Maternal intention to breast-feed and breast-feeding outcomes in term and preterm infants: Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003

Objective: To determine the effect of intention to breast-feed on short-term breast-feeding outcomes in women delivering term and preterm infants. Design: Data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS) for three states, Ohio, Michigan and Arkansas, during 2000-2003 were analysed. SAS 9.1.3 and SUDAAN 10 statistical software packages were used for analyses. Setting: Arkansas, Michigan and Ohio, USA. Subjects: Mothers of recently delivered infants, selected by birth certificate sampling. Results: Of 16 839 mothers included, 9.7% delivered preterm. Some 52.2% expressed definite intention to breast-feed, 16.8% expressed tentative intention, 4.3% were uncertain and 26.8% had no intention to breast-feed. Overall 65.2% initiated breast-feeding, 52.0% breast-fed for >= 4 weeks and 30.8% breast-fed for >= 10 weeks. Women with definite intention were more likely to initiate (OR = 24.3, 95% CI 18.4, 32.1), to breast-feed for >= 4 weeks (OR = 7.12, 95% CI 5.95, 8.51) and to breast-feed for >= 10 weeks (OR = 2.75, 95% CI 2.20, 3.45) compared with women with tentative intention. Levels of intention did not differ between women delivering preterm and term. Women delivering at <34 weeks were more likely to initiate breast-feeding (OR = 2.24, 95% CI 1.64, 3.06) and to breast-feed for >= 4 weeks (OR = 2.58, 95% CI 1.96, 3.41), but less likely to breast-feed for >= 10 weeks (OR = 0.55, 95% CI 0.44, 0.68), compared with those delivering at term. Women delivering between 34 and 36 weeks were less likely to breast-feed for >= 10 weeks than those delivering at term (OR = 0.63, 95% CI 0.49, 0.81). Conclusions: Prenatal intention to breast-feed is a powerful predictor of short-term breast-feeding outcomes in women delivering both at term and prematurely.