title: Prepregnancy Obesity Class Is a Risk Factor for Failure to Exclusively Breastfeed at Hospital Discharge among Latinas.
abstract: BACKGROUND
  Suboptimal infant feeding practices, including the failure to exclusively breastfeed, are modifiable risk factors that affect multiple maternal and child health outcomes. Women who are overweight or obese prenatally are more likely to fail to exclusively breastfeed. In the United States, Latinas represent a high-risk population with respect to overweight, obesity, and suboptimal infant feeding practices.
  
  
  OBJECTIVE
  Examine whether exclusive breastfeeding status at hospital discharge among overweight and obese Latinas was associated with (1) prepregnancy body mass index (BMI) and gestational weight gain and (2) sociodemographic, psychosocial, and maternal/infant biomedical factors.
  
  
  METHODS
  An electronic medical records review was conducted to determine exclusive breastfeeding status at hospital discharge among Latinas who gave birth at Hartford Hospital, Hartford, Connecticut, USA (N = 480). Eligible participants were ≥ 16 years, Latina, overweight or obese (BMI ≥ 25.0 kg/m(2)) and delivered a healthy full-term (≥ 37 weeks) singleton.
  
  
  RESULTS
  In the multivariable model, obese class II (BMI, 35.0-39.9 kg/m(2)) women had increased odds of failing to exclusively breastfeed at hospital discharge compared with overweight women. Planned formula use/partial breastfeeding was the single strongest predictor of nonexclusive breastfeeding status. Other risk factors included Puerto Rican ethnicity and parity.
  
  
  CONCLUSIONS
  Maternal prepregnancy obesity class is an important predictor of exclusive breastfeeding status at hospital discharge among overweight and obese Latinas. Future research should examine why in-hospital exclusive breastfeeding behaviors differ by obesity class to subsequently inform the design of breastfeeding promotion and support interventions tailored to the needs of Latinas by obesity class. Culturally appropriate prenatal breastfeeding promotion interventions emphasizing action and coping planning should be considered.
authors.affiliation: Yale School of Public Health, Yale University, New Haven, CT, USA josefa.martinez@yale.edu.
authors.forename: Josefa L
authors.initials: JL
authors.lastname: Martinez
authors.affiliation: Springfield College, Springfield, MA, USA.
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Chapman
authors.affiliation: Yale School of Public Health, Yale University, New Haven, CT, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data; D003237:Connecticut; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D041943:Infant Formula / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008425:Maternal Behavior / Q000208:ethnology* / Q000523:psychology; D009765:Obesity / Q000208:ethnology / Q000523:psychology*; D010351:Patient Discharge; D011247:Pregnancy; D012307:Risk Factors; D057566:Self Report; D055815:Young Adult
keywords: Latina women; behaviors; breastfeeding; exclusive breastfeeding; maternal obesity