420 - Maternal pre-pregnancy obesity associated with failure to meet prenatal breastfeeding goals

Poster Number: 420
Publication Number: 420.301

Shannon C. Conrey, University of Cincinnati College of Medicine, CINCINNATI, OH, United States; Allison R. Burrell, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Claire Mattison, United States Centers for Disease Control and Prevention, Atlanta, GA, United States; Daniel C. Payne, CDC, Atlanta, GA, United States; Mary A. Staat, CCHMC, Cincinnati, OH, United States; Laurie Nommsen-Rivers, University of Cincinnati, Cincinnati, OH, United States; Ardythe L. Morrow, University of Cincinnati, Cincinnati, OH, United States

Background: The American Academy of Pediatrics recommends exclusive breastfeeding (EBF) to six months of age, with continued breastfeeding for at least one year. Maternal obesity (BMI≥30) has inconsistently been associated with differences in duration of any and exclusive breastfeeding, but while metabolic health differs by obesity class, few of these studies have stratified maternal BMI to examine a dose-response mechanism.

Objective: We compared breastfeeding initiation, duration, and achievement of pre-natal EBF intentions by maternal pre-pregnancy BMI category in PREVAIL, a CDC-funded birth cohort in Cincinnati, OH.

Design/Methods: Enrolled subjects completed a questionnaire in the third trimester of pregnancy, including family demographics, pre-pregnancy weight and height, and intention to EBF to 6 months. BMI was calculated as kg/m2 and categorized as Healthy ( < 25), Overweight (25-29.9), Obesity I (30-34.9), or Obesity II+ (≥35). Breastfeeding initiation, exclusivity, and duration were reported by the mother via quarterly study questionnaires. Multivariable logistic regression was used to examine the odds of breastfeeding intention, initiation, and meeting EBF goals across BMI categories while controlling for maternal race, income and education level. Differences in median duration were compared using Kruskal-Wallis.

Results: Of Nf245 enrolled subjects, the pre-pregnancy maternal obesity rate was 40.4% (n=99), with 23.7% (n=58) meeting Obesity II+ criteria. Overall, 53.4% (n=131) intended to EBF the recommended 6 months and 86.5% (n=212) initiated breastfeeding, with no significant differences in intention or initiation by BMI category. Of those who intended EBF to month 6, mothers with Obesity II+ were less likely to EBF to 6 weeks (aOR 0.12 (95%CI 0.02-0.47)) or 6 months (aOR 0.09 (95%CI 0.00-0.60)) than mothers with a healthy BMI. In comparing breastfeeding duration, mothers with Obesity II+ provided any breastfeeding for fewer days (28 (IQR 4.3, 84.5)) than mothers with a healthy BMI (265 (IQR 46, 430), p< 0.001).Conclusion(s): No differences were found by BMI category in intention to EBF to 6 months of age or breastfeeding initiation. However, mothers with Obesity II + were less likely to achieve their prenatal EBF intentions and provided any breastfeeding for shorter durations than those with a healthy BMI. Research is needed to identify causes of early breastfeeding cessation in mothers with Obesity II + to inform interventions designed to support these mothers in meeting their breastfeeding goals.

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