Presented at the Neonatal Society 2017 Spring Meeting.
Rowsome P, Jeffries S, Andrzejewska I, Scerif S, Grantham-Hill S, White S, Oyler A, Heppolette C, Longford N, Modi N, Hyde MJ
Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital campus, 369 Fulham Road, London, SW10 9NH, UK
Background: We previously presented evidence that Caesarean section (CS) is associated with lower rate of breastfeeding initiation (1) and that pre-labour CS (PLCS) is associated with increased rate of exclusive formula feeding at 3 months post-partum. Here we explore the relationship between six key maternal or delivery related variables and exclusive breastfeeding at 3 months post-partum.
Methods: In February 2014 we commenced recruitment of a prospective cohort of babies to examine the association between mode of delivery and atopy at 1 year of age (Research Ethics Approval 13/LO/1793). Babies were recruited on the post-natal ward at Chelsea and Westminster Hospital following informed maternal consent. We collected data on the following variables: maternal age, booking BMI, Index of Multiple Deprivation (IMD) (based on mother’s postcode at recruitment), smoking status (yes/no), use of analgesia during labour (yes/no), and type of delivery (PLCS, In-labour CS, vaginal delivery). We recorded data on feeding prior to discharge, and at 3 months post-partum we telephoned mothers to obtain follow-up information. We classified infant feeding as a) exclusively breast-fed (EBF); b) mixed feeding (MF); c) exclusively formula-fed (EFF). For analysis we looked at A) exposure to breast milk (a & b v c) and B) exclusive breastfeeding (a v b & c). We applied logistic regression to breastfeeding status at 3 months in terms of the maternal and delivery variables listed above.
Results: We have to-date recruited 680 infants and have follow-up data on feeding at age 3 months on 561 (87% follow-up rate at 3 months). Of these 248 (44%) mothers reported exclusive breastfeeding at 3 months, 175 (31%) were mixed feeding, and 138 (25%) were exclusively using formula. Our final model included maternal BMI, smoking status (yes/no), IMD (decile) and mode of delivery (PLCS, In-labour CS, vaginal delivery). The model suggests that higher maternal BMI, maternal smoking, and CS delivery are all associated with reduced rate of exclusive breastfeeding at 3 months of age.
Conclusion: The Unicef UK baby friendly hospital initiative has been widely implemented in the UK. Despite this, exclusive breastfeeding to 6 months (as recommended by the WHO) remains below 5%. We show that only 44% of women giving birth in a Unicef UK baby friendly hospital are exclusively breastfeeding at 3 months post-partum, but this is twice that in the 2010 NHS Infant Feeding Survey (national average of 17%). Implementation of the Unicef UK baby friendly hospital initiative alone does not appear to achieve WHO standards for exclusive breastfeeding. Here we report clear risk factors for failure to continuing exclusive breastfeeding to three months. Given pressures on healthcare funding and cuts to post-partum care in the community, it is possible that additional breastfeeding support targeted at women at high risk of stopping breastfeeding early may help to achieve WHO standards for breastfeeding in the UK. Validity of maternally reported feeding data is a caveat in our conclusions, but the prospective design is a strength.
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1. Prior E, et al. (2012) Am J Clin Nutr 95:1113-1135
2. Scerif et al. (2015) NNS Summer Meeting