Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada

Abstract

ObjectivesTo examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months.DesignPooled data from two prospective cohort studiesSettingThree Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada.Participants337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum. Exclusions: pregnancy loss or participation in prior related study; Study B: preterm birth (<34 weeks); plan to move outside Toronto; not intending to feed human milk; hospitalisation of mother or baby at 2 weeks postpartum.Primary and secondary outcome measuresMain exposure variable: any use of expressed human milk at 2 weeks postpartum. Outcomes: cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum.ResultsAll participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84).Trial registration numbersNCT03400605, NCT03589963.

Household food insecurity is prevalent in a cohort of postpartum women who registered in the Canada Prenatal Nutrition Program in Toronto

“…All participants initiated breastfeeding and 80 % continued for 6 months, with 29 % and 16 % practising exclusive breastfeeding to 4 and 6 months postpartum, respectively, as previously reported ( 22 ) . There was no association between any food insecurity and either continued breastfeeding for 6 months or exclusive breastfeeding post-discharge to 4 or 6 months postpartum in unadjusted and adjusted analyses (Table 3 ).…”

“…The dates of breastfeeding cessation and introduction of solids were reported where applicable. Participants were classified as yes/no for any breastfeeding and for exclusive breastfeeding at each data collection point, as described previously ( 22 ) . Exclusive breastfeeding post-discharge for 4 or 6 months was determined by the number of consecutive time points at which participants were classified as exclusively breastfeeding.…”

“…Ethnicity was self-reported using a geographically based list developed and validated for a large Toronto-based birth cohort study, and the responses were then grouped into categories based on the region of origin ( 25 ) . Data related to household income were not collected in the same way in Studies A and B. Descriptive findings have been reported previously ( 22 ) , and these data were not included in the current analysis. The HFSSM itself is an assessment of financial constraint.…”

“…Detailed methods for both studies have been reported elsewhere, as have participant demographics and results for breastfeeding metrics (19)(20)(21)(22) . Study A examined the infant feeding practices of clients enrolled at the 5Ps CPNP site, which also implements a postpartum lactation support programme through additional charitable funds from The Sprott Foundation (19) .…”

Dual modality feeders: a group of human milk feeders with unique practices and needs

“…Underlying the lack of supports for DMF is a lack of research that describes the unique experiences, needs and practices of DMF in Canada (4,12,13) . Research on DMF has been conducted in the USA but is insufficient to inform policy and best practices in Canada given the distinct parental leave policies, healthcare systems and sociocultural milieu (14) .…”