Top

Published in:

01-08-2012

Risk Factors for Discontinuing Breastfeeding in Southern Brazil: A Survival Analysis

Authors: Carlos Alberto Feldens, Márcia Regina Vitolo, Fernanda Rauber, Luciane Nascimento Cruz, Juliana Balbinot Hilgert

Published in: Maternal and Child Health Journal | Issue 6/2012

Abstract

To identify risk factors for discontinuing breastfeeding during an infant’s first year of life. A cohort study recruited mothers in a hospital in São Leopoldo, Brazil, which mainly serves the low-income population. In order to obtain socioeconomic, environmental, and behavioral information, face-to-face interviews with mothers were conducted after birth, and when their infants were 6 and 12 months old. The duration of breastfeeding was investigated at 6 and 12 months, and recorded separately for each month. Depressive symptoms were assessed using the Beck Depression Inventory. The multivariate model for predicting the discontinuation of breastfeeding, adjusted Kaplan–Meier survival curves and Cox regression were used. Of the 360 participants, 201 (55.8%) discontinued breastfeeding within the first 12 months. A multivariate Cox regression model revealed that symptoms of maternal depression (low levels: RR = 1.59, 95% CI 1.02–2.47; moderate to severe: RR = 2.03, 95% CI 1.35–3.01), bottle feeding (RR = 2.07, 95% CI 1.31–3.28) and pacifier use in the first month of life (RR = 3.12, 95% CI 2.13–4.57) were independently associated with the outcomes after adjusting for confounders. Breastfeeding cessation rates were lower for children who did not use bottle feeding or a pacifier in the first month of life and for the children whose mothers presented with minimal depression. Early pacifier use and bottle feeding must be strongly discouraged to support long-term breastfeeding. In addition, screening maternal depression at a primary care service can be a step forward in promoting a longer duration of breastfeeding.

World Health Organization. (2003). Global strategy for infant and young child feeding. Geneva: World Health Organization.

Brasil Ministerio da Saude. (2010). Dez passos para alimentação saudavel para crianças menores de dois anos, 2nd edn. Brasília (DF): Ministerio da Saude.

Venancio, S. I., Escuder, M. L., Saldiva, S. R. D. M., & Giugliani, E. R. J. (2010). Breastfeeding practice in the 333 Brazilian capital cities and the Federal District: Current status and advances. Jornal de Pediatria, 86(4), 317–324.PubMed

Evelein, A. M., Geerts, C. C., Visseren, F. L., Bots, M. L., Van der Ent, C. K., Grobbee, D. E., et al. (2001). The association between breastfeeding and the cardiovascular system in early childhood. American Journal of Clinical Nutrition, 93(4), 712–718.CrossRef

Plenge-Bönig, A., Soto-Ramírez, N., Karmaus, W., Petersen, G., Davis, S., & Forster, J. (2010). Breastfeeding protects against acute gastroenteritis due to rotavirus in infants. European Journal of Pediatrics, 169(12), 1471–1476.PubMedCrossRef

Hetzner, N. M., Razza, R. A., Malone, L. M., & Brooks-Gunn, J. (2009). Associations among feeding behaviors during infancy and child illness at two years. Maternal and Child Health Journal, 13(6), 795–805.PubMedCrossRef

Huffman, S. L., Zehner, E. R., & Victora, C. (2001). Can improvements in breast-feeding practices reduce neonatal mortality in developing countries? Midwifery, 17, 80–92.PubMedCrossRef

Kramer, M. S., Aboud, F., Mironova, E., et al. (2008). Breastfeeding and child cognitive development. New evidence from a large randomized trial. Archives of General Psychiatry, 65(5), 578–584.PubMedCrossRef

Renfrew, M. J., Dyson, L., McCormick, F., et al. (2009). Breastfeeding promotion for infants in neonatal units: A systematic review and economic analysis. Health Technology Assessment, 13(40), 1–146.PubMed

10.

Scott, J. A., Binns, C. W., Oddy, W. H., Graham, K. I., & Grad Dip Nutr Diet. (2006). Predictors of breastfeeding duration: Evidence from a cohort study. Pediatrics, 117, e646–e655.PubMedCrossRef

11.

Dennis, C. L., & McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: A qualitative systematic review. Pediatrics, 123(4), e736–e751.PubMedCrossRef

12.

Karabulut, E., Yalçın, S. S., Özdemir-Geyik, P., & Karaagaoglu, E. (2009). Effect of pacifier use on exclusive and any breastfeeding: A meta-analysis. Turkish Journal of Pediatrics, 51, 35–43.PubMed

13.

Taveras, E. M., Capra, A. M., Braveman, P. A., Jensvold, N. G., Escobar, G. J., & Lieu, T. A. (2003). Clinician support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112, 108–115.PubMedCrossRef

14.

World Health Organization, & Department of Nutrition for Health and Development. (1998). Complementary feeding: Family foods for breastfed children. Geneva, Switzerland: World Health Organization.

15.

Brazil Ministry of Health. (2001). Breastfeeding prevalence in Brazilian capitals. Brasília Annual report of health statistics in Brazil. Brasília: Ministry of Health, Portuguese.

