Early Breastfeeding Problems Mediate the Negative Association between Maternal Obesity and Exclusive Breastfeeding at 1 and 2 Months Postpartum.
BACKGROUND
Compared with normal-weight women, women with obesity experience poorer breastfeeding outcomes. Successful breastfeeding among women with obesity is important for achieving national breastfeeding goals.


OBJECTIVE
The objectives were to determine whether the negative association between obesity and any or exclusive breastfeeding at 1 and 2 mo postpartum is mediated through breastfeeding problems that occur in the first 2 wk postpartum and if this association differs by parity.


METHODS
Mothers (1151 normal-weight and 580 obese) in the Infant Feeding Practices Study II provided information on sociodemographic and psychosocial characteristics, body mass index, and breastfeeding outcomes. At 1 mo postpartum, participants reported the breastfeeding problems they experienced in the first 2 wk postpartum from a predefined list of 17 options. We used factor analysis to condense these problems into 4 explanatory variables; continuous factor scores were computed for use in further analyses. We used maximum likelihood logistic regression to assess mediation of the association between obesity and breastfeeding outcomes through early breastfeeding problems.


RESULTS
No significant effect of obesity was found on any breastfeeding at 1 or 2 mo. At 1 mo postpartum, for both primiparous and multiparous women, there was a significant direct effect of obesity on exclusive breastfeeding and a significant indirect effect of obesity through early breastfeeding problems related to the explanatory mediating variable "Insufficient Milk" (throughout the remainder of the Abstract, this factor will be denoted by upper case notation). At 2 mo postpartum both the direct effect of obesity and the indirect effect through Insufficient Milk were significant in primiparous women but only the indirect effect remained significant in multiparous women.


CONCLUSIONS
Early problems related to Insufficient Milk may partially explain the association between obesity and poor exclusive breastfeeding outcomes. Women who are obese, particularly those reporting breastfeeding problems that grouped in the Insufficient Milk factor in the early postpartum period, may benefit from additional breastfeeding support.
Division of Nutritional Sciences, Cornell University, Ithaca, NY; and eo238@cornell.edu.
Elizabeth J
orcid.org/0000-0001-7418-7902
EJ
O'Sullivan
Division of Nutrition, Physical Activity, and Obesity, CDC, Atlanta, GA.
Cria G
CG
Perrine
Division of Nutritional Sciences, Cornell University, Ithaca, NY; and.
Kathleen M
orcid.org/0000-0003-2111-6478
KM
Rasmussen
D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding; D015331:Cohort Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology*; D007775:Lactation Disorders / Q000453:epidemiology / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D009765:Obesity / Q000503:physiopathology*; D010349:Patient Compliance; D049590:Postpartum Period; D015995:Prevalence; D014481:United States / Q000453:epidemiology
BMI; breastfeeding cessation; early breastfeeding problems; maternal obesity; mediation analysis