Top

BMC Pregnancy and Childbirth

Published in:

01-12-2020 | Lactation | Research article

Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes: a cross-sectional analysis

Authors: Hayley Martin, Kelly Thevenet-Morrison, Ann Dozier

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Abstract

Background

It is well established that mothers with above-normal pre-pregnancy BMI are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain (PWG) is less well-defined. Excess PWG may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. Cesarean-section, gestational diabetes), and may make effective latch more difficult to achieve.

Methods

Our objective was to determine the impact of PWG and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine’s 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N = 1207). PWG category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of PWG). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models. Results: After adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended PWG had 1.39 (1.03–1.86) and 1.48 (1.06–2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended PWG were at increased risk of cessation, although not significantly (aHR [95% CI]: 1.29 [0.95–1.75]). No significant relationship was observed for exclusive breastfeeding cessation.

Conclusions

Pre-pregnancy BMI and PWG may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.

Available only for authorised users

renamed National Academy of Medicine in 2015, but will be referred to by the name of the published guidelines throughout this text

March of Dimes. Obesity among women of childbearing age: United States 2006–2016. Internet: www.marchofdimes.org/peristats. Accessed 17 Oct 2018.

Kominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol. 2017;217:642–51.PubMedPubMedCentral

Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. 1990.

Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, Thieda P, Lux LJ, Lohr KN. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(339):e1,339.14.

Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. 2009.

Amir LH, Donath S. A systematic review of maternal obesity and breastfeeding intention, initiation and duration. BMC Pregnancy Childbirth. 2007;7:9.PubMedPubMedCentral

Hauff LE, Leonard SA, Rasmussen KM. Associations of maternal obesity and psychosocial factors with breastfeeding intention, initiation, and duration. Am J Clin Nutr. 2014;99:524–34.PubMedPubMedCentral

Nommsen-Rivers LA. Does insulin explain the relation between maternal obesity and poor lactation outcomes? An overview of the literature. Adv Nutr. 2016;7:407–14.PubMedPubMedCentral

Rasmussen KM. Association of maternal obesity before conception with poor lactation performance. Annu Rev Nutr. 2007;27:103–21.PubMed

10.

Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;153:1–186.

11.

Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475–90.PubMed

12.

Dieterich CM, Felice JP, O'Sullivan E, Rasmussen KM. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin N Am. 2013;60:31–48.

13.

Hilson JA, Rasmussen KM, Kjolhede CL. Excessive weight gain during pregnancy is associated with earlier termination of breast-feeding among white women. J Nutr. 2006;136:140–6.PubMed

14.

Jain NJ, Denk CE, Kruse LK, Dandolu V. Maternal obesity: can pregnancy weight gain modify risk of selected adverse pregnancy outcomes? Am J Perinatol. 2007;24:291–8.PubMed

15.

Centers for Disease Control and Prevention (CDC). Pregnancy Risk Assessment Monitoring System. Internet: https://www.cdc.gov/prams/ Accessed 4 Nov 2017.

16.

Dozier AM, Brownell E, Guido J, Yang H, Howard CA, Doniger A, Ossip D, Lawrence R. Adapting the pregnancy risk assessment monitoring survey to enhance locally available data: methods. Matern Child Health J. 2014;18:1196–204.PubMedPubMedCentral

17.

SAS Institute Inc. SAS/IML® 14.1 User’s Guide. 2015.

18.

R Core Team. R: A language and environment for statistical computing. 2018.

19.

Bartok CJ, Schaefer EW, Beiler JS, Paul IM. Role of body mass index and gestational weight gain in breastfeeding outcomes. Breastfeed Med. 2012;7:448–56.PubMedPubMedCentral

20.

Tao XY, Huang K, Yan SQ, Zuo AZ, Tao RW, Cao H, Gu CL, Tao FB. Pre-pregnancy BMI, gestational weight gain and breast-feeding: a cohort study in China. Public Health Nutr. 2017;20:1001–8.PubMed

21.

Castillo H, Santos IS, Matijasevich A. Maternal pre-pregnancy BMI, gestational weight gain and breastfeeding. Eur J Clin Nutr. 2016;70:431–6.PubMedPubMedCentral

22.

Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017;356:j1.PubMedPubMedCentral

23.

Molyneaux E, Poston L, Ashurst-Williams S, Howard LM. Obesity and mental disorders during pregnancy and postpartum: a systematic review and meta-analysis. Obstet Gynecol. 2014;123:857–67.PubMedPubMedCentral

24.

Kjos SL, Peters RK, Xiang A, Thomas D, Schaefer U, Buchanan TA. Contraception and the risk of type 2 diabetes mellitus in Latina women with prior gestational diabetes mellitus. JAMA. 1998;280:533–8.PubMed

25.

Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. Duration of lactation and incidence of type 2 diabetes. JAMA. 2005;294:2601–10.PubMed

26.

Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, Dewey KG, Azevedo RA, Young S, Fox G. Lactation and progression to type 2 diabetes mellitus after gestational diabetes MellitusA prospective cohort StudyLactation and incidence of diabetes after GDM. Ann Intern Med. 2015;163:889–98.PubMedPubMedCentral

27.

