68: Breastfeeding Initiation at Hospital Among Obese Women: The Role of Perinatal Factors

Abstract

Background: Despite specific benefits for infants and mothers, breastfeeding initiation at birth remains problematic in the subgroup of obese women. Objectives: To evaluate the incidence of breastfeeding initiation at hospital, according to maternal pre-pregnancy body mass index (BMI) in “Grossesse en Santé”, a large prospective birth cohort in Quebec City. Design/Methods: Data (2005 to 2010) includes pregnant women with a singleton, with delivery expected in a second or third line hospital. Sociodemographic and prenatal factors including women's weight and height were self-reported by questionnaire within 12 weeks of gestation. Initiation of breastfeeding at hospital as well as intra- and postpartum data were collected from the mother's and infant's obstetrical chart. Log-binomial analyses were performed to assess relative risk between maternal BMI and breastfeeding initiation in a model including pre- and post-natal determinants. Results: Among participants (n=6592), 13% were obese, 48% were primiparous, 97% were Caucasian, 10% were smoker and 40% had a university degree. Average maternal age was 30±4.3 years, gestational age at birth was 39.4±1.5 weeks and 21.21% of mothers gave birth by C-section. Compared with normal weight, obese women (BMI ≥30 kg/m2) initiated less often breastfeeding before discharge home (RRunadj 1.69 [95% CI 1.44 to 1.98]) even after adjustment for multiple prenatal factors including education, smoking, maternal age and parity (RRadj 1.25 [95% CI 1.08 to 1.46]). After introduction in the previous model of the per- and post-natal perinatal factors (eg, type of delivery, gestational diabetes, type of anesthesia, gestational age, baby's weight, neonatal unit transfer), the association was decreased indicating that these factors determined breastfeeding initiation after birth (RR 1.18 [95% CI 1.005 to 1.19]). However, it still remained statistically significant highlighting a potential role of other behavioural factors such as mother's motivation. Indeed, documented in a subgroup of the cohort (year 2009 to 2010, n=1174), prenatal intention of breastfeeding was decreased in the obese population, with an increased risk of bottle-feeding intention compared with normal weight women (RRunadj 1.72 [95% CI 1.10 to 2.68]). Conclusions: Maternal obesity is associated with poor breastfeeding issues. Both pre and post natal factors should be targeted by interventions in this population, considering the specific breastfeeding benefits and the increasing rates of obesity. Perinatal professionals should be aware of this reality.