The impact of excessive weight on breastfeeding intention, initiation, and duration

Authors: CRIMMINS, MEGHAN - Arkansas Children'S Nutrition Research Center (ACNC); HAND, MEGHAN - University Arkansas For Medical Sciences (UAMS); SAMUEL, HALLIE - Arkansas Children'S Nutrition Research Center (ACNC); BELLANDO, JAYNE - Arkansas Children'S Nutrition Research Center (ACNC); SIMS, CLARK - Arkansas Children'S Nutrition Research Center (ACNC); ANDRES, ALINE - Arkansas Children'S Nutrition Research Center (ACNC); SOBIL, SARAH - Arkansas Children'S Nutrition Research Center (ACNC)

Submitted to: Breastfeeding Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/5/2023
Publication Date: 9/9/2023
Citation: Crimmins, M.R., Hand, M., Samuel, H., Bellando, J., Sims, C., Andres, A., Sobil, S. 2023. The impact of excessive weight on breastfeeding intention, initiation, and duration. Breastfeeding Medicine. 18(9):688-695. https://doi.org/10.1089/bfm.2023.0072.
DOI: https://doi.org/10.1089/bfm.2023.0072

Interpretive Summary: Breastfeeding is the recommended feeding method for infants. However, breastfeeding goals are often not met especially with mothers with excessive weight. The goal of this research was to determine what factors both during and after pregnancy were connected with reaching breastfeeding goals. We found women with obesity had lower intention to breastfeed when asked during pregnancy and that mothers with obesity had shorter breastfeeding duration. Similarly, we also found that higher intention to breastfeed during pregnancy was associated with longer breastfeeding duration. In addition, we found that increasing depression scores were shown to mediate or contribute to the impact of excessive weight on intention to breastfeed. This research highlighted maternal weight and maternal depression as areas of interest for both future research and targeted interventions to increase breastfeeding success.

Technical Abstract: Background: Breastfeeding is widely recognized as the optimal feeding method for infants. However, breastfeeding goals are often unmet, especially in mothers with excessive weight. Potential factors associated with unmet goals could be disparities in care for women with higher body mass index (BMI) or mental health symptomology. Methods: Women enrolled in a longitudinal study were stratified by BMI into three groups: mothers with normal weight (18.5–24.9'kg/m2, n'='101), with overweight (25–29.9'kg/m2, n'='78), and with obesity (OB; 30–35'kg/m2, n'='48). Breastfeeding intention and standardized mental health questionnaires were administered at gestational weeks 12 and 36. The prevalence of initiation and duration of breastfeeding were determined based on self-reported breastfeeding start and end dates. Wilcoxon tests, pairwise proportion test, Cox proportional hazards regression, and linear regression were used. Results: Higher maternal weight status (OB) was significantly associated with lower breastfeeding intention and duration. As expected, higher breastfeeding intention scores were associated with significantly longer breastfeeding duration. Higher scores on the Beck Depression Inventory (BDI), associated with a greater number of depression symptoms, mediated the negative impact of weight status on breastfeeding intention. Conclusions: breastfeeding outcomes are negatively associated with maternal weight status and prenatal mental health with the relationship between the two being interconnected, despite subclinical scores on the BDI. Further research is needed to explore the role of mental health on breastfeeding outcomes. From these findings, targeted prenatal interventions for women with excessive weight and depressive symptoms would likely promote and improve breastfeeding outcomes.