Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of
Lactation, and Excess Neonatal Weight Loss
Kathryn G. Dewey, PhD, Laurie A. Nommsen-Rivers, MS, RD, IBCLC, M. Jane
Heinig, PhD, IBCLC and Roberta J. Cohen, PhD
From the Department of Nutrition, University of California, Davis, Davis,
California
Objective. Some mothers have difficulty initiating lactation even when highly
motivated to breastfeed. The purpose of this study was to determine the
incidence of and risk factors for suboptimal infant breastfeeding behavior (SIBB),
delayed onset of lactation, and excess neonatal weight loss among
mother-infant pairs in a population with high educational levels and motivation to
breastfeed.
Methods. All mothers residing in Davis, California, who gave birth to a
healthy, single, term infant at 1 of 5 area hospitals during the 10-month
recruitment period in 1999 were invited to participate if they were willing to attempt
to breastfeed exclusively for at least 1 month. Lactation guidance was
provided and data were collected in the hospital (day 0) and on days 3, 5, 7, and 14.
Infant breastfeeding behavior was evaluated by trained lactation consultants
using the Infant Breastfeeding Assessment Tool. Onset of lactation was defined
based on maternal report of changes in breast fullness. Infant weight loss
was considered excessive if it was 10% of birth weight by day 3.
Results. Of the 328 eligible mothers, 280 (85%) participated in the study.
The prevalence of SIBB was 49% on day 0, 22% on day 3, and 14% on day 7. SIBB
was significantly associated with primiparity (days 0 and 3), cesarean section
(in multiparas, day 0), flat or inverted nipples, infant status at birth (days
0 and 3), use of nonbreast milk fluids in the first 48 hours (days 3 and 7),
pacifier use (day 3), stage II labor >1 hour (day 7), maternal body mass index >
27 kg/m2 (day 7) and birth weight <3600 g (day 7). Delayed onset of lactation
(>72 hours) occurred in 22% of women and was associated with primiparity,
cesarean section, stage II labor >1 hour, maternal body mass index >27 kg/m2,
flat or inverted nipples, and birth weight >3600 g (in primiparas). Excess weight
loss occurred in 12% of infants and was associated with primiparity, long
duration of labor, use of labor medications (in multiparas), and infant status at
birth. The risk of excess infant weight loss was 7.1 times greater if the
mother had delayed onset of lactation, and 2.6 times greater if the infant had
SIBB on day 0.
Conclusions. Early lactation success is strongly influenced by parity, but
may also be affected by potentially modifiable factors such as delivery mode,
duration of labor, labor medications, use of nonbreast milk fluids and/or
pacifiers, and maternal overweight. All breastfeeding mother-infant pairs should be
evaluated at 72 to 96 hours’ postpartum.
PEDIATRICS Vol. 112 No. 3 September 2003, pp. 607-619
Received for publication Sep 9, 2002; accepted May 8, 2003.
Kathleen Fallon Pasakarnis, M.Ed. IBCLC
Nurturing Family Lactation and Parenting Services
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
