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Background
It is well established that mothers with above-normal pre-pregnancy body mass index (BMI) are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain is less well-defined. Excess pregnancy weight-gain may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. C-section, gestational diabetes), and may make effective latch more difficult to achieve.
Methods
Our objective was to determine the impact of pregnancy weight-gain and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine’s 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N=1207). Pregnancy weight-gain category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of pregnancy weight-gain). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models.
Results
After adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended pregnancy weight-gain had 1.39 (1.03-1.86) and 1.48 (1.06-2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended pregnancy weight-gain were at increased risk of cessation, although not significantly (adjusted Hazard Ratio [95% CI]: 1.29 [0.95 – 1.75]). No significant relationship was observed for exclusive breastfeeding cessation.
Conclusion
Pre-pregnancy BMI and pregnancy weight-gain may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.
Keywords
Pregnancy weight gain, pre-pregnancy BMI, pregnancy, lactation, exclusive breastfeeding, breastfeeding duration, breastfeeding cessation, infant feeding
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CURRENT STATUS: Published
View the published article at BMC Pregnancy and Childbirth.
No community comments so far
Editorial decision: Accept
On 03 Aug, 2020
Editor assigned
On 14 Jul, 2020
Submission checks complete
On 13 Jul, 2020
Editor invited
On 13 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 08 Jul, 2020
Editor assigned
On 29 Jun, 2020
Submission checks complete
On 28 Jun, 2020
Editor invited
On 28 Jun, 2020
No comments provided
Editorial decision: Major revision
On 10 Jun, 2020
Review #2 received
Received 03 Jun, 2020
Review #1 received
Received 14 Feb, 2020
Reviewer #2 agreed
On 31 Jan, 2020
Reviewer #1 agreed
On 31 Jan, 2020
Reviewers invited
Invitations sent on 23 Jan, 2020
Editor assigned
On 22 Jan, 2020
Submission checks complete
On 21 Jan, 2020
Editor invited
On 21 Jan, 2020
Version 1
Posted 09 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 08 Jan, 2020
Review #2 received
Received 07 Jan, 2020
Review #1 received
Received 03 Jan, 2020
Reviewer #2 agreed
On 15 Dec, 2019
Reviewer #1 agreed
On 13 Dec, 2019
Reviewers invited
Invitations sent on 12 Dec, 2019
Editor assigned
On 05 Dec, 2019
Submission checks complete
On 05 Dec, 2019
Editor invited
On 05 Dec, 2019
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Subject Areas
Maternal & Fetal Medicine
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A new preprint design is coming!
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See the published version of this preprint at BMC Pregnancy and Childbirth.
This is a preprint, 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
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: Published
View the published article at BMC Pregnancy and Childbirth.
No community comments so far
Editorial decision: Accept
On 03 Aug, 2020
Editor assigned
On 14 Jul, 2020
Submission checks complete
On 13 Jul, 2020
Editor invited
On 13 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 08 Jul, 2020
Editor assigned
On 29 Jun, 2020
Submission checks complete
On 28 Jun, 2020
Editor invited
On 28 Jun, 2020
No comments provided
Editorial decision: Major revision
On 10 Jun, 2020
Review #2 received
Received 03 Jun, 2020
Review #1 received
Received 14 Feb, 2020
Reviewer #2 agreed
On 31 Jan, 2020
Reviewer #1 agreed
On 31 Jan, 2020
Reviewers invited
Invitations sent on 23 Jan, 2020
Editor assigned
On 22 Jan, 2020
Submission checks complete
On 21 Jan, 2020
Editor invited
On 21 Jan, 2020
Version 1
Posted 09 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 08 Jan, 2020
Review #2 received
Received 07 Jan, 2020
Review #1 received
Received 03 Jan, 2020
Reviewer #2 agreed
On 15 Dec, 2019
Reviewer #1 agreed
On 13 Dec, 2019
Reviewers invited
Invitations sent on 12 Dec, 2019
Editor assigned
On 05 Dec, 2019
Submission checks complete
On 05 Dec, 2019
Editor invited
On 05 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pregnancy and Childbirth.
Background
It is well established that mothers with above-normal pre-pregnancy body mass index (BMI) are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain is less well-defined. Excess pregnancy weight-gain may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. C-section, gestational diabetes), and may make effective latch more difficult to achieve.
Methods
Our objective was to determine the impact of pregnancy weight-gain and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine’s 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N=1207). Pregnancy weight-gain category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of pregnancy weight-gain). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models.
Results
After adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended pregnancy weight-gain had 1.39 (1.03-1.86) and 1.48 (1.06-2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended pregnancy weight-gain were at increased risk of cessation, although not significantly (adjusted Hazard Ratio [95% CI]: 1.29 [0.95 – 1.75]). No significant relationship was observed for exclusive breastfeeding cessation.
Conclusion
Pre-pregnancy BMI and pregnancy weight-gain may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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