Article

Weight-Related Concerns as Barriers to Exclusive Breastfeeding at 6 Months

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background: Human milk is considered the gold standard for infant nutrition, but more data are needed that examine the constellation of weight-related concerns as barriers to exclusive breastfeeding. Research Aims: The aim of this study was to examine how mothers’ concerns regarding their own and their infants’ weight, as well as disordered eating behaviors, were associated with breastfeeding self-efficacy and exclusive breastfeeding at 6 months. Methods: A prospective, quantitative, and self-report online survey design was used. Participants included 206 women (88.30% White, 59.20% with graduate degrees), with a mean age of 33.04 years (SD = 4.31 years) and a mean prepregnancy body mass index (BMI) of 24.80 kg/m2 (SD = 5.50 kg/m2), who had given birth within the past 6 months. Results: Participants who reported not exclusively breastfeeding at 6 months had significantly higher prepregnancy BMI (p < .001), higher body dissatisfaction (p = .003), more disordered eating (p = .036), higher child weight concerns (p < .001), and lower breastfeeding self-efficacy (p < .001). Mediation modeling revealed a direct negative relationship between prepregnancy BMI and exclusive breastfeeding at 6 months (p < .001). Indirect negative relationships between prepregnancy BMI and exclusive breastfeeding at six months via (a) body dissatisfaction, (b) disordered eating, and (c) child weight concern, as well as breastfeeding self-efficacy (entered as concurrent mediators), were all significant. Conclusions: Mothers’ weight, body image and eating concerns, concern regarding their children’s weight, and breastfeeding self-efficacy may constitute critical barriers to exclusive breastfeeding at 6 months. Interventions to improve breastfeeding duration and confidence should target maternal body image and eating concerns.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Body image concerns have been widely documented in the literature as one reason why most women shorten the breastfeeding duration of their infants [14][15][16][17][18][19][20][21][22][23][24]. Negative body image concerns among breastfeeding mothers may lead to depressive symptoms such as constant feelings of sadness, general disinterest in one's surroundings, loss of appetite, and reduced self-esteem. ...
... These factors may eventually result in a shorter duration of breastfeeding [21,23,25,26]. Body image concerns are also associated with eating disorders among breastfeeding mothers during the postpartum period and may result in maternal obesity [14,17,19,24,27]. Obesity and overweight concerns may make breastfeeding mothers feel fat and unattractive. ...
... Obesity and overweight concerns may make breastfeeding mothers feel fat and unattractive. Such negative feelings may lead to the early cessation of breastfeeding [16,20,24]. During pregnancy some mothers may not intend to breastfeed their infants because of excess weight gain during pregnancy [15,28]. ...
Article
Full-text available
Background Body image concerns have been widely documented in the literature as one reason why most women shorten the breastfeeding duration of their infants. Negative body image concerns among breastfeeding mothers may lead to depressive symptoms. There is a paucity of literature on how body image affects the breastfeeding practices of nurses and midwives. Therefore, this study explored the perspectives of breastfeeding nurses and midwives on how their body image affected their breastfeeding practices. Methods A qualitative design was used in this study. Five focus group discussions were conducted with each group having five members. The study was conducted in the Greater Accra Region of Ghana between November and December of 2020. Participants were recruited into the study using a purposive sampling method. Focus group sessions were audiotaped and transcribed verbatim. Data were analyzed using a content analysis. Results Three main themes emerged from the data analysis: body image concerns and breastfeeding, sociocultural pressures and breastfeeding and coping strategies. Participants had concerns regarding weight gain due to the need to eat adequately while breastfeeding. Body image concerns included increase in abdominal size, sagging breasts and generalized weight gain. These concerns and pressures negatively affected the breastfeeding practices of participants. Body image concerns reflected sociocultural pressures such as negative comments from loved ones and in the social media. The coping strategies adopted by the mothers were self-motivation and the love they had for their children. Conclusions The perspectives of breastfeeding nurses and midwives on the ways their body image affected their breastfeeding practices identified the need for support in order to successfully breastfeed.
... Body image concerns have been documented widely in literature as one of the reasons why most women shorten the breastfeeding duration of their infants [16][17][18][19][20][21][22][23][24][25][26]. Negative body image concerns among breastfeeding mothers lead to depressive symptoms such as constant feelings of sadness, general disinterest in one's surroundings, loss of appetite and reduced self-esteem which eventually lead to shorter than recommended breastfeeding duration [23,25,27,28]. ...
... Negative body image concerns among breastfeeding mothers lead to depressive symptoms such as constant feelings of sadness, general disinterest in one's surroundings, loss of appetite and reduced self-esteem which eventually lead to shorter than recommended breastfeeding duration [23,25,27,28]. The body image concerns also lead to eating disorders in breastfeeding mothers during the postpartum period that can lead to obesity and gross overweight [16,19,21,26,29]. This obesity and overweight concerns make breastfeeding mothers feel fat and unattractive and such negative feelings about themselves lead to the early cessation of breastfeeding [18,22,26]. ...
... The body image concerns also lead to eating disorders in breastfeeding mothers during the postpartum period that can lead to obesity and gross overweight [16,19,21,26,29]. This obesity and overweight concerns make breastfeeding mothers feel fat and unattractive and such negative feelings about themselves lead to the early cessation of breastfeeding [18,22,26]. During pregnancy, some mothers intend not to breastfeed their infants after delivery due to issues relating to excess weight gain during pregnancy [17,30]. ...
Preprint
Full-text available
Background: The World Health Organization has recommended that, all infants should be breastfed for at least two years with six months of exclusive breastfeeding. This is due to the many benefits of breastfeeding to the mother, child and the nation. There is paucity of literature on the breastfeeding practices of nurses and midwives with regards to issues relating to body image. Therefore, this study explored the perspectives of breastfeeding nurses and midwives on how their body image affect their breastfeeding practices. Methods : Qualitative exploratory descriptive design was used to conduct this study. Five focus group discussions were conducted with each group having five members after participants were purposively selected into the study. Data was analyzed inductively after it was audiotaped and transcribed verbatim. Results : Three main themes emerged after data analysis which included: Body image concerns and breastfeeding, sociocultural pressures and breastfeeding and coping strategies. Participants were of the view that, they had concerns with regards to weight gain due to the need to eat adequately in order to lactate. To participants, those concerns and pressures negatively affect their breastfeeding practices. These body image concerns are fueled by sociocultural pressures such as negative comments from loved ones and social media. They coped with self-motivation and the love they have for their children. Conclusion : It is apparent that, breastfeeding health professionals need support in order to successfully breastfeed their infants till the stipulated time frame. Keywords: Nurses and midwives, breastfeeding, body image and breastfeeding, body image concerns, Ghana, sociocultural pressures and breastfeeding.
... After excluding 14 studies with different topics, we reviewed 95 articles for data extraction. We further excluded another 38 articles due to extreme obesity (n = 2) [37,38], pre-eclampsia (n = 1) [39], duplicate data sources (n = 1) [40], gestational diabetes mellitus (GDM) (n = 4) [41][42][43][44], inability to integrate (n = 20) [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] Nutrients 2020, 12, 2684 5 of 22 and continuous BMI (n = 10) [21][22][23][24][25][26][27][28][29][30], resulting in 57 articles that were included in the meta-analyses ( Figure 1). ...
... Indeed, few studies in which mothers continued breastfeeding up to six months (as recommended by the WHO and UNICEF) remained for analyses. Second, we excluded 10 studies [21][22][23][24][25][26][27][28][29][30] that provided continuous risk estimates because risk with a one unit increase in BMI is exponential, and thus difficult to interpret by combining the different sources of populations. Indeed, the 10 studies [21][22][23][24][25][26][27][28][29][30] vary across countries, BF types, and the length of the follow-up period. ...
