Effect of Maternal Body Mass Index on Infant Breastfeeding Behaviors and Exclusive Direct Breastfeeding

doi:10.1111/1552-6909.12755

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 44, Issue 6, November–December 2015, Pages 772-783

https://doi.org/10.1111/1552-6909.12755 Get rights and content

Abstract

Objective

To describe the effect of maternal body mass index (BMI) on infant breastfeeding behaviors (poor, steady,vigorous) and the transition of the mother-infant dyad to exclusive, direct breastfeeding during the first month of life.

Design

Longitudinal descriptive investigation.

Setting

Tertiary-level southeastern medical center and follow-up telephone calls.

Participants

One hundred sixteen healthy, racially diverse, breastfeeding mother-infant dyads (77 full-term and 39 late-preterm infants).

Main Outcome Measure(s)

Breastfeeding outcomes were classified as exclusive direct or partially breastfed. The effect of maternal BMI was compared to results from weekly mother’s reports of infant breastfeeding behaviors.

Results

Significant breastfeeding differences were observed based on maternal BMI and infant gestational age. Mothers with BMIs greater than 25 who described their infants as a vigorous breastfeeders were less likely to exclusively direct breastfeed (p < 002). Only 40% of mother-infant dyads had exclusive direct breastfeeding at any time point or gestational age with no significant increase at any time point after discharge. The BMIs of the woman made no difference in exclusive direct breastfeeding full-term infants compared to late-preterm infants.

Conclusion

Maternal BMI had limited negative influence on exclusive direct breastfeeding during the first 4 weeks after discharge. Mothers should be educated that many infants need 3 to 4 weeks after discharge to learn how to breastfeed, infant feeding demands change during this time, and this time is important to the infant’s neurologic and overall development.

Section snippets

Design

A secondary analysis of a longitudinal descriptive investigation was used to examine mothers’ reports of infant breastfeeding behaviors at five time intervals: at birth and 1, 2, 3, and 4 weeks after discharge. Mother-infant breastfeeding dyads were approached for study participation within a tertiary regional center with approximately 3,300 births annually. As a secondary analysis, the sample was aggregated from three different pilot study populations in which infant breastfeeding behavior

Results

Four hundred seventy-three mother-infant dyads were approached and a convenience sample of 116 (77 full-term and 39 preterm) mother-infant dyads was recruited (Table 2). Most mothers declined due to the perceived burden of participating in a study during the first month after birth. Maternal demographic characteristics are included inTable 2. After birth during the hospital stay, 11 (8.84%) mothers were not breastfeeding because their infants were born prematurely or bottle supplementation

Discussion

The focus of the study was to evaluate the influence of mother’s BMIs and their reports of infant breastfeeding behaviors on exclusive direct breastfeeding during the first month after discharge. In this study, breastfeeding dyads with vigorous feeders increased to 10% (10) of all infants at 2 to 3 weeks after discharge. By 1 month however, the number of vigorous feeders had dropped to 7% (7). This findings may be due to the fact that many mothers do not realize that at 2 to 3 weeks their milk

Clinical Implications

Mother-infant dyads with mothers with BMIs greater than 25 are at risk for decreased milk supply and successful transition to exclusive direct breastfeeding (Hauff et al., 2014; Jevitt, Hernandez, & Gro¨ er, 2007; Lepe et al., 2011). As more than 50% of all postpartum mothers have prepregnancy BMIs greater than 25, many health care professionals believe that obesity is normal during pregnancy. Health professionals often focus on medical issues and may not address potential barriers to

Limitations and Strengths

In this study, the main limitation is the subjectivity of the mothers’ assessments. Their descriptions may not necessarily correspond to the true feeding behaviors of each infant as mothers may have difficulty in identifying their infants’ behavior, may report their infants’ behaviors more positively, or may report that the dyad was exclusive direct breastfeeding to reflect their own competence as mothers.

A second limitation is the use of the BMIPPW. The BMIPPW may have artificially increased

Summary

In conclusion, we found that maternal BMI had limited negative influence on exclusive direct breastfeeding during the first 4 weeks after discharge. We found an interaction effect in that mothers with BMIs greater than 25 had less success with exclusive direct breastfeeding and described infants as having vigorous breastfeeding behaviors. Due to the restrictive criteria we used to define exclusive direct breastfeeding, no differences were found between infant breastfeeding behaviors and mothers

Acknowledgment

Funded by the following: Trajectories of Chronic Illness and Care Systems Postdoctoral Fellowship, Duke University School of Nursing; National Association of Neonatal Nurses Research Institute Small Grants Award Program; AWHONN Hill Rom, Celeste Phillips Family-Centered Maternity Care Award; and Council of the Advancement of Nursing American Nurse Foundation Grant.

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In FocusEffect of Maternal Body Mass Index on Infant Breastfeeding Behaviors and Exclusive Direct Breastfeeding

Abstract

Objective

Design

Setting

Participants

Main Outcome Measure(s)

Results

Conclusion

Section snippets

Design

Results

Discussion

Clinical Implications

Limitations and Strengths

Summary

Acknowledgment

Journal of Midwifery & Women’s Health,

American Journal of Clinical Nutrition

Journal of Nutrition

Journal of Midwifery & Womens Health,

Early Human Development

American Academy of Pediatrics.

American Academy of Pediatrics.

Breastfeeding and the use of human milk. Pediatrics,

Maternal obesity and breastfeeding: A review of the evidence and implications for practice

Clinical Lactation

Management of breastfeeding

Journal of the American Medical Association

Centers for Disease Control and Prevention. (2013). Breastfeeding report card — United States, 2013. Atlanta, GA:

Author.Retrieved from

Centers for Disease Control and Prevention. Body mass index.Atlanta,

GA: Author.Retrieved from

Maternal obesity and initiation and duration of breastfeeding: Data from the longitudinal study of Australian children.

Maternal & Child Nutrition,

Health professionals’ experiences providing breastfeeding-related care for obese women.

Breastfeeding Medicine,

Ultrasound imaging of infant swallowing during breastfeeding

Dysphagia,

The effect of pre-pregnancy BMI on intention, initiation and duration of breast-feeding.

Public Health Nutrition,

In Focus
Effect of Maternal Body Mass Index on Infant Breastfeeding Behaviors and Exclusive Direct Breastfeeding