title: Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding.
abstract: BACKGROUND
  Delayed onset of lactogenesis (OL) is most common in primiparas and increases the risk of excess neonatal weight loss, formula supplementation, and early weaning.
  
  
  OBJECTIVE
  We examined variables associated with delayed OL among first-time mothers who delivered at term and initiated breastfeeding (n = 431).
  
  
  METHODS
  We conducted in-person interviews during pregnancy and at days 0, 3, and 7 postpartum and extracted obstetric and newborn information from medical records. We defined OL as delayed if it occurred after 72 h and used chi-square analysis to examine its association with potential risk factors across 6 dimensions: 1) prenatal characteristics, 2) maternal anthropometric characteristics, 3) labor and delivery experience, 4) newborn characteristics, 5) maternal postpartum factors, and 6) infant feeding variables. We examined independent associations by using multivariable logistic regression analysis.
  
  
  RESULTS
  Median OL was 68.9 h postpartum; 44% of mothers experienced delayed OL. We observed significant bivariate associations between delayed OL and variables in all 6 dimensions (P < 0.05). In a multivariate model adjusted for prenatal feeding intentions, independent risk factors for delayed OL were maternal age > or =30 y, body mass index in the overweight or obese range, birth weight >3600 g, absence of nipple discomfort between 0-3 d postpartum, and infant failing to "breastfeed well" > or =2 times in the first 24 h. Postpartum edema was significant in an alternate model excluding body mass index (P < 0.05).
  
  
  CONCLUSIONS
  The risk factors for delayed OL are multidimensional. Public health and obstetric and maternity care interventions are needed to address what has become an alarmingly common problem among primiparas.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, OH 45229-3039, USA. laurie.nommsen-rivers@cchmc.org
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Nommsen-Rivers
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Chantry
authors.forename: Janet M
authors.initials: JM
authors.lastname: Peerson
authors.forename: Roberta J
authors.initials: RJ
authors.lastname: Cohen
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
mesh_terms: D001724:Birth Weight; D015992:Body Mass Index; D001942:Breast Feeding; D016009:Chi-Square Distribution; D004487:Edema / Q000503:physiopathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D007774:Lactation / Q000502:physiology*; D016015:Logistic Models; D008423:Maternal Age; D008954:Models, Biological; D009765:Obesity / Q000503:physiopathology*; D010298:Parity; D011247:Pregnancy; D011644:Puerperal Disorders / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors