title: Predictors of breastfeeding in overweight and obese women: data from Active Mothers Postpartum (AMP).
abstract: Excess maternal weight has been negatively associated with breastfeeding. We examined correlates of breastfeeding initiation and intensity in a racially diverse sample of overweight and obese women. This paper presents a secondary analysis of data from 450 women enrolled in a postpartum weight loss intervention (Active Mothers Postpartum [AMP]). Sociodemographic measures and body mass index (BMI), collected at 6 weeks postpartum, were examined for associations with breastfeeding initiation and lactation score (a measure combining duration and exclusivity of breastfeeding until 12 months postpartum). Data were collected September 2004-April 2007. In multivariable analyses, BMI was negatively associated with both initiation of breastfeeding (OR: .96; CI: .92-.99) and lactation score (β -0.22; P = 0.01). Education and infant gestational age were additional correlates of initiation, while race, working full-time, smoking, parity, and gestational age were additional correlates of lactation score. Some racial differences in these correlates were noted, but were not statistically significant. Belief that breastfeeding could aid postpartum weight loss was initially high, but unrelated to breastfeeding initiation or intensity. Maintenance of this belief over time, however, was associated with lower lactation scores. BMI was negatively correlated with breastfeeding initiation and intensity. Among overweight and obese women, unrealistic expectations regarding the effect of breastfeeding on weight loss may negatively impact breastfeeding duration. In general, overweight and obese women may need additional encouragement to initiate breastfeeding and to continue breastfeeding during the infant's first year.
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA. katrina.krause@duke.edu
authors.forename: Katrina M
authors.initials: KM
authors.lastname: Krause
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Lovelady
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007774:Lactation / Q000502:physiology*; D016015:Logistic Models; D008425:Maternal Behavior; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data*; D009657:North Carolina; D050177:Overweight; D049590:Postpartum Period; D011247:Pregnancy; D015431:Weight Loss; D055815:Young Adult
references.citation: J Am Diet Assoc. 2005 May;105(5):810-8
references.pmid: 15883562
references.citation: MMWR Morb Mortal Wkly Rep. 2006 Mar 31;55(12):335-9
references.pmid: 16572102
references.citation: BMC Pregnancy Childbirth. 2007 Jul 04;7:9
references.pmid: 17608952
references.citation: Obes Rev. 2007 Jul;8(4):307-26
references.pmid: 17578381
references.citation: NCHS Data Brief. 2008 Apr;(5):1-8
references.pmid: 19389319
references.citation: Evid Rep Technol Assess (Full Rep). 2007 Apr;(153):1-186
references.pmid: 17764214
references.citation: Am J Clin Nutr. 2007 Aug;86(2):404-11
references.pmid: 17684212
references.citation: J Am Diet Assoc. 2006 Jan;106(1 Suppl 1):S135-48
references.pmid: 16376637
references.citation: Health Rep. 2008 Jun;19(2):61-76
references.pmid: 18642520
references.citation: Adv Exp Med Biol. 2004;554:91-100
references.pmid: 15384569
references.citation: Obes Rev. 2004 Aug;5(3):137-43
references.pmid: 15245382
references.citation: Int J Obes. 1990 Feb;14(2):159-73
references.pmid: 2341224
references.citation: Pediatrics. 2003 Sep;112(3 Pt 1):607-19
references.pmid: 12949292
references.citation: J Nutr. 2001 Nov;131(11):3012S-5S
references.pmid: 11694638
references.citation: Pediatrics. 2005 Jan;115(1):e31-7
references.pmid: 15579667
references.citation: Am J Clin Nutr. 2008 Dec;88(6):1543-51
references.pmid: 19064514
references.citation: J Mammary Gland Biol Neoplasia. 1999 Jul;4(3):309-18
references.pmid: 10527472
references.citation: MMWR Morb Mortal Wkly Rep. 2007 Aug 3;56(30):760-3
references.pmid: 17673896
references.citation: Pediatrics. 2002 Dec;110(6):1103-9
references.pmid: 12456906
references.citation: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001141
references.pmid: 17253455
references.citation: Am J Public Health. 2002 Jul;92(7):1107-10
references.pmid: 12084691
references.citation: Nutr Rev. 2005 Oct;63(10):352-5
references.pmid: 16295148
references.citation: Br J Psychiatry. 1990 Aug;157:288-90
references.pmid: 2224383
references.citation: Am J Prev Med. 2009 Sep;37(3):173-80
references.pmid: 19595557
references.citation: Pediatrics. 1997 Dec;100(6):1035-9
references.pmid: 9411381
references.citation: Annu Rev Nutr. 2007;27:103-21
references.pmid: 17341160
references.citation: Obesity (Silver Spring). 2010 Jan;18(1):175-82
references.pmid: 19521347
references.citation: J Hum Lact. 2006 Aug;22(3):322-7
references.pmid: 16885492
references.citation: N Engl J Med. 2000 Feb 17;342(7):449-53
references.pmid: 10675424
references.citation: Can J Public Health. 2008 Sep-Oct;99(5):423-7
references.pmid: 19009930
references.citation: Pediatrics. 2006 Apr;117(4):e646-55
references.pmid: 16585281
references.citation: J Hum Lact. 2004 Feb;20(1):18-29
references.pmid: 14974697
references.citation: Pediatrics. 2005 Feb;115(2):e139-46
references.pmid: 15687421
references.citation: J Pediatr. 2003 May;142(5):486-91
references.pmid: 12756378
references.citation: J Am Diet Assoc. 1999 Apr;99(4):450-4; quiz 455-6
references.pmid: 10207398
references.citation: Nutr Rev. 2005 Apr;63(4):103-10
references.pmid: 15869124
references.citation: J Midwifery Womens Health. 2007 Nov-Dec;52(6):606-13
references.pmid: 17983998
references.citation: Am J Clin Nutr. 2003 Apr;77(4):931-6
references.pmid: 12663294
references.citation: Am J Prev Med. 2001 May;20(4):294-8
references.pmid: 11331120
references.citation: J Womens Health (Larchmt). 2008 Dec;17(10):1567-75
references.pmid: 19049350
references.citation: Br J Psychiatry. 1987 Jun;150:782-6
references.pmid: 3651732
references.citation: Pediatrics. 2008 May;121(5):e1319-24
references.pmid: 18450874
references.citation: Pediatrics. 2004 May;113(5):e465-71
references.pmid: 15121990
references.citation: J Hum Lact. 2000 Nov;16(4):283-90
references.pmid: 11155599
references.citation: Birth. 2002 Jun;29(2):112-23
references.pmid: 12000412
references.citation: Public Health Rep. 2006 Jan-Feb;121(1):51-9
references.pmid: 16416698
references.citation: Am J Clin Nutr. 1997 Dec;66(6):1371-8
references.pmid: 9394689
references.citation: Arch Dis Child Fetal Neonatal Ed. 2008 Nov;93(6):F448-50
references.pmid: 18450805
references.citation: J Nutr. 2004 Jul;134(7):1746-53
references.pmid: 15226464
references.citation: Matern Child Nutr. 2008 Jul;4(3):163-70
references.pmid: 18582350