge to Continue Providing Breastmilk for Her Special Needs Baby

Background Breastfeeding is the undisputed optimal feeding method for infants. In response, Healthy People 2020 called for an increase in the number of infants who are breastfed at 1 year to 34.1%. The Centers for Disease Control and Prevention reported the breastfeeding rate for 2012 as only 25.5%. To accomplish the breastfeeding goal of Healthy People, mothers need excellent breastfeeding support throughout the entire first year. In 2005, the American Academy of Pediatrics recommended that infants breastfeed exclusively for 6 months and should continue breastfeeding for at least 1 year as complimentary foods are added. Studies have shown an overwhelming number of infant health benefits associated with breastfeeding, including protection of the infant from bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, late‐onset sepsis in preterm infants, type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's disease, and childhood obesity. The more breastfeeding support a mother receives, the more likely she will be able to offer these benefits to her child. This support is even more important when a mother faces challenges that put her at risk for breastfeeding cessation. Case The mother (MB) of a 9‐month‐old infant called the lactation resource line at our institution seeking breastfeeding advice. She shared her infant's history, which was significant for severe gastrointestinal (GI) symptoms since birth, including blood in stool, vomiting, and fussiness. When MB was exclusively breastfeeding, she was able to control his symptoms with maternal diet elimination. With the introduction of solid foods however, the symptoms returned. With the help of her pediatrician MB was able to determine and eliminate the offending foods. At the time of the call, MB was suffering from mastitis and was placed on an antibiotic, which seemed to be triggering the same GI symptoms for her infant. Faced with the prospect of pumping and discarding her milk until the completion of the antibiotic treatment, she was calling for advice. The lactation consultant was able to research this otherwise safe medication and devise a feeding plan with MB. It was paramount to feed the infant when the concentration of the medication in MB's milk was at its lowest to minimize the infant's symptoms. Conclusion The implementation of this creative feeding plan allowed MB and her infant to continue breastfeeding with minimal GI disturbances. MB was extremely happy to be able to continue providing the optimal nutrition for her infant. Breastfeeding is the undisputed optimal feeding method for infants. In response, Healthy People 2020 called for an increase in the number of infants who are breastfed at 1 year to 34.1%. The Centers for Disease Control and Prevention reported the breastfeeding rate for 2012 as only 25.5%. To accomplish the breastfeeding goal of Healthy People, mothers need excellent breastfeeding support throughout the entire first year. In 2005, the American Academy of Pediatrics recommended that infants breastfeed exclusively for 6 months and should continue breastfeeding for at least 1 year as complimentary foods are added. Studies have shown an overwhelming number of infant health benefits associated with breastfeeding, including protection of the infant from bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, late‐onset sepsis in preterm infants, type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's disease, and childhood obesity. The more breastfeeding support a mother receives, the more likely she will be able to offer these benefits to her child. This support is even more important when a mother faces challenges that put her at risk for breastfeeding cessation. The mother (MB) of a 9‐month‐old infant called the lactation resource line at our institution seeking breastfeeding advice. She shared her infant's history, which was significant for severe gastrointestinal (GI) symptoms since birth, including blood in stool, vomiting, and fussiness. When MB was exclusively breastfeeding, she was able to control his symptoms with maternal diet elimination. With the introduction of solid foods however, the symptoms returned. With the help of her pediatrician MB was able to determine and eliminate the offending foods. At the time of the call, MB was suffering from mastitis and was placed on an antibiotic, which seemed to be triggering the same GI symptoms for her infant. Faced with the prospect of pumping and discarding her milk until the completion of the antibiotic treatment, she was calling for advice. The lactation consultant was able to research this otherwise safe medication and devise a feeding plan with MB. It was paramount to feed the infant when the concentration of the medication in MB's milk was at its lowest to minimize the infant's symptoms. The implementation of this creative feeding plan allowed MB and her infant to continue breastfeeding with minimal GI disturbances. MB was extremely happy to be able to continue providing the optimal nutrition for her infant.

