Abstract
Objective
In-hospital formula supplementation places infants at risk for early breastfeeding cessation. The study’s aim was to identify predictive and protective factors for in-hospital formula supplementation in individuals documented as wanting to exclusively breastfeed and residing in a geographic region with adverse social determinants of health and low breastfeeding rates. Additionally, we wished to determine if lactation consultation served as a protective factor against supplementation.
Methods
In this cross-sectional study, we retrospectively reviewed 500 randomly selected charts of newborns born in a 12 month period at a regional tertiary care hospital. We included healthy, full-term neonates having a recorded maternal decision to exclusively breastfeed. Maternal-newborn dyad characteristics were compared between those exclusively breastfeeding and those with in-hospital formula supplementation.
Results
Of the 500 charts, 70% of individuals desired to exclusively breastfeed. Overall, 41% of breastfed newborns were supplemented with formula before discharge, and 32% of women met with lactation consultants prior to supplementation. No statistically significant association was present between exclusive breastfeeding at discharge and meeting with a hospital lactation consultant (p = 0.55). When controlling for the confounders of maternal demographics and lactation consultation, significant associations with formula supplementation included Cesarean delivery (odd ratio: 2.08, 95% confidence interval: 1.04–4.16), primiparity (2.48, 1.27–4.87), and high school level of education (2.78, 1.33–5.78).
Conclusions
Maternal characteristics of high school level educational, primiparity, and Caesarean delivery place individuals at risk for in-hospital formula supplementation in individuals wishing to exclusively breastfeed. Addressing barriers to exclusive breastfeeding is essential to enhance maternal and newborn health equity.
Significance
What is already known on this subject? Exclusive breastfeeding is recognized as the ideal feeding method for infants. Newborns receiving formula in-hospital are at higher risk for early breastfeeding cessation. Rural residence and/or in the Appalachian region negatively impact breastfeeding rates.
What this study adds? Predictors for in-hospital formula supplementation in women desiring to exclusively breastfeed included high school level educational, primiparity, and C-section delivery. Lactation consultation did not associate with decreased initiation of formula supplementation.
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Data Availability
The data underlying this study are not publicly available due to patient privacy issues. The data are available from the corresponding author upon reasonable request and appropriate data use agreements.
Code Availability
Not applicable.
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Acknowledgements
The project described was supported by Award Number UL1RR025755 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
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EA collected data, interpreted results, drafted the initial manuscript, and reviewed the manuscript for important intellectual content. SB and KW collected data, interpreted results, and reviewed the manuscript for important intellectual content. ST assisted in study design, performed data analyses, and revised and reviewed the manuscript for important intellectual content. CE, KC and AD conceptualized and designed the study, interpreted results, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Alqudah, E., Davis, A., Berzingi, S. et al. In-Hospital Formula Supplementation in Appalachian Women Intending to Exclusively Breastfeed. Matern Child Health J 28, 324–332 (2024). https://doi.org/10.1007/s10995-023-03830-1
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DOI: https://doi.org/10.1007/s10995-023-03830-1