title: Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important?
abstract: This study aimed to investigate socio-demographic, medical and psychological factors that have an impact on breastfeeding.
  
  
  
  Questionnaires were administered to 330 women prenatally (TI third trimester) and postpartum (TII 3-4 days, TIII 4 months). Medical data were collected from the hospital records. Self-reported data on initiation and maintenance of breastfeeding was collected simultaneously. Primary endpoint was breastfeeding initiation and maintenance. Data analyses were performed using Spearman's ρ correlations between breastfeeding and other study variables and generalized multiple ordinal logistic regression analysis.
  
  
  
  Neonatal admission to the NICU, high BMI, cesarean section, difficulties with breastfeeding initiation and high maternal state anxiety were the strongest predictors of impaired breastfeeding initiation, explaining together 50 % of variance. After 4 months, the strongest predictors of impaired maintenance of breastfeeding were maternal smoking, a high BMI and a history of postpartum anxiety disorder, explaining 30 % of variance.
  
  
  
  Successful initiation and maintenance of breast feeding is a multifactorial process. Our results underline the need of interdisciplinary approaches to optimise breastfeeding outcomes by demonstrating the equality of medical and psychological variables. Whereas practices on maternity wards are crucial for optimal initiation, continuous lifestyle modifying and supporting approaches are essential for breastfeeding maintenance. Healthcare providers can also significantly influence breastfeeding initiation and maintenance by counselling on the importance of maternal BMI.
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. Stephanie.Wallwiener@googlemail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wallwiener
authors.affiliation: Department of Psychology, Ludwig Maximilian University, Leopoldstr. 13, 80802, Munich, Germany.
authors.forename: Mitho
authors.initials: M
authors.lastname: Müller
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Doster
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Plewniok
authors.affiliation: Department of Women's Health, University of Tübingen, Calwerstr. 7, 72076, Tübingen, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Wallwiener
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Fluhr
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Feller
authors.affiliation: Department of Women's Health, University of Tübingen, Calwerstr. 7, 72076, Tübingen, Germany.
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Brucker
authors.affiliation: Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wallwiener
authors.affiliation: Department of Psychology, Ludwig Maximilian University, Leopoldstr. 13, 80802, Munich, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Reck
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology; D015992:Body Mass Index; D001942:Breast Feeding / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011795:Surveys and Questionnaires
keywords: Breastfeeding; Breastfeeding duration; Breastfeeding initiation; Obesity, smoking, anxiety; Predictors