Medically complex pregnancies and early breastfeeding behaviors: a retrospective analysis.

Breastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor-related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices.We performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status.More than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52-0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with >30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47-0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81-8.94; and AOR = 2.68; 95% CI, 1.70-4.23, respectively).Improving clinical and hospital support for women with complex pregnancies may increase breastfeeding rates and the benefits of breastfeeding for women and infants

Baby Friendly Health Initiative Composite Measure Components.

<p>Baby Friendly Health Initiative Composite Measure Components.</p

Controlled Odds of Breastfeeding Intentions by Pregnancy Complexity (N = 2400).

<p>Note: Models are weighted to be nationally representative. Models control for age, race/ethnicity, education, census region, nativity, partnership status, parity, unintended pregnancy, birth attitudes, and health insurance status. Bold text indicates statistically significant (<i>P</i>≤.05).</p

Percentage of Women in the Study Sample (N = 2400), With a Specific Characteristic, by Pregnancy Complexity.

<p>Note: Percentages are weighted to be nationally representative. Bold values indicate statistically significant difference (<i>P</i>≤.05). <i>P</i> values are based on Pearson's χ² tests.</p

Conceptual Model.

<p>Conceptual Model.</p

Percentage of Women in the Study Population (N = 2400) With Specific Breastfeeding Behaviors, as Well as Intentions and Hospital Support, by Pregnancy Complexity.

<p>Note: Percentages are weighted to be nationally representative. Bold values indicate statistically significant difference (<i>P</i>≤.05). <i>P</i> values are based on Pearson's χ² tests.</p