Factors Associated with Breastfeeding Initiation in Adolescent Pregnancies: A Cohort Study.
OBJECTIVE
Adolescent mothers have a lower breastfeeding rate than adult women. The objective is to determine the association between multiple high-risk characteristics of pregnant adolescents with intention and initiation of breastfeeding.


METHODS
We conducted a retrospective population-based cohort study in Ontario (2006-2012) using the Better Outcomes Registry & Network (BORN) database. Breastfeeding outcomes of adolescent women (younger than 20 years) with a singleton live-born infant at term gestation (37 weeks or greater) were analyzed. The χ(2) and independent-sample t tests were used where appropriate. A multivariate logistic regression analysis was also performed.


RESULTS
This study included 22,023 adolescent women with complete breastfeeding information. Almost half (48.8%, n = 10,749) exclusively breastfed their infant at time of hospital discharge. Breastfeeding was significantly more likely in the older adolescents (odds ratio 1.10); other factors significantly associated with breastfeeding included intention to breastfeed, prenatal classes attendance, living in a higher-income neighborhood, having a spontaneous vaginal delivery, being a nonsmoker, not using substances during pregnancy, and not having any preexisting health problems or obstetrical complications (P < .0001). A significant interaction between smoking and intention to breastfeed was identified. Intention to breastfeed was found to be protective against the reduction in breastfeeding seen with smoking.


CONCLUSIONS
This large-cohort study confirms that high-risk factors are associated with lower breastfeeding in Canadian adolescent term singleton births. Breastfeeding intention is a very important driver of breastfeeding. These findings highlight the importance of early multidisciplinary adolescent pregnancy care targeting these risks factors and education in order to improve breastfeeding rates in this population.
Department of Obstetrics/Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada.
Emily
E
Leclair
BORN Ontario, CHEO, Ottawa, Ontario, Canada.
Nicole
N
Robert
BORN Ontario, CHEO, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada.
Ann E
AE
Sprague
Department of Obstetrics/Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Gynecology, CHEO, Ottawa, Ontario, Canada; BORN Ontario, CHEO, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; CHEO Research Institute, Ottawa, Ontario, Canada. Electronic address: nfleming@toh.on.ca.
Nathalie
N
Fleming
D000293:Adolescent; D000367:Age Factors; D001942:Breast Feeding / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D033182:Intention; D009035:Mothers / Q000523:psychology*; D016017:Odds Ratio; D009864:Ontario; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology; D011253:Pregnancy in Adolescence / Q000523:psychology*; D011295:Prenatal Care; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000523:psychology; D012959:Socioeconomic Factors; D055815:Young Adult
Adolescent pregnancy; Breastfeeding initiation; Breastfeeding intention; Ontario Canada; Risk factors; Sociodemographic