Exclusive breastfeeding: Relation to gestational age, birth weight, and early neonatal ward admission. A nationwide cohort study of children born after 35 weeks of gestation

Abstract

Objectives Prematurity, being small for gestational age and early neonatal ward admission are the major neonatal conditions that may interfere with breastfeeding supportive practices in infants born at gestational age ≥35+0 weeks. We aimed to investigate the associations between gestational age, small for gestational age, early neonatal ward admission and exclusive breastfeeding at one and four months. Methods A register-based cohort-study of all Danish singletons with gestational age ≥35+0 weeks born in 2014–2015. In Denmark, health visitors routinely conduct free home visits throughout infants’ first year and thereby report breastfeeding data to The Danish National Child Health Register. These data were linked with data from other national registers. Logistic regression models estimated the odds ratio for exclusive breastfeeding at one and four months, adjusted for confounding variables. Results The study population comprised 106,670 infants. Compared to gestational age 40 weeks, the adjusted odds ratio for exclusive breastfeeding at one month showed a decreasing tendency from gestational age ≥42 (n = 2,282) (1.07; 95% confidence interval (CI) 0.97–1.17) to 36 weeks (n = 2,062) (0.80; 95% CI 0.73–0.88). Small for gestational age (n = 2,342) was associated with decreased adjusted odds ratio for exclusive breastfeeding at one month (0.84; 95% CI 0.77–0.92). Neonatal ward admission was associated with increased adjusted odds ratio for exclusive breastfeeding at one month among late preterm infants (gestational age 35–36 weeks; n = 3,139) (1.31; 95% CI 1.12–1.54), as opposed to among early term (gestational age 37–38 weeks; n = 19,171) (0.84; 95% CI 0.77–0.92) and term infants (gestational age >38 weeks; n = 84,360) (0.89; 95% CI 0.83–0.94). The associations seemed to persist at four months. Conclusions Decreasing gestational age and small for gestational age were associated with decreased exclusive breastfeeding rates. Neonatal ward admission was associated with increased exclusive breastfeeding rates among late preterm infants, whereas the opposite was observed among early term and term infants.

Evaluation of the Impact of a Midwife-Led Breastfeeding Group Intervention on Prevention of Postpartum Depression: A Multicentre Randomised Clinical Trial

“…Another factor in our study related to the initiation of breastfeeding was greater gestational age at birth, indicating that these newborns had greater biological maturity that allowed for a more satisfactory initiation of breastfeeding and better adaptation to extrauterine life. Conversely, early term infants (born between weeks 37 + 0 and 38 + 6) are more likely to experience adverse neonatal outcomes that necessitate medical interventions, thereby complicating the initiation of breastfeeding [ 48 , 49 ]. This could not be analysed in our study, as participants with preterm pregnancies were not included.…”

Evaluation of the Impact of a Midwife-Led Breastfeeding Group Intervention on Prevention of Postpartum Depression: A Multicentre Randomized Clinical Trial

“…Another factor in our study related to the initiation of breastfeeding was greater gestational age at birth, indicating that these newborns had greater biological maturity that allowed for a more satisfactory initiation of breastfeeding and better adaptation to extrauterine life. Conversely, earlyterm infants (born between weeks 37 + 0 and 38 + 6) are more likely to experience adverse neonatal outcomes that necessitate medical interventions, thereby complicating the initiation of breastfeeding [47,48]. This could not be analysed in our study, as participants with preterm pregnancies were not included.…”

Implementation of a community-based breastfeeding support intervention to prolong duration of and reduce social inequality in exclusive breastfeeding: a mixed-methods systematic process evaluation in a cluster-randomised trial

“…In high-income countries, breastfeeding rates are suboptimal (3) and distributed unequally across socio-economic positions in favour of more advantaged groups (4). This also holds true in a Danish context (5). Mothers ask for available and individual support from health professionals (6) which has been underscored as crucial for duration and exclusivity of breastfeeding (7).…”