... Second, we excluded 10 studies [21][22][23][24][25][26][27][28][29][30] that provided continuous risk estimates because risk with a one unit increase in BMI is exponential, and thus difficult to interpret by combining the different sources of populations. Indeed, the 10 studies [21][22][23][24][25][26][27][28][29][30] vary across countries, BF types, and the length of the follow-up period. Nine studies [21][22][23][24][25][26][27][28][29] were reported from Western countries and three investigated initiation [23,25,27]. ...
Article
Full-text available
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.
... 45 Women with obesity also report weight-stigmatizing and suboptimal communication with obstetric and perinatal professionals along with feeling uncomfortable when breastfeeding in public. 101,102 These women are also less likely to be exposed to pro-breastfeeding practices. For instance, they have lower odds of receiving breastfeeding information and higher odds of implementing pacifier use in the infant. ...
Article
As the growing weight stigma literature has developed, one critically relevant and vulnerable population has received little consideration-pregnant and postpartum women. Because weight fluctuations are inherent to this life phase, and rates of prepregnancy overweight and obesity are already high, this gap is problematic. More recently, however, there has been a rising interest in pregnancy-related weight stigma and its consequences. This paper therefore sought to (a) review the emerging research on pregnancy-related weight stigma phenomenology and (b) integrate this existing evidence to present a novel theoretical framework for studying pregnancy-related weight stigma. The Weight gain, Obesity, Maternal-child Biobehavioral pathways, and Stigma (WOMBS) Framework proposes psychophysiological mechanisms linking pregnancy-related weight stigmatization to increased risk of weight gain and, in turn, downstream childhood obesity risk. This WOMBS Framework highlights pregnant and postpartum women as a theoretically unique at-risk population for whom this social stigma engages maternal physiology and transfers obesity risk to the child via social and physiological mechanisms. The WOMBS Framework provides a novel and useful tool to guide the emerging pregnancy-related weight stigma research and, ultimately, support stigma-reduction efforts in this critical context.
... Factors that may influence whether a mother initiates, sustains, or terminates breastfeeding range from demographic (e.g., race, age, marital status, education, socioeconomics) to biological (e.g., insufficient milk supply, infant health problems, and maternal obesity) (Thulier and Mercer, 2009). Considerations surrounding breastfeeding may also be psychological, relating to maternal confidence or body image Zimmerman et al., 2018). Several previous studies have examined breastfeeding self-efficacy in mothers with more than one child and prior breastfeeding experience, finding birth order important (Kronborg and Vaeth, 2004;Yang et al., 2016). ...
Article
The goal of this prospective study was to identify effects of birth order on breastfeeding self-efficacy, parental-report of infant feeding behaviors, infant non-nutritive sucking and oral feeding skills in full-term infants at 3-months. Mothers were separated into primipara and multipara groups, and infants were grouped into siblings and no siblings groups. Parents completed the Breastfeeding Self-Efficacy Scale-Short Form, and Neonatal Eating Assessment Tool–Breastfeeding and Bottle-feeding scales. Non-nutritive sucking was assessed using a custom research pacifier and researchers completed the Oral Feeding Skills scale to assess feeding performance. Fifty-six mother-infant dyads (55% male infants) were included. Primipara mothers reported significantly lower breastfeeding self-efficacy and more feeding problems across breast and bottle-feeds on the Neonatal Eating Assessment Tool. There were no significant differences in non-nutritive sucking or oral feeding skills between infant groups. First-time mothers require more feeding support as they exhibited lower breastfeeding self-efficacy and reported more problematic infant feeding behaviors.
... This may have influenced participants' experience of weight stigmatization during the perinatal period and its influence on breastfeeding behavior. For instance, while it is known some individuals with pre-pregnancy overweight or obesity experience discomfort breastfeeding in public due to body image concerns (Zimmerman et al., 2018), this may not be a significant issue for Black individuals, such as those in our study who collectively voiced high self-confidence. ...
Article
Weight stigmatization is related to emotional and psychological distress including low self-esteem, body image dissatisfaction, depression, and anxiety; all linked with suboptimal breastfeeding outcomes. This qualitative descriptive study explored postpartum individuals’ recalled experiences of weight stigma during interactions with perinatal healthcare professionals and its perceived influence on their breastfeeding experiences. Semi-structured phone interviews were conducted with (n= 18) participants. Three themes emerged: (1) “Size Doesn’t Matter: They Looked Beyond the Scale,” (2) “My Self-Confidence and Desire to Breastfeed is More Important than Weight,” and (3) “I Was on My Own”— Limited Social Support not Weight Stigma Influenced Breastfeeding.
Article
Background Recent research among postpartum women has considered body image and eating attitudes as well as exclusive breastfeeding within common theoretical models. However, these efforts have so far neglected to include partner-related constructs, which constitutes an important gap. Thus, the aim of this study was to examine an integrated model of body image and eating concerns, and exclusive breastfeeding among mothers of infants six months and younger, that included partner appearance influences as well as general postpartum support. Methods A sample of new mothers (N = 156), aged 20–47 years, mean = 32.7 (SD = 4.7) years, reported on postpartum partner support and appearance pressures, thin-ideal internalization and body dissatisfaction, symptoms of disordered eating, depression, breastfeeding self-efficacy and exclusive breastfeeding. Path analyses were conducted to test the hypothetical model. Results Findings revealed that the final model was a good fit to these data. Postpartum partner support was associated with lower depression and higher breastfeeding self-efficacy, through which it was related to higher reports of exclusive breastfeeding and lower eating disorder symptoms. In addition, partner appearance pressures and thin-ideal internalization were associated with higher body dissatisfaction, and thin-ideal internalization was also related to lower breastfeeding self-efficacy. Conclusions Partner influences may be important to account for in models of body image and eating concerns among postpartum women, and exclusive breastfeeding, and further research on ways in which they can support mothers of young infants is warranted.
Article
Objective To explore trajectories of breastfeeding exclusivity and perceived insufficient milk (PIM) over the first 8 weeks postpartum among primiparous women and the association of these trajectories with prepregnancy body mass index (BMI). Design Secondary analysis of data from a randomized controlled trial. Setting Recruitment for the primary study was conducted in Pittsburgh, Pennsylvania. Participants One hundred twenty-two primiparous women with intention to exclusively breastfeed. Methods We used group-based trajectory modeling to classify participants into breastfeeding exclusivity and PIM trajectory groups. We used logistic regression to explore the predictive relationship between prepregnancy BMI and breastfeeding exclusivity and PIM trajectory group memberships. Results We identified two trajectories each for breastfeeding exclusivity and PIM over the first 8 weeks postpartum. For breastfeeding exclusivity, one group (n = 60, 49%) had low initial probability of exclusive breastfeeding with linear decline in likelihood of exclusivity over time. The other group (n = 62, 51%) had greater initial probability of exclusive breastfeeding, which remained constant over time. For PIM, one group (n = 41, 34%) had consistently greater probability of endorsing PIM at each time point, whereas the other group (n = 81, 66%) had consistently low probability of endorsing PIM over time. Prepregnancy BMI did not predict group membership in breastfeeding exclusivity, χ²(1) = 2.8, p = .094, or PIM, χ²(1) = 0.72, p = .397. Conclusion Breastfeeding exclusivity and PIM appeared to be relatively stable phenomena in the postpartum period among a sample of predominately White primiparous women who intended to breastfeed. We did not find a clear association with prepregnancy BMI.
Article
The goal of this study was to examine breastfeeding behavior and attitudes as predictors of women’s body image and weight control behavior. This study extends past research by focusing on positive body image variables including body appreciation and perceived body functionality. Women (N = 597) from the United States who had recently birthed biological babies ages 0–12 months participated in an online study. Current breastfeeding rates were high (86 %), and average breastfeeding duration was approximately 3 months. Women who were currently breastfeeding indicated more positive body images and less likelihood of engaging in maladaptive weight control behaviors than women who were no longer breastfeeding or had never breastfed their baby. Women’s positive attitudes toward breastfeeding were associated with awareness and appreciation of body functionality and fewer maladaptive weight control behaviors. These findings extend research on the health benefits of positive body image and suggest that breastfeeding may occur within a constellation of beliefs and behaviors indicative of positive body image.
