Association of prenatal medical risk with breastfeeding outcomes up to 12 months in the All Our Families community-based birth cohort

Abstract

Background Prenatal medical risk describes physical health issues or biological factors that predate or arise during pregnancy which heighten the risk of adverse outcomes, and often warrant specialized obstetric care. The influence of the nature and magnitude of prenatal risk on breastfeeding outcomes remains poorly understood. The objective of this study was to determine the association between prenatal medical risk and breastfeeding initiation and duration up to 1 year postpartum. Methods We analysed a subset of data from the All Our Families longitudinal cohort (n = 2706) of women in Calgary, Canada who delivered a liveborn infant between 2008 and 2010. Data were collected from self-report questionnaires and medical records. Women with complete data on prenatal medical risk factors and breastfeeding outcomes were included in this analysis. Prenatal medical risk was operationalized as one integer score of risk severity and four binary risk types capturing pre-pregnancy characteristics, past obstetric problems, current obstetric problems, and substance use. Outcomes were breastfeeding initiation defined as the infant ever receiving breast milk, and duration operationalized as still breastfeeding at 4 months, at 12 months, and time to breastfeeding cessation in weeks. We used logistic regression and Cox regression with right censoring at 52 weeks or attrition to calculate odds ratios (OR) and hazard ratios (HR), respectively, adjusting for sociodemographic vulnerability, parity, mode of delivery, and gestational age. Results Prenatal medical risk severity and type were not significantly associated with breastfeeding initiation, with the exception of pre-pregnancy risk type (OR 0.45; 95% CI 0.26, 0.77). Risk severity was associated with lower odds of breastfeeding to 4 months (OR 0.94; 95% CI 0.90, 0.99), 12 months (OR 0.93; 95% CI 0.87, 0.98), and earlier breastfeeding cessation (HR 1.05; 95% CI 1.02, 1.08). Associations with shorter breastfeeding length across the first postpartum year were observed for pre-pregnancy, current obstetric, and substance use risk types, but not past obstetric problems. Conclusion Prenatal medical risk is associated with shortened duration of breastfeeding. Women with prenatal medical risk may benefit from the proactive arrangement of lactation support before and following delivery to promote continued breastfeeding.

Association of postpartum medication practices with early breastfeeding cessation among mothers with chronic conditions: A prospective cohort study

“…More broadly, this research reinforces the view that women with chronic conditions are at high risk for suboptimal breastfeeding 12,38 and would benefit from targeted lactation support and research that extends beyond medication use to account for the range of unique postpartum challenges experienced by this population.…”

“…Findings suggest that maintenance of chronic condition medication plans established prior to birth is generally the ideal approach to facilitate desired breastfeeding duration. More broadly, this research reinforces the view that women with chronic conditions are at high risk for suboptimal breastfeeding 12,38 and would benefit from targeted lactation support and research that extends beyond medication use to account for the range of unique postpartum challenges experienced by this population.…”

“…First, to address the impact of potential confounders while cognizant of unnecessary adjustment for covariates that do not affect bias but may impact precision, 37 we additionally adjusted for a set of obstetrical factors (mode of delivery, obstetric morbidity) and a set of neonatal health factors (gestational age at birth, small‐for‐gestational age, neonatal intensive care unit admission), separately. These are established risk factors for breastfeeding cessation 38–41 and we suspect they could be weakly related to postpartum medication practices through shared impacts on maternal physical health or through impacting maternal perceptions of infant vulnerability to medication exposure. Secondly, we repeated the models restricted to women who reported taking prescription medications prior to pregnancy for chronic condition management.…”

Maternal disability and initiation and duration of breastfeeding: analysis of a Canadian cross-sectional survey

“…Other unmeasured factors may also be important, including perinatal complications [ 33 – 35 ]. Qualitative studies also suggest disability-related symptoms such as pain and fatigue [ 22 ], receipt of conflicting advice about breastfeeding while using medications [ 36 ], and difficulty accessing tailored information and adaptive strategies to support breastfeeding [ 21 , 22 ] may act as barriers.…”

“…It is therefore likely that the sample captures mostly mild disabilities; we may have thus under-estimated disparities experienced by all women with disabilities. We had no information on covariates such as parity, or possible explanatory factors such as perinatal complications [ 35 ]. We also had no data on breastfeeding supports, breastfeeding self-efficacy, or breastfeeding intentions [ 39 , 40 ]; these are important areas for research to understand the breastfeeding experiences of disabled women.…”