Pre-pregnancy Obesity and Lack of Breastfeeding Initiation in the United States: An Examination of Racial and Ethnic Differences

Background:Pre-pregnancy overweight/obesity can adversely affect breastfeeding initiation, but studies examining this association among different racial/ethnic groups of U.S. women are limited. This study utilized a large, nationally representative sample to assess racial/ethnic differences in breastfeeding initiation among U.S. women of different body mass index (BMI) classifications.

Methods: This study analyzed data from the Pregnancy Risk Assessment Monitoring System, including 95,141 women who delivered a live, singleton baby from 2009-2011 and provided BMI and breastfeeding information. Pre-pregnancy BMI (kilogram/meters²) was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (>30.0). Breastfeeding initiation was reported as having ever breastfed after delivery (yes or no). Adjusted models, which included only potential confounders resulting in a 10% or greater change in estimate, generated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for lack of breastfeeding initiation. All results were stratified by race/ethnicity.

Results: Compared to normal weight non-Hispanic White women, the odds of breastfeeding non-initiation was 17% and 25% higher among overweight (AOR = 1.17, 95% CI = 1.07-1.29) and obese (AOR = 1.25, 95% CI = 1.14-1.36) non-Hispanic White women, respectively. Among non-Hispanic Black women, the odds of not breastfeeding was 29% higher only in obese women. No association was observed among Hispanic women or women of other race.

Conclusions: Pre-pregnancy BMI is a significant predictor for breastfeeding initiation for non-Hispanic White and non-Hispanic Black women. Health care workers and public health practitioners should be aware of the effect of pre-pregnancy obesity on breastfeeding, especially among non Hispanic Black women.