title: Maternal and Neonatal Factors Adversely Affecting Breastfeeding in the Perinatal Period.
abstract: BACKGROUND
  Despite its known advantages, breastfeeding rates are low world over. Large number of factors affect breastfeeding. This study was designed to detect maternal and neonatal factors that adversely affect breastfeeding in the perinatal period.
  
  
  METHODS
  A prospective, single-blinded study was conducted on randomly chosen mother-infant pairs in the maternity ward of a tertiary care service hospital. Only full term singletons born by normal vaginal delivery were studied. The B.R.E.A.S.T observation score and time spent by the infant at the mother's breast were primary outcome variables. Maternal age, gravida, para status and education level were recorded. Birth weight, sex, gestation age of the infant and time interval from birth to observation were also recorded. Initial univariate analysis followed by multivariate analysis was performed using SPSS ver 7.5 software.
  
  
  RESULTS
  A total of 54 mother-infant pairs formed the study group; 19(35.2%) were primigravidas. Primigravidas status of the mother led to significantly lower scores (p<0.04; 95% CI 0.10 to 3.62) as did maternal age < 26 years (p<0.04; 95% CI 0.2. to 3.46) on univariate analysis. Low birth weight (<2500 g) was the only neonatal factor that significantly lowered breastfeeding scores (p<0.02;95%Cl 0.56 to 6.31). On multivariate analysis only primigravida status was significantly associated with lower scores (p<0.02). The alpha value of the study was 5% and the power was 74%. Time spent by infant on breast was not significantly different between primigravida and non-primigravida mothers.
  
  
  CONCLUSIONS
  Primigravida status adversely affects breastfeeding scores; therefore counseling and support should be focused on this group. Extra care should also be taken to ensure adequate breastfeeding by younger mothers and in those with low birth weight infants. Larger studies with long-term follow up will be able to identify other factors and dertermine the effects of focused counseling and support in the perinatal period upon long-term breastfeeding rates.
authors.affiliation: Classified Specialist (Paediatrics) and Neonatologist, INHS Asvini, Colaba, Mumbai-5.
authors.forename: Shankar
authors.initials: S
authors.lastname: Narayan
authors.affiliation: Postgraduate Trainee (Paediatrics), INHS Asvini, Colaba, Mumbai-5.
authors.forename: Nisha
authors.initials: N
authors.lastname: Natarajan
authors.affiliation: Ex-Senior Advisor (Paediatrics), INHS Asvini, Colaba, Mumbai-5.
authors.forename: K S
authors.initials: KS
authors.lastname: Bawa
keywords: Breastfeeding; Counseling; Primigravida