Maternal Body Mass Index and Breastfeeding Non-Initiation and Cessation: A Quantitative Review of the Literature

Abstract

This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I2 = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I2 = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I2 = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I2 = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.

Exclusive Breastfeeding and Factors Influencing Its Abandonment During the 1st Month Postpartum Among Women From Semi-rural Communities in Southeast Mexico

“…Women with larger bodies (i.e., higher BMI) at the time of the study visit were less likely to practice EBF beyond 1 month, a finding in accord with previous reports (52,53). Since higher maternal BMI or higher fat mass percentage have been associated with shorter duration of EBF and delayed lactogenesis (53), physical, hormonal or socio-cultural factors are commonly proposed to explain such correlations (54).…”

Why do first-time mothers not intend to breastfeed? ——A qualitative exploratory study on the decision-making of non-initiation in Jingzhou, China

“…According to Morrison's study [8], the two most common reasons for early cessation were perceived inadequate milk supply and maternal breast or nipple pain. Other studies [9,10] confirmed that obesity and smoking are risk factors. Social support characteristics (e.g., lack of breastfeeding support in the hospital, poor breastfeeding environment [11], and insufficient maternity leave [12]) have also been described as important reasons for early weaning.…”

Relationship between Child Care Exhaustion and Breastfeeding Type at Two and Six Months in a Cohort of 1210 Japanese Mothers

“…Previously, these factors were accumulated as evidence reported as the socioeconomic factors of income and educational attainment. In addition, maternal obesity is an independent and important factor of exclusive breastfeeding, as we have already noted from a teaching hospital in Japan [ 9 ] and a meta-analysis about maternal overweight/obesity [ 10 ]. We previously reported that primiparous mothers of late childbearing ages (35 years or older) were at the most significant risk of not initiating exclusive breastfeeding [ 31 ].…”

“…There are several reasons why it is difficult to maintain a high prevalence of breastfeeding. We previously reported that overweight or obese mothers, gestational week, cesarean section, nulliparity, older maternal age [ 9 , 10 ], and mental anxiety [ 11 ] were associated with an increased risk of not initiating/continuing breastfeeding.…”