Maternal Obesity, Psychological Factors, and Breastfeeding Initiation

Objective: Maternal obesity has been associated with lower initiation of breastfeeding, but reasons for why this association exists have not been well studied. In this study, we examined associations among prepregnancy obesity, psychological factors during pregnancy, and breastfeeding initiation. Methods: Data came from the postpartum component of the Pregnancy, Infection, and Nutrition study, a prospective cohort study. Pregnant women were recruited from the University of North Carolina hospitals between January 2001 and June 2005. This analysis used data from 688 women followed from pregnancy to 3 months postpartum. Multivariable binomial regression was used to determine the association between having a body mass index (BMI) > 26 kg/m(2) before pregnancy and breastfeeding initiation. We tested for mediation of the association between pregravid BMI and breastfeeding initiation by certain psychological factors during pregnancy (depressive symptoms, perceived stress, anxiety, and self-esteem). Results: Women who began pregnancy overweight or obese (BMI > 26 kg/m2) had almost four times the risk of not initiating breastfeeding compared with underweight or normal weight women (BMI <= 26 kg/m(2)) (risk ratio 3.94 [95% confidence interval 2.17, 7.18]) after adjusting for race, poverty level, education level, and marital status. Depressive symptoms, perceived stress, anxiety, and self-esteem levels during pregnancy were not found to mediate the association between pregravid BMI and breastfeeding initiation. Conclusions: Women who started pregnancy either overweight or obese were more likely to not initiate breastfeeding. Contrary to expectations, pregnancy-related psychological factors did not influence this relationship.