Intent to breastfeed and successful breastfeeding in an inner city population: Does obesity matter?

Background: Studies have shown intention to breastfeed and initiation of breastfeeding are negatively correlated with obesity. Objective: To examine the relationship of pregravida body mass index (BMI) to intention to breastfeed and initiation of breastfeeding in an inner city population. Design/Methods: We conducted a retrospective study of mothers of infants born 7/10-9/10 and discharged from the term nursery at an academic community hospital in Philadelphia, PA. Mothers were classified as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese (BMI >30). Outcome measures were prenatal intention to breastfeed (exclusive or breast and formula) and breastfeeding at discharge (exclusive or breast and formula). Results: 635 mothers participated: 61% African American, 18% Latino; 85% had Medicaid; 26% were overweight, 24% obese, 4% underweight. Mothers with higher BMI were more likely to intend to breastfeed exclusively after controlling for ethnicity, age, parity and insurance (p= 0.001). Obese women were 3 times more likely than underweight women to intend to breastfeed (OR 3.08, 95% CI 1.17-8.15; p=0.023). However, rates of breastfeeding at discharge were not significantly different across BMI categories.

Intent to breastfeed Breastfeeding at discharge N=635 exclusive BF Breast+formula exclusive BF Breast+formula Underweight 19% 19% 14% 23% Normal Weight 42% 13% 19% 27% Overweight 46% 13% 22% 34% Obese 59% 5% 25% 28% Conclusions: In this inner city population, obese women showed higher intent to breastfeed but were less likely to progress to successful breastfeeding at discharge. Increased support in the postpartum period may boost breastfeeding rates in obese women.