title: Failure to initiate breastfeeding among high risk obstetrical patients who intended to breastfeed.
abstract: BACKGROUND
  In the US, at the time of discharge from the hospital, 79% of women had initiated breastfeeding. Intention to breastfeed is a strong predictor of breastfeeding initiation; however, we reported initiation failure in 45% of women with pregestational diabetes who intended to breastfeed. Information regarding intention and initiation among women with other high risk obstetrical conditions (HROB) remains scarce.
  
  
  OBJECTIVE
  To ascertain demographic and clinical factors associated with breastfeeding initiation failure among women with HROB conditions who intended to breastfeed.
  
  
  METHODS
  The study population is comprised of 89 women with diabetes (DM), 57 who were receiving treatment for substance abuse (SA), 51 women diagnosed with miscellaneous (MISC) conditions and 32 with history of preterm labor/delivery (PTL/D). Intention to exclusively breastfeed or in combination with formula (breastfed/FF) was ascertained prenatally. Breastfeeding was considered initiated if at discharge ≥50% of their infant feedings were maternal milk. Statistics include chi-square, Wilcoxon's and logistic regression (p < 0.05).
  
  
  RESULTS
  Of all women, 59% initiated any breastfeeding. Intention to breastfeed/FF, lack of mother-infant contact during the first hour following birth and limited lactation consultation were predictive of initiation failure. The odds of initiation failure were 2.3 times higher among women who wished to breastfeed/FF as compared to those who wished to exclusively breastfeed. Women from the SA group had lower rates of initiation failure than the other three HROB groups.
  
  
  CONCLUSIONS
  Intention to breastfeed among women with diverse HROB conditions is similar to that of the general population; however, initiation rates are disappointingly low. Intention to exclusively breastfeed results in fewer initiation failures. Prenatal intention to combine breast and formula feeding characterize women who may benefit from specific educational programs.
authors.affiliation: Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: L
authors.initials: L
authors.lastname: Cordero
authors.affiliation: Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Oza-Frank
authors.affiliation: Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: Moore-Clingenpeel
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Landon
authors.affiliation: Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Nankervis
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D033182:Intention; D016015:Logistic Models; D009035:Mothers; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications; D011254:Pregnancy in Diabetics; D018566:Pregnancy, High-Risk; D047928:Premature Birth; D012189:Retrospective Studies; D019966:Substance-Related Disorders
keywords: Breastfeeding initiation; high risk pregnancies