16.

Vitolo, M. R., Bortolini, G. A., Feldens, C. A., & Drachler, M. L. (2005). Impacts of the 10 steps to healthy feeding in infants: A randomized field trial. Cadernos de Saude Publica, 21, 1448–1457. Portuguese.PubMedCrossRef

17.

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.PubMedCrossRef

18.

Cunha, J. A. (2001). Manual da versão em português das Escalas Beck. São Paulo, SP: Casa do Psicólogo.

19.

Vieira, G. O., Martins, C. C., Vieira, T. O., Oliveira, N. F., & Silva, L. R. (2010). Factors predicting early discontinuation of exclusive breastfeeding in the first month of life. Jornal de Pediatria, 86(5), 441–444.PubMedCrossRef

20.

Santos Neto, E. T., Oliveira, A. E., Zandonade, E., & Molina, M. C. B. (2008). Pacifier use as a risk factor for reduction in breastfeeding duration: A systematic review. Revista Brasileira de Saude Materno Infantil, 8(4), 377–389.

21.

Howard, C. R., Howard, F. M., Lanphear, B., Eberly, S., Deblieck, E. A., Oakes, D., et al. (2003). Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics, 111, 511–518.PubMedCrossRef

22.

Silveira, F. J., & Lamounier, J. A. (2006). Factors associated with breastfeeding duration in three cities in the region of Alto Jequitinhonha, Minas Gerais, Brazil. Cadernos de Saude Publica, 22, 69–77.PubMedCrossRef

23.

Soares, M. E., Giugliani, E. R., Braun, M. L., Salgado, A. C., de Oliveira, A. P., & de Aguiar, P. R. (2003). Pacifier use and its relationship with early weaning in infants born at a Child-Friendly Hospital. Jornal de Pediatria, 79, 309–316.PubMed

24.

Nascimento, M. B. R., Reis, M. A., Franco, S. C., Issler, H., Ferraro, A. A., & Grisi, S. J. (2010). Exclusive Breastfeeding in Southern Brazil: Prevalence and Associated Factors. Breastfeeding Medicine, 5(2), 79–85.PubMedCrossRef

25.

França, M. C. T., Giugliani, E. R., Oliveira, L. D., Weigert, E. M., Santo, L. C., Köhler, C. V., et al. (2008). Bottle feeding during the first month of life: Determinants and effect on breastfeeding technique. Revista de Saude Publica, 42(4), 607–614. Portuguese.PubMedCrossRef

26.

Moimaz, S. A., Zina, L. G., Saliba, N. A., & Saliba, O. (2008). Association between breast-feeding practices and sucking habits: A cross-sectional study of children in their first year of life. Journal of Indian Society of Pedodontics and Preventive Dentistry, 26, 102–106.PubMedCrossRef

27.

Araújo de França, G. V., Brunken, G. S., da Silva, S. M., Escuder, M. M., & Venancio, S. I. (2007). Breast feeding determinants on the first year of life of children in a city of Midwestern Brazil. Revista de Saude Publica, 41, 711–718. Portuguese.PubMedCrossRef

28.

Binns, C. W., & Scott, J. A. (2002). Using pacifiers: What are breastfeeding mothers doing? Breastfeeding Review, 10(2), 21–25.PubMed

29.

Kramer, M. S., Barr, R. G., Dagenais, S., Yang, H., Jones, P., Ciofani, L., et al. (2001). Pacifier use, early weaning, and cry/fuss behavior: A randomized controlled trial. JAMA, 286, 322–326.PubMedCrossRef

30.

Bogen, D. L., Hanusa, B. H., Moses-Kolko, E., & Wisner, K. L. (2010). Are maternal depression or symptom severity associated with breastfeeding intention or outcomes? Journal of Clinical Psychiatry, 71(8), 1069–1078.PubMedCrossRef

31.

Wei, G., Greaver, L. B., Marson, S. M., Herndon, C. H., Rogers, J., Robeson Healthcare Corporation, et al. (2008). Postpartum depression: Racial differences and ethnic disparities in a tri-racial and bi-ethnic population. Maternal and Child Health Journal, 212(6), 699–707.CrossRef

32.

Dennis, C. L., & McQueen, K. (2007). Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatrica, 96, 590–594.PubMedCrossRef

33.

Akman, I., Kuscu, M. K., Yurdakul, Z., et al. (2008). Breastfeeding duration and postpartum psychological adjustment: Role of maternal attachment styles. Journal of Paediatrics and Child Health, 44, 369–373.PubMedCrossRef

34.

Hasselmann, M. H., Werneck, G., & Silva, C. V. C. (2008). Symptoms of postpartum depression and early interruption of exclusive breastfeeding in the first two months of life. Cadernos de Saude Publica, 24(Suppl 2), S341–S352.PubMedCrossRef

35.

Galler, J. R., Harrison, R. H., Ramsey, F., Chawla, S., & Taylor, J. (2006). Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados. Infant Behaviour and Development, 29, 189–203.CrossRef

36.

