Abstract
Objective
Breastfeeding has multiple benefits for women and babies. Understanding factors contributing to intention to exclusively breastfeed may allow for improving the rates in first-time mothers. The study objective was to examine factors associated with a woman’s intention to breastfeed her first child.
Methods
A secondary analysis of the prospective “Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be” (nuMoM2b) study of nulliparous women in the U.S. with singleton pregnancies was performed. Sociodemographic and psychosocial factors were analyzed for associations with breastfeeding intention.
Results
For the 6443 women with complete information about breastfeeding intention and all factors under consideration, women who intended to breastfeed (either exclusively or any breastfeeding) were more likely to be older, not black, have reached a higher level of education, have higher incomes, have a lower body mass index (BMI), and be nonsmokers. Reporting a planned pregnancy and several psychosocial measures were also associated with intention to breastfeed. In the multivariable analysis for exclusive breastfeeding, in addition to age, BMI, race, income, education, and smoking, of the psychosocial measures assessed, only women with higher hassle intensity ratios on the Pregnancy Experience Scale had lower odds of exclusive breastfeeding intention (OR 0.71, 95% CI 0.55–0.92). Other psychosocial measures were not associated with either exclusive breastfeeding or any breastfeeding after controlling for demographic characteristics.
Conclusions for Practice
Several sociodemographic factors, having a planned pregnancy, and fewer intense pregnancy hassles compared to uplifts are associated with intention to exclusively breastfeed. Identifying these factors may allow providers to identify women for focused, multilevel efforts to enhance breastfeeding rates.
Similar content being viewed by others
References
Agho, K. E., Ogeleka, P., Ogbo, F. A., Ezeh, O. K., Eastwood, J., & Page, A. (2016). Trends and predictors of prelacteal feeding practices in Nigeria (2003–2013). Nutrients. https://doi.org/10.3390/nu8080462.
Bann, C. M., Parker, C. B., Grobman, W. A., Willinger, M., Simhan, H. N., Wing, D. A., et al. (2017). Psychometric properties of stress and anxiety measures among nulliparous women. Journal of Psychosomatic Obstetrics & Gynecology,38(1), 53–62. https://doi.org/10.1080/0167482X.2016.1252910.
Brown, H., & Prescott, R. (2015). Applied mixed models in medicine (3rd ed.). West Sussex, UK: Wiley.
Centers for Disease Control and Prevention. (2019). Breastfeeding. Retrieved January 28, 2020, from https://www.cdc.gov/breastfeeding/index.htm.
Cole, S. R. (1999). Assessment of differential item functioning in the perceived stress scale-10. Journal of Epidemiology and Community Health,53(5), 319–320.
Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The connor-davidson resilience scale (CD-RISC). Depress Anxiety,18(2), 76–82. https://doi.org/10.1002/da.10113.
Cox, J. L., Chapman, G., Murray, D., & Jones, P. (1996). Validation of the edinburgh postnatal depression scale (EPDS) in non-postnatal women. Journal of Affective Disorders,39(3), 185–189.
Davis, K. E., Li, X., Adams-Huet, B., & Sandon, L. (2018). Infant feeding practices and dietary consumption of US infants and toddlers: National Health and Nutrition Examination Survey (NHANES) 2003–2012. Public Health Nutrition,21(4), 711–720. https://doi.org/10.1017/S1368980017003184.
Dewey, K. G., Heinig, M. J., & Nommsen-Rivers, L. A. (1995). Differences in morbidity between breast-fed and formula-fed infants. Journal of Pediatrics,126(5 Pt 1), 696–702. https://doi.org/10.1016/s0022-3476(95)70395-0.
DiPietro, J. A., Christensen, A. L., & Costigan, K. A. (2008). The pregnancy experience scale-brief version. Journal of Psychosomatic Obstetrics & Gynecology,29(4), 262–267.
Dozier, A. M., Nelson, A., & Brownell, E. (2012). The Relationship between life stress and breastfeeding outcomes among low-income mothers. Advances in Preventive Medicine,2012, 902487–902487. https://doi.org/10.1155/2012/902487.
Dubois, L., & Girard, M. (2003). Social determinants of initiation, duration and exclusivity of breastfeeding at the population level: The results of the longitudinal study of child development in Quebec (ELDEQ 1998–2002). Canadian Journal of Public Health,94(4), 300–305.
