title: Maternal Education Is Associated with Disparities in Breastfeeding at Time of Discharge but Not at Initiation of Enteral Feeding in the Neonatal Intensive Care Unit.
abstract: To investigate the relationship between maternal education and breastfeeding in very preterm infants admitted to neonatal intensive care units.
  
  
  
  This prospective, population-based cohort study analyzed the data of all very preterm infants admitted to neonatal care during 1 year in 3 regions in Italy (Lazio, Emilia-Romagna, and Marche). The use of mothers' own milk was recorded at initial enteral feedings and at hospital discharge. We used multilevel logistic analysis to model the association between maternal education and breastfeeding outcomes, adjusting for maternal age and country of birth. Region was included as random effect.
  
  
  
  There were 1047 very preterm infants who received enteral feeding, and 975 were discharged alive. At discharge, the use of mother's own milk, exclusively or not, and feeding directly at the breast were significantly more likely for mothers with an upper secondary education or higher. We found no relationship between maternal education and type of milk at initial enteral feedings. However, the exclusive early use of the mother's own milk at initial feedings was related significantly with receiving any maternal milk and feeding directly at the breast at discharge from hospital, and the association with feeding at the breast was stronger for the least educated mothers.
  
  
  
  In this population-based cohort of very preterm infants, we found a significant and positive association between maternal education and the likelihood of receiving their mother's own milk at the time of discharge. In light of the proven benefits of maternal milk, strategies to support breastfeeding should be targeted to mothers with less education.
authors.affiliation: Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Lena Carolin
authors.initials: LC
authors.lastname: Herich
authors.affiliation: Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. Electronic address: marina.cuttini@opbg.net.
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
authors.affiliation: Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Ileana
authors.initials: I
authors.lastname: Croci
authors.affiliation: Hospital Network Planning and Research Area, Lazio Regional Health Authority, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Franco
authors.affiliation: Hospital Network Planning and Research Area, Lazio Regional Health Authority, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Lallo
authors.affiliation: Hospital Care Services, General Directorate for Health and Social Policies, Emilia Romagna Region, Bologna, Italy.
authors.forename: Dante
authors.initials: D
authors.lastname: Baronciani
authors.affiliation: Neonatal Intensive Care Unit, Salesi Children's Hospital, Ancona, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Fares
authors.affiliation: Neonatal Intensive Care Unit, Department of Obstetrics and Pediatrics, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Gargano
authors.affiliation: Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Raponi
authors.affiliation: INSERM, Obstetrics, Perinatal and Paediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), and DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004522:Educational Status; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007558:Italy; D008297:Male; D009035:Mothers; D010351:Patient Discharge; D011446:Prospective Studies
keywords: mediation analysis; socioeconomic indicators