Article
Objective This study aimed to examine the relationship between internalized weight stigma during pregnancy and breastfeeding outcomes at 1 month post partum among individuals with prepregnancy overweight or obesity. Secondarily, the study explored the temporal stability of internalized weight stigma from the third trimester to 1 month post partum via the Weight Bias Internalization Scale (WBIS). Methods A total of 103 pregnant individuals with overweight or obesity were recruited for this study. Participants completed the WBIS during the third trimester and self‐reported breastfeeding initiation, continuation, and exclusivity outcomes at 1 month post partum. A paired t test and binomial logistic regression were conducted with covariates hierarchically added to the model. Results The average prepregnancy BMI was 33.53 (SD 7.17) kg/m² (range = 25.4‐62), and average prenatal WBIS scores were 25.95 (SD 11.83). No difference was found in mean prenatal and postpartum scores (25.95 [SD 11.83]; 26.86 [SD 13.03], respectively; t94 = −0.83, P = 0.41), evidencing temporal stability in WBIS scores from pre to post partum. Prenatal WBIS scores did not predict breastfeeding initiation, continuation, or exclusivity at 1 month post partum in either unadjusted or adjusted models. Conclusions Collectively, this sample displayed low weight bias internalization, which was not predictive of breastfeeding initiation, continuation, or exclusivity at 1 month post partum. Future research is needed to develop a pregnancy‐specific weight stigma measure.
Article
Objective To synthesize existing research on communication practices between healthcare professionals and overweight and obese pregnant women. Methods Following PRISMA guidance on conducting scoping reviews, we included original research addressing communication/counseling practices of healthcare professionals with overweight and/or obese pregnant women, published between 2008–2018, and available in English. Fourteen articles are included in this review. Results Study findings were organized into three themes: (a) topics addressed during encounters, (b) providers’ comfort/confidence, knowledge and methods in communicating with overweight/obese pregnant women, and (c) overweight/obese pregnant women’s experiences in communicating with healthcare providers. The most prevalent topics addressed were gestational weight gain, physical activity, and nutrition. Healthcare professionals experience discomfort and are reluctant to address weight status with overweight/obese pregnant patients, use vague statements about weight gain and weight-related obstetric risks, and report low confidence when counseling obese pregnant women. Overweight/obese pregnant women perceive weight stigma when interacting with providers. Conclusion Weight-related counseling in obstetric care is suboptimal. Providers may benefit from training to more confidently and effectively counsel overweight and obese pregnant women about gestational weight gain, physical activity, and nutrition. Practice implications Patients perceive weight stigma in the obstetric setting, which may be prevented by effective, patient-centered communication.
Article
The aims of this article are to (1) present a shared definition of weight stigma related to pregnancy and (2) develop a definition to inform valid and reliable nursing research addressing weight stigma in the obstetric setting. Weight stigma is increasingly prevalent in society, especially among women with prepregnancy overweight or obesity. However, a universally accepted definition of weight stigma related to pregnancy has yet to be identified. We followed Walker and Avant's concept analysis methodology using an iterative approach to ensure a robust and conceptually sound definition of weight stigma related to pregnancy.
Article
Full-text available
Abstract Background: Despite consistent evidence showing the importance of exclusive breastfeeding (EBF) for six months, it remains a sub-optimal practice in The Gambia. This study aimed at investigating the determinants of EBF knowledge and intention to or practice of EBF. Methods: A cross-sectional study was conducted among 334 women receiving care at the Edward Francis Small Teaching Hospital (EFSTH) from December 2015 to February 2016. Using a structured interviewer-administered questionnaire, knowledge on EBF was determined and scored. Participants scoring above or equal to the median were determined to have sufficient EBF knowledge. Multivariate logistic regression analyses were used to identify predictors of EBF knowledge and intention to or practice of exclusive breastfeeding. Results: The proportion of women with sufficient exclusive breastfeeding knowledge and intended to or practice EBF were 60.2% and 38.6% respectively, while only 34.4% received EBF counseling. Earning ≥1500 GMD monthly (Adjusted Odds Ratio [aOR] 1.98; 95% Confidence Interval [Cl] 1.24, 3.16), having positive attitude (aOR 2.40; 95% Cl 1.40, 4.10) and partner supporting EBF (aOR 2.18; 95% Cl 1.23, 3.87) predicted sufficient EBF knowledge. Mothers aged 26–34 years (aOR 0.50; 9 5% Cl 0.31, 0.82) and EBF counseling (aOR 2.68; 95% Cl 1.68, 4.29) significantly associated with intention to or practice of exclusive breastfeeding. Conclusion: In conclusion, improving EBF rates will, therefore, require improved access to information on EBF targeting low socio-economically disadvantaged and older mothers. In addition, emphasis on strengthening the ongoing EBF counseling already within the health system is required. Keywords: Exclusive breastfeeding, Knowledge, Intention, Practice, Predictors, The Gambia
Article
Full-text available
Introduction Numerous studies have shown that the constructs of the Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB) and Breastfeeding Self-Efficacy (BSE) Framework can effectively identify relationships between maternal psychosocial factors and breastfeeding initiation. However, the ability of these theories to predict breastfeeding duration has not been adequately analyzed. The aim of the review was to examine the utility of the constructs of TRA/TPB and BSE to predict breastfeeding duration. Methods We conducted a literature search using Pubmed (1980-May 2015), Medline (1966-May 2015), CINAHL (1980-May 2015), EMBASE (1980-May 2015) and PsycINFO (1980-May 2015). We selected studies that were observational studies without randomization or blinding, using TRA, TPB or BSE as the framework for analysis. Only studies reporting on breastfeeding duration were included. Results Thirty studies were selected, which include four using TRA, 10 using TPB, 15 using BSE and one using a combination of TPB and BSE. Maternal intention and breastfeeding self-efficacy were found to be important predictors of breastfeeding duration. Inconsistent findings were found in assessing the relationship between maternal attitudes, subjective norms, perceived behavior control and breastfeeding duration. Discussion The inadequacy of these constructs in explaining breastfeeding duration indicates a need to further explore the role of maternal self-determination in breastfeeding behavior.
Article
Full-text available
Background After discharge from a neonatal intensive care unit (NICU), many mothers of preterm infants (gestational age < 37 weeks) experience a lack of support for breastfeeding. An intervention study was designed to evaluate the effects of proactive (a daily telephone call initiated by a member of a breastfeeding support team) and/or reactive (mothers could call the breastfeeding support team) telephone based breastfeeding support for mothers after discharge from the NICU. The mothers in the intervention group had access to both proactive and reactive support; the mothers in the control group only had access to reactive support. The aim of this study was to explore the mothers’ experiences of the proactive and reactive telephone support. Methods This study was a qualitatively driven, mixed-method evaluation using three data sources: questionnaires with qualitative open-ended questions, visual analogue scales and telephone interviews. In total, 365 mothers contributed data for this study. The qualitative data were analysed with an inductive thematic network analysis, while the quantitative data were analysed with Student’s t-test and the chi-square test. ResultsProactive support contributed to greater satisfaction and involvement in breastfeeding support. The mothers who received proactive support reported that they felt strengthened, supported and secure, as a result of the continuous care provided by staff who were knowledgeable and experienced (i.e., in breastfeeding and preterm infants), which resulted in the global theme ‘Empowered by proactive support’. The mothers who received reactive support experienced contradictory feelings; some felt secure because they had the opportunity to call for support, whereas others found it difficult to decide when and if they should use the service, which resulted in the global theme; ‘Duality of reactive support’. Conclusion There were positive aspects of both proactive (i.e., greater satisfaction and feelings of empowerment) and reactive support (i.e., the opportunity to call for support); however, the provision of reactive support alone may be inadequate for those with the greatest need for support as they are the least likely to access it. Trial registrationNCT01806480 on 5 March 2013.
