Breastfeeding intentions, difficulties, and outcomes in mothers with chronic physical health conditions: the Motherhood and Chronic Illness (MaCI) prospective cohort study
Date
2022-07-11
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Abstract
Breastfeeding from birth to 6 months has numerous benefits for maternal and child health. Mothers with chronic conditions are at risk for suboptimal breastfeeding outcomes, yet the underlying reasons for this are poorly understood. This thesis research investigated the factors associated with breastfeeding intentions, difficulties, and outcomes in mothers with chronic conditions. We conducted a prospective, community-based pregnancy cohort study called the Motherhood and Chronic Illness (MaCI) Study following 405 women from Alberta who reported living with a long-term physical health condition, carrying a singleton pregnancy, and intending to try breastfeeding. Women completed questionnaires at 32 weeks gestation, 6 weeks postpartum, and 6 months postpartum (overall response rate, 86.7%). In the prenatal period, we found that women who perceived their chronic condition to worsen during pregnancy were less likely to plan to exclusively breastfeed to 6 months per the global recommendation (adjusted odds ratio [OR] 0.50, 95% CI 0.30–0.82). From birth to 6 weeks postpartum, we identified three clusters of breastfeeding difficulties corresponding to physiologically expected lactation changes (51.1% of women), low milk production (15.4%), and ineffective latch (33.5%). Mothers with endocrine (adjusted relative risk ratio [RRR] 2.41, 95% CI 1.13–5.13), cardiovascular (adjusted RRR 2.87, 95% CI 1.02–8.09), and gastrointestinal (adjusted RRR 2.57, 95% CI 1.13–5.82) conditions were more likely to belong to the low milk production cluster and mothers with gastrointestinal (adjusted RRR 2.47, 95% CI 1.27–4.81) conditions were more likely to belong to the ineffective latch cluster, relative to the physiologically expected cluster. By 6 months postpartum, we found that one third (31.2%) of mothers had stopped breastfeeding, nearly all of whom did so earlier than planned. Compared to mothers who adhered to their pre-existing medications, mothers who did not adhere to pre-existing medications had shorter breastfeeding duration (adjusted hazard ratio [HR] 1.69, 95% CI 1.04–2.74) and greater odds of earlier than planned breastfeeding cessation (adjusted OR 1.85, 1.01–3.41). The MaCI Study highlighted three unique determinants of breastfeeding in mothers with chronic conditions, which can be addressed through person-centred support that jointly considers the ways in which breastfeeding patterns influence, and are influenced by, chronic condition status and management.
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Keywords
Breastfeeding, Chronic Conditions, Prospective Study, Pregnancy, Postpartum, Epidemiology
Citation
Scime, N. V. (2022). Breastfeeding intentions, difficulties, and outcomes in mothers with chronic physical health conditions: the Motherhood and Chronic Illness (MaCI) prospective cohort study (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.