Risk of Breastfeeding Cessation Among Low-Income Women, Infants, and Children

Women who receive services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) often stop breastfeeding earlier than recommended. Little is known about maternal background and intrapersonal variables that predict the timing of breastfeeding cessation over the 12-month postpartum period. The aim of this study was to identify the maternal background and intrapersonal predictors associated with the timing of breastfeeding cessation in WIC participants over the course of the 12-month postpartum period. Existing longitudinal survey and administrative data from low-income breastfeeding WIC recipients (n = 309) were analyzed using discrete time survival analysis. Risk of breastfeeding cessation was the outcome, and self-reported items were used to derive predictor variables that corresponded to the background and intrapersonal variables of the Interaction Model of Client Health Behavior. Rates of breastfeeding were low (31% at 6 months and 6% at 12 months). In the best fitting discrete time survival analysis model, women who were older and of Mexican ethnicity, who had previous breastfeeding experience, and who had breastfeeding support from family or friends were at lowest risk for breastfeeding cessation at each monthly interval. Breastfeeding duration rates were lower than Healthy People 2020 benchmarks of 61% at 6 months and 34% at 12 months. Clinicians and researchers can use the findings from this study to develop interventions that are targeted to periods of greatest risk of premature breastfeeding cessation to prolong breastfeeding duration in this vulnerable population.

Effect of maternal obesity on lactation: systematic review.

The short duration or lack of breastfeeding has been associated with maternal obesity. The purpose of this study was to systematically review prospective studies that assessed the effect of maternal obesity on lactation. A search of studies was conducted in Pubmed, these included prospective studies on maternal obesity and initiation, intention and duration of breastfeeding: 653 articles were found, only seven were prospective studies. After adding other studies found by hand, a total of nine studies were analyzed. Three out of four papers observed a higher risk for delay lactogenesis among obese mothers, odds ratio ranging from 1.02 to 1.10. The study assessing the initiation of lactation showed that non-obese mothers initiated lactation sooner, OR: 0.39 (95% CI: 0.25-0.62). The overall risk for cessation of breastfeeding showed that obese mothers had higher risks of early cessation, HR: 1.50 (CI 95% 1.11-2.04). In one study it was observed that obese mothers were not more likely to never breastfeed, OR = 1.56 (95% CI: 0.97-1.50). This review shows that in prospective studies, obese mothers are more likely to have delayed lactogenesis and reduced lactation. Therefore, weight control and breastfeeding promotion should be reinforced before and during pregnancy. In overweight and obese mothers, breastfeeding should be closely monitored after birth.

Breastfeeding in Preterm and Term Twins—Maternal Factors Associated With Early Cessation: A Population-Based Study

To investigate the duration of breastfeeding and the impact of maternal factors for cessation of breastfeeding in twin infants, the authors undertook a population-based cohort study. Breastfeeding data obtained from Child Health Centres were matched with data on infant and maternal demographics from Swedish national registers. A total of 1.657 twins were included, of whom 695 were born preterm. Breastfeeding frequencies in preterm twins were 79% at 2 months, 58% at 4 months, 39% at 6 months, 14% at 9 months, and 6% at 12 months. In term twins, the corresponding frequencies were 84%, 63%, 45%, 18%, and 6%, respectively. In both preterm and term mothers, mothers who had a lower educational level or smoked at first antenatal care visit were subject to earlier cessation of breastfeeding by 6 months of age. In addition, in mothers of term infants, mothers who were < 23 years old or primiparous had a higher risk for cessation of breastfeeding before 6 months. Thus, mothers of twins have a good potential to breastfeed, but additional support is needed for those more susceptible to early cessation of breastfeeding.

Early discharge with tube feeding at home for preterm infants is associated with longer duration of breast feeding

Objective:Mothers of preterm infants are more likely to discontinue breast feeding early than mothers of term infants. We evaluated the effect of early discharge with tube feeding of preterm infants...

A breast-feeding assessment score to evaluate the risk for cessation of breast-feeding by 7 to 10 days of age

Objectives: To develop a succinct and comprehensive breast-feeding assessment score (BAS) to accurately identify infants at risk for early cessation of breast-feeding before initial hospital discharge. Study design: Mothers who intended to breast-feed their infants were solicited from 9 suburban hospitals. Two detailed data forms covering 107 items were completed before hospital discharge. A third form was completed at 7 to 10 days of age after telephone contact with the mother. Results: Cessation of breast-feeding occurred in 113 of 1075 infants (10.5%). A multiple logistic regression analysis revealed 8 variables that were significant (P <.05) in predicting breast feeding cessation. A BAS was developed based on the odds ratios and relative risks of breast-feeding cessation for these 8 variables. Conclusions: The BAS was easily and quickly performed before hospital discharge for near term and term infants, which accurately predicted the risk of breast-feeding cessation within 7 to 10 days of age in the population studied. (J Pediatr 2002;141:659-64)