Furman, L., Taylor, G., Minich, N., & Hack, M. (2003). The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Archives of Pediatrics and Adolescent Medicine,157(1), 66–71. https://doi.org/10.1001/archpedi.157.1.66.
Grobman, W. A., Parker, C., Wadhwa, P. D., Willinger, M., Simhan, H., Silver, B., et al. (2016). Racial/ethnic disparities in measures of self-reported psychosocial states and traits during pregnancy. American Journal of Perinatology,33(14), 1426–1432. https://doi.org/10.1055/s-0036-1586510.
Gunderson, E. P., Lewis, C. E., Lin, Y., Sorel, M., Gross, M., Sidney, S., et al. (2018). Lactation duration and progression to diabetes in women across the childbearing years: The 30-year CARDIA study. JAMA Internal Medicine,178(3), 328–337. https://doi.org/10.1001/jamainternmed.2017.7978.
Haas, D. M., Parker, C. B., Wing, D. A., Parry, S., Grobman, W. A., Mercer, B. M., et al. (2015). A description of the methods of the Nulliparous pregnancy outcomes study: Monitoring mothers-to-be (nuMoM2b). American Journal of Obstetrics & Gynecology,212(4), 539.e531–539.e524. https://doi.org/10.1016/j.ajog.2015.01.019.
Horta, B. L., Loret de Mola, C., & Victora, C. G. (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis. Acta Paediatrica,104(467), 30–37. https://doi.org/10.1111/apa.13133.
Hylander, M. A., Strobino, D. M., Pezzullo, J. C., & Dhanireddy, R. (2001). Association of human milk feedings with a reduction in retinopathy of prematurity among very low birthweight infants. Journal of Perinatology,21(6), 356–362. https://doi.org/10.1038/sj.jp.7210548.
Johnson, A., Kirk, R., Rosenblum, K. L., & Muzik, M. (2015). Enhancing breastfeeding rates among African American women: A systematic review of current psychosocial interventions. Breastfeeding Medicine,10(1), 45–62. https://doi.org/10.1089/bfm.2014.0023.
Keitt, S. H., Reis-Reilly, H., Fuller-Sankofa, N., & Carr, M. (2018). Breastfeeding in the community: Sharing stories on implementations that work. Journal of Human Lactation: Official Journal of International Lactation Consultant Association,34(2), 285–303. https://doi.org/10.1177/0890334418757957.
Kwan, M. L., Buffler, P. A., Abrams, B., & Kiley, V. A. (2004). Breastfeeding and the risk of childhood leukemia: A meta-analysis. Public Health Reports,119(6), 521–535. https://doi.org/10.1016/j.phr.2004.09.002.
Levy, I., Comarsca, J., Davidovits, M., Klinger, G., Sirota, L., & Linder, N. (2009). Urinary tract infection in preterm infants: The protective role of breastfeeding. Pediatric Nephrology(Berlin, Germany),24(3), 527–531. https://doi.org/10.1007/s00467-008-1007-7.
McManus, M. A., Khalessi, A. A., Lin, J., Ashraf, J., & Reich, S. M. (2017). Positive feelings during pregnancy, early feeding practices, and infant health. Pediatrics International,59(5), 593–599. https://doi.org/10.1111/ped.13209.
Mortensen, E. L., Michaelsen, K. F., Sanders, S. A., & Reinisch, J. M. (2002). The association between duration of breastfeeding and adult intelligence. JAMA,287(18), 2365–2371. https://doi.org/10.1001/jama.287.18.2365.
Noble, S., & Pregnancy, A. S. T. A. L. S. O., & Childhood. (2001). Maternal employment and the initiation of breastfeeding. Acta Paediatrica,90(4), 423–428. https://doi.org/10.1080/08035250121419.
Nuzrina, R., Roshita, A., & Basuki, D. N. (2016). Factors affecting breastfeeding intention and its continuation among urban mothers in West Jakarta: A follow-up qualitative study using critical point contact for breastfeeding. Asia Pacific Journal of Clinical Nutrition,25(Suppl 1), S43–S51. https://doi.org/10.6133/apjcn.122016.s10.
Pearson, R. M., Lightman, S. L., & Evans, J. (2011). Attentional processing of infant emotion during late pregnancy and mother–infant relations after birth. Archives of Women's Mental Health,14(1), 23–31. https://doi.org/10.1007/s00737-010-0180-4.
