Combined Influence of Gestational Diabetes and Gestational Weight Gain on Exclusive Breastfeeding.

Background: Over half of pregnant women in the United States do not meet the recommended gestational weight gain (GWG). In addition, the prevalence of gestational diabetes mellitus (GDM) is increasing. We examined the combined influence of GDM and GWG on breastfeeding practices on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Materials and Methods: A cross-sectional study was performed on 173,603 women from the pregnancy risk assessment monitoring system, 2009-2015. Descriptive statistics and multivariable logistic regression modeling were performed. Results: The prevalence of GDM was 9.5%. Only 30.7% of women had weight gain within the Institute of Medicine (IOM) recommended guidelines. Approximately 21.7% and 10.3% of the participants exclusively breastfed their infants during the neonatal period and at 3 months postpartum, respectively. After adjusting for potential confounders, there was a significant multiplicative interaction between GWG and GDM on exclusive breastfeeding during the neonatal period and at 3 months postpartum. Among women with normal and excessive GWG, the odds of exclusively breastfeeding during the neonatal period were lower for women with GDM compared with women without GDM (odds ratio, 95% confidence interval: 0.74, 0.64-0.85 and 0.75, 0.66-0.85, respectively). Similarly, among women with normal and excessive GWG, the odds of exclusively breastfeeding at 3 months postpartum were lower for women with GDM compared to women without GDM (0.67, 0.55-0.81 and 0.71, 0.60-0.85, respectively). Conclusion: With the increasing prevalence of GDM and weight gain outside the IOM guidelines, it is critical to identify populations at risk and to promote exclusive breastfeeding practices.

Factors That Modify the Association of Maternal Postpartum Smoking and Exclusive Breastfeeding Rates.

BACKGROUND AND OBJECTIVE: Maternal postpartum smoking increases the risk for poor infant health outcomes, while exclusive breastfeeding has been shown to support infant health. Limited population-based research has been published on the interaction between maternal smoking and exclusive breastfeeding. The objective of this study was to examine factors modifying the association between maternal postpartum smoking and exclusive breastfeeding among women in the United States. METHODS: Secondary data analysis was conducted using the 2009-2011 Pregnancy Risk Assessment Monitoring System. Stratified analyses were used to examine the associations between maternal postpartum smoking and exclusive breastfeeding by sociodemographic factors. RESULTS: The postpartum smoking rate was 17.1%. The relationship between postpartum smoking and exclusive breastfeeding at 12 weeks varied by maternal education level, race/ethnicity, Medicaid use, and pregestational or gestational diabetes. The magnitude of reduction in the odds of exclusive breastfeeding at 12 weeks postpartum among the women who smoked in the postpartum period ranges from odds ratio (95% confidence interval) 0.52 (0.37-0.74) for non-Hispanic blacks to 0.31 (0.22-0.43) for women who had <12 years of education. CONCLUSIONS: Women who smoked in the postpartum period, who also suffered from socioeconomic disadvantages, had a higher likelihood of not continuing exclusive breastfeeding. Identification of women at high risk for not exclusively breastfeeding is important for targeting populations in need of appropriate and timely support for prenatal and postpartum smoking cessation and breastfeeding promotion.

Association Between Gestational Weight Gain and Delayed Onset of Lactation: The Moderating Effects of Race/Ethnicity.

BACKGROUND: In the United States, a high percentage of pregnant women gain weight outside of the current Institute of Medicine's (IOM) gestational weight gain (GWG) recommendations. There is limited research examining the relationship between GWG and onset of lactation. Delayed onset of lactation (DOL) can negatively affect breastfeeding outcomes. METHODS: Secondary data analysis was conducted using data from 2,053 women who participated in the population-based Infant Feeding Practices Study II between 2005 and 2007. The main outcome of interest was maternal perception of DOL, defined as milk coming in >3 days postpartum. Three categories of GWG were created based on the IOM's revised cutoff: inadequate, adequate, and excessive. Descriptive statistics and multivariable logistic regression modeling were performed. Interactions between GWG and race/ethnicity on DOL were examined to test whether the relationship between GWG and DOL differs by race/ethnicity. RESULTS: Overall, 23.7% of the study sample reported DOL. Of these, 49.5% and 19.5% of women had excessive GWG and inadequate GWG, respectively. After adjusting for potential confounders, there was a significant interaction between GWG and race/ethnicity on DOL. Among non-Hispanic white women, the odds of DOL were higher in women with excessive GWG compared to those who had the recommended GWG (OR 1.47, 95% CI 1.14-1.90, p = 0.003). For other race/ethnicity groups, no significant relationships between GWG and DOL were detected. CONCLUSIONS: With the increasing rates of excessive GWG, it is critical to identify populations at increased risk of DOL and provide targeted breastfeeding support, especially in the early postpartum period.