title: Risk factors for discontinuing breastfeeding in southern Brazil: a survival analysis.
abstract: To identify risk factors for discontinuing breastfeeding during an infant's first year of life. A cohort study recruited mothers in a hospital in São Leopoldo, Brazil, which mainly serves the low-income population. In order to obtain socioeconomic, environmental, and behavioral information, face-to-face interviews with mothers were conducted after birth, and when their infants were 6 and 12 months old. The duration of breastfeeding was investigated at 6 and 12 months, and recorded separately for each month. Depressive symptoms were assessed using the Beck Depression Inventory. The multivariate model for predicting the discontinuation of breastfeeding, adjusted Kaplan-Meier survival curves and Cox regression were used. Of the 360 participants, 201 (55.8%) discontinued breastfeeding within the first 12 months. A multivariate Cox regression model revealed that symptoms of maternal depression (low levels: RR = 1.59, 95% CI 1.02-2.47; moderate to severe: RR = 2.03, 95% CI 1.35-3.01), bottle feeding (RR = 2.07, 95% CI 1.31-3.28) and pacifier use in the first month of life (RR = 3.12, 95% CI 2.13-4.57) were independently associated with the outcomes after adjusting for confounders. Breastfeeding cessation rates were lower for children who did not use bottle feeding or a pacifier in the first month of life and for the children whose mothers presented with minimal depression. Early pacifier use and bottle feeding must be strongly discouraged to support long-term breastfeeding. In addition, screening maternal depression at a primary care service can be a step forward in promoting a longer duration of breastfeeding.
authors.affiliation: Department of Pediatric Dentistry, Universidade Luterana do Brasil, Rua João Telles 185/1301, Porto Alegre, Canoas, Rio Grande do Sul 90035-121, Brazil. cafeldens@terra.com.br
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Feldens
authors.forename: Márcia Regina
authors.initials: MR
authors.lastname: Vitolo
authors.forename: Fernanda
authors.initials: F
authors.lastname: Rauber
authors.forename: Luciane Nascimento
authors.initials: LN
authors.lastname: Cruz
authors.forename: Juliana Balbinot
authors.initials: JB
authors.lastname: Hilgert
mesh_terms: D000293:Adolescent; D001903:Bottle Feeding / Q000706:statistics & numerical data; D001938:Brazil; D001942:Breast Feeding / Q000523:psychology*; D002648:Child; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000523:psychology; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D008423:Maternal Age; D009035:Mothers / Q000523:psychology*; D041361:Pacifiers / Q000706:statistics & numerical data; D011204:Poverty Areas; D016016:Proportional Hazards Models; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors; D014886:Weaning