(193) Patient characteristics and unexpected delivery complications predict cessation of exclusive breastfeeding by 4-8 weeks postpartum

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Emma Trawick Roberts, MD (she/her/hers)

Fellow
University of North Carolina
Chapel Hill, NC, United States

Coauthor(s)

Sarah Heerboth, MD (she/her/hers)

Fellow
University of North Carolina
Chapel Hill, North Carolina, United States
Tracy A. Manuck, MD, MSCI (she/her/hers)

Professor
University of North Carolina
Chapel Hill, North Carolina, United States
Alison M. Stuebe, MD, MSc

Professor
UNC School of Medicine
Chapel Hill, NC, United States

Objective: Although exclusive breastfeeding (BF) is recommended for the first 6 months of life, many women encounter barriers to meeting their BF goals. We analyzed predictors of early cessation of exclusive BF to identify women who may benefit from more intensive lactation support in the early postpartum period.

Study Design: Secondary analysis of a multicenter randomized controlled trial of elective labor induction vs. expectant management of low risk nulliparas at 39 weeks’ gestation (MFMU ARRIVE trial). Participants were included in this analysis if they reported infant feeding data at 4-8 weeks postpartum. Logistic regression modeled the association between participant characteristics, unexpected delivery complications, and cessation of exclusive BF by 4-8 weeks postpartum. We defined unexpected delivery complications as neonatal morbidity (as per the initial RCT), neonatal intensive care unit (ICU) admission, intrapartum cesarean, operative vaginal delivery, 3rd or 4th degree perineal lacerations, preeclampsia, magnesium administration, chorioamnionitis, postpartum hemorrhage, blood transfusion, maternal ICU admission, labor pain scores ≥90%ile, and postpartum stay ≥4 days. Backward selection identified independent predictors of cessation of exclusive BF at 4-8 weeks postpartum. Model accuracy was assessed via the area under the ROC curve.

Results: 5,412 individuals were included in the analytic sample; 33% were exclusively BF at 4-8 weeks postpartum. In the backward elimination model, predictors of cessation of exclusive BF included Black race, non-Hispanic ethnicity, not being employed, having public or no insurance, smoking, body mass index ≥30, NICU admission, and intrapartum cesarean (Table). The model had an area under the ROC of 0.73 (95%CI 0.72-0.75).

Conclusion: In a cohort of low risk nulliparas, we identified maternal characteristics and unexpected delivery complications that predicted cessation of exclusive BF at 4-8 weeks postpartum. Targeted postpartum lactation support to individuals at high risk of BF cessation has the potential to enable more women to meet their infant feeding goals.