Breastfeeding Initiation Among Macrosomic Infants Born to Obese Nondiabetic Mothers

Background: Women who are overweight or obese are at risk for maternal and neonatal medical complications, including macrosomia (birth weight 4,000g), that may contribute to breastfeeding initiation failure. This study examined factors associated with breastfeeding initiation among obese women without diabetes who delivered macrosomic infants. Study Design and Methods: A retrospective chart review was conducted from 2008 to 2011. Based on prepregnancy body mass index (in kg/m(2)), women were classified as normal (18-24.9), overweight (25-29.9), obese (30-34.9), very obese (35-39.9), and extremely obese (40). Intention to breastfeed was ascertained prenatally, and breastfeeding initiation was defined if at discharge 50% of the infant feedings were breastmilk. Results: Twenty-nine percent of the population was overweight, 23% obese, 14% very obese, and 12% extremely obese. Intention to breastfeed was similar among normal-weight, overweight, obese, and very obese women but was significantly lower for those who were extremely obese (p<0.05). Breastfeeding initiation was 75% for normal-weight, 72% for overweight, 71% for obese, 66% for very obese, and 53% for extremely obese women (p<0.05). Among women who intended to breastfeed, breastfeeding initiation was uniformly high: 94% for normal-weight, 93% for overweight, 95% for obese, 92% for very obese, and 87% for extremely obese women. Conclusions: Intention to breastfeed as well as breastfeeding initiation was significantly lower for extremely obese women. Lack of intention to breastfeed declared during the antepartum period by extremely obese women highlights a need as well as an opportunity for intervention.