Associations between high prepregnancy body mass index, breast-milk expression, and breast-milk production and feeding

Abstract

Background: Breast-milk expression is widely practiced by American mothers, but little is known about who expresses milk, how expression affects breastfeeding, or whether overweight or obese women, who have less breastfeeding success than do normal-weight women, express milk differently. Objectives: We investigated 1) whether breast-milk expression behavior differed by body mass index (BMI; in kg/m 2 ) category and 2) whether the different breastfeeding behaviors of overweight (BMI: 25 and ,30) and obese (BMI: 30) women resulted in different breastfeeding outcomes. Design: The subjects (n = 2288) provided information on BMI and breast-milk production, feeding, and expression in mail-in questionnaires as part of the Infant Feeding Practices Study II. Longitudinal and cross-sectional data were analyzed by using regression procedures adjusted for confounding. Results: Women of different BMI categories overall did not differ in whether, when, or why they expressed breast milk. Before 2 mo postpartum, however, obese women were more likely (P = 0.04, unadjusted) to try milk expression and were less likely (P = 0.01, unadjusted) to express milk successfully. In addition, overweight or obesity was associated (P , 0.03, unadjusted) with a shorter duration of breast-milk production only in women who never expressed milk. In overweight or obese women, those who ever expressed milk had longer durations of breastfeeding (P , 0.003, unadjusted) than did those who never expressed milk. Conclusions: Breast-milk expression behaviors may differ by maternal BMI category only in the early postpartum period. In addition, breast-milk expression may reduce differences between BMI categories in the duration of breastfeeding and support longer durations of breastfeeding.

Predictive Models for Characterizing Disparities in Exclusive Breastfeeding Performance in a Multi-ethnic Population in the US

“…As reported previously, high prepregnancy BMI was associated with poor lactation performance [34][35][36][37][38][39].…”

Socioeconomic disparities in prepregnancy BMI and impact on maternal and neonatal outcomes and postpartum weight retention: the EFHL longitudinal birth cohort study

“…These findings have contributed to the evidence-base obtained by studies conducted in various countries [24, 25, 41] on the association of socioeconomic status with pregnancy obesity or high postpartum weight retention. In addition, overweight and obese women are less likely to breastfeed longer than 3 months, partly due to that obese women are less likely to express milk successfully within 2 months postpartum [42], and engage in recreational activities with their baby. This high-risk subgroup of women may therefore greatly benefit from interventions to improve weight retention outcomes by promoting nutrition knowledge, healthy eating and physical activity.…”

Predictors of Breastmilk Expression by 1 Month Postpartum and Influence on Breastmilk Feeding Duration

“…Although breastmilk feeding difficulties were not predictive of milk expression in this study, the potential connection with overweight mothers using breastmilk expression is beginning to be recognized. 21,22 Women in our cohort who fed their infants breastmilk longer were married, had a baby previously, had a lower BMI at 1 week postpartum, did not use supplemental formula within the first month, and intended to provide breastmilk for a greater period of time (Table 3). Although our study results are not conclusive about the relationship between breastmilk expression by 4 weeks postpartum and duration of breastmilk feeding, it does appear that mothers who express during this early postpartum time may stop breastmilk feeding sooner.…”