title: Breastfeeding practices during the first month postpartum and associated factors: impact on breastfeeding survival.
abstract: BACKGROUND
  The introduction of fluids to infants during the first days postpartum, which may be harmful to infant health, is a common practice in Iran.
  
  
  OBJECTIVE
  This study aimed to find the prevalence of breastfeeding practices using monthly dietary recall and factors associated with introduction of fluids during the first month of life and determine the effects of these supplementations on breastfeeding survival.
  
  
  METHODS
  This longitudinal study carried out in Shahroud, Iran from May 2011 to October 2013. Using convenient sampling strategy, 358 mothers in their third trimester of pregnancy were enrolled in the study and completed the questionnaires. Then the data regarding the introduction of fluids during first month postpartum was collected. We followed women monthly up to breastfeeding cessation. Kaplan-Meier and time-to-event methods were used to assess breastfeeding survival. A multinomial logistic regression analysis was used to identify the variables that determined breastfeeding practices at the first month postpartum. The Cox regression analysis was used to estimate the effect of variables on breastfeeding survival.
  
  
  RESULTS
  The prevalence of exclusive, predominant, and partial breastfeeding during the first month postpartum were 33.1%, 58.2%, and 8.6%, respectively. Predominant breastfeeding was associated with the lack of breastfeeding experience (OR = 1.93; 95% CI [1.02 - 3.66]). Partial breastfeeding was associated with the maternal age ≥ 30 y (OR = 5.96; CI [1.66 - 21.37]), family income higher than the mean (OR = 3.39; 95% CI [1.17 - 9.81]), and breastfeeding difficulties score higher than mean (OR = 3.09; 95% CI [1.10 - 8.71]). The Cox regression analysis revealed that breastfeeding practices at the first month was associated with an increased risk for breastfeeding discontinuation. The hazard ratio of breastfeeding discontinuation for predominant and partial breastfeeding groups were 1.11 (95% CI: 0.82, 1.51; P = 0.49) and 2.23 (95% CI: 1.39, 3.58; P = 0.001), respectively compared to the exclusive group.
  
  
  CONCLUSIONS
  The prevalence of predominant breastfeeding during the first month postpartum is high in Shahroud. Interventions to strengthen adherence to WHO guidelines for breastfeeding should be considered. Breastfeeding education providers at the hospitals should emphasize the effects of formula on breastfeeding continuation at early postpartum.
authors.affiliation: Department of Midwifery, Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, IR Iran.
authors.forename: Forough
authors.initials: F
authors.lastname: Mortazavi
authors.affiliation: Research Center of Psychiatry, Golestan University of Medical Sciences, Gorgan, IR Iran.
authors.forename: Seyed Abbas
authors.initials: SA
authors.lastname: Mousavi
authors.affiliation: Department of Community Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, IR Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Chaman
authors.affiliation: School of Nursing, University of Kansas, Kansas City, USA.
authors.forename: Karen Ann
authors.initials: KA
authors.lastname: Wambach
authors.affiliation: Chemistry Department, University of Texas at El Paso (UTEP), El Paso, USA.
authors.forename: Saideh Sadat
authors.initials: SS
authors.lastname: Mortazavi
authors.affiliation: Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, IR Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Khosravi
keywords: Breast Feeding; Cohort Studies; Feeding Methods; Infant Formula