title: Association of Postpartum Predischarge Depot-Medroxyprogesterone Acetate with In-Hospital Breastfeeding Initiation.
abstract: The primary aim of this study was to examine the association between postpartum predischarge depot-medroxyprogesterone acetate (ppDMPA) and in-hospital breastfeeding initiation, and the secondary exploratory aim was to determine if any racial disparities are associated with ppDMPA receipt or its relationship to breastfeeding initiation.
  
  
  
  We conducted a cross-sectional retrospective chart review of maternal and newborn records at a large urban academic medical center. Variables extracted included in-hospital feeding choice, obstetrical and sociodemographic variables, infant characteristics, and ppDMPA receipt. The association of ppDMPA and maternal-child characteristics with breastfeeding initiation was examined using logistic regression analysis.
  
  
  
  Among singleton live births of 919 mother-infant pairs (76.5% African American [AA]), 67% initiated breastfeeding (34% exclusive and 33% mixed) and 31.4% received ppDMPA. Breastfeeding rates differed significantly between AA (60.7%) and non-AA mothers (86.6%), and ppDMPA also differed significantly between AA (37.6%) and non-AA mothers (11.6%). Adjusting for other independent predictors, mothers who received ppDMPA were 1.5 times more likely not to initiate breastfeeding if AA, and 5.2 times more likely not to initiate breastfeeding if non-AA.
  
  
  
  ppDMPA receipt was independently associated with decreased rates of breastfeeding initiation. Although more AA mothers received ppDMPA than non-AA, the association of ppDMPA with breastfeeding noninitiation was stronger in non-AA than in AA mothers. Future research should examine this question prospectively to ascertain if there is a cause-effect relationship and should address both physiological effects and social perceptions.
authors: 1 Case Western Reserve University School of Medicine , Cleveland, Ohio.
authors: Dinah
authors: D
authors: Chen
authors: 1 Case Western Reserve University School of Medicine , Cleveland, Ohio.
authors: Elena
authors: E
authors: Fuell Wysong
authors: 2 Center for Clinical Investigation, Statistical Science Core, Case Western Reserve University , Cleveland, Ohio.
authors: Hong
authors: H
authors: Li
authors: 3 Sidney Kimmel Medical College at Thomas Jefferson University , Philadelphia, Pennsylvania.
authors: Lisa
authors: L
authors: Perriera
authors: 4 University Hospitals Rainbow Babies and Children's Hospital , Cleveland, Ohio.
authors: Lydia
authors: L
authors: Furman
mesh_terms: D000328:Adult; D001741:Black or African American; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D007231:Infant, Newborn; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D009035:Mothers / Q000193:education / Q000523:psychology; D009820:Ohio; D049590:Postpartum Period; D011247:Pregnancy; D012959:Socioeconomic Factors; D014505:Urban Population; D044465:White People
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
keywords: breastfeeding; contraceptive methods; healthcare disparity; medroxyprogesterone acetate