title: In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed.
abstract: OBJECTIVE
  To evaluate in-hospital formula supplementation among first-time mothers who intended to exclusively breastfeed and determined if in-hospital formula supplementation shortens breastfeeding duration after adjusting for breastfeeding intention.
  
  
  METHODS
  We assessed strength of breastfeeding intentions prenatally in a diverse cohort of expectant primiparae and followed infant feeding practices through day 60. Among mothers planning to exclusively breastfeed their healthy term infants for ≥1 week, we determined predictors, reasons, and characteristics of in-hospital formula supplementation, and calculated the intention-adjusted relative risk (ARR) of not fully breastfeeding days 30-60 and breastfeeding cessation by day 60 with in-hospital formula supplementation (n = 393).
  
  
  RESULTS
  Two hundred ten (53%) infants were exclusively breastfed during the maternity stay and 183 (47%) received in-hospital formula supplementation. The most prevalent reasons mothers cited for in-hospital formula supplementation were: perceived insufficient milk supply (18%), signs of inadequate intake (16%), and poor latch or breastfeeding (14%). Prevalence of not fully breastfeeding days 30-60 was 67.8% vs. 36.7%, ARR 1.8 (95% CI, 1.4-2.3), in-hospital formula supplementation vs exclusively breastfed groups, respectively, and breastfeeding cessation by day 60 was 32.8% vs. 10.5%, ARR 2.7 (95% CI, 1.7-4.5). Odds of both adverse outcomes increased with more in-hospital formula supplementation feeds (not fully breastfeeding days 30-60, P = .003 and breastfeeding cessation, P = .011).
  
  
  CONCLUSIONS
  Among women intending to exclusively breastfeed, in-hospital formula supplementation was associated with a nearly 2-fold greater risk of not fully breastfeeding days 30-60 and a nearly 3-fold risk of breastfeeding cessation by day 60, even after adjusting for strength of breastfeeding intentions. Strategies should be sought to avoid unnecessary in-hospital formula supplementation and to support breastfeeding when in-hospital formula supplementation is unavoidable.
authors: Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA. Electronic address: caroline.chantry@ucdmc.ucdavis.edu.
authors: Caroline J
authors: CJ
authors: Chantry
authors: Department of Nutrition, University of California Davis, Davis, CA.
authors: Kathryn G
authors: KG
authors: Dewey
authors: Department of Nutrition, University of California Davis, Davis, CA.
authors: Janet M
authors: JM
authors: Peerson
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Erin A
authors: EA
authors: Wagner
authors: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Laurie A
authors: LA
authors: Nommsen-Rivers
mesh_terms: D000328:Adult; D000367:Age Factors; D001903:Bottle Feeding / Q000379:methods / Q000523:psychology*; D001942:Breast Feeding / Q000379:methods / Q000523:psychology*; D015331:Cohort Studies; D016001:Confidence Intervals; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods*; D041943:Infant Formula; D007231:Infant, Newborn; D007297:Inpatients / Q000706:statistics & numerical data*; D033182:Intention; D008137:Longitudinal Studies; D008297:Male; D008425:Maternal Behavior; D016017:Odds Ratio; D010298:Parity; D011181:Postnatal Care / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D028761:Withholding Treatment