Article
Full-text available
Purpose: To examine the potential impact of paraprofessional home visitors in promoting breastfeeding initiation and continuation among a high-risk population. Design: A secondary analysis of program data from a statewide home visitation program. Setting: Thirty-six Healthy Families New York sites across New York State. Subjects: A total of 3521 pregnant mothers at risk of poor child health and developmental outcomes. Intervention: Home visitors deliver a multifaceted intervention that includes educating high-risk mothers on benefits of breastfeeding, encouraging them to breastfeed and supporting their efforts during prenatal and postnatal periods. Measures: Home visitor-reported content and frequency of home visits, participant-reported breastfeeding initiation and duration, and covariates (Kempe Family Stress Index, race and ethnicity, region, nativity, marital status, age, and education). Analysis: Logistic regression. Results: Breastfeeding initiation increased by 1.5% for each 1-point increase in the percentage of prenatal home visits that included breastfeeding discussions. Breastfeeding continuation during the first 6 months also increased with the percentage of earlier home visits that included breastfeeding discussions. Additionally, if a participant receives 1 more home visit during the third month, her likelihood of breastfeeding at 6 months increases by 11%. Effect sizes varied by months postpartum. Conclusions: Delivering a breastfeeding message consistently during regular home visits is important for increasing breastfeeding rates. Given that home visiting programs target new mothers least likely to breastfeed, a more consistent focus on breastfeeding in this supportive context may reduce breastfeeding disparities.
Article
Full-text available
Purpose: To compare breastfeeding initiation rates for women across body mass index (BMI) classes, including normal BMI (18.50 − 24.99 kg/m²), overweight (25.00 − 29.99 kg/m²), obese (30.00 − 39.99 kg/m²), morbidly obese (40.00 − 49.99 kg/m²) and extreme obesity (> 50.00 kg/m²). Materials and methods: Retrospective cohort of women with singleton pregnancies, delivering in St. John’s, NL between 2002–2011. The primary outcome was any breastfeeding on hospital discharge. Breastfeeding rates across BMI categories were compared, using univariate analyses. Multivariate analysis included additional maternal and obstetric variables. Results: Twelve thousand four hundred twenty-two women were included: 8430 breastfed and 3992 did not breastfeed on hospital discharge. Progressively decreasing rates of breastfeeding were noted with increasing obesity class: normal BMI (71.1%), overweight (69.1%), obese (61.6%), morbidly obese (54.2%) and extremely obese women (42.3%). Multivariate analysis confirmed that increasing obesity class resulted in lower odds of breastfeeding: overweight (adjusted odds ratios (aOR) 0.86,95%CI 0.76–0.98), obese (aOR 0.65,95%CI 0.57–0.74), morbidly obese (aOR 0.57,95%CI 0.44–0.74) and extreme obesity (aOR 0.37,95%CI 0.19–0.74). Conclusion: Women in higher obesity classes are progressively less likely to initiate breastfeeding. Women with the highest prepregnancy BMIs should be particularly counseled on the benefits of breastfeeding.
Article
Full-text available
p>Breastfeeding is widely acknowledged as the normal and unequalled method for feeding infants due to its associated health benefits, both for the infant and the mother. The World Health Organization recommends that infants are exclusively breastfed up to the completion of six months of age, with breastfeeding continuing to be an important part of the diet until the infant is at least two years old. The several health benefits associated with breastfeeding are driven by the combined action of the nutritional and bioactive components in human milk and the magnitude of the majority of the ascertained biological effects is directly dependent on breastfeeding duration. This review briefly summarizes the current knowledge on the composition of human milk and provides an overview on its functional effects on health outcomes, focusing on the latest research results. </p
Article
Full-text available
The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years and 20 000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
Article
Full-text available
Background/objectives: The aims were to investigate the association of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with breastfeeding (BF) duration and BF pattern at 3 months of age. Subjects/methods: This was a prospective cohort study of 4231 children who were enrolled at birth and were followed-up at 3, 12, 24 and 48 months of age to gather information on maternal and offspring characteristics including BF patterns and BF duration. Maternal pre-pregnancy BMI was categorized according to the WHO classification and GWG according to the 2009 Institute of Medicine recommendations. Cox's proportional hazards model was used to assess whether pre-pregnancy BMI and GWG were associated with BF and exclusive breastfeeding (EBF) duration. Predicted probabilities of BF patterns at 3 months were estimated by multinomial logistic regression. Results: Information on BF was available to 4011 infants. The total BF and EBF median durations were 7.0 months and 1.5 months, respectively. There were no differences in duration of any BF or EBF according to pre-pregnancy BMI or GWG categories. There was an increased predicted probability for weaning before the age of 3 months among infants from obese women, compared with those from mothers with normal pre-pregnancy BMI, with margins adjusted predictions of 0.36 (95% confidence interval (CI) 0.31-0.41) and 0.23 (95% CI 0.21-0.25), respectively. Conclusions: Infants from pre-pregnancy overweight/obese mothers presented higher probability of early weaning compared with infants from normal-weight mothers. Obese/overweight pregnant women need supplementary guidance about BF benefits to infant health during prenatal and postnatal care.European Journal of Clinical Nutrition advance online publication, 27 January 2016; doi:10.1038/ejcn.2015.232.
Article
Full-text available
Objective: To investigate the association between prepregnancy obesity and birth outcomes using fixed effect models comparing siblings from the same mother. Methods: A total of 7496 births to 3990 mothers from the National Longitudinal Survey of Youth 1979 survey are examined. Outcomes include macrosomia, gestational length, incidence of low birthweight, preterm birth, large and small for gestational age (LGA, SGA), c-section, infant doctor visits, mother's and infant's days in hospital post-partum, whether the mother breastfed, and duration of breastfeeding. Association of outcomes with maternal pre-pregnancy obesity was examined using Ordinary Least Squares (OLS) regression to compare across mothers and fixed effects to compare within families. Results: In fixed effect models we find no statistically significant association between most outcomes and prepregnancy obesity with the exception of LGA, SGA, low birth weight, and preterm birth. We find that prepregnancy obesity is associated with a with lower risk of low birthweight, SGA, and preterm birth but controlling for prepregnancy obesity, increases in GWG lead to increased risk of LGA. Conclusions: Contrary to previous studies, which have found that maternal obesity increases the risk of c-section, macrosomia, and LGA, while decreasing the probability of breastfeeding, our sibling comparison models reveal no such association. In fact, our results suggest a protective effect of obesity in that women who are obese prepregnancy have longer gestation lengths, and are less likely to give birth to a preterm or low birthweight infant.
Article
Full-text available
b>Objective to examine the effect of psychosocial factors on exclusive breastfeeding duration to six months postpartum Design longitudinal, prospective questionnaire based study. Setting participants were recruited from a publically funded antenatal clinic located in the western metropolitan region of Melbourne, Victoria, Australia and asked to complete questionnaires at three time points; 32 weeks pregnancy, two months postpartum and six months postpartum. Participants the participants were 125 pregnant women aged 22–44 years. Measurements and findings psychosocial variables such as breastfeeding self-efficacy, body attitude, psychological adjustment, attitude towards pregnancy, intention, confidence and motivation to exclusively breastfeed and importance of exclusive breastfeeding were assessed using a range of psychometrically validated tools. Exclusive breastfeeding behaviour up to six months postpartum was also measured. At 32 weeks gestation a woman׳s confidence to achieve exclusive breastfeeding was a direct predictor of exclusive breastfeeding duration to six months postpartum. At two months postpartum, psychological adjustment and breastfeeding self-efficacy were predictive of exclusive breastfeeding duration. Finally, at six months postpartum, psychological adjustment, breastfeeding self-efficacy, confidence to maintain and feeling fat were directly predictive of exclusive breastfeeding duration.
Article
Full-text available
The Child Feeding Questionnaire (CFQ) assesses parental feeding attitudes, beliefs and practices concerned with child feeding and obesity proneness. The questionnaire has been developed in the U.S., and validation studies in other countries are limited. The aim of this study was to examine the psychometric properties of the CFQ in Sweden and the associations between parenting practices and children's weight status. Based on records from the Swedish population register, all mothers of 4-year-olds (n=3007) from the third largest city in Sweden, Malmo, were contacted by mail. Those who returned the CFQ together with a background questionnaire (n = 876) received the CFQ again to enable test-retest evaluation; 564 mothers completed the CFQtwice. We used confirmatory factor analysis to test whether the original 7-factor model was supported. Good fit (CFI = 0.94, TLI = 0.95, RMSEA = 0.04, SRMR = 0.05) was obtained after minor modifications such as dropping 2 items on restriction and adding 3 error covariances. The internal reliability and the 2-week test-retest reliability were good. The scores on restriction were the lowest ever reported. When the influence of parenting practices on child BMI (dependent variable) was examined in a structural equation model (SEM), child BMI had a positive association with restriction and a negative association with pressure to eat. Restriction was positively influenced by concern about child weight. The second SEM treated parenting practices as dependent variables. Parental foreign origin and child BMI had direct effects on restriction, while pressure to eat was also influenced by parental education. While the results of the study support the usefulness of the CFQin Sweden, carefully designed cross-cultural comparisons are needed to explain why the levels of restrictive feeding in Swedish families are the lowest reported. (C) 2014 The Authors. Published by Elsevier Ltd.
Article
Full-text available
Importance: Appropriate infant feeding practices have the potential for long-term health effects. However, research findings on improving early infant feeding practices are limited. The wide use of mobile phone short message service (SMS) provides new opportunities for health promotion and services. Objective: To assess the effect of an SMS intervention on infant feeding practices. Design and setting: Quasiexperimental design with follow-up measures scheduled at 4, 6, and 12 months at 4 community health centers in Shanghai, China. Two community health centers represented the intervention group, and 2 other community health centers represented the control group. Participants: In total, 582 expectant mothers were recruited during the first trimester. Expectant mothers were eligible to participate if they owned a mobile phone, were first-time mothers, conceived a singleton fetus, were older than 20 years and less than 13 weeks' gestation, had completed at least a compulsory junior high school education, and had no illness that limited breastfeeding after childbirth. Intervention: Mothers in the intervention group received weekly SMS messages about infant feeding from the third trimester to 12 months' post partum. Main outcomes and measures: The primary outcome was the duration of exclusive breastfeeding (EBF). Survival analysis was used to compare the duration of EBF between the intervention group and the control group. Results: Compared with the control group, the intervention group had a significantly longer median duration of EBF at 6 months (11.41 [95% CI, 10.25-12.57] vs 8.87 [95% CI, 7.84-9.89] weeks). The hazard ratio for stopping EBF in the intervention group was 0.80 (95% CI, 0.66-0.97). The intervention resulted in a significantly higher rate of EBF at 6 months (adjusted odds ratio, 2.67 [95% CI, 1.45-4.91]) and a significantly lower rate of the introduction of solid foods before 4 months (adjusted odds ratio, 0.27 [95% CI, 0.08-0.94]). Conclusions and relevance: An SMS intervention may be effective in promoting EBF, delaying the introduction of solid foods, increasing awareness of the World Health Organization breastfeeding guidelines, and improving knowledge of appropriate infant feeding practices for new mothers.
Article
Full-text available
to investigate the psychosocial variables associated with the ability to exclusively breastfeed to six months postpartum. Additionally, to evaluate a conceptual model of psychosocial correlates of exclusive breastfeeding duration. online, retrospective questionnaire. the questionnaire was placed online and participants accessed it through social networking sites including groups relating to breastfeeding, motherhood and parenting. Participants were also able to share the link with their own networks. This online setting facilitated recruitment of a wide range of Australian and international participants. 174 women aged 18 years and older who had given birth between six months to two years prior. Participants completed an online questionnaire, which asked them to report on three time points: pre-pregnancy, during pregnancy and during the first six months postpartum. Data were collected from June to December 2011. psychometrically validated tools such as the breastfeeding Self-Efficacy Scale, Body Attitude Questionnaire, Depression Anxiety and Stress Scale, Fetal Health Locus of Control Scale, and the brief COPE scale were used to measure psychosocial variables. Additional scales were developed by the researchers and met scale reliability criteria. correlation analyses, t-tests and path analysis were used to statistically analyse the data. Results showed that women who exclusively breast fed to six months postpartum exhibited higher intention to exclusively breastfeed, breastfeeding self-efficacy, comfort breastfeeding in public, perceived physical strength and reported less perceived breastfeeding difficulties. Path analyses indicated that breastfeeding self-efficacy was a strong significant predictor of both exclusive breastfeeding intention and duration. Maternal attitude towards pregnancy (both during pregnancy and postpartum), psychological adjustment and early breastfeeding difficulties were also found to be significant predictors of exclusive breastfeeding intention and duration. psychosocial factors are likely to play a significant role in the maintenance of exclusive breastfeeding for six months post-birth. Future research should adopt a prospective study design to examine the influence of psychosocial factors systematically and rigorously. longitudinal, prospective studies are needed to further examine the role of psychosocial factors on exclusive breastfeeding outcomes. Interventions, which involve improving psychosocial factors such as breastfeeding self-efficacy, may improve exclusive breastfeeding outcomes.
Article
Full-text available
Background: Breastfeeding is the reference against which alternative infant feeding models must be measured with regard to growth, development and other health outcomes. Although not a systematic review, this report provides an update for dental professionals, including an overview of general and oral health-related benefits associated with breastfeeding. Types of studies reviewed: The authors examined the literature regarding general health protections that breastfeeding confers to infants and mothers and explored associations between breastfeeding, occlusion in the primary dentition and early childhood caries. To accomplish these goals, they reviewed systematic reviews when available and supplemented them with comparative studies and with statements and reports from major nongovernmental and governmental organizations. Results: When compared with health outcomes among formula-fed children, the health advantages associated with breastfeeding include a lower risk of acute otitis media, gastroenteritis and diarrhea, severe lower respiratory infections, asthma, sudden infant death syndrome, obesity and other childhood diseases and conditions. Evidence also suggests that breastfed children may develop a more favorable occlusion in the primary dentition. The results of a systematic review in which researchers examined the relationship between breastfeeding and early childhood caries were inconclusive. Conclusions and clinical implications: The American Academy of Pediatric Dentistry, Chicago, suggests that parents gently clean infants' gums and teeth after breastfeeding. The American Academy of Pediatrics, Elk Grove Village, Ill., recommends that breastfeeding should be exclusive for about the first six months of life and should continue, with the introduction of appropriate complementary foods, to at least age 12 months or beyond, as desired by mother and child. Dentists and staff members can take steps to ensure they are familiar with the evidence and guidelines pertaining to breastfeeding and to oral health. They are encouraged to follow the surgeon general's recommendations to promote and support optimal breastfeeding and oral health practices among their patients.
Article
Full-text available
This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N = 367) and suggested that the diagnoses from this scale possessed temporal reliability (mean kappa = .80) and criterion validity (with interview diagnoses; mean kappa = .83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test-retest reliability (r = .87), internal consistency (mean alpha = .89), and convergent validity with extant eating-pathology scales. Results implied that this scale was reliable and valid in this investigation and that it may be useful for clinical and research applications.
Article
Full-text available
The Child Feeding Questionnaire (CFQ) is a self-report measure to assess parental beliefs, attitudes, and practices regarding child feeding, with a focus on obesity proneness in children. Confirmatory factor analysis tested a 7-factor model, which included four factors measuring parental beliefs related to child's obesity proneness, and three factors measuring parental control practices and attitudes regarding child feeding. Using a sample of 394 mothers and fathers, three models were tested, and the third model confirmed an acceptable fit, including correlated factors. Internal consistencies for the seven factors were above 0.70. With minor changes, this same 7-factor model was also confirmed in a second sample of 148 mothers and fathers, and a third sample of 126 Hispanic mothers and fathers. As predicted, four of the seven factors were related to an independent measure of children's weight status, providing initial support for the validity of the instrument. The CFQ can be used to assess aspects of child-feeding perceptions, attitudes, and practices and their relationships to children's developing food acceptance patterns, the controls of food intake, and obesity. The CFQ is designed for use with parents of children ranging in age from about 2 to 11 years of age.
