Abstract
BackgroundIt is well established that mothers with above-normal pre-pregnancy body mass index (BMI) are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain is less well-defined. Excess pregnancy weight-gain may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. C-section, gestational diabetes), and may make effective latch more difficult to achieve.MethodsOur objective was to determine the impact of pregnancy weight-gain 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). Pregnancy weight-gain category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of pregnancy weight-gain). 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.ResultsAfter adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended pregnancy weight-gain 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 pregnancy weight-gain were at increased risk of cessation, although not significantly (adjusted Hazard Ratio [95% CI]: 1.29 [0.95 – 1.75]). No significant relationship was observed for exclusive breastfeeding cessation. ConclusionPre-pregnancy BMI and pregnancy weight-gain 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.
Exclusive Breastfeeding Rates at 6 Weeks Postpartum as a Function of Preconception Body Mass Index Are Not Impacted by Postpartum Obstetrical Practices or Routines
