title: Maternal Prepregnant Body Mass Index and Gestational Weight Gain Are Associated with Initiation and Duration of Breastfeeding among Norwegian Mothers.
abstract: BACKGROUND
  Pregnancy is associated with weight gain. Moreover, overweight and obese women subsequently have difficulties with breastfeeding. Both of these factors may contribute to the observed relations between reproduction and weight problems.
  
  
  OBJECTIVE
  In this study we evaluated the combined effects of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) on the ability to initiate and sustain breastfeeding in a large, population-based study, the MoBa (Norwegian Mother and Child Cohort Study).
  
  
  METHODS
  Initiation and maintenance of breastfeeding for 4 and 6 mo postpartum in relation to prepregnancy BMI and GWG were evaluated among 49,669 women with complete information on BMI, GWG, and breastfeeding by using multivariable logistic regression analyses.
  
  
  RESULTS
  An excess risk of unsuccessful initiation of breastfeeding was observed among all categories of prepregnant overweight and obese women as well as among most GWG categories of prepregnant underweight women. For all of these groups, risks of unsuccessful initiation of breastfeeding were significantly higher with GWG below recommendations. The same patterns were seen among all categories of prepregnant overweight and obese women with respect to risks of inability to sustain full or any breastfeeding for 4 and 6 mo postpartum. However, prepregnant obese women had the highest risk of inability to sustain full or any breastfeeding if they had also experienced GWG above recommendations. The associations between prepregnancy BMI and breastfeeding were modified by Apgar scores and maternal asthma.
  
  
  CONCLUSIONS
  The results show the importance of encouraging women to start pregnancy with a healthy BMI as well as to have GWG within recommendations for the benefit of successful breastfeeding. The interactions with medical conditions further highlight the complexity of the associations.
authors.affiliation: Departments of Internal Medicine and Clinical Nutrition and anna.winkvist@nutrition.gu.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Winkvist
authors.affiliation: Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; and.
authors.forename: Anne Lise
authors.initials: AL
authors.lastname: Brantsæter
authors.affiliation: Swedish National Data Service (SND), Gothenburg, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Brandhagen
authors.affiliation: Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; and.
authors.forename: Margaretha
authors.initials: M
authors.lastname: Haugen
authors.affiliation: Division of Environmental Medicine, Norwegian Institute of Public Health, Oslo, Norway; and.
authors.forename: Helle Margrete
authors.initials: HM
authors.lastname: Meltzer
authors.affiliation: Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
authors.forename: Lauren
authors.initials: L
authors.lastname: Lissner
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009664:Norway; D009765:Obesity; D050177:Overweight; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013851:Thinness; D015430:Weight Gain; D044465:White People; D055815:Young Adult
keywords: MoBa; The Norwegian Mother and Child Cohort Study; body mass index; breastfeeding; gestational weight gain; medical conditions; prepregnant