Differences in Breastfeeding Initiation by Maternal Diabetes Status and Race, Ohio 2006–2011

Abstract

To examine breastfeeding trends at hospital discharge from 2006 to 2011 by diabetes status and to determine associations between diabetes status and breastfeeding. Ohio Vital Statistics birth certificate data from 2006 to 2011, including all singleton births to Ohio resident mothers of reproductive age (16-44 years), were used to analyze trends in breastfeeding by diabetes status [prepregnancy diabetes (PDM), gestational diabetes (GDM)]. Logistic regression was used to evaluate the relationship between breastfeeding at discharge and diabetes type. Because a significant interaction between diabetes status and race existed, the model was stratified by race. This study includes 803,222 Ohio births from 2006 to 2011. A significant, increasing trend of breastfeeding (P < .0001) existed among women with GDM (63-70 %) and no DM (62-69 %). GDM breastfeeding rates were frequently the highest, while women with PDM often had the lowest breastfeeding initiation rates, regardless of sample characteristic. In models stratified by race, Black women were often the least likely to breastfeed, but overweight or obese and diabetes were not associated with a decreased likelihood of breastfeeding as they were among White women. While breastfeeding rates have increased in Ohio, they have still not reached the Healthy People 2020 goals. Our study shows that breastfeeding initiation rates vary by diabetes status and race. This study can aid in tailoring breastfeeding intervention and counseling efforts to women least likely to initiate breastfeeding, such as women with pregnancy diabetes, to improve the health of both infants and mothers.

Prepregnancy Obesity and Breastfeeding Noninitiation in the United States: An Examination of Racial and Ethnic Differences

“…In the current study, within racial/ethnic groups of women, no differences in breastfeeding initiation were found between underweight and normal weight women. In contrast, Thompson et al 19 reported underweight non-Hispanic black and Hispanic women to be less likely to initiate breastfeeding compared with normal weight women, whereas Kachoria and Oza-Frank 27 reported underweight non-Hispanic white women were less likely to initiate breastfeeding than normal weight non-Hispanic white women. In Italy, researchers found that underweight women were less likely to initiate breastfeeding, but analyses did not include maternal race/ethnicity.…”

“…suggests some degree of directionality from prepregnancy BMI. Lastly, women who had multiple births were excluded from this study, but this deliberate restriction is consistent with the literature 15,17,19,27 and helps to control for possible confounding bias because women who give birth to multiples may face more challenges that in turn affect breastfeeding outcomes. 26…”

“…24 However, differences in study design may have contributed to these conflicting results. Although the current study used a large, nationally representative sample of women, previous studies have been limited to smaller groups living in specific settings in the United States 18,27,28 and controlled for different potential confounding factors. Having afforded stronger study design, the current study's findings provide more robust evidence that prepregnancy obesity, but not prepregnancy overweight, is adversely associated with breastfeeding initiation among non-Hispanic black women in the United States.…”

“…Another novel finding from this study was that, overall, underweight women had a higher prevalence of breastfeeding noninitiation compared with normal weight women, which supports growing evidence in the literature. 19,27,29 However, research findings on racial/ethnic differences have been inconsistent. In the current study, within racial/ethnic groups of women, no differences in breastfeeding initiation were found between underweight and normal weight women.…”

“…29 In light of these inconsistent findings and the fact that the association between prepregnancy underweight and breastfeeding initiation is relatively unknown, further research is needed. 19,27,29 Current research posits that the link between elevated prepregnancy BMI and breastfeeding may be attributable to a woman's biological, physical, or psychosocial characteristics. 11,30 For example, obese women who have greater amounts of adipose tissue may have larger breasts or flattened nipples, which can hinder infant latching.…”