411 - Associations of COVID-19 Perinatal Hospital Practices with Breastfeeding Outcomes Post-Discharge

Poster Number: 411
Publication Number: 411.301

Lara Rostomian, Brigham and Women's Hospital, Boston, MA, United States; Asimenia Angelidou, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Ilona T. Goldfarb, Massachusetts General Hospital, Boston, MA, United States; Katherine Sullivan, UMass Memorial Medical Center, Worcester, MA, United States; Patrice Melvin, Boston Children's Hospital, Boston, MA, United States; Ruby Bartolome, Boston Medical Center, Boston, MA, United States; Jessica E. Shui, MassGeneral Hospital for Children, Lynnfield, MA, United States; Diana Yanni, Harvard Medical School, Boston, MA, United States; Rachana Singh, Tufts Childrens Hospital, Boston, MA, United States; Neha Chaudhary, Tufts Childrens Hospital, Westwood, MA, United States; Ruben Vaidya, Baystate Children's Hospital, Springfield, MA, United States; Tina M. Steele, Brigham and Women's Hospital, Boston, MA, United States; Margaret Parker, Boston Medical Center, Boston, MA, United States; Mandy B. Belfort, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States

Background: The onset of the COVID-19 pandemic caused large-scale disruption in adherence to perinatal hospital practices known to promote and support breastfeeding. During the initial surge of COVID-19 many hospitals implemented short-term guidelines to separate SARS-CoV-2 positive mothers from their newborn infants and advised against initiating breastfeeding to prevent mother-to-infant transmission of SARS-CoV-2 during the birth hospitalization. The impact of these changes on breastfeeding practices post-discharge is unknown.

Objective: Among SARS-CoV-2 positive mothers and their newborn infants, we aimed to determine the extent to which 1) mother-infant separation and 2) a lack of breastfeeding initiation in-hospital were associated with breastfeeding post-discharge.

Design/Methods: From 11 birthing hospitals in Massachusetts, we identified 255 women who tested positive for SARS-CoV-2 within 14 days before and up to 72 hours after delivery between March 1 and July 31, 2020. In this analysis, we included 187 dyads with available electronic medical record (EMR) data about post-discharge breastfeeding from obstetrical and/or pediatric outpatient encounters. We collected EMR data from the perinatal hospitalization on main exposure variables (mother-infant separation, in-hospital breastmilk feeding [expressed milk feeding and direct breastfeeding]) and covariates. We used multivariate logistic and linear regression to estimate associations of in-hospital practices with post-discharge breastfeeding outcomes, adjusting models for potential confounders (maternal illness severity, delivery route, infant hospital length of stay, age at follow-up).

Results: Mother-infant separation in-hospital was associated with a shorter duration of any breastmilk feeding (-5.29 days, 95% CI -8.89, -1.69) and with lower odds of direct breastfeeding (AOR 0.43, 95% CI 0.16, 1.10) post-discharge but not with the likelihood of any breastmilk feeding (Adjusted Odds Ratio, AOR 0.99, 95% CI 0.30, 3.36). Direct breastfeeding in-hospital was associated with higher odds of any breastmilk feeding (AOR 5.68, 95% CI 1.65, 23.63) and direct breastfeeding (AOR 8.19, 95% CI 2.99, 24.91), and a trend towards longer post-discharge breastmilk feeding duration (3.85 days, 95% CI -0.05, 7.76). Any breastmilk feeding in-hospital yielded similar results to direct breastfeeding in-hospital (Figure 1).Conclusion(s): Perinatal hospital care practices implemented at the start of the COVID-19 pandemic, specifically mother-infant separation and prevention of breastmilk feeding initiation, were associated with poorer post-hospital breastfeeding outcomes.
Lara Rostomian CVCV_LaraRostomian [December, 2021].pdf
Table 2Associations Between In-Hospital Separation and In-Hospital Breastmilk Feeding Practices