Biological and social factors associated with reduced lactation duration in overweight women.

Abstract

There is a well-established association between high pre-pregnant maternal body mass index and reduced lactation duration, yet the cause(s) of this relationship is unclear. The goal of this research was to examine how maternal overweight negatively impacts lactation duration using a holistic approach. Specifically, I explored the following questions: 1) Do psychosocial factors relating to body image impact the relationship between pre-pregnant maternal overweight and reduced lactation duration?; 2) Are breastfeeding problems in the early postpartum period more prevalent among overweight women and if so, do these problems mediate the association with reduced duration?; and 3) Do obese women have difficulty obtaining efficient positioning or experience hormonal abnormalities that result in low milk supply and, ultimately, early cessation of exclusive breastfeeding? Following a prospective, longitudinal design, data were collected from questionnaire responses, hormone analyses, observations of breastfeeding behavior, and measures of milk output. The sample consisted of 239 primiparous women from Minnesota who were well supported and had a strong intention to breastfeed. Results demonstrate that overweight women were less comfortable with and confident in their bodies and they had more concerns about their body shape and weight. Body image concerns during the postpartum period mediated the association between maternal overweight and reduced duration. Similarly, breastfeeding problems in the early postpartum period, especially maternal perception of insufficient milk, also mediated the relationship between maternal overweight and reduced duration. Finally, obese women had lower prolactin levels shortly after birth and they had more difficulty establishing efficient positioning while nursing. Poor positioning was a strong predictor of low milk output, which was associated with early cessation of exclusive breastfeeding. These findings speak to the importance of these factors for breastfeeding success. Fortunately, many of them are modifiable, which provide an opportunity for health professionals to intervene during the critical early postpartum time period when breastfeeding patterns are established.