Predictors of breastfeeding in overweight and obese women: data from Active Mothers Postpartum (AMP)

Abstract

Excess maternal weight has been negatively associated with breastfeeding. We examined correlates of breastfeeding initiation and intensity in a racially diverse sample of overweight and obese women. This paper presents a secondary analysis of data from 450 women enrolled in a postpartum weight loss intervention (Active Mothers Postpartum [AMP]). Sociodemographic measures and body mass index (BMI), collected at 6 weeks postpartum, were examined for associations with breastfeeding initiation and lactation score (a measure combining duration and exclusivity of breastfeeding until 12 months postpartum). Data were collected September 2004-April 2007. In multivariable analyses, BMI was negatively associated with both initiation of breastfeeding (OR: .96; CI: .92-.99) and lactation score (β -0.22; P = 0.01). Education and infant gestational age were additional correlates of initiation, while race, working full-time, smoking, parity, and gestational age were additional correlates of lactation score. Some racial differences in these correlates were noted, but were not statistically significant. Belief that breastfeeding could aid postpartum weight loss was initially high, but unrelated to breastfeeding initiation or intensity. Maintenance of this belief over time, however, was associated with lower lactation scores. BMI was negatively correlated with breastfeeding initiation and intensity. Among overweight and obese women, unrealistic expectations regarding the effect of breastfeeding on weight loss may negatively impact breastfeeding duration. In general, overweight and obese women may need additional encouragement to initiate breastfeeding and to continue breastfeeding during the infant's first year.

Trial registration: ClinicalTrials.gov NCT00212251.

Fig. 1

Inclusion in the analysis samples

Fig. 2

Breastfeeding in the first year postpartum. Percent fully breastfeeding or combining with formula (mixed feeding) by month among those completing the 12-month survey (n = 385)

Fig. 3

Breastfeeding by BMI group. Initiation of breastfeeding (n = 450), and percent continuing to breastfeed at 6 and 12 months among those completing the 12-month survey (n = 385)