Robinson, K., Garnier-Villarreal, M., & Hanson, L. (2018). Effectiveness of centeringpregnancy on breastfeeding initiation among African Americans: A systematic review and meta-analysis. Journal of Perinatal & Neonatal Nursing,32(2), 116–126. https://doi.org/10.1097/JPN.0000000000000307.
Rodriguez-Palmero, M., Koletzko, B., Kunz, C., & Jensen, R. (1999). Nutritional and biochemical properties of human milk: II. Lipids, micronutrients, and bioactive factors. Clinics in Perinatology,26(2), 335–359.
Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., et al. (2016). Why invest, and what it will take to improve breastfeeding practices? Lancet,387(10017), 491–504. https://doi.org/10.1016/S0140-6736(15)01044-2.
Schanler, R. J., Shulman, R. J., & Lau, C. (1999). Feeding strategies for premature infants: Beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics,103(6 Pt 1), 1150–1157. https://doi.org/10.1542/peds.103.6.1150.
Schwarz, E. B., Ray, R. M., Stuebe, A. M., Allison, M. A., Ness, R. B., Freiberg, M. S., et al. (2009). Duration of lactation and risk factors for maternal cardiovascular disease. Obstetrics and Gynecology,113(5), 974–982. https://doi.org/10.1097/01.AOG.0000346884.67796.ca.
Shakya, P., Kunieda, M. K., Koyama, M., Rai, S. S., Miyaguchi, M., Dhakal, S., et al. (2017). Effectiveness of community-based peer support for mothers to improve their breastfeeding practices: A systematic review and meta-analysis. PLoS ONE,12(5), e0177434. https://doi.org/10.1371/journal.pone.0177434.
Smith James, R. (2017). Breastfeeding disparities in African American women. Retrieved January 28, 2020, from https://nimhd.blogs.govdelivery.com/2017/08/08/breastfeeding-disparities-in-african-american-women/.
Spielberger, C. D. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.
Sutherland, T., Pierce, C. B., Blomquist, J. L., & Handa, V. L. (2012). Breastfeeding practices among first-time mothers and across multiple pregnancies. Maternal and Child Health Journal,16(8), 1665–1671. https://doi.org/10.1007/s10995-011-0866-x.
Temple Newhook, J., Newhook, L. A., Midodzi, W. K., Murphy Goodridge, J., Burrage, L., Gill, N., et al. (2017). Poverty and breastfeeding: Comparing determinants of early breastfeeding cessation incidence in socioeconomically marginalized and privileged populations in the FiNaL study. Health Equity,1(1), 96–102. https://doi.org/10.1089/heq.2016.0028.
U.S. Department of Health and Human Services Office of Minority Health. (2019). Infant mortality and African Americans. Retrieved January 28, 2020, from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23.
United States Department of Health and Human Services. (2010). Healthy people 2020. Washington, DC
Victora, C. G., Bahl, R., Barros, A. J., Franca, G. V., Horton, S., Krasevec, J., et al. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet,387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7.
WHO/UNICEF. (2014). Global nutrition targets 2025: Breastfeeding policy brief (WHO/NMH/NHD/14.7). Retrieved January 28, 2020, from https://www.who.int/nutrition/global-target-2025/en/.
Wright, A. L., Holberg, C. J., Martinez, F. D., Morgan, W. J., & Taussig, L. M. (1989). Breast feeding and lower respiratory tract illness in the first year of life group health medical associates. BMJ,299(6705), 946–949. https://doi.org/10.1136/bmj.299.6705.946.
Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment,55(3–4), 610–617. https://doi.org/10.1080/00223891.1990.9674095.
Acknowledgements
This study is supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): U10 HD063036, RTI International; U10 HD063072, Case Western Reserve University; U10 HD063047, Columbia University; U10 HD063037, Indiana University; U10 HD063041, University of Pittsburgh; U10 HD063020, Northwestern University; U10 HD063046, University of California Irvine; U10 HD063048, University of Pennsylvania; and U10 HD063053, University of Utah. In addition, support was provided by respective Clinical and Translational Science Institutes to Indiana University (UL1TR001108) and University of California Irvine (UL1TR000153).
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Conflict of interest
The authors report no conflict of interest related to this project.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Baumgartner, T., Bhamidipalli, S.S., Guise, D. et al. Psychosocial and Sociodemographic Contributors to Breastfeeding Intention in First-Time Mothers. Matern Child Health J 24, 1047–1056 (2020). https://doi.org/10.1007/s10995-020-02928-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-020-02928-0