title: Prepregnancy obesity and breastfeeding noninitiation in the United States: an examination of racial and ethnic differences.
abstract: BACKGROUND
  Prepregnancy overweight/obesity can adversely affect breastfeeding initiation, but studies examining this association among different racial/ethnic groups of U.S. women are limited. This study used a large, nationally representative sample to assess racial/ethnic differences in breastfeeding noninitiation among U.S. women of different body mass index (BMI) classifications.
  
  
  METHODS
  This study analyzed data from the Pregnancy Risk Assessment Monitoring System, including 95,141 women who delivered a live, singleton baby from 2009 to 2011 and provided BMI and breastfeeding information. Prepregnancy BMI was categorized as underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (≥30.0 kg/m(2)). Breastfeeding initiation was reported as having ever breastfed after delivery (yes or no). Adjusted models, which included only potential confounders resulting in a 10% or greater change in estimate, generated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for breastfeeding noninitiation. Analysis was stratified by race/ethnicity.
  
  
  RESULTS
  Compared with normal weight non-Hispanic white women, the odds of breastfeeding noninitiation were 17% and 25% higher among overweight (AOR=1.17, 95% CI=1.07-1.29) and obese (AOR=1.25, 95% CI=1.14-1.36) non-Hispanic white women, respectively. Among non-Hispanic black women, the odds of breastfeeding noninitiation were 29% higher only in obese women compared with normal weight non-Hispanic black women. No association was observed among Hispanic women or women of other races.
  
  
  CONCLUSIONS
  Prepregnancy BMI is a significant predictor for breastfeeding noninitiation for non-Hispanic white and non-Hispanic black women. Further exploration of the differences underlying the association between prepregnancy BMI and breastfeeding behaviors among racial subpopulations of women in the United States is warranted.
authors.affiliation: Department of Family Medicine and Population Health, School of Medicine , Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Saba W
authors.initials: SW
authors.lastname: Masho
authors.affiliation: Department of Family Medicine and Population Health, School of Medicine , Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Susan
authors.initials: S
authors.lastname: Cha
authors.affiliation: Department of Family Medicine and Population Health, School of Medicine , Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Morris
mesh_terms: D000328:Adult; D001741:Black or African American; D001942:Breast Feeding / Q000208:ethnology / Q000523:psychology*; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006630:Hispanic or Latino; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D011247:Pregnancy; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D044465:White People