The association of maternal overweight and obesity with breastfeeding duration

doi:10.1016/j.jpeds.2006.04.005

The Journal of Pediatrics

Volume 149, Issue 2, August 2006, Pages 185-191

https://doi.org/10.1016/j.jpeds.2006.04.005 Get rights and content

Objective

To determine whether maternal prepregnancy overweight or obesity has an independent effect on breastfeeding duration.

Study design

A prospective birth cohort study of 1803 live-born children and their mothers ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth, Australia, were followed until 3 years of age. Unconditional logistic, Cox regression, and Kaplan Meier analyses were used to model the association between maternal prepregnancy overweight and obesity and the duration of predominant or any breastfeeding allowing for adjustment of confounders (infant factors: gender, birth weight, gestational age, age solids introduced, and older siblings; maternal factors: smoking, education, age, race, marital status, pregnancy and birth complications, cesarean section, and socioeconomic status).

Results

Overweight and obese women were more likely to have discontinued breastfeeding at any time before 6 months than normal weight women (P < .0005) following adjustment for potential confounders.

Conclusion

We have shown that prepregnancy body mass index is associated with reduced breastfeeding duration, and that mothers who are overweight or obese before pregnancy tend to breastfeed their infants for a shorter duration than normal weight mothers independent of maternal socioeconomic and demographic characteristics.

Section snippets

Study Population

The Western Australian Pregnancy Cohort Study commenced in 1989¹⁶ in which 2968 women were serially recruited at or before the 18th week of gestation from the public antenatal clinic at King Edward Memorial Hospital (KEMH) and nearby private antenatal clinics in Perth, Western Australia. Approximately 100 women per month were enrolled for a total of 30 months commencing in May 1989 and finishing in November 1991. The criteria for enrollment were gestational age between 16 and 20 weeks,

Results

Of 2868 live births, 2611 (91%) children were available for follow-up at 3 years (13 children had since died, 124 children had been withdrawn, and 120 children [predominantly living overseas] were lost to follow-up). Complete data for all analyses were available for 1803 (69% [1803/2611]) children. Selected sociodemographic, prenatal, and perinatal characteristics of the Raine Study cohort at birth were compared with those in our study children. Between nonparticipants and participants the

Discussion

We have shown that independent of maternal socioeconomic, demographic, and biomedical characteristics, maternal prepregnancy overweight and obesity reduces breastfeeding duration at all time points up to 6 months following birth.

The findings from our study agree with those of a prospective Australian study that examined the perinatal effects of maternal BMI.²¹ Despite adjusting for the effects of mother’s age, occupation, and time of first breastfeed, the findings from their study showed that

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The importance of the maternal-infant dyad in the genesis of nonalcoholic fatty liver disease (NAFLD) is of increasing interest. The Avon Longitudinal Study of Parents and Children (ALSPAC) showed that at age 24, 1 in 5 had NAFLD measured by transient elastography and controlled attenuation parameter (CAP). Our aim was to investigate the association between breastfeeding duration and maternal pre-pregnancy BMI on offspring NAFLD in young adulthood.
4021 participants attended clinic for FibroScan and CAP measurement using Echosens 502 Touch®. 440 participants with Alcohol Use Disorders were excluded. Offspring of 100 non-singleton pregnancies were excluded. 2961 valid CAP measurements for NAFLD were analysed. Exposures of interest were breastfeeding of any duration, ≥6months exclusive breastfeeding, and maternal pre-pregnancy BMI. Multivariable regression models estimated the odds of NAFLD at 24 years. We performed a paternal negative control test to explore residual confounding in the analyses of pre-pregnancy BMI.
There was a modest inverse association of exclusive and non-exclusive breastfeeding ≥6 months having a protective effect on NAFLD in offspring (OR 0·92 [95%CI 0·66-1·27] and OR 0·90 [0·67-1·21] respectively).The odds of offspring NAFLD in overweight pre-pregnancy maternal BMI and paternal BMI was OR 2·09 [1·62-2·68] and OR 1·33 [95%CI 1·07-1·65] respectively, with the ratio of effect sizes OR 1·57 [1·11-2·22]. Similarly, odds of offspring NAFLD with obese pre-pregnancy maternal BMI and paternal BMI was OR 2·66 [1·71-4·14] and OR 1·35 [0·91-2·00] respectively, with the ratio of effect sizes OR 1·98 [1·05-3·74].
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Citation Excerpt :
Our results on breastfeeding disparities associated with maternal race and ethnicity, age at delivery, obesity, and education level were consistent with results reported previously. Breastfeeding rates were lower in women who were black and Hispanic,11-16 younger ages,27,28 obese,13,17-26 and with less education.21,29,38 Although parity has been associated with breastfeeding in combination with older maternal age in Japanese women,27 there was little disparity associated with parity overall in this study.
To assess trends and disparities in breastfeeding by maternal characteristics (race and ethnicity, age at delivery, obesity, parity, and level of education) and the relative importance among these for breastfeeding at 6 months.
This retrospective birth cohort study included 195 861 live singleton children born at 32-42 weeks of gestation from 2008 to 2015 within a single integrated healthcare system. All children had healthcare coverage during the first year of life. Maternal characteristics and breastfeeding status at 6 months of age were extracted from electronic medical records. Trends over time of any breastfeeding ≥6 months were evaluated for the 5 maternal characteristics. Robust Poisson regression models were used to estimate breastfeeding rate differences associated with each of the 5 characteristics. The relative importance among them associated with breastfeeding ≥6 months was assessed by comparing model quasi-likelihood information criteria.
Rates of breastfeeding ≥6 months significantly increased overall and among groups defined by the maternal characteristics. However, there was little improvement over time in closing disparities associated with maternal race and ethnicity, age at delivery, prepregnancy obesity status, and level of education. Education level contributed to the greatest disparity in breastfeeding ≥6 months. Maternal age was the second factor, followed by prepregnancy obesity and maternal race and ethnicity.
Breastfeeding outreach programs focusing on women with less than a college education, women <25 years old, and women from non-Hispanic black or Hispanic race and ethnicity may help to reduce disparities and improve breastfeeding persistence rates within integrated healthcare systems.
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W.H. Oddy is supported by a Population Health Research Fellowship from the National Health & Medical Research Council of Australia. The Raine Study is funded by the National Health & Medical Research Council of Australia, the Western Australian Health Promotion Foundation and the Raine Study Foundation.

W.H. Oddy developed the hypothesis, undertook statistical analyses, wrote the main drafts of the paper and is correspondent for this manuscript and requests for reprints. J. Li contributed to writing of the main draft, statistical analysis and result interpretation. L. Landsborough was responsible for the literature review and contributed to interpretation of the results. S. Henderson, G.E. Kendall, and J. Downie assisted with drafts of the manuscript and interpretation of the results.

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Original articleThe association of maternal overweight and obesity with breastfeeding duration

Objective

Study design

Results

Conclusion

Section snippets

Study Population

Results

Discussion

Am J Obstet Gynecol

Semin Perinatol

Am J Clin Nutr

J Am Diet Assoc

J Nutr

Lancet

Obesitypreventing and managing the global epidemic

Weight gain and the outcome of pregnancy

Am J Obstet Gynecol

Effects of obesity on women’s reproduction and complications during pregnancy

Obesity Rev

Obesity increases the risk of spontaneous abortion during infertility treatment

Obesity Res

Macrosomia—maternal characteristics and infant complications

Obstet Gynecol

Original article
The association of maternal overweight and obesity with breastfeeding duration