241274 In-hospital formula supplementation associated with shorter breastfeeding duration in two separate cohorts of first-time mothers intending to exclusively breastfeed

Monday, October 31, 2011: 8:50 AM

Laurie Nommsen-Rivers, PhD, RD, IBCLC , Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH
Caroline Chantry, MD , Medical Center, University of California Davis, Sacramento, CA
Janet Peerson, MS , Department of Nutrition, University of California Davis, Davis, CA
Bin Huang, PhD , Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Erin Wagner, MS , Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Kathryn G. Dewey, PhD , Nutrition, University of California, Davis, Davis, CA
Background: The extent to which in-hospital formula supplementation (H-formula) affects breastfeeding duration, after adjusting for maternal BF intentions, is not known.

Objective: To examine if H-formula predicts shorter breastfeeding duration after taking into account exclusive breastfeeding (EBF) intentions.

Design: We examined our objective in two cohorts. In cohort 1, we enrolled primiparas (50% low-income) prenatally from an academic medical center and followed to 2 months postpartum. In cohort 2, we enrolled primiparas (all low-income) at 2515 hours postpartum from a private non-profit hospital and followed 6 months. In both cohorts, we assessed strength of EBF intentions with the Infant Feeding Intentions (IFI) Scale at enrollment and recorded frequency of H-formula from a combination of maternal report at day 3 and the medical record. We restricted our analyses to those with EBF intentions and full-term deliveries.

Results: Cohort 1:Of 407 participants intending EBF, 189(46%) of their infants received H-Formula. 32% among H-Formula, versus 9% among no H-Formula, stopped breastfeeding before 60 days; Relative Risk (RR)[95% Confidence Interval (CI)]=3.5[2.2-5.6], p<0.0001; Adjusted RR, with IFI score=3.3[2.0-5.5], p<0.0001. Cohort 2: Of 121 participants intending EBF, 63(52%) of their infants received H-Formula. Adjusting for IFI score, the hazard of stopping full breastfeeding increased 14% for every H-Formula incident (P=0.0002).

Conclusions: H-formula supplementation is significantly associated with poorer breastfeeding outcomes in two separate cohorts of first-time mothers planning EBF. In both cohorts, the risk remained significant even after adjusting for strength of EBF intentions. These results support efforts to minimize in-hospital formula supplementation.

Learning Areas:
Administration, management, leadership
Advocacy for health and health education
Program planning

Learning Objectives:
1. Describe the extent to which in-hospital formula supplementation is associated with increased risk of shorter breastfeeding duration among mothers intending to exclusively breastfeed.

Keywords: Breastfeeding, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: In collaboration with my co-authors, I was involved in designing and conducting the research, analyzing the data and writing up the results for the studies presented in the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.