Relationship between social support and the initiation and success of breast milk expression among mothers of premature infants at social-environmental risk

Background: Premature infants often require gavage feeding initially. Infants benefit from receiving expressed human breast milk (BM) during gavage feedings, but expressing BM is difficult for new mothers. Little is known about social support and success in BM expression among mothers of premature infants.

Methods: Maternal interview data and daily infant data on proportion of nutrition from BM during hospitalization were analyzed from a larger randomized trial testing a developmental intervention on 181 mother-premature infant dyads with at least two of ten social-environmental risks. Multivariable log-binomial regression examined the relationship between social support (PRQ-2000; dichotomized as low for lowest quartile), initiation (Any BM expressed vs. None), and success in BM expression (Mothers with babies consuming less than 30% BM during hospitalization were categorized as Low). All models adjusted for race, language preference, age-appropriate education, hospital site, infant morbidity at delivery, and gestational age.

Results: 70.3% of mothers initiated BM expression, and 32% of those mothers expressed low proportions of BM. In adjusted multivariable analyses, social support did not differ between mothers who initiated BM expression and those who did not (p > 0.10). Low social support was significantly associated with low proportions of BM expressed for those who initiated (adjusted Prevalence Ratio: 1.58, 95% CI = 1.00 – 2.50).

Conclusions: Low social support was significantly associated with low proportions of BM expressed during hospitalization among a sample of socially-disadvantaged mothers of premature infants. Interventions designed to enhance social support for new mothers of premature infants may increase long-term breastfeeding success.