Interaction between sociodemographic and psychosocial factors on the initiation of breastfeeding in a population of African American mothers in the District of Columbia

Ecological factors may play an important role in modifying the effect of personal characteristics in mothers who initiate breastfeeding (BF) . The relative importance of these factors is unclear. In this study, 684 pregnant African Americans were followed through postpartum (PP). Mothers were >18 years, <28 weeks gestation and had one or more risk factors: smoking, environmental tobacco smoke, depression or intimate partner violence. Sociodemographic and psychobehavioral data were collected at baseline (BL), during follow-up in the second and third trimesters (FU) and at PP. Logistic models showed significantly increased odds of initiating BF in women who had some college education, were first time mothers, had a partner at BL and were not receiving Medicaid. Mothers depressed at BL who either recovered or remained depressed were more likely to initiate BF than mothers who were not depressed at BL but became depressed later in pregnancy.

Some college versus < High school (OR=2.29, 95%CI=1.41-3.71)

Medicaid recipient (OR=0.65, 95%CI=0.42-1.00)

Had a partner (OR=1.64, 95%CI=1.06-2.55)

Primiparous (OR=1.61, 95%CI=1.11-2.34)

Depressed at BL and FU/Depressed at FU only (OR=2.54, 95%CI=1.35-4.78)

Depressed at BL not FU/Depressed at FU only (OR=2.59, 95%CI=1.27-5.29)

Not Depressed at BL or FU/Depressed at FU only (OR=1.77, 95% CI=0.98-3.21)

Higher education and parity are important determinants of BF. What is new about our results is that depression early in pregnancy does not reduce the likelihood of BF even if it continues to the latter part of pregnancy and PP, but depression starting later in pregnancy does reduce BF.