Factors Associated with Breastfeeding Initiation and Continuation at Two Months Postpartum in American Indian Women: An Exploratory Analysis.

This study aimed to determine the prevalence of breastfeeding initiation and continuation at two months postpartum in American Indian (AI) mothers in South Dakota and to identify factors associated with breastfeeding. Using logistic regression, data from the South Dakota Pregnancy Risk Assessment Monitoring System were used to investigate the relationship between binary breastfeeding initiation and continuation outcomes and maternal behaviors and experiences including access to health care, safe sleep practices, ability to handle life events, depression, and sources of breastfeeding information. Higher odds of initiation were seen for factors including access to health care services, ability to handle life events, and sources of breastfeeding information, while lower odds were seen for factors including safe sleep. Higher odds of continuation were seen among mothers who reported not taking long to get over setbacks and among mothers who reported no postpartum depression, while lower odds of continuation were seen among mothers practicing safe sleep. Several modifiable factors were identified as reasons for stopping breastfeeding. This information about factors associated with higher odds of breastfeeding initiation and continuation at two months postpartum can be used to inform interventions, programs, and policies designed to support breastfeeding among AI women and to guide future research in this area.

Association Between Prepregnancy Obesity and Health Behaviors, Adverse Conditions, and Birth Outcomes in South Dakota.

INTRODUCTION: Prepregnancy obesity has been shown to be associated with increased risk of adverse birth outcomes but little is known about the associations with health-related behaviors and conditions before, during and after pregnancy. METHODS: This retrospective cohort study used data from the South Dakota Pregnancy Risk Assessment Monitoring System (SD PRAMS) survey, which is an ongoing state-based surveillance system of maternal behaviors, attitudes, and experiences before, during, and shortly after pregnancy. The 2017 and 2018 SD PRAMS sampled a total of 3,805 mothers who were randomly selected from birth certificate records to be representative of all South Dakota women who delivered a live-born infant. Logistic regression was used to determine whether prepregnancy obesity was associated with adverse health conditions after controlling for demographic factors. RESULTS: Women with prepregnancy obesity, compared to those who were non-obese, were more likely to report an unintended pregnancy (45 percent vs. 39 percent), smoking three months before pregnancy (32 percent vs. 22 percent), delayed prenatal care (12 percent vs. 16 percent), hypertension during pregnancy (22 percent vs. 9 percent), gestational diabetes (19 percent vs. 8 percent), depression during pregnancy (21 percent vs. 14 percent), C-section delivery (35 percent vs. 22 percent), high birth weight (15 percent vs. 8 percent), and the infant hospitalized for three or more days (41 percent vs. 30 percent). Of women with prepregnancy obesity, 37 percent had been talked to by health care providers about maintaining a healthy weight the 12 months before pregnancy compared to 13 percent of non-obese women. CONCLUSIONS: Health care workers should be more intentional about stressing the potential risks of prepregnancy obesity to properly educate mothers and women of childbearing age.

Safe Sleep Behaviors Among South Dakota Mothers and the Role of the Healthcare Provider.

INTRODUCTION: The purpose of this report was to determine the prevalence of safe sleep practices among South Dakota mothers, and the impact that education from their healthcare provider had on infant safe sleep practices as defined by the American Academy of Pediatrics (AAP). METHOD: A population-based survey was administered to a random sample of mothers delivering in 2017. Data were weighted to obtain statewide and race-specific (white, non-Hispanic; American Indian; other races) prevalence rates. RESULTS: Weighted response rate was 67 percent, with 9.9 percent of mothers giving birth in 2017 completing a survey. Greater than 85 percent of mothers met recommendations regarding placing their infant on their back, breastfeeding, not consuming alcohol or illicit drugs during pregnancy, and attending 80 percent or more of prenatal visits. Less than 85 percent met recommendations regarding infant always sleeping alone on an approved sleep surface (30.8 percent), room-sharing without bed-sharing (44.3 percent), keeping soft objects and loose bed- ding out of crib (47.7 percent), and avoiding smoke exposure during and after pregnancy (82.1 percent). Only 7.7 percent of mothers met all eight recommendations. Healthcare providers talking to the mother about placing the infant to sleep in a crib and placing the crib in the mother's room were associated with a higher percent of mothers meeting these recommendations. Although the health care provider asking the mother if she was going to breastfeed was not associated with ever breastfeeding (p=0.95), if the mother received information from the doctor about breastfeeding she was slightly more likely to breastfeed than if she did not receive information (90.3 vs. 85 percent, p=0.06). CONCLUSIONS: A low percentage of South Dakota mothers met all eight AAP safe sleep recommendations that could be assessed using these data. Health care providers can influence a mother's compliance with some of the safe sleeping recommendations.