Falceto, O. G., Giugliani, E. R., & Fernandes, C. L. (2004). Influence of parental mental health on early termination of breast-feeding: A case-control study. Journal of the American Board of Family Practice, 17, 173–183.PubMedCrossRef

37.

Henderson, J. J., Evans, S. F., Straton, J. A., Priest, S. R., & Hagan, R. (2003). Impact of postnatal depression on breastfeeding duration. Birth, 30, 175–180.PubMedCrossRef

38.

Edhborg, M., Friberg, M., Lundh, W., & Widström, A. (2005). “Struggling with life”: Narratives from women with signs of postpartum depression. Scandinavian Journal of Public Health, 33(4), 261–267.PubMedCrossRef

39.

Dennis, C. L., Janssen, P. A., & Singer, J. (2004). Identifying women at-risk for postpartum depression in the immediate postpartum period. Acta Psychiatrica Scandinavica, 110(5), 338–346.PubMedCrossRef

40.

Flores-Quijano, M. E., Córdova, A., Contreras-Ramírez, V., Farias-Hernández, L., Cruz Tolentino, M., & Casanueva, E. (2008). Risk for postpartum depression, breastfeeding practices, and mammary gland permeability. Journal of Human Lactation, 24(1), 50–57.PubMedCrossRef

41.

Picciano, M. F. (2001). Nutrient composition of human milk. Pediatric Clinics of North America, 48(1), 53–67.PubMedCrossRef

42.

Sheehan, A., Schmied, V., & Barclay, L. (2009). Women’s experiences of infant feeding support in the first 6 weeks post-birth. Maternal and Child Nutrition, 5, 138–150.PubMedCrossRef

43.

Dewey, K. G., Nommsen-Rivers, L. A., & Heining, M. J. (2003). Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation and excess neonatal weight loss. Pediatrics, 112, 607–619.PubMedCrossRef

44.

Bonuck, K. A., Huang, V., & Fletcher, J. (2010). Inappropriate bottle use: An early risk for overweight? Literature review and pilot data for a bottle-weaning trial. Maternal and Child Nutrition, 6, 38–52.PubMedCrossRef

45.

Dewey, K. G., Peerson, J. M., Brown, K. H., et al. (1995). Growth of breast-fed infants deviates from current reference data: A pooled analysis of US, Canadian and European data sets. Pediatrics, 96, 495–503.PubMed

46.

Nommsen-Rivers, L. A., Chantry, C. J., Cohen, R. J., & Dewey, K. G. (2010). Comfort with the idea of formula helps explain ethnic Disparity in Breastfeeding intentions among expectant first-time mothers. Breastfeeding Medicine, 5, 25–33.PubMedCrossRef

47.

Kavanagh, K. F., Cohen, R. J., Heinig, M. J., & Dewey, K. G. (2008). Educational intervention to modify bottle-feeding behaviors among formula-feeding mothers in the WIC Program: Impact on infant formula intake and weight gain. Journal of Nutrition Education and Behavior, 40, 244–250.PubMedCrossRef

48.

Lorant, V., Deliège, D., Eaton, W., Robert, A., Philippot, P., & Ansseau, M. (2003). Socioeconomic Inequalities in Depression: A Meta-Analysis. American Journal of Epidemiology, 157, 98–112.PubMedCrossRef

49.

Ritsher, J. E., Warner, V., Johnson, J. G., & Dohrenwend, B. P. (2011). Inter-generational longitudinal study of social class and depression: A test of social causation and social selection models. British Journal of Psychiatry, 40, s84–s90.

50.

Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. American Journal of Psychiatry, 152, 1026–1032.PubMed

51.

Victora, C. G., Behague, D. P., Barros, F. C., Olinto, M. T., & Weiderpass, E. (1997). Pacifier use and short breastfeeding duration: Cause, consequence, or coincidence? Pediatrics, 99, 445–453.PubMedCrossRef

52.

Rothman, K. J., & Greenland, S. (1998). Modern Epidemiology (2nd ed.). Philadelphia: Lippincott Williams and Wilkins.

Title: Risk Factors for Discontinuing Breastfeeding in Southern Brazil: A Survival Analysis
Authors: Carlos Alberto Feldens
Márcia Regina Vitolo
Fernanda Rauber
Luciane Nascimento Cruz
Juliana Balbinot Hilgert
Publication date: 01-08-2012
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue 6/2012
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-011-0885-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk Factors for Discontinuing Breastfeeding in Southern Brazil: A Survival Analysis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2012

Prioritizing Maternal and Child Health in Independent South Sudan

Life Course, Social Determinants, and Health Inequities: Toward a National Plan for Achieving Health Equity for African American Infants—a Concept Paper

Utility of a Summative Scale Based on the Children with Special Health Care Needs (CSHCN) Screener to Identify CSHCN with Special Dental Care Needs

Characteristics and Factors Associated with the Risk of a Nicotine Exposed Pregnancy: Expanding the CHOICES Preconception Counseling Model to Tobacco

Acculturation and Health Care Utilization among Mexican Heritage Women in the United States

Women’s Autonomy and Unintended Pregnancy Among Currently Pregnant Women in Bangladesh