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Research Article
Why does mode of conception affect early breast-feeding outcomes? A retrospective cohort study
Min Chang
Shin Kong WHS Memorial Hospital
Corresponding Author
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Background: Women who conceived through Assisted Reproductive Technology (ART) may experience poorer breast-feeding outcomes compared to women who conceived naturally; nevertheless, the mechanism of this relationship has not been explored. This study aimed to examine the effect of mode of conception on breast-feeding outcomes during the first two months postpartum and identify the potential pathways for this relationship.
Methods: A retrospective cohort study was conducted in a sample of 5,474 women with live births using hospital administrative data from January 2014 through December 2018. Participants were classified by mode of conception as follows: fertile women who conceived naturally (fertile women; n=4,363), women with infertility who conceived naturally (sub-fertile women; n=706), and women with infertility who conceived through ART (women with infertility; n=405). The patterns of infant feeding were acquired at hospital discharge, the first week, the first month, and the second month postpartum. Binary and multinomial logistic regression and causal mediation analyses were performed.
Results: Infertile and sub-fertile women had 34% (95% CI 1.03, 1.73) and 60% (95% CI 1.11, 2.31) increased risks of introducing formula prior to the first week postpartum, respectively, and 31% (95% CI 1.01, 1.70) and 59% (95% CI 1.10, 2.31) higher risks of exclusive breastfeeding for less than one week during the first two months postpartum, respectively, compared to fertile women. The relationships were mediated through delivery complications, multiple gestations, preterm delivery, low birth weight, and admission to neonatal/paediatric intensive care units (NICU/PICU). The path with the highest proportion mediated was through multiple gestations (60.47% for infertile women) and admission to NICU/PICU (68.60-72.61%). The effect of mode of conception on breastfeeding outcomes was not significant in cases of no maternal and infant morbidities.
Conclusions: During the first two months postpartum, infertile and sub-fertile women both had short duration (<7 days) of exclusive breastfeeding and introduction of formula prior to the first week postpartum. The relationships were mainly mediated through multiple gestations and admission to NICU/PICU. Designing programmes to reduce adverse maternal and infant health events, like a single embryo transfer policy, is suggested to improve perinatal outcomes, together with the following breast-feeding outcomes.
Keywords
assisted reproductive technology, infertility, breastfeeding, causal mediation analysis, conception
Figure 1
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.docx
Additional file 1: Supplementary Figure 1. Directed acyclic graph of the hypothesised associations between mode of conception, early breast-feeding outcomes, and covariates in our study.
- Additionalfile2.docx
Additional file 2: Supplementary Table 1. Coefficient estimations in models for mediators and mode of conception as independent variables Supplementary Table 2. Coefficient estimations in models for breast-feeding outcomes and mediators as independent variable
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This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Why does mode of conception affect early breast-feeding outcomes? A retrospective cohort study
Min Chang
Shin Kong WHS Memorial Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 17 Dec, 2020
No community comments so far
Reviewer #3 agreed
On 26 Dec, 2020
Review #3 received
Received 24 Dec, 2020
Review #5 received
Received 24 Dec, 2020
Review #1 received
Received 24 Dec, 2020
Review #4 received
Received 24 Dec, 2020
Review #2 received
Received 24 Dec, 2020
Reviewer #28 agreed
On 22 Dec, 2020
Reviewer #30 agreed
On 22 Dec, 2020
Reviewer #20 agreed
On 22 Dec, 2020
Reviewer #21 agreed
On 22 Dec, 2020
Reviewer #4 agreed
On 22 Dec, 2020
Reviewer #26 agreed
On 22 Dec, 2020
Reviewer #29 agreed
On 22 Dec, 2020
Reviewer #2 agreed
On 22 Dec, 2020
Reviewer #24 agreed
On 22 Dec, 2020
Reviewer #19 agreed
On 22 Dec, 2020
Reviewer #22 agreed
On 22 Dec, 2020
Reviewer #27 agreed
On 22 Dec, 2020
Reviewer #25 agreed
On 22 Dec, 2020
Reviewer #1 agreed
On 22 Dec, 2020
Reviewer #23 agreed
On 22 Dec, 2020
Reviewers invited
Invitations sent on 22 Dec, 2020
Editor assigned
On 22 Dec, 2020
Editor invited
On 16 Dec, 2020
Submission checks complete
On 16 Dec, 2020
First submitted
On 09 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Women who conceived through Assisted Reproductive Technology (ART) may experience poorer breast-feeding outcomes compared to women who conceived naturally; nevertheless, the mechanism of this relationship has not been explored. This study aimed to examine the effect of mode of conception on breast-feeding outcomes during the first two months postpartum and identify the potential pathways for this relationship.
Methods: A retrospective cohort study was conducted in a sample of 5,474 women with live births using hospital administrative data from January 2014 through December 2018. Participants were classified by mode of conception as follows: fertile women who conceived naturally (fertile women; n=4,363), women with infertility who conceived naturally (sub-fertile women; n=706), and women with infertility who conceived through ART (women with infertility; n=405). The patterns of infant feeding were acquired at hospital discharge, the first week, the first month, and the second month postpartum. Binary and multinomial logistic regression and causal mediation analyses were performed.
Results: Infertile and sub-fertile women had 34% (95% CI 1.03, 1.73) and 60% (95% CI 1.11, 2.31) increased risks of introducing formula prior to the first week postpartum, respectively, and 31% (95% CI 1.01, 1.70) and 59% (95% CI 1.10, 2.31) higher risks of exclusive breastfeeding for less than one week during the first two months postpartum, respectively, compared to fertile women. The relationships were mediated through delivery complications, multiple gestations, preterm delivery, low birth weight, and admission to neonatal/paediatric intensive care units (NICU/PICU). The path with the highest proportion mediated was through multiple gestations (60.47% for infertile women) and admission to NICU/PICU (68.60-72.61%). The effect of mode of conception on breastfeeding outcomes was not significant in cases of no maternal and infant morbidities.
Conclusions: During the first two months postpartum, infertile and sub-fertile women both had short duration (<7 days) of exclusive breastfeeding and introduction of formula prior to the first week postpartum. The relationships were mainly mediated through multiple gestations and admission to NICU/PICU. Designing programmes to reduce adverse maternal and infant health events, like a single embryo transfer policy, is suggested to improve perinatal outcomes, together with the following breast-feeding outcomes.
Figure 1
Figure 1