Bajaj H, Ye C, Hanley AJ, Connelly PW, Sermer M, Zinman B, Retnakaran R. Prior lactation reduces future diabetic risk through sustained postweaning effects on insulin sensitivity. Am J Physiol Endocrinol Metab. 2017;312:E215–23.PubMed

28.

Aune D, Norat T, Romundstad P, Vatten L. Breastfeeding and the maternal risk of type 2 diabetes: a systematic review and dose–response meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis. 2014;24:107–15.PubMed

29.

Hollis JL, Crozier SR, Inskip HM, Cooper C, Godfrey KM, Harvey NC, Collins CE, Robinson SM. Modifiable risk factors of maternal postpartum weight retention: an analysis of their combined impact and potential opportunities for prevention. Int J Obes. 2017;41:1091–8.

30.

Brandhagen M, Lissner L, Brantsaeter AL, Meltzer HM, Haggkvist AP, Haugen M, Winkvist A. Breast-feeding in relation to weight retention up to 36 months postpartum in the Norwegian mother and child cohort study: modification by socio-economic status? Public Health Nutr. 2014;17:1514–23.PubMed

31.

Neville C, McKinley M, Holmes V, Spence D, Woodside J. The relationship between breastfeeding and postpartum weight change--a systematic review and critical evaluation. Int J Obes. 2014;38:577.

32.

Martin JE, Hure AJ, Macdonald-Wicks L, Smith R, Collins CE. Predictors of post-partum weight retention in a prospective longitudinal study. Matern Child Nutr. 2014;10:496–509.PubMed

33.

Ohlin A, Rossner S. Maternal body weight development after pregnancy. Int J Obes. 1990;14:159–73.PubMed

34.

Dewey KG, Heinig MJ, Nommsen LA. Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr. 1993;58:162–6.PubMed

35.

Olson CM, Strawderman MS, Hinton PS, Pearson TA. Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. Int J Obes Relat Metab Disord. 2003;27:117–27.PubMed

36.

Ohlin A, Rossner S. Factors related to body weight changes during and after pregnancy: the Stockholm pregnancy and weight development study. Obes Res. 1996;4:271–6.PubMed

37.

Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. J Affect Disord. 2015;171:142–54.PubMed

38.

Warner R, Appleby L, Whitton A, Faragher B. Demographic and obstetric risk factors for postnatal psychiatric morbidity. Br J Psychiatry. 1996;168:607–11.PubMed

39.

Cooper PJ, Murray L, Stein A. Psychosocial factors associated with the early termination of breast-feeding. J Psychosom Res. 1993;37:171–6.PubMed

40.

Hannah P, Adams D, Lee A, Glover V, Sandler M. Links between early post-partum mood and post-natal depression. Br J Psychiatry. 1992;160:777–80.PubMed

41.

Henderson JJ, Evans SF, Straton JA, Priest SR, Hagan R. Impact of postnatal depression on breastfeeding duration. Birth. 2003;30:175–80.PubMed

42.

Seimyr L, Edhborg M, Lundh W, Sjögren B. In the shadow of maternal depressed mood: experiences of parenthood during the first year after childbirth. J Psychosom Obstet Gynecol. 2004;25:23–34.

43.

Al-Ajmi K, Lophatananon A, Ollier W, Muir KR. Risk of breast cancer in the UK biobank female cohort and its relationship to anthropometric and reproductive factors. PLoS One. 2018;13:e0201097.PubMedPubMedCentral

44.

Moy FM, Greenwood DC, Cade JE. Associations of clothing size, adiposity and weight change with risk of postmenopausal breast cancer in the UK Women's cohort study (UKWCS). BMJ Open. 2018;8:e022599,2018–022599.

45.

Keum N, Greenwood DC, Lee DH, Kim R, Aune D, Ju W, Hu FB, Giovannucci EL. Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies. J Natl Cancer Inst. 2015;107. https://doi.org/10.1093/jnci/dju428 Print 2015 Mar.

46.

Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, Bahl R, Martines J. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015;104:96–113.PubMedPubMedCentral

47.

Ahluwalia IB, Helms K, Morrow B. Assessing the validity and reliability of three indicators self-reported on the pregnancy risk assessment monitoring system survey. Public Health Rep. 2013;128:527–36.PubMedPubMedCentral

Title: Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes: a cross-sectional analysis
Authors: Hayley Martin
Kelly Thevenet-Morrison
Ann Dozier
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Lactation
Overweight
Published in: BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-020-03156-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes: a cross-sectional analysis

Abstract

Background

Methods

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Prevalence of and socioeconomic gradient in low birth weight in Ethiopia: further analysis of the 2016 demographic and health survey data

Post-traumatic stress disorder and association with low birth weight in displaced population following conflict in Malakand division, Pakistan: a case control study

Quality of consumer-oriented websites containing information about the second trimester ultrasound examination during pregnancy

Postnatal depression and its association with adverse infant health outcomes in low- and middle-income countries: a systematic review and meta-analysis

Decreased biventricular myocardial deformation in fetuses with lower urinary tract obstruction

Speculum versus digital insertion of Foley catheter for induction of labor in Nulliparas with unripe cervix: a randomized controlled trial