Prenatal perception of breastfeeding recommendation predicts early breastfeeding outcomes of participants in the Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Am J Clin Nutr. 2021 Jul 24;nqab268. doi: 10.1093/ajcn/nqab268. Online ahead of print.

Abstract

Background: Prenatal psychosocial factors predict breastfeeding practices but are not assessed in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Objective: This study examined how prenatal perceptions of WIC's breastfeeding recommendations were associated with early breastfeeding outcomes.

Methods: This study used longitudinal data from a national sample of 2,053 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2) in 2013, the only national data assessing prenatal perceptions of WIC's breastfeeding recommendations. Early breastfeeding outcomes included breastfeeding initiation, breastmilk first fed after birth, breastfeeding in the first hour, breastmilk first fed after leaving the hospital, and breastfeeding status at the first and third month. The primary predictor was the participant's prenatal perception of whether WIC recommended breastfeeding only or not. Log binomial regression was used with adjustment for socio-demographics, previous breastfeeding, WIC participation, breastfeeding support, and infant feeding intentions (IFI).

Results: Without controlling for IFI, the perception of WIC recommending breastfeeding only predicted breastfeeding outcomes positively. The risk ratio (RR) associated with prenatal perceptions varied from 1.14 (95% Confidence Interval [CI]: 1.03, 1.25; P = 0.008) for breastfeeding in the first hour, 1.27 (95% CI: 1.12, 1.43; P < 0.001) for breastmilk first fed after leaving hospital, to 1.66 (95% CI: 1.35, 2.04; P < 0.001) for 3-month breastfeeding only. After controlling for IFI, the RRs were 1.13 (95% CI: 1.02, 1.24; P = 0.017) for breastfeeding in the first hour, 1.20 (95% CI: 1.06, 1.35; P = 0.004) for breastmilk first fed after leaving hospital, and 1.49 (95% CI: 1.21, 1.84; P < 0.001) for 3-month breastfeeding only, suggesting that prenatal perception was independently associated with breastfeeding outcomes.

Conclusions: Prenatal perception of WIC's breastfeeding recommendations can be a new psychosocial predictor of breastfeeding and a possible target for future intervention.

Keywords: WIC; breastfeeding; infants; perception; psychosocial factors.