Role of marital status in the association between pre-pregnancy body mass index and breastfeeding success

background: According to the Surgeon General, one highly effective preventative measure to promote health and well-being in both mother and child is through breastfeeding. In addition to various factors that affect breastfeeding duration, recent literature suggests that elevated pre-pregnancy BMI is negatively associated with breastfeeding duration. However, there is a lack of understanding of the inter-relationship between BMI, marital status and breastfeeding duration. Considering the importance of body image in society, it is important to examine this inter-relationship and design targeted interventions.

methods: 2009-2011 data from the Pregnancy Assessment Monitoring System (PRAMS) were analyzed. The sample included women who had singleton babies and did not have missing information on pre-pregnancy BMI (exposure) or breastfeeding duration (outcome). Multiple logistic regression was used to determine the association between BMI and breastfeeding duration by marital status.

 results: Among married women, the odds of never breastfeeding and breastfeeding less than 8 weeks was higher among overweight (AOR= 1.23, 95% CI= 1.10-1.38; AOR=1.36, 95% CI= 1.24-1.49) and obese women (AOR=1.72, 95% CI=1.53-1.93; AOR=1.95, 95% CI=1.77-2.15, respectively) compared to normal weight women who breastfeed more than 8 weeks. In contrast, no association was observed among unmarried, overweight women and the association was attenuated among obese, unmarried women (AOR=1.38, 95% CI=1.21-1.58, AOR=1.43, 95% CI=1.27-1.62, respectively).

conclusions: The results suggest that marital status is an important effect modifier in the association between BMI and breastfeeding duration. Healthcare professionals should be aware of this association and further research is needed on the differences observed by marital status.