title: When Breast Milk Alone Is Not Enough: Barriers to Breastfeeding Continuation among Overweight and Obese Mothers.
abstract: BACKGROUND
  Maternal overweight and obesity are associated with decreased breastfeeding duration.
  
  
  OBJECTIVE
  This study aimed to identify barriers to breastfeeding continuation among overweight and obese mothers.
  
  
  METHODS
  A retrospective cohort study examining breastfeeding continuation barriers was conducted using results of the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System survey from Illinois, Maine, and Vermont from 2004 to 2008. SAS Complex Survey version 9.3 was used for analysis.
  
  
  RESULTS
  Of 19,145 mothers surveyed, 3717 (19%) were obese and 4367 (23%) were overweight. Overall, 14,731 women initiated breastfeeding, and 6467 discontinued breastfeeding prior to survey completion, around 4 months postpartum. The most common reasons that mothers reported for discontinuing breastfeeding were insufficient milk supply, infant not satisfied with breast milk alone, and breastfeeding difficulty. Overweight and obese women, compared with women of normal weight, had higher odds of discontinuing breastfeeding because their babies were not satisfied by breast milk alone (overweight: odds ratio [OR] = 1.39, 95% confidence interval [CI], 1.16-1.68; obese: OR = 1.26, 95% CI, 1.03-1.54). Obese mothers, compared with normal weight mothers, had lower odds of discontinuing breastfeeding because it felt like the right time (OR = 0.64, 95% CI, 0.47-0.88) and higher odds of discontinuing due to breastfeeding difficulties (OR = 1.29, 95% CI, 1.05-1.58) and infant jaundice (OR = 1.81, 95% CI, 1.26-2.60).
  
  
  CONCLUSIONS
  Obese and overweight mothers were significantly more likely to discontinue breastfeeding due to infant dissatisfaction with breast milk alone. Obese mothers had higher odds than normal weight mothers of discontinuing breastfeeding due to breastfeeding difficulties and infant jaundice. Breastfeeding education and support should be enhanced for this at-risk population.
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa, Carver College of Medicine, Iowa City, IA, USA laura-kair@uiowa.edu.
authors.forename: Laura R
authors.initials: LR
authors.lastname: Kair
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Tarah T
authors.initials: TT
authors.lastname: Colaizy
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D016015:Logistic Models; D008425:Maternal Behavior / Q000502:physiology / Q000523:psychology*; D009765:Obesity / Q000503:physiopathology / Q000523:psychology; D050177:Overweight / Q000503:physiopathology / Q000523:psychology*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: breastfeeding; breastfeeding cessation; breastfeeding duration; obesity; overweight