title: Breastfeeding initiation among macrosomic infants born to obese nondiabetic mothers.
abstract: BACKGROUND
  Women who are overweight or obese are at risk for maternal and neonatal medical complications, including macrosomia (birth weight ≥4,000 g), that may contribute to breastfeeding initiation failure. This study examined factors associated with breastfeeding initiation among obese women without diabetes who delivered macrosomic infants.
  
  
  METHODS
  A retrospective chart review was conducted from 2008 to 2011. Based on prepregnancy body mass index (in kg/m(2)), women were classified as normal (18-24.9), overweight (25-29.9), obese (30-34.9), very obese (35-39.9), and extremely obese (≥40). Intention to breastfeed was ascertained prenatally, and breastfeeding initiation was defined if at discharge ≥50% of the infant feedings were breastmilk.
  
  
  RESULTS
  Twenty-nine percent of the population was overweight, 23% obese, 14% very obese, and 12% extremely obese. Intention to breastfeed was similar among normal-weight, overweight, obese, and very obese women but was significantly lower for those who were extremely obese (p<0.05). Breastfeeding initiation was 75% for normal-weight, 72% for overweight, 71% for obese, 66% for very obese, and 53% for extremely obese women (p<0.05). Among women who intended to breastfeed, breastfeeding initiation was uniformly high: 94% for normal-weight, 93% for overweight, 95% for obese, 92% for very obese, and 87% for extremely obese women.
  
  
  CONCLUSIONS
  Intention to breastfeed as well as breastfeeding initiation was significantly lower for extremely obese women. Lack of intention to breastfeed declared during the antepartum period by extremely obese women highlights a need as well as an opportunity for intervention.
authors.affiliation: 1 Department of Pediatrics, The Ohio State University , Columbus, Ohio.
authors.forename: Leandro
authors.initials: L
authors.lastname: Cordero
authors.affiliation: 1 Department of Pediatrics, The Ohio State University , Columbus, Ohio.|2 Center for Perinatal Research, Nationwide Children's Hospital , Columbus, Ohio.
authors.forename: Reena
authors.initials: R
authors.lastname: Oza-Frank
authors.affiliation: 3 Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University , Columbus, Ohio.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.affiliation: 1 Department of Pediatrics, The Ohio State University , Columbus, Ohio.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Nankervis
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D037001:Directive Counseling; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D033182:Intention; D008425:Maternal Behavior; D009035:Mothers / Q000523:psychology*; D009765:Obesity / Q000523:psychology*; D009820:Ohio / Q000453:epidemiology; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D012189:Retrospective Studies