title: Obese Mothers have Lower Odds of Experiencing Pro-breastfeeding Hospital Practices than Mothers of Normal Weight: CDC Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008.
abstract: OBJECTIVE
  This study examines the extent to which a mother's pre-pregnancy body mass index (BMI) category is associated with her exposure to pro-breastfeeding hospital practices.
  
  
  METHODS
  Data from the 2004-2008 CDC PRAMS were analyzed for three states (Illinois, Maine, and Vermont) that had administered an optional survey question about hospital pro-breastfeeding practices.
  
  
  RESULTS
  Of 19,145 mothers surveyed, 19 % were obese (pre-pregnancy BMI ≥ 30). Obese mothers had lower odds than mothers of normal weight of initiating breastfeeding [70 vs. 79 % (unweighted), p < 0.0001]. Compared with women of normal weight, obese mothers had lower odds of being exposed to pro-breastfeeding hospital practices during the birth hospitalization. Specifically, obese mothers had higher odds of using a pacifier in the hospital [odds ratio (OR) 1.31, 95 % confidence interval (CI) (1.17-1.48), p < 0.0001] and lower odds of: a staff member providing them with information about breastfeeding [OR 0.71, 95 % CI (0.57-0.89), p = 0.002], a staff member helping them breastfeed [OR 0.69, 95 % CI (0.61-0.78), p < 0.0001], breastfeeding in the first hour after delivery [OR 0.55, 95 % CI (0.49-0.62), p < 0.0001], being given a telephone number for breastfeeding help [OR 0.65, 95 % CI (0.57-0.74), p < 0.0001], rooming in [OR 0.84, 95 % CI (0.73-0.97), p = 0.02], and being instructed to breastfeed on demand [OR 0.66, 95 % CI (0.58-0.75), p < 0.0001]. Adjusting for multiple covariates, all associations except rooming in remained significant.
  
  
  CONCLUSIONS
  Obesity stigma may be a determinant of breastfeeding outcomes for obese mothers. Breastfeeding support should be improved for this at-risk population.
authors.affiliation: Stead Family Department of Pediatrics, University of Iowa, 200 Hawkins Dr. 2626 JCP, Iowa City, IA, 52242, 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, 200 Hawkins Dr. 8809 JCP, Iowa City, IA, 52242, USA. Tarah-Colaizy@uiowa.edu.
authors.forename: Tarah T
authors.initials: TT
authors.lastname: Colaizy
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D006761:Hospitals; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008281:Maine / Q000453:epidemiology; D008425:Maternal Behavior; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods*; D012649:Self Concept; D011795:Surveys and Questionnaires; D014481:United States; D014707:Vermont / Q000453:epidemiology; D055815:Young Adult
keywords: Baby-friendly; Breastfeeding; Obesity; Pre-pregnancy BMI; Pregnancy