A prospective study of breastfeeding intentions of healthy weight and overweight women as predictors of breastfeeding outcomes

- This study showed a differential impact of intentions on breastfeeding for healthy weight and overweight women at hospital discharge and 4 months post-partum.
- High breastfeeding intentions was associated with exclusive breastfeeding in healthy weight but not overweight women at hospital discharge.
- High breastfeeding intentions was associated with exclusively/fully breastfeeding for both weight group at 4 months post-partum.
- Women who experienced a caesarean delivery were at a significant risk of giving formula supplementation by the time of hospital discharge.

ObjectiveWomen with a higher BMI are at increased risk of breastfeeding for a shorter duration, however it is unclear if weight status itself or other factors such as feeding intentions are responsible for early breastfeeding cessation. The aim of this study was determine the influence of maternal pre-pregnancy weight status on infant feeding intentions during pregnancy using a validated scale and assess whether high intentions to exclusively breastfeed measured during pregnancy predicted feeding mode at discharge and at 4 months postpartum in both healthy weight (Hwt) (BMI< 25 kg/m2) and overweight (Owt)(BMI > 25 kg/m2) women.DesignThis prospective, observational study commenced when participants were <20 weeks gestation, continuing until four months post partum. Self-administered questionnaires assessed pre-pregnancy weight, infant feeding intentions at 36 weeks gestation, and breastfeeding practices at hospital discharge and 4 months postpartum. Hospital records provided details of delivery mode, gestation and breastfeeding during hospital stay. Binary logistic regression analyses were used to compare weight groups on the breastfeeding beliefs and practices adjusting for selected covariatesParticipants and settingA consecutive sample of pregnant women (n = 715) were recruited from an Australian metropolitan hospital between August 2010 and January 2011. All women <20 weeks gestation were eligible unless they had pre-existing Type 1 or 2 diabetes or insufficient English language skills to complete questionnaires.Measurements and findingsOf 715 women recruited, 402 had complete data at 4 months post-partum. There were no differences in high breastfeeding intentions (66% vs 53%, p = 0.10) or initiation (96% vs. 98%, p = 0.33) between Hwt and Owt women. Owt women were less likely to be exclusively breastfeeding at hospital discharge AOR [95%CI] 0.57 [0.33,0.98] and 4 months post-partum 0.62 [0.40,0.97]. High intention to breastfeed was positively associated with exclusively/fully breastfeeding at hospital discharge in Hwt 3.24 [1.52,6.89] but not Owt women 1.73 [0.75,4.00] and 4 months post partum in both weight groups (Hwt 4.1 [2.4-7.2], Owt 6.5 [2.9-14.3]).Key conclusionsHealthy and overweight women appear to have similar antenatal intentions for infant feeding but overweight mothers are less likely to be exclusive breastfeeding at hospital discharge. High antenatal intentions for breastfeeding are related to exclusively/fully breastfeeding at 4 months post partum in both healthy and overweight women.Implications for practiceInvestigation of early hospital practices that support and hinder the establishment of successful breastfeeding in overweight mothers may help to identify effective strategies to protect breastfeeding relationships between mother-infant dyads, particularly those who have experienced a caesarean delivery.