Article
Recent studies have identified a relationship between maternal body mass index during prepregnancy (BMI) and exclusive breastfeeding (EBF), which is less common among mothers with higher BMI. The purpose of this literature review is to provide a pooled effect for the association between maternal excess weight during prepregnancy and cessation of exclusive breastfeeding. A systematic review was performed using articles present in six databases (PubMed, Scopus, Web off Science, Science direct, CINAHL and LILACS) published till February 2017. Studies investigating the association between excess maternal weight during prepregnancy and cessation of exclusive breastfeeding were included in the review. A meta-analysis using random effects to obtain a pooled effect of the studied association was conducted only with studies reporting odds ratio (OR) or available data for the calculation. Univariate meta-regression was performed to evaluate possible sources of heterogeneity. Egger's tests were also performed to verify possible publication bias. From the 6889 studies identified, 102 were read in full and 17 were included in the meta-analysis, providing 28 estimates for the association. Overall, a positive association was observed between maternal excess weight during prepregnancy and cessation of exclusive breastfeeding (ES: 1.60 (95% CI: 1.47, 1.74), I2: 93.2%). According to the used independent variables, no sources of heterogeneity were identified between studies Bias in publication was found. Maternal excess weight during prepregnancy was associated with cessation of exclusive breastfeeding. A standardized measure for exclusive breastfeeding is still needed for estimating its duration, in addition to further studies in developing countries to understand what could explain the heterogeneity of the findings.
Article
Pregnancy and childbirth result in dramatic changes in a woman's body shape, which can be associated with body image concerns. To date, however, little is known about how sociocultural factors may influence body dissatisfaction in postpartum women. This study aimed to test a sociocultural model of body image and eating concerns among a sample of postpartum women. A sample of N = 474 women, mean (SD) age = 30.6 (4.8), having given birth during the last year, completed an online survey and reported on sociocultural pressures from media, peers, family and partners, thin-ideal internalization, appearance comparison, body dissatisfaction, and psychological functioning. Structural equation modeling analyses revealed a good fit to the data, χ2 (49) = 220.20, p < .001, RMSEA = .086, CFI = .93. Findings suggest that women experience strong sociocultural pressures to attain unrealistic body shapes/sizes during the post-pregnancy period, contributing to their body image concerns.
Article
Background: The relation between breastfeeding and early motor development is difficult to characterize because of the problems in existing studies such as incomplete control for confounding, retrospective assessment of infant feeding, and even the assessment of some motor skills too early.Objective: We sought to estimate associations between infant feeding and time to achieve major motor milestones in a US cohort.Design: The Upstate New York Infant Development Screening Program (Upstate KIDS Study) enrolled mothers who delivered live births in New York (2008-2010). Mothers of 4270 infants (boys: 51.7%) reported infant motor development at 4, 8, 12, 18, and 24 mo postpartum; information on infant feeding was reported at 4 mo. Accelerated failure time models were used to compare times to standing or walking across feeding categories while adjusting for parental characteristics, daycare, region, and infant plurality, sex, rapid weight gain, and baseline neurodevelopmental test results. Main models were stratified by preterm birth status.Results: The prevalence of exclusive breastfeeding in preterm infants was lower than in term infants at 4 mo postpartum (8% compared with 19%). After adjustment for confounders, term infants who were fed solids in addition to breast milk at 4 mo postpartum achieved both standing [acceleration factor (AF): 0.93; 95% CI: 0.87, 0.99] and walking (AF: 0.93; 95% CI: 0.88, 0.98) 7% faster than did infants who were exclusively breastfed, but these findings did not remain statistically significant after correction for multiple testing. We did not identify feeding-associated differences in motor milestone achievement in preterm infants.Conclusion: Our results suggest that differences in feeding likely do not translate into large changes in motor development. The Upstate KIDS Study was registered at clinicaltrials.gov as NCT03106493.
Article
Background: Although breastfeeding is associated with proven benefits to both mother and child, there are many factors that influence a mother's decision to breastfeed. Pregnancy intentionality at the time of conception is associated with postpartum maternal behavior including breastfeeding. Research aim: We sought to understand how maternal and paternal pregnancy intentions were associated with breastfeeding initiation and duration in a nationally representative sample. Methods: We used a cross-sectional, retrospective study of the CDC National Survey of Family Growth data to examine the link between pregnancy intentionality and breastfeeding initiation and duration among women ages 15 to 44 years. Results: We found that whereas the mother's intention to have a child was a factor in how long she breastfed, the paternal intention to have a child predicted whether the mother breastfed at all. Additionally, Hispanic mothers were most likely to breastfeed and breastfed the longest of any other group. Age and education were also positive predictors of ever breastfeeding. Conclusion: Understanding the father's and mother's attitudes toward the pregnancy and influence on breastfeeding intention is important for intervention planning.
Objective: To define the different breastfeeding interventions that promote breastfeeding exclusivity and duration in the late preterm infant and to synthesize findings from the published empirical literature on late preterm infant breastfeeding interventions. Data sources: The databases CINAHL, Scopus, and PubMed were searched for primary research articles on breastfeeding interventions for late preterm infants. Inclusion criteria included original research studies in which authors examined a breastfeeding intervention or second-line strategy in a sample inclusive of but not necessarily limited to the gestational age range of 34 to 3667 weeks gestation, written in English, and published between 2005 and 2015. Study selection: Thirteen articles were identified, including five randomized controlled trials, three quasi-experimental studies, four descriptive studies, and one case study. Data extraction: Whittemore and Knafl's methodology guided this integrative review. Data extraction and organization occurred under the following headings: author and year, study design, level of evidence, purpose, sample, setting, results, limitations, recommendations, and intervention. Data synthesis: Studies on breastfeeding interventions were synthesized under four concepts within the Late Preterm Conceptual Framework: Physiologic Functional Status, Care Practices, Family Role, and Care Environment. Conclusion: Most breastfeeding interventions within this integrative review had positive effects on exclusivity and duration of breastfeeding in the late preterm infant. However, second-line strategies had equivocal effects on exclusivity but had positive effects on duration. The positive effects of breastfeeding interventions on breastfeeding exclusivity and duration are highlighted in our results, and we point to the need for a focus on breastfeeding after the transition home for late preterm infants.
Article
Objective The purpose of the present study was to examine the influence of maternal pre-pregnancy BMI and gestational weight gain (GWG) on initiation and duration of infant breast-feeding in a prospective birth cohort study. Design Breast-feeding information was collected at 1, 3, 6 and 12 months postpartum. The association of pre-pregnancy BMI and GWG with delayed lactogenesis II and termination of exclusive breast-feeding was assessed with logistic regression analysis. The risk of early termination of any breast-feeding during the first year postpartum was assessed with Cox proportional hazards models. Setting Urban city in China. Subjects Women with infants from the Ma’anshan Birth Cohort Study ( n 3196). Results The median duration of any breast-feeding in this cohort was 7·0 months. Pre-pregnancy obese women had higher risks of delayed lactogenesis II (risk ratio=1·89; 95 % CI 1·04, 3·43) and early termination of any breast-feeding (hazard ratio=1·38; 95 % CI 1·09, 1·75) adjusted for potential maternal and infant confounders, when compared with normal-weight women. No differences in breast-feeding initiation or duration of exclusive breast-feeding according to pre-pregnancy BMI were found. Moreover, GWG was not associated with any poor breast-feeding outcomes. Conclusions The present study indicated that pre-pregnancy obesity increases the risks of delayed lactogenesis II and early termination of any breast-feeding in Chinese women.
