Why Aren't US Women Breastfeeding? An Examination of Barriers to Breastfeeding Associated with Pre-pregnancy Health Pubblico

Abstract

Objective: To examine the association between pre-pregnancy health and breastfeeding outcomes and to investigate breastfeeding barriers among a racially and economically diverse population in 4 PRAMS sites in the United States.

Methods: Data were obtained from the Pregnancy Risk Assessment Monitoring Survey (PRAMS). Participants included women who had live births between 2004 and 2008 and who resided in Georgia, North Carolina, South Carolina and Illinois. Multinomial logistic regression was conducted to determine the association between pre-pregnancy hypertension and diabetes and breastfeeding duration. A descriptive analysis of reasons for breastfeeding non-initiation stratified by maternal health status was conducted. Simple logistic regression modeling was used to examine the relationship between pre-pregnancy health status and breastfeeding non-initiation due to maternal illness or medication use.

Results: Our analyses show that having pre-pregnancy hypertension has no significant correlation with short term breastfeeding duration. However, among hypertensive women, the odds of breastfeeding for more than 4 weeks was 21% less likely than their odds of not breastfeeding at all (AOR=0.79, 95% CI 0.67-0.94). Diabetes was not found to be independently associated with breastfeeding duration. Our studies found that pre-pregnancy hypertension correlated with mothers reporting reasons for non-initiation because of maternal illness (AOR: 2.1; 95% CI 1.66-2.65). Pre-pregnancy diabetes was also significantly associated with not initiating breastfeeding due to maternal illness (AOR: 2.6; 95% CI 1.41-4.60).

Conclusion: Our study was one of few that aimed to examine the specific barriers women face when deciding whether to breastfeed in a large and diverse population. In the midst of many limitations, these data gives a broad overview of the effect of pre-pregnancy chronic disease status and future breastfeeding practices.

Table of Contents

Chapter 1: Introduction 1
Research Objectives 4
Chapter II: Literature Review 6
Obesity during Pregnancy 6
Breastfeeding and Obesity 8
Pre-pregnancy Hypertension and Diabetes 9
Hypertension, Diabetes and Breastfeeding 9
Explaining the Reasons for Low Breastfeeding Rates 11
Using PRAMS to Study Breastfeeding Behavior 12
Chapter III: Methodology 15
Study Design 15
Sample population 15
Measures 16
Exposure variables 16
Outcome Variables 16
Covariates 16
Data Analysis 17
Univariate Analysis 17
Multivariate Analysis 17
Chapter IV: Results 19
Descriptive Characteristics 19
Association between Breastfeeding and Pre-pregnancy Health 21
Barriers to Breastfeeding Initiation 21
Chapter V: Discussion 24
Strengths and Limitations 24
Public Health Implications and Recommendations 26
Appendices: Tables 28
References 36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Health Sciences, Epidemiology
Parola chiave	hypertension diabetes PRAMS breastfeeding
Committee Chair / Thesis Advisor	Stein, Aryeh D, Emory University
Partnering Agencies	State or local health department (not in Georgia) Georgia state or local health department CDC

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