Abstract
Introduction
Breastfeeding has significant health benefits for infants and birthing persons, including reduced risk of chronic disease. The American Academy of Pediatrics recommends exclusively breastfeeding infants for 6 months and recently extended its recommendation for continuing to breastfeed with supplementation of solid foods from one to two years. Studies consistently identify lower breastfeeding rates among US infants, with regional and demographic variability. We examined breastfeeding in birthing person-infant pairs among healthy, term pregnancies enrolled in the New Hampshire Birth Cohort Study between 2010 and 2017 (n = 1176).
Methods
Birthing persons 18–45 years old were enrolled during prenatal care visits at ~ 24–28 weeks gestation and have been followed since enrollment. Breastfeeding status was obtained from postpartum questionnaires. Birthing person and infant health and sociodemographic information was abstracted from medical records and prenatal and postpartum questionnaires. We evaluated the effects of birthing person age, education, relationship status, pre-pregnancy body mass index, gestational weight gain (GWG), smoking and parity, and infant sex, ponderal index, gestational age and delivery mode on breastfeeding initiation and duration using modified Poisson and multivariable linear regression.
Results
Among healthy, term pregnancies, 96% of infants were breastfed at least once. Only 29% and 28% were exclusively breastfed at 6-months or received any breastmilk at 12-months, respectively. Higher birthing person age, education, and parity, being married, excessive GWG, and older gestational age at delivery were associated with better breastfeeding outcomes. Smoking, obesity, and cesarean delivery were negatively associated with breastfeeding outcomes.
Conclusions
Given the public health importance of breastfeeding for infants and birthing persons, interventions are needed to support birthing persons to extend their breastfeeding duration.
Significance
What is already known? The benefits of breastfeeding to child and birthing person health are well-documented, however, rates of breastfeeding initiation and duration continue to fall short of health-based guidelines. Regional differences exist and certain rural New England states tend to have amongst the highest breastfeeding rates in the US.
What this study adds? This study of n = 1176 birthing persons-infant pairs enrolled in the New Hampshire Birth Cohort Study, a rural, general population pregnancy cohort, suggests that factors influencing breastfeeding outcomes align closely with studies conducted in urban settings and using nationally-representative surveys.
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Data Availability
Investigators interested in additional information about this study are referred to the New Hampshire Birth Cohort Study website. For other questions, investigators should contact Margaret Karagas, PhD (margaret.r.karagas@dartmouth.edu).
Code Availability
Not applicable.
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Funding
Support for this work was provided by NIGMS P20 GM104416, NIEHS P01-ES022832 and P42 ES007373, and EPA RD-83544201.
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All authors provided critical review and feedback of the manuscript. KAC conducted all analyses and drafted the manuscript. LGG assisted with data management and provided technical expertise to inform the statistical analyses. ERB provided technical review on pregnancy and breastfeeding concepts. MRK developed and oversees the NHBCS, contributed to study design and provided technical review of the analysis and manuscript. MER was responsible for study design, provided technical review of all analyses, and contributed to manuscript preparation.
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Approval for this study was granted by the Institutional Review Board (IRB) at Dartmouth College. Participants provided written, informed consent via IRB-approved consent protocols.
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Crawford, K.A., Gallagher, L.G., Baker, E.R. et al. Predictors of Breastfeeding Duration in the New Hampshire Birth Cohort Study. Matern Child Health J 27, 1434–1443 (2023). https://doi.org/10.1007/s10995-023-03714-4
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DOI: https://doi.org/10.1007/s10995-023-03714-4