Article
Background: To a large extent, breastfeeding practices depend on cultural norms. It is thus of particular importance to examine these practices in various settings, especially when considering the effect of complex factors, such as body mass index (BMI) or socioeconomic status. Objective: This study aimed to compare the breastfeeding practices of obese mothers with those of normal weight, taking into account social and economic status. Methods: Obese (BMI ≥ 30 kg/m(2)) and normal-weight (18.5 kg/m(2) ≤ BMI < 25 kg/m(2)) mothers with children between the ages of 6 months and 3 years were recruited for this study in Leipzig, Germany, via newspaper ads and other means. Kaplan-Meier curves for portraying breastfeeding over time were analyzed using Cox regression after checking the proportional hazards model. Results: Eighty obese and 70 normal-weight mothers were recruited. Significantly fewer obese mothers breastfed (84%) than normal-weight mothers (96%) (95% confidence interval [CI] for the difference is 3 to 22 percentage points, P = .02). Even after adjusting for the level of education and family income, breastfeeding duration was significantly shorter (2.7 months; 95% CI, 0.8-4.6 months; P = .005) in the obese group than in the normal-weight group. Conclusion: Our findings demonstrate that even at the earliest stages, breastfeeding behavior of obese mothers differs from that of normal-weight mothers.
Article
Background: Many studies have documented that breastfeeding is associated with a significant reduction in child obesity risk. However, a persistent problem in this literature is that unobservable confounders may drive the correlations between breastfeeding behaviors and child weight outcomes. Objective: This study examines the effect of breastfeeding practices on child weight outcomes at age 2. Methods: This study relied on population-based data for all births in Oregon in 2009 followed for two years. We used instrumental variables methods to exploit variations in breastfeeding by mothers immediately after delivery and the degree to which hospitals encouraged mothers to breastfeed in order to isolate the effect of breastfeeding practices on child weight outcomes. Results: We found that for every extra week that the child was breastfed, the likelihood of the child being obese at age 2 declined by 0.82% [95% CI -1.8% to 0.1%]. Likewise, for every extra week that the child was exclusively breastfed, the likelihood of being obese declined by 0.66% [95% CI -1.4 to 0.06%]. While the magnitudes of effects were modest and marginally significant, the results were robust in a variety of specifications. Conclusion: The results suggest that hospital practices that support breastfeeding may influence childhood weight outcomes.
Article
The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years and 20 000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
Article
Background: Suboptimal infant feeding practices, including the failure to exclusively breastfeed, are modifiable risk factors that affect multiple maternal and child health outcomes. Women who are overweight or obese prenatally are more likely to fail to exclusively breastfeed. In the United States, Latinas represent a high-risk population with respect to overweight, obesity, and suboptimal infant feeding practices. Objectives: Examine whether exclusive breastfeeding status at hospital discharge among overweight and obese Latinas was associated with (1) prepregnancy body mass index (BMI) and gestational weight gain and (2) sociodemographic, psychosocial, and maternal/infant biomedical factors. Methods: An electronic medical records review was conducted to determine exclusive breastfeeding status at hospital discharge among Latinas who gave birth at Hartford Hospital, Hartford, Connecticut, USA (N = 480). Eligible participants were ≥ 16 years, Latina, overweight or obese (BMI ≥ 25.0 kg/m(2)) and delivered a healthy full-term (≥ 37 weeks) singleton. Results: In the multivariable model, obese class II (BMI, 35.0-39.9 kg/m(2)) women had increased odds of failing to exclusively breastfeed at hospital discharge compared with overweight women. Planned formula use/partial breastfeeding was the single strongest predictor of nonexclusive breastfeeding status. Other risk factors included Puerto Rican ethnicity and parity. Conclusion: Maternal prepregnancy obesity class is an important predictor of exclusive breastfeeding status at hospital discharge among overweight and obese Latinas. Future research should examine why in-hospital exclusive breastfeeding behaviors differ by obesity class to subsequently inform the design of breastfeeding promotion and support interventions tailored to the needs of Latinas by obesity class. Culturally appropriate prenatal breastfeeding promotion interventions emphasizing action and coping planning should be considered.
Article
The gap between the demand and delivery of mental health services in mainland China can be reduced by validating freely available and psychometrically sound psychological instruments. The present research examined the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21). Study 1 administered the DASS-21 to 1,815 Chinese college students and found internal consistency indices (Cronbach's alpha) of .83, .80, and .82 for the Depression, Anxiety, and Stress subscales, respectively, and .92 for the total DASS total. Test-retest reliability over a 6-month interval was .39 to .46 for each of the 3 subscales and .46 for the total DASS. Moderate convergent validity of the Depression and Anxiety subscales was demonstrated via significant correlations with the Chinese Beck Depression Inventory (r = .51 at Time 1 and r = .64 at Time 2) and the Chinese State-Trait Anxiety Inventory (r = .41), respectively. Confirmatory factor analyses supported the original 3-factor model with 1 minor change (nonnormed fit index [NNFI] = .964, comparative fit index [CFI] = .968, and root mean square error of approximation [RMSEA] = .079). Study 2 examined the clinical utility of the Chinese DASS-21 in 166 patients with schizophrenia and 90 matched healthy controls. Patients had higher Depression and Anxiety but not Stress subscale scores than healthy controls. A discriminant function composed of the linear combination of 3 subscale scores correctly discriminated 69.92% of participants, which again supported the potential clinical utility of the DASS in mainland China. Taken together, findings in these studies support the cross-cultural validity of the DASS-21 in China. (PsycINFO Database Record
Article
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short-and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Medical contraindications to breastfeeding are rare. Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive. Hospital routines to encourage and support the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed WHO/UNICEF "Ten Steps to Successful Breastfeeding." National strategies supported by the US Surgeon General's Call to Action, the Centers for Disease Control and Prevention, and The Joint Commission are involved to facilitate breastfeeding practices in US hospitals and communities. Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad. The "Business Case for Breastfeeding" details how mothers can maintain lactation in the workplace and the benefits to employers who facilitate this practice. Pediatrics 2012; 129:e827-e841
Article
The postnatal feeding practices of obese and overweight mothers may place their children at increased risk for the development of obesity through shared biology and family environments. This article reviews the feeding practices of obese mothers, describes the potential mechanisms linking maternal feeding behaviors to child obesity risk, and highlights the potential avenues of intervention. Strategies important for improving the quality of the eating environment and preventing the intergenerational transmission of obesity include supporting breastfeeding, improving the food choices of obese women, and encouraging the development of feeding styles that are responsive to hunger and satiety cues.
To determine what factors affect breastfeeding duration after discharge home from the neonatal intensive care unit (NICU) for high-risk mothers and their premature infants. The electronic databases of CINAHL and PubMed were used to identify studies published in English. Date of publication did not limit inclusion in the review. Using exclusion and inclusion criteria, 292 articles were initially assessed for relevance to the research question through abstract review. Further screening resulted in full review of 52 articles. Reference list searching added an additional six articles. Finally, in-depth review of these 58 articles resulted in 24 studies that fully met inclusion and exclusion criteria. Studies were reviewed for information related to factors associated with breastfeeding duration for high-risk mothers and preterm infants after NICU discharge home. Studies were categorized into five themes, including NICU factors, feeding and soothing methods, maternal characteristics, maternal experiences, and support programs. Most significant factors affecting duration included exposure to kangaroo mother care, prenatal education, and quantity of maternal breast milk supply during the first week after discharge. Breastfeeding also was affected by maternal breastfeeding knowledge and perception of providing appropriate volumes. Mothers face many challenges breastfeeding their premature infants after NICU discharge. Ideally, all mothers need to receive support after NICU discharge, and the transition to home can be challenging even if breastfeeding is well established. However, NICU professionals are in a perfect position to provide guidance to families so they are able to anticipate and effectively solve lactation challenges at home.
