Background:Despite high initiation rates for mother’s own milk (MOM) provision, MOM feeding at discharge from the NICU drops precipitously and reveals a racial/ethnic disparity. This study sought to identify factors that 1) predict MOM feeding at NICU discharge, and 2) mediate racial/ethnic disparity in MOM feeding at discharge.Methods:Secondary analysis of prospective cohort study of 415 mothers and their VLBW infants. Variables were grouped into five categories (Demographics, Neighborhood Structural, Social, Maternal Health, and MOM Pumping). Significant predictors from each category were entered into a multivariable logistic regression model.Results:Although 97.6% of infants received MOM feedings, black infants were significantly less likely to receive MOM feeding at discharge. Positive predictors were daily pumping frequency, reaching pumped MOM volume ≥500mL/d by 14 days, and maternal age. Negative predictors were low socioeconomic status (SES) and perceived breastfeeding support from the infant’s maternal grandmother. Low SES, maternal age and daily pumping frequency mediated the racial/ethnic differences.Conclusions:Multiple potentially modifiable factors predict MOM feeding at NICU discharge. Importantly, low SES, pumping frequency and maternal age were identified as the mediators of racial and ethnic disparity. Strategies to mitigate the effects of modifiable factors should be developed and evaluated in future research.

Background: While black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity. Materials and Methods: A prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences. Results: For all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers. Conclusions: Future interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.

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contraception until the postpartum visit, women choosing contraceptive methods other than immediate postpartum LARC also had a higher rate of SIP (12.6%) when compared with the LARC group (4.0%, P50.003). After adjustment for potential confounders including nulliparity, young maternal age, and married status, SIP was lower with immediate postpartum LARC [AOR 0.27 (95% CI 0.18, 0.64), P5.003] and higher by married status [AOR 1.89 (95% CI 1.26, 2.84), P5.002].CONCLUSION: Implementation of an immediate postpartum LARC program decreased SIP rates. Improved counseling about the impact of immediate LARC placement for family planning is encouraged.