The effect of maternal obesity on initiation and duration of breast-feeding in Greece: the GENESIS study

Abstract

Objective: The current paper aims to describe the characteristics of mothers failing to initiate breast-feeding, provide information on the factors contributing to longer duration of breast-feeding and identify the association of maternal obesity with both initiation and duration of breast-feeding in the Greek population. Design: Data from the cross-sectional GENESIS (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers) study were used. Mothers were categorized by their pre-pregnancy BMI and their gestational weight gain according to guidelines from the Institute of Medicine. Setting: Preschool children aged 1-5 years in five counties in Greece. Subjects: Preschoolers (n 2374) with full maternal anthropometric data before and during pregnancy and breast-feeding data.Results: A higher percentage of mothers with increased pre-pregnancy BMI or high gestational weight gain failed to initiate breast-feeding compared with their normal-weight counterparts. Obese mothers were 2?86 times more likely to fail in initiating breast-feeding in a multiple logistic regression model. Multiple linear regression analysis showed that among women initiating breast-feeding, those who were either underweight before pregnancy or smoked at the third trimester of pregnancy breast-fed their children for about 1?5 weeks less than their normal-weight or non-smoking counterparts, respectively. Similarly, multiparous women breast-fed their children for about 7 weeks less than uniparous women. In women who initiated breast-feeding, no significant differences in breast-feeding duration were found between women of different gestational weight gains. Conclusions: Mothers with high pre-pregnancy BMI are less likely to initiate breast-feeding while high gestational weight gain has no effect on either the initiation or duration of breast-feeding in Greece. Keywords Breast-feedingObesity Greece Gestational weight gain The benefits of breast-feeding for the health and well-being of infants have been well recognized (1)(2)(3)(4) . However in most industrialized countries, including Greece, the percentage of mothers following the recommended breast-feeding practices is far from that desired (5)(6)(7)(8)(9) . As recent studies in local cohorts in Greece have shown, although more than 90 % of women initiate breast-feeding (5,10) , only 16?0 % of mothers provide any breast-feeding at 6 months postpartum (5) and only 7?3 % breast-feed for more than 1 year (11)

Maternal Prepregnancy Body Mass Index and Initiation and Duration of Breastfeeding: A Review of the Literature

“…11,15,16,[18][19][20][21][22][23] Of the 13 studies that evaluated BF duration, 10 found an association between maternal obesity or overweight and reduced duration of BF [17][18][19][20][21][23][24][25] (Table 1). For some of the studies, the results were heterogeneous (present for BF initiation but not duration, or vice versa), or the association was present only for specific population groups and not others.…”

“…A few studies analyzed the possible interaction between gestational weight gain and maternal prepregnancy BMI. Manios et al 22 evaluated gestational weight gain separately from prepregnancy BMI, finding that the two variables were highly correlated in regression analyses. The study by Baker et al 25 found that gestational weight gain did not interact with or confound the relationship between prepregnancy BMI and terminating BF, although gestational weight gain increased the odds of termination of BF inconsistently when prepregnancy BMI was not in the model.…”

“…19,20,22,23 One study found increased risk only in very obese women (BMI !35). 21 Baker et al 25 found progressively higher relative risks of termination of any BF and exclusive BF based on obesity class ( 17 which were still relatively large studies.…”

The Association Between Prepregnancy Body Mass Index and Breastfeeding Duration in Iranian Women

“…Additionally, Manios et al studied 2375 preschool children, aged 1-5 years, in Greece. In their study, high maternal prepregnancy BMI had a negative association with the initiation of breastfeeding, but not maternal gestational weight gain (16). tional weight gain above the IOM recommendations were at risk of early discontinuation of exclusive breastfeeding (15).…”

“…In a study by Manios, 37.1% and 31.1% of Greece women (n, 2374) had inadequate and excessive gestational weight gain, respectively (16). Moreover, in a study conducted in Guilan, North of Iran, the percentage of urban women who gained weight above the IOM recommendation was 10%, while 41.1% gained weight less than the recommended range (17).…”