Article
Abstract Objective: To explore the relationship between overweight and obesity and breastfeeding behaviours, a cohort study was conducted among 22,131 women who delivered in Ontario hospitals between April 1 2008 and March 31 2010. Methods: Data regarding maternal characteristics, maternal body mass index (BMI), infant characteristics, and breastfeeding practices was obtained through the Better Outcomes Registry & Network birth records Database. Multivariate linear regression analysis was used to determine the rates of three outcome measures - intention to breastfeed, exclusive breastfeeding in hospital, and exclusive breastfeeding upon discharge from hospital- between non-obese, overweight and obese patients. Results: While overweight mothers have similar intentions to breastfeed compared to non-overweight mothers (OR 1.03 (0.87-1.21), obese mothers were less likely to intend to breastfeed (OR 0.84 (0.70- 0.99). Overweight and obese mothers were less likely to exclusively breastfeed in hospital compared to non-overweight mothers (aOR 0.67 (0.60- 0.75) and 0.67 (0.60-0.75) respectively), and overweight and obese mothers were less likely to exclusively breastfeed on discharge (aOR 0.68 (0.61-0.76) and 0.68 (0.61-0.76) respectively). Conclusions: This study highlights that while overweight and obese women may benefit more from exclusive breastfeeding compared to non-overweight women, they are less likely to exclusively breastfeed in the immediate post-partum period.
Article
This article systematically reviews the literature pertaining to correlates of body dissatisfaction during pregnancy. A total of 8 electronic databases were searched and 251 papers identified, 56 of which met inclusion criteria. Full text scrutiny of these papers reduced the final list of reviewed papers to 22. Results of the review highlight that psychological factors were associated with body dissatisfaction during pregnancy, and noted the surfeit of studies examining the relationship was between body dissatisfaction and depression. It is concluded that the prevention of heightened body dissatisfaction during the reproductive phase will only be effective when models of risk factors have been examined systematically and rigorously.
Article
The Eating Disorder Inventory (EDI) has been demonstrated to have high internal consistency in the form of split-half reliability. Demonstration of stability in the form of test-retest reliability has been absent. Test-retest reliability for the EDI was obtained with a sample of 70 university undergraduates. Test-retest reliability was also obtained with a restricted group drawn from the original sample who were considered to be at risk on the basis of their EDI scores. The interval between test administrations was 3 weeks. With both samples, test-retest reliability of the total EDI score was exceptionally high. Test-retest reliability for the eight subscales was, with one exception, within the usual range of acceptability.
Article
Previous studies have found an association between maternal obesity and overweight and breastfeeding (BF) difficulties, including delayed lactogenesis and shorter duration of BF. Biological, psychological, and mechanical causes have been linked with poor BF outcomes. Other review articles on this topic have included studies that measured maternal body mass index (BMI) in the postpartum period instead of prenatally, presenting difficulties in teasing out the role of gestational weight gain and prepregnancy BMI on BF success. My objective was to evaluate the relationship between maternal prepregnancy BMI, including comorbidities associated with overweight and obesity such as diabetes mellitus, and BF initiation and duration. Four PubMed searches were conducted, retrieving 13 articles. Of the 12 studies reviewed that assessed the association between prepregnancy maternal BMI category and BF initiation, 9 found an association between maternal overweight or obesity and delayed lactogenesis or failure to initiate BF. One study found increased risk for not initiating BF only in Hispanic women, and 1 found the association only among women with medical comorbidities in addition to obesity. Of the 13 studies retrieved that assessed the association between BMI category and BF duration, 10 found an association between higher BMI categories and shorter duration of BF. Ten of the 13 studies reviewed adjusted for multiple confounders, including maternal smoking status, parity, type of delivery, and infant birthweight. The studies that found an association between BMI category and reduced duration did so in some cases only for certain ethnic/racial groups or BMI categories or if other comorbidities were present in addition to overweight/obesity. Higher BMI levels can adversely impact BF initiation and duration. Further studies need to be conducted to better understand the role of race/ethnicity, gestational weight gain, and such comorbidities as diabetes in increasing risk for reduced BF initiation and duration in overweight and obese women.
Article
The purpose of this study was to explore relationships between maternal concern about child under- and overweight, the use of maternal feeding practices (pressure to eat and restriction, monitoring and modelling of healthy eating), child eating behaviours (fussiness and food responsiveness) and child body mass index. The sample consisted of 183 mothers of 2- to 4-year-old children who completed questionnaires about their feeding practices, concern about their child's weight, their child's eating behaviours, height and weight. Correlation analyses found that pressure to eat was positively associated with concern about child underweight, while restriction was positively associated with concern about child overweight. Monitoring and modelling were not independently associated with concern about child weight. Regression analysis revealed that child food fussiness positively predicted maternal pressure to eat, and this relationship was partially mediated by concern about child underweight. Child food responsiveness positively predicted restriction, and this relationship was partially mediated by concern about child overweight. Child BMI did not independently predict maternal feeding practices. The findings provide a useful contribution to the literature on determinants of maternal feeding practices, but further research is necessary to gain an understanding of the impact of these behaviours on child eating behaviour and weight.
Article
The purpose of this study was to reduce the number of items on the original Breastfeeding Self-Efficacy Scale (BSES) and psychometrically assess the revised BSES-Short Form (BSES-SF). As part of a longitudinal study, participants completed mailed questionnaires at 1, 4, and 8 weeks postpartum. Health region in British Columbia. A population-based sample of 491 breastfeeding mothers. BSES, Edinburgh Postnatal Depression Scale, Rosenberg Self-Esteem Scale, and Perceived Stress Scale. Internal consistency statistics with the original BSES suggested item redundancy. As such, 18 items were deleted, using explicit reduction criteria. Based on the encouraging reliability analysis of the new 14-item BSES-SF, construct validity was assessed using principal components factor analysis, comparison of contrasted groups, and correlations with measures of similar constructs. Support for predictive validity was demonstrated through significant mean differences between breastfeeding and bottle feeding mothers at 4 (p < .001) and 8 (p < .001) weeks postpartum. Demographic response patterns suggested the BSES-SF is a unique tool to identify mothers at risk of prematurely discontinuing breastfeeding. These psychometric results indicate the BSES-SF is an excellent measure of breastfeeding self-efficacy and considered ready for clinical use to (a) identify breastfeeding mothers at high risk, (b) assess breastfeeding behaviors and cognitions to individualize confidence-building strategies, and (c) evaluate the effectiveness of various interventions and guide program development.
Article
This study examined changes in body image and predictors of body dissatisfaction during pregnancy. It was expected that higher levels of depression, social comparison tendencies, teasing, societal pressure to be thin and public self-consciousness would predict body dissatisfaction prospectively. Healthy pregnant women (n=128) completed questionnaires on three occasions during their pregnancies reporting on a total of four time points: 3 months prior to pregnancy (retrospectively reported), in the early to mid-second trimester, the late-second/early-third trimester, and the latter part of the third trimester. For the most part women reported adapting to the changes that occurred in their body; however, women were most likely to experience higher levels of body dissatisfaction in early to mid-second trimester. Findings related to predictors of body dissatisfaction revealed that both social and psychological factors contributed to body image changes in pregnancy. Implications of the findings are discussed.
Article
The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based diagnoses, convergent validity with risk factors for eating pathology, and internal consistency. Studies 2 and 3 found that the EDDS was sufficiently sensitive to detect the effects of eating disorder prevention programs. Regarding predictive validity, Studies 3 and 4 found that the EDDS predicted response to a prevention program and future onset of eating pathology and depression. Results provide additional evidence of the reliability and validity of this scale and suggest it may be useful in clinical and research applications.
  • D Garner
Garner, D. (1991). Eating Disorder Inventory (2nd ed.). Odessa, TX: Psychological Assessment Resources.
Effect of short message service on infant feeding practice: Findings from a community-based study in
  • H Jiang
  • M Li
  • L M Wen
  • Q Hu
  • D Yang
  • G He
  • . . Qian
Jiang, H., Li, M., Wen, L. M., Hu, Q., Yang, D., He, G.,... Qian, X. (2014). Effect of short message service on infant feeding practice: Findings from a community-based study in Shanghai, China. JAMA Pediatrics, 168(5), 471-478. doi:10.1001/jamapediatrics.2014.58
Health topics: breastfeeding
World Health Organization. (2016). Health topics: breastfeeding. Geneva, Switzerland: Author.