title: Breastfeeding initiation: impact of obesity in a large Canadian perinatal cohort study.
abstract: OBJECTIVE
  To evaluate incidence of breastfeeding initiation according to maternal pre-pregnancy body mass index (BMI) in "Grossesse en Santé", a large prospective birth cohort in Quebec City.
  
  
  METHODS
  Breastfeeding initiation in the post-partum period, pre-pregnancy BMI, sociodemographic determinants and obstetrical and neonatal factors were collected from years 2005 to 2010 in 6592 women with single pregnancies. Prenatal non-intention to breastfeed was documented in a subgroup of the cohort (years 2009-2010). Log-binomial regression analyses were performed to assess relative risk (RR) of non-initiation of breastfeeding between maternal BMI categories in models including pre- and post-natal determinants, after exclusion of variables with a mediating effect.
  
  
  RESULTS
  Twenty percent (20%) of obese women did not initiate breastfeeding in the post-natal period at hospital compared to 12% for normal weight women. Compared with those having a normal pre-pregnancy BMI, obese women had a higher risk of non-initiation of breastfeeding (RRunadj 1.69, 95% CI 1.44-1.98), even after adjustment for prenatal and sociodemographic factors (RRadj 1.26, 95% CI 1.08-1.46). Furthermore, the risk of non-initiation of breastfeeding in obese women still remained higher after introduction of per- and post-natal factors (RR 1.22, 95% CI 1.04-1.42). The prenatal non-intention to breastfeed was strongly associated with the non-initiation of breastfeeding for all categories of BMI.
  
  
  CONCLUSIONS
  Maternal obesity is associated with a two-fold rate of non-initiation of breastfeeding. Considering the benefits of breastfeeding and the increasing obesity rate, adapted interventions and specialized support should target both pre- and immediate post-natal periods in this population.
authors: Departments of Pediatrics, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada.
authors: Julie
authors: J
authors: Verret-Chalifour
authors: Departments of Medical Biology, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada.
authors: Yves
authors: Y
authors: Giguère
authors: Departments of Medical Biology, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada.
authors: Jean-Claude
authors: JC
authors: Forest
authors: Laboratory of Biostatistics, Centre de recherche de l'institut universitaire en santé mentale de Quebec (Université Laval), Quebec city, Quebec, Canada.
authors: Jordie
authors: J
authors: Croteau
authors: Departments of Pediatrics, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada.
authors: Peiyin
authors: P
authors: Zhang
authors: Departments of Pediatrics, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada.
authors: Isabelle
authors: I
authors: Marc
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding; D005260:Female; D006801:Humans; D008954:Models, Biological; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies